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Sexually transmitted diseases (STDs) are a major public health problem. According to data collected in the U.S. by the Centers for Disease Control and Prevention (CDC) in 2007, there were 1,108,374 reported cases of chlamydia infection, 355,991 reported cases of gonorrhea, and 40,920 cases of syphilis reported.1 The World Health Organization estimates that more than 340 million people are infected each year by a curable STD.2 The primary ED goal is the diagnosis and treatment of STDs, but important secondary goals are protection of the health and future fertility of the patient, protection of the patient’s sexual contacts, preventive education, and provision of instructions for future screening. Diagnosis of any STD warrants testing for human immunodeficiency virus (HIV) infection and hepatitis B as well.3


Because of frequent changes in treatment guidelines and resistance patterns, the authors recommend that the reader access the Morbidity and Mortality Weekly Report ( issued by the CDC to check any modifications for treatment and also to obtain patient information in several languages.


The most important aspect of STD diagnosis is maintaining a high level of awareness. The signs and symptoms of an STD may be obvious, such as a genital lesion or vaginal discharge, or less specific, such as dysuria, lower abdominal pain, painful intercourse, or spotting and abnormal periods. Obtain a thorough sexual history in an objective, nonjudgmental manner to determine the risk of STD, HIV infection, or hepatitis and to direct the physical examination and laboratory testing. There are special populations with a high risk of morbidity from STDs, including young women (15 to 24 years old), pregnant women, and homosexual men. The CDC has suggested questions that providers might consider using when obtaining a sexual history and determining a patient’s risk for an STD. The questions focus on five key areas, namely, partners, prevention, protection, practices, and history of STD (Table 144-1).

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Table 144-1 Centers for Disease Control and Prevention Recommended Questions for the Five PS of Sexually Transmitted Disease (STD) Prevention

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