Sexually transmitted infections (STIs) are a major public health problem. In 2010, there were 1,307,893 cases of chlamydia infection, 309,341 cases of gonorrhea, and 45,834 cases of syphilis reported in the United States.1 The World Health Organization estimates that 500 million people are infected each year by a curable STI.2
The primary medical goals are identifying and treating STIs, but important secondary goals include preserving future health (including fertility), protection of any sexual contacts, preventive education, and provision of instructions for future screening. Lack of treatment can contribute to infertility, cancer, and urogenital complications. Failure of patients to follow up and adhere to a prescribed medical regimen complicates individual care and public health reduction efforts.
Multiple STIs frequently occur together. Once an STI is diagnosed, further testing for human immunodeficiency virus (HIV) infection and hepatitis B is warranted.3
Because of frequent changes in treatment guidelines and resistance patterns, we recommend that the reader access the Morbidity and Mortality Weekly Report (http://www.cdc.gov/mmwr) to check any modifications for treatment and also to obtain patient information in several languages.
GENERAL PRINCIPLES FOR DIAGNOSIS AND SCREENING
The signs and symptoms of an STI 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. Less specific signs lead to frequent ED STI underrecognition. Obtain a thorough sexual history in an objective, nonjudgmental manner to determine the risk of STI, HIV infection, or hepatitis. The young (13 to 24 years old), pregnant women, and homosexual men are all at higher risk of STI and subsequent morbidity. The Centers for Disease Control and Prevention have questions that providers can use when obtaining a sexual history and determining a patient's risk for an STI (Table 149-1).
TABLE 149-1Factors Influencing the Physical Appearance of Cyanosis |Favorite Table|Download (.pdf) TABLE 149-1 Factors Influencing the Physical Appearance of Cyanosis
"Are you currently sexually active?" "If no, have you ever been sexually active?"
"In recent months, how many sex partners have you had?"
"Are your sex partners men, women, or both?"
2. Prevention of pregnancy
"Are you currently trying to conceive or father a child?"
"Are you concerned about getting pregnant or getting your partner pregnant?"
"Are you using contraception or practicing any form of birth control?" "Do you need any information on birth control?"
3. Protection from STI
"Do you and your partner(s) use any protection against STI?" "If not, could you tell me the reason?"
"If so, what kind of protection do you use?"
"How often do you use this protection?" "If 'sometimes,' in what situations or with whom do you use protection?"
"Do you have any other questions, or are there other ...