Sexually Transmitted Diseases

The spectrum of sexually transmitted diseases includes the classic venereal diseases – gonorrhea, syphilis, chancroid, lymphogranuloma venereum, and granuloma inguinale – as well as a variety of other pathogens known to be spread by sexual contact (Table Sexually Transmitted Diseases). Common clinical syndromes associated with sexually transmitted diseases are listed in Table Selected Syndromes Associated with Common Sexually Transmitted Pathogens.

All currently recommended regimens are single-dose treatments with various oral or parenteral cephalosporins and fluoroquinolones. Ceftriaxone (125 mg intramuscularly) is the only parenteral agent recommended by the Centers for Disease Control as a first-line agent for treatment of gonorrhea.

Primary syphilis is characterized by the appearance of a chancre on cutaneous or mucocutaneous tissue. Chancres persist only for 1 to 8 weeks before spontaneously disappearing.

Treatment of chlamydial infections with the recommended regimens is highly effective; therefore, posttreatment cultures are not routinely recommended. Infants with pneumonitis should receive follow-up testing, because erythromycin is only 80% effective.

The term herpes is used to describe two distinct but antigenically related serotypes of herpes simplex virus. Herpes simplex virus type 1 (Herpes Simplex Virus-1) is most commonly associated with oropharyngeal disease; type 2 (Herpes Simplex Virus-2) is most closely associated with genital disease.

A sexually transmitted disease characterized by painful genital ulcerations and inflammatory inguinal adenopathy. It is uncommon in the United States but found worldwide. Chancroid is endemic in developing countries and a cofactor for HIV transmission.

An obligate intracellular membrane-bound prokaryotic organism, chlamydia trachomatis causes an estimated 3 million new sexually transmitted infections in the US each year. The estimated cost of chlamydia STDs in 1994 was $2 billion per year in the U. S., largely due to costly complications such as PID, infertility, and ectopic pregnancy. Studies indicate that 75-90% of women and 50-90% of men with chlamydial STD are asymptomatic.