- Privacy, confidentiality, and legal disease reporting concerns affect detection and treatment.
- Suspicion or diagnosis of one sexually transmitted disease (STD) should prompt screening tests for others.
- Diagnosis of an STD should always include identification and treatment of partners, and education to reduce risk of future infection.
STDs include sexually transmitted infections and the clinical syndromes they cause. Based on estimates there are up to 19 million new STDs in the United States annually, almost half of them among persons aged 15-24 years. Rates in the United States are among the highest in the developed world.
Although all sexually active individuals are susceptible to infection, adolescents and young adults are most commonly affected. Reasons for this include (1) adolescents' biological susceptibility to increased morbidity (eg, cervical dysplasia in women exposed to human papillomavirus [HPV] as adolescent girls), (2) an attitude of invincibility, (3) lack of knowledge about the risks and consequences of STDs, and (4) barriers to health care access. Chlamydia and gonorrhea can result in infertility if left untreated. In many instances, these infections may be asymptomatic and not diagnosed. International travelers may be another population at increased risk for STDs and may benefit from pretravel counseling.
This chapter emphasizes the clinical presentation, diagnostic evaluation, and treatment of STDs commonly found in the United States. Readers of this chapter should be able to:
- Differentiate common STDs on the basis of clinical information and laboratory testing.
- Treat STDs according to current guidelines.
- Intervene in patients' lives to reduce risk of future STD acquisition.
The discussion draws greatly from the most recent Centers for Disease Control and Prevention (CDC) guidelines for treatment of STDs. We are indebted to the individuals who worked to develop these recommendations.
Federal and state laws create disease-reporting requirements for many STDs. Gonorrhea, Chlamydia, chanchroid, syphilis, and AIDS are reportable in every state. HIV is reportable in many states. Because reporting requirements for other diseases vary by state, clinicians should contact their local health department for pertinent information.
Privacy and confidentiality concerns are different for STDs than for general medical information. Patients generally experience greater anxiety about information pertaining to a possible diagnosis of an STD, and this may limit their willingness to disclose clinically pertinent information. Conversely, legal requirements for disease reporting and health department partner notification programs can inadvertently compromise patient confidentiality if not handled with the utmost professionalism. Furthermore, although minors generally require parental consent for nonemergent medical care in all states, minors can be diagnosed and treated for STDs without parental consent. Additionally, many US states legislation may permit physicians to prescribe treatment for the heterosexual partners of men or women with Chlamydia or gonorrhea without examining the partner. Thus, laws in different jurisdictions create additional options and complexities in treating STDs. Practitioners need to be familiar with local requirements.