Sexually transmitted disease

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Sexually transmitted disease Microchapters

Patient Information

Overview

Classification

Chlamydia
Gonorrhea
Human Immunodeficiency Virus (HIV)
Human papillomavirus (HPV)
Herpes Simplex Virus (HSV)
Mycoplasma genitalium
Syphilis
Trichomonas vaginalis
Zika Virus
Hepatitis B
Hepatitis C
Bacterial vaginosis

Differential Diagnosis

Risk Factors

Prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]}; Associate Editor(s)-in-Chief: Tarek Nafee, BSc, M.D. [2]

Synonyms and Keywords: Sexually transmissible disease; STD; VD; STI; sexually transmitted infection; venereal disease.

Overview

Sexually transmitted diseases (or STDs) are bacterial, viral, fungal, or protozoal infections that are transmitted via sexual contact. Sexual contact may entail non-penetrative contact of the genitalia, performing or receiving oral sex (cunnilingus, anilingus, or fellatio), and insertive or receptive vaginal or anal sexual intercourse. Sexually transmitted infections may have a variety of clinical presentations including dermatological manifestations, generalized symptoms, or urogenital tract symptoms such as discharge and dysuria. Some infectious agents may be transmitted primarily through sexual contact while others may less frequently be transmitted sexually.

In 2016, the CDC reported a updated prevalences of sexually transmitted diseases in the United States, which included chlamydia, gonorrhea, and syphilis.[1] Complications of STDs depend on the causative pathogen and may range from genital or oral pruritis and discomfort to more serious complications such as pelvic inflammatory disease, primary CNS lymphoma, cervical cancer, as well as cardiac and neurological complications. If left untreated, some STDs may progress to septic shock and mortality.

Most STDs have well-established risk factors and preventative measures. If followed appropriately, most STD transmissions can be avoided.

Classification

Transmission Clinical Presentation Disease Diagnosis Mother to Child Transmission Most Serious Complications
Laboratory studies Clinical Diagnosis Vertical Transmission Trans-vaginal transmission
Primarily sexually transmitted Genital Dermatological Manifestation
(e.g., ulcers, chancre, vesicles, warts, balanitis etc.)
HPV Cervical Cancer
Herpes simplex-2 Severe pruritis/discomfort
Syphilis
Scabies Moderate to Severe pruritis/discomfort
Pubic lice Moderate to Severe pruritis/discomfort
Candidiasis
(in males)
Mild to moderate pruritis/discomfort
Generalized Symptoms
(e.g. constitutional symptoms
HIV
Syphilis
Urogenital infections
(e.g.,Vaginitis, Urethritis, Cervicitis, and PID)
Gonorrhea PID
Chlamydia PID
Syphilis
Mycoplasma genitalium unknown unknown PID
Trichomonas vaginalis PID
Less frequently sexually transmitted Generalized Symptoms
(e.g. constitutional symptoms)
Zika Virus Vertical transmission and congenital abnormalities
Hepatitis B Hepatocellular Carcinoma
Hepatitis C Liver cirrhosis
Urogenital Infections
(e.g.,Vaginitis, Urethritis, Cervicitis, and PID)
Gardnerella vaginalis Moderate to severe discomfort
Candidiasis
(in females)
Moderate to severe pruritis/discomfort
Ureaplasma urealyticum Moderate to severe pruritis/discomfort

Differential Diagnosis

Disease Symptoms
Discharge Dysuria Vaginal odor Dyspareunia Genital skin lesion Genital pruritis Fever Lymphadenopathy Other symptoms
Chlamydia Cough, shortness of breath, red eye with discharge (neonate), joint pains
Gonorrhea Sore throat, polyarthralgia, tenosynovitis, rash, eye discharge (neonates)
HIV Fever, lymphadenopathy, rash, fatigue, myalgia, arthritic pain, headache
Herpes simplex Fatigue, myalgias, painful oral ulcers
HPV Weight loss, hoarseness (adults), altered cry, stridor (infants)
Hepatitis B Fever, fatigue, nausea, vomiting, loss of appetite, abdominal pain, dark urine, clay-colored bowel movements, joint pain, yellowish discoloration of the eyes and skin, skin rash, muscle pain
Hepatitis C Fever, fatigue, anorexia, arthralgia, nausea, vomiting
Bacterial vaginosis None
Mycoplasma genitalium None
Zika virus Conjunctivitis, rash, joint pains

Risk Factors

Risk factors for acquiring a sexually transmitted disease may vary depending on the disease. However, most sexually transmitted diseases share common risk factors including:

  • Multiple sexual partners
  • Prostitution
  • Illicit drug use
  • Intravenous drug use
  • Unprotected sex
  • Men who have sex with men
  • Residence in highly prevalent areas
  • Underlying HIV infection as a risk for other STDs
  • Presence of other STIs
  • Previous history of STIs
  • Low socioeconomic status
  • Health care professionals who are predisposed to occupational risk with infected patients

Prevention

The most effective way to prevent sexual transmission of STIs is to avoid contact of body parts or fluids which can lead to transfer. Abstinence is one method of avoiding contact. Ideally, both partners should get tested for STIs before initiating sexual contact, or if a partner engaged in contact with someone else.

Vaccines

Vaccines are available that protect against some viral STIs, such as Hepatitis B, Hepatitis C, Herpes simplex (both Herpevac and ImmunoVex), and some types of HPV. Vaccination before initiation of sexual contact is advised to assure maximal protection.

Barrier Protection

Condoms only provide protection when used properly as a barrier and to and from the area that it covers. Uncovered areas are still susceptible to many STD's. In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin thus properly shielding the insertive penis with a properly worn condom from the vaginaand anus effectively stops HIV transmission. An infected fluid to broken skin-borne direct transmission of HIV would not be considered "sexually transmitted", but can still theoretically occur during sexual contact, this can be avoided simply by not engaging in sexual contact when having open bleeding wounds.

Condoms are designed, tested, and manufactured to never fail if used properly. There has not been any documented case of an HIV transmission due to an improperly manufactured condom. However, there have been cases of condom recall, as in a case in South Africa.

Proper usage entails:

  • Not putting the condom on too tight at the end, and leaving 1.5 cm (3/4 inch) room at the tip for ejaculate. Putting the condom on snug can and often does lead to failure.
  • Wearing a condom too loose can defeat the barrier.
  • Avoiding inverting, spilling a condom once worn, whether it has ejaculate in it or not.
  • Avoiding condoms made of substances other than latex or polyurethane, as they don't protect against HIV.
  • Avoiding the use of oil-based lubricants (or anything with oil in it) with latex condoms, as oil can cause thinning and perforation of the material.

Not following the five guidelines above perpetuates the common misconception that condoms are not appropriately designed or tested.

In order to best protect oneself and the partner from STIs, a condom used by an infected individual and its contents should be assumed to be still infectious. Therefore the used condom must be properly disposed off. A new condom should be used for each act of intercourse, as multiple usages increase the chance of breakage, defeating the primary purpose as a barrier and increases the risk of disease transmission.

References

  1. CDC Fact Sheet: Reported STDs in the United States - 2015 National Data for Chlamydia, Gonorrhea, and Syphilis. The Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/std-trends-508.pdf Accessed on November 28, 2016.

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