Sexually Transmitted Diseases

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 ...