Infectious Disease Book

http://www.fpnotebook.com/

Sexually Transmitted DiseaseAka: STD

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  1. See Also
    1. Postexposure Prophylaxis for HIV
    2. Postexposure Prophylaxis for Hepatitis B
    3. Rape Management
  2. High Risk Groups
    1. Adolescents
      1. Multiple partners
      2. Sequential monogamy
      3. Unconcerned
      4. Uniformity
    2. Racial or ethnically skewed
      1. Black: Chlamydia more common
    3. Homosexual men or women
    4. Coasts or Ports of entry
    5. Prostitutes
    6. Teenage runaways
    7. Immigrants
  3. Transmission
    1. Contact
      1. Secretions
      2. Mucus membrane
      3. Skin abrasion
    2. Intercourse not necessary for STD transmission
      1. Herpes Simplex Virus
      2. Condyloma
      3. Gonorrhea
      4. Chlamydia
  4. Causes
    1. Sexually Transmitted Disease Genital Ulcers
      1. Painful Ulcers
        1. Herpes Genitalis
        2. Chancroid
      2. Non-Painful Ulcers
        1. Granuloma inguinale
        2. Lymphogranuloma venereum
        3. Syphilis (Early)
    2. Sexually Transmitted Disease Non-ulcerative
      1. Non-Gonococcal Urethritis
      2. Pelvic Inflammatory Disease
      3. Gonorrhea
      4. Chlamydia
      5. Syphilis (Secondary or tertiary)
      6. Human Papillomavirus (HPV) and Cervical Dysplasia
      7. Human Immunodeficiency Virus (HIV)
      8. Hepatitis B Virus
      9. Parasitic Infection
        1. Pediculosis pubis
        2. Scabies (pruritic genital bumps awaken patient)
  5. Screening: Wet Mount microscopic exam of cervical swab
    1. Positive: Polymorphonuclear Leukocytes (PMNs) >10/hpf
    2. Positive test should be followed by specific testing
      1. Chlamydia trachomatis
      2. Neisseria gonorrhoeae
    3. Efficacy
      1. Test Sensitivity: 90%
      2. Test Specificity: 87%
    4. Reference
      1. Bohmer (1999) Am J Obstet Gynecol 181:283
  6. Symptoms: Women
    1. Vaginal Discharge
    2. Postcoital spotting
    3. Dyspareunia
  7. Signs: Women
    1. Genital Ulcers
    2. Cervicitis
      1. Erythema of cervix
        1. GynCervicalColposcopyVaginoCervicitis.jpg
      2. Mucopurulent discharge from Cervical os
  8. Pitfalls
    1. Pharyngeal Gonorrhea in Men who have sex with men
      1. Morris (2006) Clin Infect Dis 43:1284
  9. Management: Rescreening
    1. Routinely Rescreen positive STD cases in 3 months
      1. Peterman (2006) Ann Intern Med 145:654
  10. Resources for Patients
    1. STD Hotline: (800) 227-8922
    2. Information from your Family Doctor: Prevent AIDS
      1. http://www.familydoctor.org/healthfacts/005/

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