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 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 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 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 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 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. 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 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 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 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.     

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 in men in Mogadishu, Somalia

The prevalence of viral and bacterial sexually transmitted diseases were studied in 101 men attending a dermatovenereal outpatient clinic in Mogadishu. A control group of 103 healthy adult men were included for the serological part of the study. Serological markers of hepatitis B virus (HBV), human immunodeficiency virus (HIV), cytomegalovirus (CMV) and herpes simplex virus (HSV) were studied. All sera were tested for syphilis markers. HBV serum markers were detected in 84% of the men in the study group and 66% of the healthy controls (P less than 0.005). Hepatitis B virus carriers were detected more frequently in the study group than among the controls. Also, 96% of the men in both groups had CMV antibodies and all of them had antibodies to HSV. No sera were found to contain HIV antibodies. The TPHA-positivity was 10% and 3% in the study and control groups respectively, and 5% of the patients had syphilis IgM antibodies. Sexual contact with prostitutes was recorded in 54% and 48% respectively of patients and controls, and such contact was correlated with TPHA-positivity in the study group. Chlamydia trachomatis antigen was detected in urogenital specimens of 14% of the men in the study group and gonococcal culture was positive in 53% of those with urethral discharge.     

Sexually transmitted diseases. Lower genital tract infections in women

Infections of the female urinary tract, cervix, vulva, and vagina produce a variety of overlapping symptoms, including vulvar pruritis, dysuria, dyspareunia, and increased or altered vaginal discharge. Recent studies have considerably improved our understanding of the etiology, pathophysiology, diagnosis, and treatment of these infections.     

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. Genital ulceration with regional adenopathy

The specific agent causing genital ulceration is difficult to identify without laboratory confirmatory testing including darkfield microscopy, syphilis and lymphogranuloma venereum serology, and culture for Haemophilus ducreyi and herpes simplex virus. Empiric antimicrobial therapy risks masking clinical or serologic diagnosis of syphilis.