Sexually transmitted diseases: an update

Sexually transmitted diseases (STDs) have reached epidemic numbers in this country and represent considerable costs to the health care system. Nurses, who see clients in a variety of acute and community settings, have a unique opportunity to discuss STDs and their prevention. However, nurses must retain knowledge that is up-to-date on each of these diseases. Nurses need to take the lead in evaluating their clients' risk of acquiring STDs and tailor specific preventative techniques to the individual needs uncovered.     

Diagnosis and treatment of common sexually transmitted diseases

Sexually transmitted diseases (STDs) are common and often are asymptomatic. This article reviews the presentation and treatment recommendations for some of the most common symptomatic STDs, as well as reviews recent advances in diagnostic methods that may impact patient care. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.     

Self-disclosure of sexually transmitted diseases: an integrative review

In the United States, there are currently more than 65 million individuals living with a sexually transmitted disease (STD), and approximately 19 million new infections will continue to occur each year. To decrease the transmission of potentially dangerous and life-altering STDs, self-disclosure of sexual and drug history and sexual orientation is paramount. This integrative review examines the concept of self-disclosure of STDs, suggests areas of additional research, and proposes a comprehensive public health campaign, with a specific focus on the recent human papillomavirus epidemic to improve the physical and psychological health of all individuals.     

Quinolones in the treatment of sexually transmitted diseases

Many of the new quinolone-carboxylic acids possess in vitro activity against a variety of sexually transmitted pathogens. Neisseria gonorrhoeae and Hemophilus ducreyi are particularly susceptible to those antimicrobial agents while the in vitro sensitivities of Chlamydia trachomatis and genital mycoplasmas vary widely amongst the quinolones and range from poor to modest. Clinically, single dose therapy with many of the quinolones has been highly effective in curing gonorrhea and appears to be promising in the management of chancroid. In contrast, however, the quinolones (even when used in multiple dose, 7 to 10 day regimens) have been disappointing to date in the treatment of chlamydial and nongonococcal infections. Currently there is little data available with regard to other sexually transmitted diseases but it appears that the quinolones will not be useful in the therapy of syphilis or bacterial vaginosis.     

Condoms and sexually transmitted diseases

Many of our patients and colleagues will be surprised and disturbed by the latest revelation from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC). For more than a decade, the NIH and CDC have been promoting "safe sex," a message apparently based solely on the hope that condoms are effective in prevention of sexually transmitted diseases (STDs). This hope was discredited in mid-July when the NIH released the "Scientific Evidence on Condom Effectiveness for STD Prevention," commissioned in June 2000 by then-House member, Dr. Tom Coburn (R-OK). The report disclosed that the body of medical research shows no evidence that condoms protect against most STDs. I refer to the NIH and CDC's "hope" because their recommendations have not been based on good science, but rather on theoretical models, possibly unduly influenced by a strong bias that condoms would prove to be effective.     

Sequelae of sexually transmitted diseases

The sequelae of sexually transmitted diseases most seriously affect women and their infants. Pelvic inflammatory disease with associated ectopic pregnancy and infertility leads the list. Male infertility as a result of sexually transmitted diseases appears uncommon.     

Update on the prevention and treatment of sexually transmitted diseases

The Centers for Disease Control and Prevention updated its guidelines for the treatment of sexually transmitted diseases. The guidelines include the following information: recommendations for hepatitis A immunization and expanded indications for hepatitis B vaccination; updated diagnostic criteria for pelvic inflammatory disease and parenteral treatment regimens; information on two additional antiviral agents for the treatment of genital herpes; a recommendation for use of a single 1-g dose of azithromycin (Zithromax) to treat urethritis and chlamydial cervicitis; information on the use of quinolones in the treatment of gonococcal infections; information on podofilox and imiquimod, which are both patient-applied medications, in the treatment of noncervical human papillomavirus infection; updated guidelines for the prevention and detection of congenital syphilis; and information on how to prevent the spread of sexually transmitted diseases by educating patients about the importance of changing their sexual behaviors. To have a significant impact on the current rate of transmission of sexually transmitted diseases, family physicians should develop a plan to integrate the guidelines into their practices.     

Update on the prevention and treatment of sexually transmitted diseases

The Centers for Disease Control and Prevention (CDC) recently published updated guidelines that provide new strategies for the prevention and treatment of sexually transmitted diseases (STDs). Patient education is the first important step in reducing the number of persons who engage in risky sexual behaviors. Information on STD prevention should be individualized on the basis of the patient's stage of development and understanding of sexual issues. Other preventive strategies include administering the hepatitis B vaccine series to unimmunized patients who present for STD evaluation and administering hepatitis A vaccine to illegal drug users and men who have sex with men. The CDC recommends against using any form of nonoxynol 9 for STD prevention. New treatment strategies include avoiding the use of quinolone therapy in patients who contract gonorrhea in California or Hawaii. Testing for cure is not necessary if chlamydial infection is treated with a first-line antibiotic (azithromycin or doxycycline). However, all women should be retested three to four months after treatment for chlamydial infection, because of the high incidence of reinfection. Testing for herpes simplex virus serotype is advised in patients with genital infection, because recurrent infection is less likely with the type 1 serotype than with the type 2 serotype. The CDC guidelines also include new information on the treatment of diseases characterized by vaginal discharge.     

Diagnosis and treatment of common sexually transmitted diseases in women

Chlamydia trachomatis and Neisseria gonorrhoeae are 2 very common sexually transmitted organisms, whose clinical manifestations in women can range from an asymptomatic carrier state to active pelvic inflammatory disease with known serious sequelae, including chronic pelvic pain, infertility, and ectopic pregnancy. The economic and clinical burden of these 2 infectious organisms are significant in the sexually active population. New developments in diagnosis and treatment of these infections raise great hope that substantial reduction in morbidity and disease prevalence rates can be achieved. Herpes simplex virus is probably better publicized and more feared in the sexually active population, and is far more prevalent than previously recognized; fortunately, however, it is not generally associated with significant morbidity. This article will review the current diagnoses and treatments of these conditions and consider some of the issues surrounding the impact of screening asymptomatic sexually active individuals. The treatment guidelines will emphasize the 1998 Guidelines for Treatment of Sexually Transmitted Diseases from the Centers for Disease Control and Prevention.     

Chronic exposure to sexually transmitted diseases

The presence of chronic STD is due to various factors such as lifestyle behaviors, psychological factors, stress, reinfection, deviations of the urogenital tract, failure of treatment, resistant strains, allergic response, alternate sites, no known treatment, and errors in diagnosis. The presence of a chronic STD may have varying effects on the individual. It is important to consider the factors that cause chronic infections. The most common cause of chronic infections is reinfection. The assessment of the client should include both a nursing history and through physical examination. The nursing history should include a sexual history to identify health risks for the development of STD. Sensitivity and caring are needed in approaching the client with chronic STD exposure.     

Ectoparasites and endoparasites in sexually transmitted diseases

A number of protozoan organisms, both ectoparasitic and endoparasitic, may be related to sexual activity. The broad range of clinical presentations makes this group of diseases challenging to diagnose. Patients may present with skin, genital, gastroenterologic, pulmonary, or neurologic symptoms, or may be asymptomatic. A careful history, including specific sexual history, with appropriate laboratory evaluation will aid the primary care physician in making the correct diagnosis and thus supply the correct treatment. Awareness that infection with multiple organisms is frequent in some populations is important. Prevention of reinfection or further transmission of the disease must be aggressively pursued by patient education about the means of transmission of the disease and avoidance of high-risk sexual practices.