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sexually-transmitted disease; sexually-transmitted infection; venereal disease (STD, STI)

STD. Encompasses older term venereal disease. Etiology: 1) Treponema pallidum (syphilis) 2) Neisseria gonorrhoeae (gonorrhea) 3) Chlamydia trachomatis 4) Trichomonas vaginalis 5) HIV-1 6) hepatitis B virus 7) hepatitis C virus 8) Papillomavirus (HPV) 9) Herpes simplex virus (HSV) 10) parasites a) Pediculosis pubis (pubic lice) b) Scabies Risk factors: - multiple sexual partners - pubic hair grooming [13] - cutaneous STDs (RR=2.6), secretory STDs (RR=1.7) - more frequent grooming (shaving) associated with higher risk [13] Epidemiology: - 67% of patients are < 24 years of age - rates of Chlamydia, gonorrhea, & syphilis in 2015 were the highest on record [12] & again in 2016 [15] (> 2,000,000 cases in U.S.), 1.6 million cases of Chlamydia [15] - 2.3 million cases diagnosed in 2017, an increase of 200,000 over 2016, including cases of gonorrhea, syphilis, & chlamydia [16] Laboratory: - Chlamydia trachomatis DNA (urine, urethral vaginal, endocervical) - Neisseria gonorrhoeae DNA (urine, urethral vaginal, endocervical) - see ARUP consult [6] Complications: 1) infertility 2) ectopic pregnancy 3) congenital & perinatal infections 4) chronic pelvic pain 5) cervical cancer, anal cancer & penile cancer Management: 1) screening a) sexually-active women < 25 year of age annually for - Chlamydia trachomatis - Neisseria gonorrhoeae - HIV1 infection - hepatitis B infection [1,4,9,18] b) screen women > 25 year of age with risk factors for Chlamydia trachomatis & Neisseria gonorrhoeae [1,9] c) screen patients with any sexually-transmitted disease for HIV1 & syphilis d) men who have sex with men - annual screening for HIV1, syphilis, Chlamydia trachomatis & Neisseria gonorrhoeae [1] e) screen women with pelvic inflammatory disease & men with epididymitis for Chlamydia trachomatis & Neisseria gonorrhoeae [1] f) pregnant women should be screened for syphilis, Chlamydia trachomatis, HIV1, hepatitis B [1] 2) treat patient & partner(s) [2] 3) behavioral counseling for sexually-active women < 25 years of age & older women at risk [9] 4) rape victims: ceftriaxone, metronidazole & doxycycline* * doxycycline covers syphilis, metronidazole covers Trichomonas Notes: - sexually active teenagers on their parent's health insurance - females with confidentiality concerns had lower rates or screening for chlamydia (17% vs 39%) [14] - presence of a parent during contact with health care provider diminished likelihood of sexual health services [14]

Related

Chlamydia trachomatis genital ulcer human immunodeficiency virus (HIV) papillomavirus risk factors for sexually transmitted disease safe sex (prevention of HIV1 & other STDs) urethritis

Specific

cervicitis chancroid (soft chancre) condyloma acuminata (anogenital wart) genital Herpes (Herpes genitalis) gonorrhea lymphogranuloma venereum (inguinale); Favre-Durand-Nicholas disease; tropical bubo molluscum contagiosum syphilis trichomoniasis

General

infection (infectious disease)

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 17. American College of Physicians, Philadelphia 1998, 2006, 2009, 2015
  2. Prescriber's Letter 12(4): 2005 Patient-deliverd partner therapy Detail-Document#: 210404 (subscription needed) http://www.prescribersletter.com
  3. Journal Watch 25(7):60, 2005 Golden MR, Whittington WL, Handsfield HH, Hughes JP, Stamm WE, Hogben M, Clark A, Malinski C, Helmers JR, Thomas KK, Holmes KK. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005 Feb 17;352(7):676-85. PMID: 15716561
  4. Workowski KA, Berman SM. Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep. 2006 Aug 4;55(RR-11):1-94. PMID: 16888612 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm - Workowski KA, Berman S. Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17;59(RR-12):1-110. PMID: 21160459 many of these guidelines withdrawn from NGC Jan 2016 - Prescriber's Letter 13(9): 2006 Summary Chart of 2006 CDC treatment guidelines for STDs Detail-Document#: 220912 (subscription needed) http://www.prescribersletter.com
  5. Prescriber's Letter 15(6): 2008 Expedited Partner Therapy (EPT) for Chlamydia and Gonorrhea Detail-Document#: 240601 (subscription needed) http://www.prescribersletter.com
  6. ARUP Consult: Sexually Transmitted Infections The Physician's Guide to Laboratory Test Selection & Interpretation https://www.arupconsult.com/content/sexually-transmitted-infections
  7. Prescriber's Letter 19(10): 2012 COMMENTARY: Updated Treatment Recommendations for Gonorrhea CHART: Sexually Transmitted Diseases Treatment Guidelines Detail-Document#: 281007 (subscription needed) http://www.prescribersletter.com
  8. U.S. Preventive Services Task Force. Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008 Oct 7;149(7):491-6, W95. PMID: 18838729 - U.S. Preventive Services Task Force. Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement. DRAFT. Summary of Recommendation and Evidence. http://www.uspreventiveservicestaskforce.org/draftrec3.htm
  9. Zakher B et al Screening for Gonorrhea and Chlamydia: An Update for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 23 September 2014 PMID: 25244000 http://annals.org/article.aspx?articleid=1906845 - LeFevre ML et al Behavioral Counseling Interventions to Prevent Sexually Transmitted Infections: U.S. Preventive Services Task Force Recommendation Statement Ann Intern Med. Published online 23 September 2014 PMID: 25244227 http://annals.org/article.aspx?articleid=1906847 - O'Connor EA et al Behavioral Sexual Risk-Reduction Counseling in Primary Care to Prevent Sexually Transmitted Infections: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 23 September 2014 PMID: 25243895 http://annals.org/article.aspx?articleid=1906844
  10. Workowski KA, Bolan GA (CDC) Sexually Transmitted Diseases Treatment Guidelines, 2015 Recommendations and Reports. MMWR June 5, 2015 / 64(RR3);1-137 PMID: 26042815 Free Article http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm
  11. World Health Organization (WHO). Growing antibiotic resistance forces updates to recommended treatment for sexually transmitted infections. WHO releases new treatment guidelines for chlamydia, gonorrhoea and syphilis. News Release. Aug 30, 2016 http://www.who.int/mediacentre/news/releases/2016/antibiotics-sexual-infections/en/
  12. Centers for Disease Control and Prevention (CDC) 2015 STD Surveillance Report Press Release. October 19, 2016 https://www.cdc.gov/nchhstp/newsroom/2016/std-surveillance-report-2015-press-release.html - Centers for Disease Control and Prevention (CDC). Sexually-Transmitted Disease Surveillance. 2015 http://www.cdc.gov/std/stats15/std-surveillance-2015-print.pdf
  13. Osterberg EC, Gaither TW, Awad MA et al Correlation between pubic hair grooming and STIs: results from a nationally representative probability. Sex Transm Infect. Dec 5, 2016 PMID: 27920223 http://sti.bmj.com/content/early/2016/10/31/sextrans-2016-052687
  14. Leichliter JS, Copen C, Dittus PJ. Confidentiality Issues and Use of Sexually Transmitted Disease Services Among Sexually Experienced Persons Aged 15-25 years of age - United States, 2013-2015 MMWR Morb Mortal Wkly Rep 2017;66:237-241 https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a1.htm
  15. Centers for Disease Control & Prevention (CDC) 2016 Sexually Transmitted Diseases Surveillance. https://www.cdc.gov/std/stats16/toc.htm
  16. Centers for Disease Control & Prevention (CDC) New CDC analysis shows steep and sustained increases in STDs in recent years NCHHSTP Newsroom. Press Release. Aug 28, 2018 https://www.cdc.gov/nchhstp/newsroom/2018/press-release-2018-std-prevention-conference.html
  17. Payette M, Russomanno K Visual Findings of 9 Sexually Transmitted Infections. Medscape. Oct 6, 2022 https://reference.medscape.com/slideshow/sti-6006090
  18. NEJM Knowledge+ - Workowski KA et al Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021 Jul 23; 70:1 PMID: 34292926 PMCID: PMC8344968 Free PMC article
  19. National Institute of Allergy and Infectious Diseases (NIAID) Sexually Transmitted Diseases https://www.niaid.nih.gov/diseases-conditions/sexually-transmitted-diseases