Sexually transmitted diseases in postpubertal female rape victims

Seventy-six postpubertal women were referred from a municipal hospital emergency room within 60 h of sexual assault for evaluation. Of the 76 victims, 20 (26%) had active Chlamydia trachomatis infection detected by culture (11 subjects), a fourfold serologic titer rise (6), or both (3). The risk of acquiring C. trachomatis infection after sexual assault was 3%-16%. Pelvic inflammatory disease was detected in 8 (11%) of the 76 victims. Bacterial vaginosis was diagnosed in 38 women (50%), at least 8 of whom appeared to have been infected during the assault. Trichomoniasis was found in 17 victims (22%), at least 5 of whom may have acquired the infection at the time of the assault. In view of the high rates of these infections and the poor compliance with follow-up (76% [58/76] kept their appointments), all postpubertal victims of sexual assault should be offered treatment with ceftriaxone, 250 mg intramuscularly, followed by 100 mg of oral doxycycline and 500 mg of oral metronidazole twice daily for 7 days.     

Sexually transmitted diseases

Traditionally, STD is considered a disease of younger adults, and older adults continue to present a challenge to health care providers. Geriatric health care professionals must offer older adults adequate information relating to sexuality and aging. In addition, sexual health must be evaluated as a standard domain in routine comprehensive geriatric evaluation and management. Large-scale community education programs are helpful in encouraging cultural and societal acceptance of the sexuality of older adults. Finally, as baby-boomers age, health care professionals will face increasing pressure from their patients to address sexual health problems in geriatric clinical practice. The current dearth of relevant evidence-based information highlights the urgent need for prioritized research in this area.     

Sexually transmitted infections in female rape victims

Sexual assault is a common occurrence that carries significant physical and mental health morbidity. Some of the most common concerns expressed by sexual assault victims can be allayed by addressing the risks of rape-related sexually transmitted infections. Although exact risks cannot be accurately quantified, it is important that health-care professionals provide counseling as well as prophylaxis and/or treatment as indicated. Screening and treatments should follow established guidelines, and follow-up care is indicated to confirm successful prevention or treatment. Continued support, surveillance, and medical attention should be offered as needed. This article will address important clinical issues regarding the prevalence and consequences of sexual assault, and will summarize current recommendations for the prophylaxis and treatment of sexually transmitted infections in adolescent and adult rape victims. Some of the logistical issues surrounding HIV testing, counseling, and prevention for rape victims will also be addressed.     

HIV post-exposure prophylaxis after sexual assault: the experience of a sexual assault service in London

OBJECTIVES: To review the provision, uptake and outcome of HIV post-exposure prophylaxis (HIV-PEP) after sexual assault. METHODS: A retrospective case note review of patients attending a sexual assault service in London during 1999. RESULTS: Ten out of 150 patients were considered eligible for PEP after a careful risk assessment. Eight patients accepted HIV-PEP. Highly active antiretroviral therapy (HAART) consisted of Combivir/indinavir in six patients and Combivir/nelfinavir in two patients. Two patients changed their combination due to adverse events. Five patients completed the recommended 28 days of treatment. Three patients discontinued therapy due to adverse events. Two patients who completed HIV-PEP were noted to have raised cholesterol at follow-up. All patients who took PEP were HIV-1 and -2 antibody negative at six months. CONCLUSIONS: Compared with other published studies the completion rate of HIV-PEP in our study was high. The uptake and adverse events of HAART in this scenario were similar to previously published studies. A multidisciplinary approach to the management of this patient group will improve adherence to PEP.     

Sexually transmitted diseases and sexual lifestyles of long-distance truck drivers: a clinico-epidemiologic study in south India

Our study objective was to determine the prevalence and pattern of sexually transmitted diseases (STDs) and to study sexual lifestyles of long-distance truck drivers and their assistants in south India. For this, a total of 263 truck drivers/assistants were recruited from the highway clinic from October 1999 to March 2001. All of them were sexually active and heterosexual contact was the predominant mode (99.2%). Two-thirds of them had contact with commercial sex workers (CSWs) and roughly 60% admitted alcohol consumption. One hundred and two participants (38.7%) had various STDs. The positivity rates of HIV, VDRL and HBsAg were 15.9%, 13.3% and 21.2% respectively. The higher median age, education less than primary school level, longer duration of occupation, longer duration of each trip and a previous history of genital ulcer disease were significant risk factors for the acquisition of HIV infection.     

Sexually transmitted diseases in travelers

International travelers engaging in casual sex are at risk for acquiring sexually transmitted diseases (STDs), including HIV. The frequency of international travel emphasizes the need for a travel sexual activity history to be included in the clinical assessment of any returned traveler. When formulating a differential diagnosis, the STD prevalence rates at the travel destination and the risk profile of the traveler and the sexual partner need to be considered. Casual sex with host country nationals residing in tropical and subtropical areas of the developing world increases the traveler’s risk for acquiring STDs rarely seen in industrialized countries, particularly bacterial genital ulcer diseases. Pretravel counseling needs to include education on STD prevention. A post-travel STD diagnostic evaluation is indicated when casual sexual activity has occurred during travel, regardless of whether symptoms are present.     

Sexually transmitted diseases in pregnancy

Sexually transmitted diseases may have a significant impact on the pregnant woman and her fetus and neonate. Infection at various stages of pregnancy may result in severe maternal disease, congenital defects, premature delivery, or neonatal infection. The clinician caring for pregnant women must be aware of the multitude of sexually transmitted diseases and their potential risks during pregnancy.     

Sexually transmitted diseases in lesbians

The limited published data support the assumption that lesbians are a low risk group for sexually transmitted diseases (STDs). However, there are virtually no contemporary data and the older papers do not take into account genital wart virus infection, now the third most prevalent STD in Britain. One of the dangers in assuming that lesbians are a 'safe group' for STD and allied disorders is that patients may not attend for regular cervical cytology and could be at risk of developing cervical cancer. In an unselected series of 27 lesbians attending a genitourinary medicine clinic, the most important findings were a relatively high prevalence of the viral STDs, herpes simplex and human papillomavirus. Additionally, 10 patients had abnormal cytology ranging from inflammation to dyskaryosis. There is a need for more information about the true prevalence of STDs in this group and evaluation of the risk factors for female-to-female transmission of infections. Lesbians should continue to have regular cervical smears, especially as many have had earlier heterosexual intercourse.     

Sexually transmitted diseases in Germany

In the former West Germany, in specific venereal diseases legislation passed in 1953, only syphilis, gonorrhoea, ulcus molle, and lymphogranuloma venereum were defined as venereal diseases and subject to mandatory notification. The proportion of unreported cases was as high as 75% for syphilis and up to 90% for gonorrhoea. Epidemiological data for the past 10 years exist only on selected populations from research studies and are summarized in this article. In the former East Germany reporting of sexually transmitted infections (STIs) was mandatory and, due to the centralized organization, underreporting was considered to be low, although no specific studies have examined this. After the unification in 1990 of the two German states the West German laws were adopted in East Germany. Since 1982 - when the first AIDS case was reported in Germany - information on AIDS cases has voluntarily been collected at the national register at the AIDS Centre of the Robert Koch Institute in Berlin. The law governing the reporting of infectious diseases has recently been revised. Under the new Protection against Infection Act, which became effective on 1 January 2001, clinical diagnoses of STIs (with the exception of hepatitis B) are no longer notifiable diseases. Laboratory reporting of positive test results for Treponema pallidum has been introduced. With T. pallidum and HIV notifications, additional disaggregated data are collected. Since T. pallidum and HIV remain the only notifiable STIs, all other STIs have to be monitored through sentinel surveillance systems. These surveillance systems are currently being established. Under the new legislation, local health authorities have to provide adequate counselling and testing services for STIs, which may be provided free of charge if necessary.     

Sexually transmitted diseases in incarcerated adolescents

PURPOSE OF REVIEW: The objectives of this review are to summarize recent developments in the epidemiology of sexually transmitted disease in incarcerated adolescents and to review screening and treatment recommendations for sexually transmitted disease in juvenile corrections facilities. RECENT FINDINGS: The introduction of non-invasive, urine-based nucleic acid-amplification tests for chlamydia and gonorrhea has led to a dramatic increase in the ability to screen for chlamydia and gonorrhea in non-traditional settings, including corrections facilities. The prevalence of chlamydia and gonorrhea has been uniformly high in incarcerated adolescents. The prevalences of chlamydia and gonorrhea in adolescents aged 18-19 years incarcerated in adult corrections facilities were higher than those incarcerated in juvenile facilities. The prevalence was higher in incarcerated adolescent women than adolescent men and in black adolescents than non-black adolescents. Screening for chlamydia in incarcerated adolescents has been shown to be a cost-effective strategy for preventing adverse health consequences. Syphilis prevalence in incarcerated adolescents is relatively low. Hepatitis B is relatively common among incarcerated adolescents. SUMMARY: The high prevalence of chlamydia in incarcerated adolescents and gonorrhea in incarcerated adolescent women suggests that screening of these populations should be a priority. The reasons for the higher prevalence of chlamydia and gonorrhea in young adults aged 18-19 years incarcerated in selected adult corrections facilities compared with those incarcerated in juvenile facilities should be investigated. Hepatitis B virus vaccination in juvenile correction facilities is recommended to prevent and control the transmission of this disease.     

Sexually transmitted diseases: magnitude, determinants and consequences

Sexually transmitted diseases (STDs) including human immuno-deficiency virus (HIV) infections constitute a major reproductive health burden for sexually-active individuals. The short-term and long-term consequences of STD have been well documented and include genital and other cancers, pelvic inflammatory disease, ectopic pregnancy, infertility, and adverse outcomes of pregnancy including pre-term delivery and low birth weight. The burden of sexually transmitted infections falls disproportionately on the young, the poor, minorities and women. At the societal level, there is a continuing need to educate people, particularly adolescents, about their risk for STDs and their sequelae and to increase the use of barrier methods including condoms. Policy decisions that facilitate more open discussion of sexuality and STDs, and that expand the accessibility and acceptability of sexual risk assessment, STD screening and treatment services would help decrease STD rates in the United States to levels similar to those observed in other industrialized countries.     

Sexually transmitted diseases in older adults

Health professionals are frequently reluctant to recognize or investigate the sexuality of their older patients. Thus, sexual health may never be addressed, even among older adults who come into frequent contact with health care professionals. As the dominant culture continues to shift toward a more realistic view of aging that supports the expression of sexuality among older adults, evaluation of sexual health will become a critical component of comprehensive assessment of the geriatric patient. This article reviews the clinical features and management of common sexually transmitted diseases in the older adult.     

Sexually transmitted diseases in travelers.

Prevention of sexually transmitted diseases (STDs) is a low priority among travel clinic services, despite increasing evidence that travelers have an increased risk of acquiring such infections. A proportion of 5%-50% of short-term travelers engage in casual sex while abroad, and this rate is even higher among long-term travelers. Few publications are available on STD preventive interventions among travelers. Education and counseling are recognized as key components of risk reduction. New efforts should be put forth with regard to identifying effective tools to promote safer sexual behaviors and to reduce the spread of infection by promoting condom use. Travelers at increased risk should be identified for targeted interventions; research to validate proposed markers of increased risk is prospectively needed. Hepatitis B infection is the only STD that is preventable by vaccination. The feasibility and cost-effectiveness of STD screening in travelers after exposure is a virtually unexplored field, though it may represent an important component of STD control strategies in developed countries.     

Sexually transmitted diseases in children and adolescents

Sexually transmitted diseases have an impact on children's health at three times in their development: during pregnancy or delivery (through maternal-neonatal transmission), during prepubertal childhood (through sexual transmission), and during adolescence (through sexual transmission). These phases must be considered distinctly by the physician, since not only the type of infection but also the management and long-term implications of the disease vary with the time period in which it was acquired.     

Sexually transmitted diseases. Urethritis in men

Gonococcal and nongonococcal urethritis (NGU) are among the most common syndromes afflicting men. NGU is caused primarily by Chlamydia trachomatis and Ureaplasma urealyticum, but the cause is unknown in approximately 20 to 30 percent of cases. Evaluation of a gram-stained urethral smear is generally sufficient to distinguish between gonococcal and nongonococcal urethritis. Owing to the frequent coexistence of Neisseria gonorrhoeae and C. trachomatis in heterosexual men, treatment regimens for gonococcal urethritis should generally include an effective antichlamydial regimen. Complications of urethritis are uncommon, but the causative pathogens produce serious morbidity in women. Prevention of urethritis is based on identification of asymptomatically infected persons who serve as the major reservoir of infection with both N. gonorrhoeae and C. trachomatis.     

Sexually transmitted diseases in injection drug users

The recommended work up for diagnosis of STDs in injection drug users is presented in the box. Diagnostic work up for sexually transmitted disease in injection drug users Asymptomatic patients-screening work up Serology VDRL, HIV antibody, hepatitis B surface antigen, hepatitis C antibodies AND Endocervical specimen Gonococcal culture, gonococcal DNA detection (probe) OR Amplification (PCR), chlamydial DNA detection or amplification OR Urine specimen-gonococcal and chlamydial DNA amplification (PCR) AND Vaginal specimen pH, clue cells, Trichomonas Endourethral specimen Gonococcal DNA amplification, chlamydial DNA amplification OR Urine specimen-gonococcal and chlamydial amplification Symptomatic patients-diagnostic work up All the above AND Genital ulcers Dark-field microscopy, Herpes simplex virus-DNA detection or culture, and, depending on geographic risk factors, Gram's stain for Hemophilus duceryl Exophytic lesions Clinical diagnosis of genital warts, skin biopsy if treatment fails VDRL, Venereal Disease Research Laboratory; PCR, polymerase chain reaction.     

Sexually transmitted diseases in Lithuania: some epidemiological and social aspects

With political, economical and social changes in Lithuania following the break-up of the Soviet Union, the health-care system has changed. The old Soviet system has been abandoned and it has taken time to re-establish a system under the new government. Resources are limited in most aspects of health care, including sexually transmitted infections (STIs). This has, also limited the development of education packages on STIs which are so important when trying to combat the spread of HIV infection. Notifications of syphilis, in Lithuania, have increased 52 fold between 1990 and 1996 although, since then, the incidence has started to decrease. Syphilis has been more reliably notified than other STIs and serves as the most reliable indicator of STI trends.     

Sexually transmitted diseases among psychiatric patients in Brazil

Sexually transmitted diseases are still highly prevalent worldwide and represent an important public health problem. Psychiatric patients are at increased risk of sexually transmitted diseases but there are scarce published studies with representative data of this population. We sought to estimate the prevalence and correlates of self-reported sexually transmitted diseases among patients with mental illnesses under care in a national representative sample in Brazil (n = 2145). More than one quarter of the sample (25.8%) reported a lifetime history of sexually transmitted disease. Multivariate analyses showed that patients with a lifetime sexually transmitted disease history were older, had history of homelessness, used more alcohol and illicit drugs, suffered violence, perceived themselves to be at greater risk for HIV and had high risk sexual behavioral: practised unprotected sex, started sexual life earlier, had more than ten sexual partners, exchanged money and/or drugs for sex and had a partner that refused to use condom. Our findings indicate a high prevalence of self-reported sexually transmitted diseases among psychiatric patients in Brazil, and emphasize the need for implementing sexually transmitted diseases prevention programs in psychiatric settings, including screening, treatment, and behavioral modification interventions.