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Key Features

Essentials of Diagnosis

  • All sexually transmitted diseases (STDs) have subclinical or latent periods, and patients may be asymptomatic

  • Simultaneous infection with several organisms is common

  • All patients who seek STD testing should be screened for syphilis and HIV

  • Partner notification and treatment are important to prevent further transmission and reinfection in the index case

General Considerations

  • The most common sexually transmitted diseases (STDs) are

    • Gonorrhea

    • Syphilis

    • Condyloma acuminatum

    • Chlamydial genital infections

    • Herpesvirus genital infections

    • Trichomonas vaginitis

    • Chancroid

    • Granuloma inguinale

    • Scabies

    • Louse infestation

  • Shigellosis, hepatitis A, B, and C, amebiasis, giardiasis, cryptosporidiosis, salmonellosis, and campylobacteriosis may also be transmitted by sexual (oral–anal) contact, especially in men who have sex with men

  • Bacterial vaginosis may be sexually transmitted among women who have sex with women

  • Homosexual contact and increasing, bidirectional heterosexual transmission are the typical methods of transmission of HIV

  • Ebola virus and Zika virus have both been associated with sexual transmission

Sexual assault

  • Victims of assault have a high baseline rate of infection

    • Neisseria gonorrhoeae, 6%

    • Chlamydia trachomatis, 10%

    • Trichomonas vaginalis, 15%

    • Bacterial vaginosis, 34%

  • The risk of acquiring infection as a result of the assault is significant but is often lower than the preexisting rate

    • N gonorrhoeae, 6–12%

    • C trachomatis, 4–17%

    • T vaginalis, 12%

    • Syphilis, 0.5–3%

    • Bacterial vaginosis, 19%

  • The likelihood of HIV transmission from vaginal or anal receptive intercourse when the source is known to be HIV positive is 1–5 per 1000, respectively

Clinical Findings

Symptoms and Signs

  • See individual diseases

Diagnosis

Laboratory Tests

  • Simultaneous infection by several different agents is common

  • Laboratory examinations are of particular importance in the diagnosis of asymptomatic patients during the subclinical or latent phases of STDs

  • All patients who seek STD testing should also undergo routine testing for HIV

Sexual assault

  • Victims should be evaluated within 24 h after the assault and cultures or nucleic acid amplification tests for N gonorrhoeae and C trachomatis should be performed

  • Vaginal secretions are obtained for Trichomonas wet mount and culture, or point-of-care testing

  • If a discharge is present, if there is itching, or if secretions are malodorous, a wet mount should be examined for Candida and bacterial vaginosis

  • A blood sample should be obtained for immediate serologic testing for syphilis, hepatitis B, and HIV

Treatment

Medications

Prophylactic therapy

  • The usefulness of prophylactic therapy for victims of sexual assault is controversial

  • Prophylactic therapy may include postexposure hepatitis B vaccination without hepatitis B immune globulin; postexposure prophylaxis (PEP) of HIV; treatment for chlamydial, gonorrheal, or trichomonal infection; and emergency contraception

  • Testing should be repeated only if the victim has symptoms

  • If the status of the source is ...

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