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Sexually transmitted diseases (STDs) are common problems that have an impact on patients seen by many, if not all, clinicians, irrespective of their chosen.
Table of contents
- Current Diagnosis & Treatment Of Sexually Transmitted Diseases
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The collection will continue with further research and discussion articles appearing over the next few weeks. Health care provider perspectives on managing sexually transmitted infections in HIV care settings in Kenya: A qualitative thematic analysis. August Interventions to address unequal gender and power relations and improve self-efficacy and empowerment for sexual and reproductive health decision-making for women living with HIV: A systematic review. August Multidrug-resistant gonorrhea: A research and development roadmap to discover new medicines. July Antimicrobial resistance in Neisseria gonorrhoeae: Global surveillance and a call for international collaborative action.
July Assessing process, content and politics in developing the global health sector strategy on sexually transmitted infections implementation opportunities for policymakers. June Pathways and progress to enhanced global sexually transmitted infection surveillance. January In this funny and eye-opening talk about the challenges we face today with safe sex and Sexually Transmitted Infections STIs , Teodora Elvira Wi shares heartwarming personal stories around sex, STIs and the urgent need to break down the stigma.
Sign up for WHO updates. Skip to main content. Search Search the WHO. Menu Sexual and reproductive health What's new? Culture of C. Invasive specimen collection is necessary to acquire sufficient epithelial cells, and samples must be processed and inoculated onto a cell monolayer without delay. Infected cells are incubated with chlamydial antibodies to detect the presence of the organism. This process is technically complex, and methods are highly variable among laboratories Therefore, culture is not practical for most clinical laboratories and is typically reserved for public health facilities.
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Current Diagnosis & Treatment Of Sexually Transmitted Diseases
Specimens should be collected on swabs with plastic or metal shafts owing to possible inhibitory effects of wood or cotton on the growth of bacteria, and specialized transport medium is required to preserve organism viability. Additionally, selective and enriched growth media and incubation in an increased CO 2 environment are required for isolation. Treatment of chlamydial and gonococcal infection is critical to prevent further transmission to a partner or neonate or possible sequelae such as reproductive complications.
The recommended treatment for chlamydial infections is azithromycin or doxycycline, which have been shown to be equally effective in eradication of infection Treatment of gonococcal infection has evolved recently due to increasing concerns about antibiotic-resistant strains of N. A recent increase in the incidence of tetracycline resistance and strains with increased minimum inhibitory concentrations to cefixime has prompted the CDC to recommend combination therapy with ceftriaxone and azithromycin 2 , 19 , 20 , which is also effective against uncomplicated chlamydial coinfection.
If treatment failure is observed after this regimen, antimicrobial susceptibility testing AST of the N.
The pathogenesis of M. Diagnostic testing for M.
The organism can take up to 6 months to grow in culture, and very few laboratories can culture clinical isolates. Thus, the organism may be underdiagnosed in people with persistent or recurrent nongonococcal urethritis. As a result of these diagnostic challenges, the decision to treat a suspected case of M. Studies have shown that doxycycline is relatively ineffective against M.
However, resistance to azithromycin is rapidly emerging, and an alternative regimen consisting of treatment with moxifloxacin has been effective in a small number of cases in which previous treatment measures have failed 26 , Genital ulcers can have infectious or noninfectious etiologies. Less prevalent infectious causes include chancroid Hemophilus ducreyi , granuloma inguinale Klebsiella granulomatis , and lymphogranuloma venereum serovar L1, L2, L2a, or L3 of Chlamydia trachomatis. The presence of genital ulcers is associated with an increased risk of HIV acquisition and transmission 28 , However, determining the cause of genital ulcers is often complicated by the fact that multiple etiologies may be present simultaneously.
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Syphilis, which is caused by the bacterium Treponema pallidum , is divided into primary, secondary, and tertiary stages of infection, depending on clinical manifestation. Asymptomatic infection is known as latent syphilis and may be detected by serologic testing. In addition, T. Routine screening for syphilis is not recommended in the US, owing to the low positive predictive value of testing asymptomatic individuals Because the majority of primary and secondary syphilis cases are diagnosed in MSM, screening should be reserved for these individuals and others at high risk of infection 2.
Transplacental transmission of syphilis from mother to fetus can result in stillbirth, hydrops fetalis, or premature birth. Because of the severe morbidity associated with infection, routine syphilis screening is recommended for all pregnant women during the first prenatal visit and in the third trimester for women who are at high risk for infection, live in high prevalence areas, or were previously untested Serologic testing methods for syphilis are categorized as treponemal specific or nontreponemal.
Treponemal tests include the T. These are typically confirmatory tests that detect antibodies against treponemal cellular components. Although they display very good sensitivity and specificity, they are labor intensive and cannot be used to follow disease, as they remain positive after successful treatment. Nontreponemal tests, including venereal disease research laboratory VDRL and rapid plasma reagin RPR tests, detect antibodies to a cardiolipin-cholesterol-lecithin antigen produced in response to syphilis infection.
Although these tests lack specificity, they are rapid and inexpensive and can be used to screen for active infection and monitor response to treatment. Dilution of samples should be considered in patients with high clinical suspicion for syphilis because of a potential prozone effect with RPR and VDRL tests 31 , In most settings, nontreponemal testing is used for initial screening, and positive results are confirmed by treponemal-specific testing The recent development of automated treponemal serologic immunoassays has created a paradigm shift in the algorithm for syphilis diagnostic testing.
However, the low prevalence of syphilis in the US in most patient populations and geographic regions has a detrimental effect on the positive predictive value of this algorithm, which can lead to uncertainty about patient management Although the seroprevalence of HSV-2 has declined in recent years, an increasing proportion of new infections has been attributed to HSV-1, particularly in young women and MSM 37 , Many infections are unrecognized, because genital HSV infections are often asymptomatic or subclinical.
A clinical diagnosis of genital herpes is neither sensitive nor specific. Therefore, laboratory testing methods are routinely used to support the diagnosis. Viral culture was once the gold standard for HSV diagnosis, but as a result of the long turnaround time and reduced sensitivity of the method compared with molecular testing, viral culture for HSV has largely fallen out of favor Nucleic acid testing by PCR assay of a swab of a lesion is highly sensitive in an individual presenting with active lesions 40 , However, latent infection cannot be ruled out in a patient with no active lesions and a negative result.
At the time of preparation of this manuscript, there are 3 FDA-cleared molecular assays for detection of HSV DNA in genital and oral lesions that provide rapid results with detection rates superior to viral culture Serologic assays are available for type-specific testing of HSV-1 and Antibodies develop within the first several weeks after infection and are present indefinitely. Furthermore, detection of IgM has no utility, as it does not correlate with recent infection and IgM testing is not type specific Approximately 1.
In recent years, the rate of HIV diagnosis in the US has been stable at 15 per population, with the overwhelming majority of new infections in men, particularly MSM HIV-2 is endemic to West Africa and is an important cause of infection in areas with historic ties to this region, including Portugal, Spain, India, and Brazil HIV is acquired through contact with infected bodily fluids, such as blood, semen, vaginal fluids, or breast milk, and most infections are acquired by sexual contact After a brief acute illness, HIV infection shifts to a chronic syndrome that progressively depletes CD4 T-lymphocytes, leading to AIDS and an increased risk of opportunistic infections.
The recommendation for expanded HIV testing should facilitate earlier diagnosis of HIV infections, which will decrease further spread of infection and permit prompt treatment with antiretroviral therapy before serious sequelae develop. Therefore, the CDC recommends that all pregnant women be screened for HIV early in pregnancy, and retesting is recommended during the third trimester for women at high risk of acquiring HIV infection 48 , Prenatal HIV screening has reduced perinatal HIV infection, as women who test positive can be started on antiretroviral therapy and managed appropriately during delivery to reduce the risk of transmission Previously implemented third-generation assays did not include p24 antigen detection.
Therefore, testing with fourth-generation methods shortens the window for detection of acute infection from approximately 1 month with third-generation assays to 15—20 days, attributed to the ability to detect HIV infection before seroconversion Fig. HIV-1 Western blots, which identify HIV-1 antibodies separated by electrophoresis, are not positive until 5—6 weeks after infection onset. Most of these are third-generation assays. If the screening assay is nonreactive, no further testing is necessary. Specimens with a reactive result are tested in the second step of the algorithm with an IA that differentiates HIV-1 antibodies from HIV-2 antibodies Differentiation of HIV types is important, because strains of HIV-2 are naturally resistant to many antiretroviral drugs and are managed differently The differentiation IAs have several advantages over the Western blot confirmation method, including faster turnaround time, lower cost, and recognition of HIV-2 strains.
Hepatitis may result from many infectious and noninfectious causes. Viral hepatitis most often induces a hepatocellular pattern of liver injury in which aspartate aminotransferase and alanine aminotransferase are markedly increased i. Common symptoms of acute viral hepatitis include malaise, fever, nausea, vomiting, jaundice, and dark urine.
Hepatitis B virus HBV is a well-known cause of sexually transmitted viral infection, whereas hepatitis C virus HCV is generally not efficiently transmitted through sexual contact 58 , Sexual transmission is thought to be the major route of HBV infection in developed countries. The virus is efficiently transmitted via mucosal exposure to infected blood or body fluids. Infections are usually self-limiting, but a small percentage of infected adults go on to develop chronic hepatitis, cirrhosis, and hepatocellular carcinoma.
Risk factors include sexual intercourse with multiple partners, anal sex, and intravenous drug use. Viral hepatitis occurs with the same frequency in pregnant women as would be expected in a comparable age group Women who acquire hepatitis B late in pregnancy or who are chronic carriers are more likely to transmit the disease to their babies, with possible outcomes including fulminant hepatitis, mild hepatitis, or chronic hepatitis. As a result, all pregnant women should be screened for hepatitis B infection in the first trimester and at delivery if at high risk for HBV infection Serologic testing is used to diagnose acute or chronic HBV Fig.
In certain populations, such as transplant patients, serologic markers may be useful to categorize the risk for HBV reactivation after immune suppression. We refer the reader to the published guidelines on this topic for further information Hepatitis B surface antigen HepBsAg and e antigen HepBeAg appear in the blood within weeks to months after infection onset and are likely to be present in a symptomatic patient seeking care. HepBsAg is present in both acute and chronic infections. Therefore, the presence of an IgM antibody directed against the hepatitis B core antigen anti-HBc-IgM is helpful in the differentiation of acute vs chronic infection Table 2.
Antibody to HBsAg anti-HBs is produced in people with resolved infection and is the only serologic marker present in vaccinated individuals. The appearance of HBV markers occurs in a predictable pattern. HBV DNA red bars is detectable very early in infection and declines until approximately 36 weeks after infection onset. HBV antigens green bars appear within 4—6 weeks after exposure and serve as good markers of acute infection.
HBV antibodies appear approximately 6 weeks after infection. IgG antibodies to the core and surface antigens generally persist for life and serve as a marker of chronic or past infection. Summary of interpretations of HBV virologic and serologic test results. Major efforts to vastly decrease the incidence of HBV infection include strategies aimed at increasing vaccination rates and preventing vertical transmission of HBV from a mother to her infant.
The Advisory Committee on Immunization Practices ACIP recommends vaccination of infants at birth, of all previously unvaccinated children and adolescents, and of previously unvaccinated adults who are at increased risk of infection 68 , Current guidelines for the treatment of HBV infection are reviewed elsewhere More than 3 million people in the US are chronically infected with blood-borne HCV, and global prevalence is increasing worldwide. Chronic HCV infection causes considerable morbidity due to increased risk of liver cirrhosis, hepatocellular carcinoma, and liver failure.
Because there is no effective vaccine for HCV, current efforts are focused on effective screening measures and treatment of infected individuals, and several recent advances in these areas may improve the clinical outcomes of infected patients. In the past, screening for HCV was recommended for individuals, such as intravenous drugs users, considered at high risk for HCV transmission.