Sexually transmitted infections (STIs) are a major public health problem. In 2016, there were 1.59 million cases of chlamydia infection, 468,514 cases of gonorrhea, and 27,814 cases of syphilis reported in the United States.1 The World Health Organization estimates that 357 million people are infected each year by a curable STI.2
The primary medical goals are identifying and treating STIs, but important secondary goals include preserving future health (including fertility), protection of any sexual contacts, preventive education, and provision of instructions for future screening. Lack of treatment can contribute to infertility, cancer, and urogenital complications, as well as pregnancy complications and potential harm to a fetus in pregnant women with STIs. Failure of patients to follow up and adhere to a prescribed medical regimen complicates individual care and public health reduction efforts.
Multiple STIs frequently occur together. Once an STI is diagnosed, further testing for human immunodeficiency virus (HIV) infection and hepatitis B is warranted.3
Because of frequent changes in treatment guidelines and resistance patterns, we recommend that the reader access the Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (http://www.cdc.gov/mmwr) to check any modifications for treatment and also to obtain patient information in several languages.
GENERAL PRINCIPLES FOR DIAGNOSIS AND SCREENING
The signs and symptoms of an STI may be obvious, such as a genital lesion or vaginal discharge, or less specific, such as dysuria, lower abdominal pain, painful intercourse, or spotting between periods. Less specific signs lead to frequent STI underrecognition. Obtain a thorough sexual history in an objective, nonjudgmental manner to determine the risk of STI, HIV infection, or hepatitis. The young (13 to 24 years old), pregnant women, and homosexual men are all at higher risk of STI and subsequent morbidity. The Centers for Disease Control and Prevention has questions that providers can use when obtaining a sexual history and determining a patient’s risk for an STI (Table 153-1).
TABLE 153-1Centers for Disease Control and Prevention Recommended Questions for the Five Ps of Sexually Transmitted Infection (STI) Prevention4 |Favorite Table|Download (.pdf) TABLE 153-1 Centers for Disease Control and Prevention Recommended Questions for the Five Ps of Sexually Transmitted Infection (STI) Prevention4
“Are you currently sexually active?” “If no, have you ever been sexually active?”
“In recent months, how many sex partners have you had?”
“Are your sex partners men, women, or both?”
Prevention of pregnancy
“Are you currently trying to conceive or father a child?”
“Are you concerned about getting pregnant or getting your partner pregnant?”
“Are you using contraception or practicing any form of birth control?”
“Do you need any information on birth control?”
Protection from STI
“Do you and your partner(s) use any protection against STI?” “If not, could you tell me ...