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.     

Sexually transmitted diseases in adolescents: An update

Sexually transmitted diseases are a significant cause of morbidity for U.S. adolescents. Recent advances in diagnosis may lead to enhanced recognition of infected individuals, particularly those who lack symptoms. New approaches to therapy have simplified treatment and may enhance compliance.     

Sexually transmitted diseases and travelers.

Sexually active travelers are at risk for a variety of STDs, including traditional venereal infections such as gonorrhea, chlamydial urethritis, syphilis, chancroid, and herpes simplex infection. More recently, hepatitis B, hepatitis C, and HIV-1 have also been described. Risk varies depending on the geographic area of travel and the type of sexual contact. Physicians should be aware of the prevalence of antimicrobial resistance of N. gonorrhoeae and H. ducreyi because this will affect empiric antibiotic therapy. Prevention should focus on proper and consistent usage of barrier contraceptives.     

Sexually transmitted diseases

Over the past two decades the incidence of STDs has dramatically increased in the United States. Most patients with these infections present first to primary care physicians. All physicians must be familiar with the common STD syndromes and the indications for specific diagnostic tests in order to provide a comprehensive treatment plan. Primary prevention strategies based on patient education and secondary prevention through judicious use of screening tests in appropriate settings can also limit the morbidity associated with STDs.     

Sexually transmitted diseases

This article summarizes the major sexually transmitted diseases with an emphasis on diagnosis, therapy, and follow-up. Topics included are syphilis, gonorrhea, herpes genitalis, nongonococcal urethritis, lymphogranuloma venereum, granuloma inguinale, chancroid, condyloma acuminatum, molluscum contagiosum, and venereally transmitted gastrointestinal disease.     

Sexually transmitted diseases

STDs are commonly encountered in emergency department patients. The emergency physician can optimize individual patient outcomes and contribute to public health STD control initiatives by: maintaining a high index of suspicion for STDs; obtaining suitable diagnostic tests and instituting appropriate empiric therapy; counseling patients regarding treatment compliance, follow-up, partner notification, and preventive measures; and 4) reporting selected STDs to public health authorities. This article provides a general review of STDs commonly encountered in the United States and gives guidelines for routine treatment of adult patients with these infections. For a more detailed discussion of available treatment options and for guidelines regarding treatment in special patient populations (pediatric patients, pregnant patients, immunosuppressed patients) the reader is referred to the Centers for Disease Control publication "1998 Guidelines for Treatment of Sexually Transmitted Diseases," which is available on-line via the CDC website at http://www.cdc.gov.     

Sexually transmitted diseases

Simon Wright discusses four sexually transmitted diseases commonly seen at sexual health clinics. He describes the management issues involved and ways in which information and advice can be given to minimise patients' distress.     

Sexually transmitted urogenital diseases

Patients with sexually transmitted diseases (STDs) frequently present for care to the Emergency Department. Some of the more common STDs are increasing in number despite public health efforts to control their spread. Relatively simple diagnostic modalities for several of the more common STDs are presented. In addition, the most current treatment regimens for each STD discussed are described in detail.     

Sexually transmitted parasitic diseases

Sexual activity is the primary method of transmission for several important parasitic diseases and has resulted in a significant prevalence of enteric parasitic infection among male homosexuals. The majority of parasitic sexually transmitted diseases involve protozoan pathogens; however, nematode and arthropod illnesses are also included in this group. Trichomoniasis, caused by Trichomonas vaginalis, is the most common parasitic STD. Infection with this organism typically results in the signs and symptoms of vaginitis. Trichomoniasis can be diagnosed in the office setting by performing a microscopic evaluation of infected vaginal secretions and can be successfully treated with metronidazole. Both pediculosis pubis, caused by the crab louse Pthirus pubis, and scabies, caused by the itch mite Sarcoptes scabiei, present with severe pruritus. A papular or vesicular rash and linear burrows seen in the finger webs and genital area are characteristic of scabies. Pediculosis pubis is diagnosed by observing adult lice or their nits in areas that bear coarse hair. The diagnosis of scabies is confirmed by scraping suspicious burrows and viewing the mite or its byproducts under the microscope. Lindane, 1% used in treating scabies, is also very effective for treating pediculosis pubis. Synthetic pyrethrins, also applied as a cream or lotion, are less toxic alternatives for the treatment of either condition. Oral-anal and oral-genital sexual practices predispose male homosexuals to infection with many enteric pathogens, including parasitic protozoans and helminths. The most common of these parasitic infections are amebiasis, caused by Entamoeba histolytica, and giardiasis caused by Giardia lamblia. Both entities may cause acute or chronic diarrhea, as well as other abdominal symptoms. Most gay men with amebiasis are asymptomatic, and invasive disease in this group is extremely rare. Both amebiasis and giardiasis can be diagnosed on the basis of microscopic examination of stool specimens, although duodenal aspiration is occasionally necessary to confirm a diagnosis of giardiasis. Multiple treatment regimens exist for amebiasis. Iodoquinol is a good choice for asymptomatic cyst carriers, whereas the combination of metronidazole plus iodoquinol is used for symptomatic patients. Quinacrine and metronidazole are both efficacious in the treatment of giardiasis.