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Chapter 46: Sexually Transmitted Diseases

INTRODUCTION

  • The spectrum of sexually transmitted diseases (STDs) 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 46–1). Common clinical syndromes associated with STDs are listed in Table 46–2. The most current information on epidemiology, diagnosis, and treatment of STDs provided by the Centers for Disease Control and Prevention (CDC) can be found at www.cdc.gov.

TABLE 46–1Sexually Transmitted Diseases
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TABLE 46–1 Sexually Transmitted Diseases
Disease Associated Pathogens
Bacterial
Gonorrhea Neisseria gonorrhoeae
Syphilis Treponema pallidum
Chancroid Haemophilus ducreyi
Granuloma inguinale Calymmatobacterium granulomatis
Enteric disease Salmonella spp., Shigella spp., Campylobacter fetus
Campylobacter infection Campylobacter jejuni
Bacterial vaginosis Gardnerella vaginalis, Mycoplasma hominis, Bacteroides spp., Mobiluncus spp.
Group B streptococcal infections Group B Streptococcus
Chlamydial
Nongonococcal urethritis Chlamydia trachomatis
Lymphogranuloma venereum C. trachomatis, type L
Viral
Acquired immunodeficiency syndrome Human immunodeficiency virus
Herpes genitalis Herpes simplex virus, types I and II
Viral hepatitis Hepatitis A, B, C, and D viruses
Condylomata acuminata Human papillomavirus
Molluscum contagiosum Poxvirus
Cytomegalovirus infection Cytomegalovirus
Mycoplasmal
Nongonococcal urethritis Mycoplasma genitalium
Protozoal
Trichomoniasis Trichomonas vaginalis
Amebiasis Entamoeba histolytica
Giardiasis Giardia lamblia
Fungal
Vaginal candidiasis Candida albicans
Parasitic
Scabies Sarcoptes scabiei
Pediculosis pubis Phthirus pubis
Enterobiasis Enterobius vermicularis
TABLE 46–2abcdSelected Syndromes Associated with Common Sexually Transmitted Pathogens
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TABLE 46–2 Selected Syndromes Associated with Common Sexually Transmitted Pathogens
Syndrome Commonly Implicated Pathogens Common Clinical Manifestationsa
Urethritis Chlamydia trachomatis, herpes simplex virus, Neisseria gonorrhoeae, Trichomonas vaginalis, Ureaplasma Mycoplasma genitalium Urethral discharge, dysuria
Epididymitis C. trachomatis, N. gonorrhoeae Scrotal pain, inguinal pain, flank pain, urethral discharge
Cervicitis/vulvovaginitis C. trachomatis, Gardnerella vaginalis, herpes simplex virus, human papillomavirus, N. gonorrhoeae, T. vaginalis Abnormal vaginal discharge, vulvar itching/irritation, dysuria, dyspareunia
Genital ulcers (painful) Haemophilus ducreyi, herpes simplex virus Usually multiple vesicular/pustular (herpes) or papular/pustular (H. ducreyi) lesions that can coalesce; painful, tender lymphadenopathyb
Genital ulcers (painless) Treponema pallidum Usually single papular lesion
Genital/anal warts Human papillomavirus Multiple lesions ranging in size from small papular warts to large exophytic condylomas
Pharyngitis C. trachomatis (?), herpes simplex virus, N. gonorrhoeae Symptoms of acute pharyngitis, cervical lymphadenopathy, feverc
Proctitis C. trachomatis, herpes simplex virus, N. gonorrhoeae, T. pallidum Constipation, anorectal discomfort, tenesmus, mucopurulent rectal discharge
Salpingitis C. trachomatis, N. gonorrhoeae Lower abdominal pain, purulent cervical or vaginal discharge, adnexal swelling, feverd
a

For some syndromes, clinical manifestations can be minimal or absent.

b

Recurrent herpes infection can manifest as a single lesion.

c

Most cases of pharyngeal gonococcal infection are asymptomatic.

d

Salpingitis increases the risk of subsequent ectopic pregnancy and infertility.

GONORRHEA

  • Neisseria gonorrhoeae is a gram-negative diplococcus estimated to cause over 300,000 new infections per year in the ...

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