- All recommended treatment regimens for gonorrhea include antibiotic therapy directed against Chlamydia species because of the high prevalence of coexisting infections, unless chlamydia has been ruled out.
- Parenteral penicillin is the treatment of choice for all syphilis infections. For patients who are penicillin allergic, few well-studied alternative agents are available, and all are oral medications that require 2 to 4 weeks of therapy to be effective. Patient compliance and thus efficacy are a concern when alternative regimens must be used.
- Chlamydia genital tract infections represent the most frequently reported communicable disease in the United States. In females, these infections are frequently asymptomatic or minimally symptomatic and, if left untreated, are associated with the development of pelvic inflammatory disease and attendant complications such as ectopic pregnancy and infertility. As a result, all sexually active females aged 20 to 25 years and sexually active women with multiple sexual partners should be screened annually for this infection.
- Oral acyclovir, famciclovir, and valacyclovir are effective in reducing viral shedding, duration of symptoms, and time to healing of first-episode genital herpes infections, with maximal benefits seen when therapy is initiated at the earliest stages of infection. The benefit of these agents for recurrent infections has not been demonstrated. Patient-initiated, single-day antiviral therapy started within 6 to 12 hours of prodromal symptom onset offers an alternative to continuous suppressive therapy of recurrent infection in some individuals.
- Metronidazole and tinidazole are the only agents currently approved in the United States to treat trichomoniasis. Although a single 2-g dose of either agent is widely used for compliance and other reasons, the alternative 7-day metronidazole regimen may be a better choice if sexual partners of treated individuals cannot be treated concurrently.
On completion of the chapter, the reader will be able to:
Discuss factors that contribute to the epidemic nature of sexually transmitted diseases (STDs).
Discuss the pathophysiology, including any nonsexual routes of disease transmission and the usual incubation period, for genital infections associated with Neisseria gonorrhoeae, Treponema pallidum, Chlamydia trachomatis, herpes simplex virus, and Trichomonas. vaginalis.
Describe various measures that can reduce the risk of STD transmission in individuals who have sexual contact with an infected partner.
Describe the common presenting symptoms of genital infections associated with N. gonorrhoeae, T. pallidum, C. trachomatis, herpes simplex virus, and T. vaginalis.
Describe the laboratory tests commonly used in the diagnosis of genital infections associated with N. gonorrhoeae, T. pallidum, C. trachomatis, herpes simplex virus, and T. vaginalis.
Describe the potential complications associated with genital infections due to N. gonorrhoeae, T. pallidum, C. trachomatis, herpes simplex virus, and T. vaginalis.
Differentiate the different stages of syphilis infection in terms of time of onset and the risk of disease transmission from an infected individual to a sexual partner and the risk of neonatal transmission from an infected pregnant female.
Differentiate first-episode and recurrent genital herpes infections based on severity of ...