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A search and evaluation of the medical literature was performed on January 22, 2008. This search was limited to studies published in English concerning human trials. An Ovid search was performed, as was a search of the Centers for Disease Control and Prevention website and the National Guideline Clearinghouse.

Sexually transmitted diseases (STDs) are a heterogeneous group of infections with a wide variety of causative agents. The pathogens associated with STDs run the range from bacterial, viral, and fungal sources to parasitic organisms. The common link between the infecting agents and the diseases they cause, is their propensity to be spread through sexual contact.

Primary care providers are in the unique position to not only diagnose and treat current STD infections, but they also have the opportunity to reduce STD transmission through risk reduction counseling. Screening for STD risk factors should occur at each health care contact and education on safer sexual practices is appropriate for all at-risk patients. Counseling measures aimed at preventing transmission of STDs must be delivered in a nonjudgmental manner and should address each patient’s particular risk factors. Patients who seek testing for one STD should also be offered testing for all STDs, including HIV.

Risk factors for acquiring STDs include young age, socioeconomic factors, immune status, sexual orientation and sexual behaviors among others. Specific behaviors associated with increased risk of infection with a STD (regardless of other risk factors) include multiple sexual partners, male with male sex, and sexual contact with those people known to be infected with STDs.

Short of abstinence, the best protection against contracting a STD is participation in a mutually monogamous relationship with an uninfected partner. Consistent and proper usage of latex condoms offers the next best protection against STDs.

Although STDs occur more commonly in males than females, the complications associated with STDs tend to be more severe in women. These complications can include damage to the reproductive system, increased risk of cervical cancer and disease transmission to the neonate during pregnancy or childbirth.

This chapter will focus on the most commonly encountered STDs (Table 45-1). The recommendations contained in this chapter are derived from the Centers for Disease Control and Prevention (CDC) treatment guidelines.1

Table 45-1. Sexually Transmitted and Sexually Transmissible Microorganisms

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