Sexually transmitted disease: Difference between revisions

	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
Treatment

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Latest revision as of 18:03, 10 December 2020

For patient information click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Carla Vorsatz, M.D.[2]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [3]

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.

The CDC reported updated Surveillance data on sexually transmitted diseases from 2018 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 death.

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

Classification

Table below provides a concise comparison of various sexually transmitted diseases:^[1]

Transmission	Clinical Presentation	Disease	Diagnosis		Mother to Child Transmission		Most Serious Complications
Transmission	Clinical Presentation	Disease	Laboratory Studies	Clinical Diagnosis	Vertical Transmission	Trans-vaginal Transmission	Most Serious Complications
Primarily sexually transmitted	Genital Dermatological Manifestation (e.g., ulcers, chancre, vesicles, warts, balanitis etc.)	HPV	✔	✔			Cervical Cancer
		''Herpes simplex'' 1 and 2	✔	✔	✔	✔	Moderate to severe pruritis/discomfort, superinfection
		Syphilis	✔	✔	✔		Neurosyphilis Cardiosyphilis
		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	✔		✔		Primary CNS Lymphoma Immunosuppression (AIDS)
	Generalized Symptoms (e.g., constitutional symptoms)	Syphilis	✔	✔	✔		Neurosyphilis Cardiosyphilis
	Urogenital infections (e.g., Vaginitis, Urethritis, Cervicitis, and PID)	Gonorrhea	✔	✔		✔	PID
		Chlamydia	✔	✔		✔	PID
		Syphilis	✔	✔	✔		Neurosyphilis Cardiosyphilis
		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, Hepatocellular Carcinoma
	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

Table below provides differential diagnosis of sexually transmitted diseases:^[1]

Disease	Symptoms
Disease	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 pain
Gonorrhea	✔	✔	✔	✔			✔		Sore throat, polyarthralgia, tenosynovitis, rash, eye discharge (neonates)
HIV	✔	✔					✔	✔	Fever, lymphadenopathy, rash, fatigue, myalgia, arthritic pain, headache
Herpes simplex	✔	✔			✔		✔	✔	Fatigue, myalgia, 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 stools, 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 pain, myalgia

Treatment

To view the treatment of chlamydia infection click here.
To view the detailed treatment of gonorrhea click here.
To view the detailed treatment of herpes simplex click here.
To view the detailed treatment of mycoplasma genitalium infection click here.
To view the detailed treatment of syphilis click here.
To view the detailed treatment of trichomoniasis click here.
To view the detailed treatment of bacterial vaginosis click here.
To view the detailed treatment of human papillomavirus click here.

References

↑ ^1.0 ^1.1 ^1.2 CDC Sexually Transmitted Disease Surveillance 2018 STDs in the United States. The Centers for Disease Control and Prevention. https://www.cdc.gov/std/stats18/toc.htm Accessed on January 25, 2020.

[CDCFact-1] 1.0 ^1.1 ^1.2 CDC Sexually Transmitted Disease Surveillance 2018 STDs in the United States. The Centers for Disease Control and Prevention. https://www.cdc.gov/std/stats18/toc.htm Accessed on January 25, 2020.

[1]

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 '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
 {{Sexually transmitted disease}}
-{{CMG}}}{{cv}}; {{AE}} {{TarekNafee}}<br>
+{{CMG}}{{cv}}; {{AE}} {{TarekNafee}}<br>
 {{SK}} Sexually transmissible disease; STD; VD; STI; sexually transmitted infection; venereal disease.
@@ Line 12: / Line 12: @@
 Most [[STDs]] have well-established risk factors and preventative measures. If followed appropriately, most [[STD ]]transmissions can be avoided.
 ==Classification==
+Table below provides a concise comparison of various sexually transmitted diseases:<ref name=CDCFact> CDC Sexually Transmitted Disease Surveillance 2018 [[STDs]] in the United States. The Centers for Disease Control and Prevention. https://www.cdc.gov/std/stats18/toc.htm Accessed on January 25, 2020. </ref>
 {| style="border: 0px; font-size: 90%; margin: 3px;" align=center class="wikitable" style="border: 2; background: none;"
 ! colspan="1" rowspan="2" style="border: 1; background: 1;"| Transmission
@@ Line 81: / Line 80: @@
 ==Differential Diagnosis==
+Table below provides differential diagnosis of sexually transmitted diseases:<ref name=CDCFact> CDC Sexually Transmitted Disease Surveillance 2018 [[STDs]] in the United States. The Centers for Disease Control and Prevention. https://www.cdc.gov/std/stats18/toc.htm Accessed on January 25, 2020. </ref>
 {| class="wikitable" style="border: 2; background: none;"
 |-
@@ Line 109: / Line 109: @@
 | [[Zika virus]] || || || || || || ||✔|| ||[[Conjunctivitis]], [[rash]], [[joint pain]], [[myalgia]]
 |}
-==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
-*[[Intravenous drug use (recreational)|Illicit drug use]]
-*[[Intravenous drug use (recreational)|Intravenous drug use]]
-*[[Unprotected sex]]
-*Men who have sex with men
-*Residence in highly prevalent areas
-*Underlying [[Human Immunodeficiency Virus (HIV)|HIV]] infection as a risk for other [[STD]]s
-*Presence of other [[STD]]s
-*Previous history of [[STD]]s
-*Low socioeconomic status
-*Health care professionals who are predisposed to occupational risk with infected patients
 ==Treatment==
 * To view the treatment of [[chlamydia infection]] [[Chlamydia infection medical therapy|click here]].
@@ Line 133: / Line 118: @@
 * To view the detailed treatment of [[bacterial vaginosis]] [[Bacterial vaginosis medical therapy|click here]].
 * To view the detailed treatment of [[human papillomavirus]] [[Human papillomavirus medical therapy|click here]].
-==Prevention==
-The most effective way to prevent sexual transmission of [[STI]]s 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 [[STI]]s before initiating sexual contact, ''or if a partner engaged in contact with someone else''.
-===Vaccines===
-[[Vaccines]] are available that protect against some viral [[STD]]s, such as [[Hepatitis B vaccine|Hepatitis B]], [[Herpes simplex]] (Herpevac and ImmunoVex, both in clinical trials not yet approved by the FDA), 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 [[vagina]]and 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 [[STI]]s, 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. 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==
 {{Reflist|2}}
-{{WH}}
-{{WS}}
-[[Category:Emergency medicine]]
 [[Category:Disease]]
-[[Category:Up-To-Date]]
-[[Category:Gynecology]]
-[[Category:Surgery]]
 [[Category:Urology]]
 [[Category:Infectious disease]]
-[[Category:Emergency mdicine]]
+[[Category:Primary care]]
-[[Category:Rheumatology]]
-[[Category:Dermatology]]
-[[Category:Neurology]]
-[[Category:Cardiology]]
-[[Category:Gastroenterology]]
-[[Category:Otolaryngology]]