Preface

Sexually transmitted diseases (STDs) are common problems that have an impact on patients seen by many, if not all, clinicians, irrespective of their chosen practice. Family practitioners, internists, pediatricians, obstetrician-gynecologists, urologists, and dermatologists all regularly care for patients at risk for STDs. They are also common: the Centers for Disease Control and Prevention (CDC) estimates that nearly 20 million new STD cases occur each year, with about half among people less than 25 years of age. In addition, STD diagnosis and management is a dynamic area in medicine with significant recent advances in prevention, diagnosis, treatment, and clinical care. The advent of a vaccine for human papillomavirus, which is recommended for females aged 9–26, provides an important opportunity for clinicians to assess and discuss sexual activity with adolescents and their parents while offering a highly effective preventive intervention. Similarly, for the most common bacterial STDs, nucleic acid-based assays enable rapid and accurate identification of infections by clinicians, using noninvasively collected specimens (urine) and eliminating barriers to screening. Finally, multiple clinical trials have demonstrated the safety and efficacy of single-dose therapy for a number of common STDs and the widespread recognition that reinfection is common has led to important changes in partner management and recommendations for retesting. Each of these new elements for managing the infections caused by the nearly 30 organisms that are principally transmitted sexually provides clinicians with new tools for efficient, effective STD management.

We hope that the busy clinician, whether the experienced subspecialist, recently trained graduate, or hardworking mid-level practitioner, will find the up-to-date, practical, and evidence-based chapters in Current Diagnosis Management of Sexually Transmitted Diseases a useful and easy reference guiding the day-to-day clinical care of the patients they surely see who are at risk for STDs. Students of medicine and physicians in training will note the informative discussions of epidemiology and pathogenesis in certain chapters and tables summarizing the differential diagnosis of syndromes, lists of etiologic organisms, and clinical practice points.

Leading experts in medicine, surgery, obstetrics and gynecology, and pediatrics have joined together to create this first edition to further the appropriate and timely diagnosis and treatment of sexually transmitted diseases. Highlights of this edition include current U.S. STD and HIV screening guidelines, syndromic-based evaluations and rapid point-of-care tests, new evidence of the role of certain infections like Mycoplasma genitalium, and the renewed recognition of old diseases like lymphogranuloma venereum. Attention should be paid to chapters that focus on prevention—risk-reduction counseling and partner notification—which can enable the clinician to serve in his or her larger role as a potential agent of individual change and public health advocate. Lastly, recognizing the unique role of behavior and development in the risk and management of STDs, we have included specific chapters dedicated to special populations.

With the carefully composed chapters in this book, we hope that clinicians will be better able to manage sexually transmitted infections and, even more importantly, ally with their patients to prevent further infections and the continued spread of those diseases. As this is the first edition, we aim to continue to improve this text to increase its usefulness and welcome recommendations, comments, and criticism from our readers.

ACKNOWLEDGMENTS

We would like to acknowledge the hard work of the expert contributors whose dedication to the improvement of sexual health and knowledge was critical to the high quality of this text. We would like to acknowledge further our local administrative support staff, Joanne Carpio (San Francisco) and Sharron Hagy (Birmingham). Finally, we would like to acknowledge that without the support of our families (San Francisco: Tammy, Henry, Teddy, and Anna; and Birmingham: Kathy, Sarah, and Jessie) and their patience and tolerance of late nights and “working vacations,” this text would not have been possible.