Chapter 29: Sexually Transmitted and Infectious Diseases

LEARNING OBJECTIVES

1. Identify cultural, ethnic, and racial differences in sexually transmitted diseases (STDs) in women.

2. Describe screening and prevention strategies for STDs.

3. Recognize the symptoms associated with common STDs and pelvic inflammatory disease in women.

4. Recommend appropriate first-line treatment for an identified STD in a woman.

INTRODUCTION

The Centers for Disease Control and Prevention (CDC) estimates that there are 20 million new cases of sexually transmitted infectious diseases each year in the United States.¹ In 2016 alone, a collective of 2 million cases of chlamydia, gonorrhea, and syphilis were reported. As the highest number of annual cases reported in the US national surveillance since 1941, this represents only a fraction of the true sexually transmitted disease (STD) burden due to reporting limitations. These infections are common, costly, and yet preventable.¹ Furthermore, there are troubling concerns over pregnancy complications and congenital transmission. Women remain disproportionately underrepresented in identified STD cases, subsequently accounting for more serious complications when compared with men. A 2009 study identified that as many as one in four adolescent girls in the United States has had or is infected with an STD.² A number of factors contribute to a woman’s increased risk for serious complications. Risk factors include the asymptomatic nature of many of these diseases in women; greater susceptibility to acquisition of disease, especially in younger women between the ages of 15 and 24 years (as a result of both physiological and emotional maturity); lower socioeconomic status; and the potential for sexual coercion.¹ Additionally, the secrecy of sexuality, especially among women in a variety of cultures, tends to limit the potential for educational initiatives that assist in decreasing risks.

Compared with men, women have a greater risk of contracting nearly all STDs when exposed.^1,3 Moreover, the presence of almost any STD increases a woman’s risk of contracting HIV.⁴ Identification of women who may be classified as high-risk, as well as all of those already infected, is essential. High-risk populations include those who have a history of a prior STD, have new or multiple sex partners, use condoms inconsistently, are commercial sex workers, or have a history of drug use, as well as those with partners who possess such high-risk characteristics.^1,5

Screening and Prevention

Women with symptomatic infections frequently seek medical treatment, but those who are asymptomatic often go undetected and thus remain untreated. All high-risk patients and those who are treated for a prior STD should receive education and counseling on STD prevention, screening, and subsequent treatment of any diagnosed STD. This process diminishes the risk for reinfection and potential complications. Furthermore, all partners should be screened and treated when possible.⁵ Partner-referral programs are available in many states for health screening and education, and often offer free treatment. (See Web Resources for STD Guidelines Resources.)

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