Sexually transmitted disease

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Sexually transmitted disease Microchapters
Patient Information
Overview
Classification Chlamydia Gonorrhea Human Immunodeficiency Virus (HIV) Human papillomavirus (HPV) Herpes Simplex Virus (HSV) Mycoplasma genitalium Syphilis Trichomonas vaginalis Zika Virus Hepatitis B Hepatitis C Bacterial vaginosis
Differential Diagnosis
Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]}; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [2]
Synonyms and keywords: Sexually transmissible disease; STD; VD; STI; sexually transmitted infection; venereal disease.

Classification

Transmission	Clinical Presentation	Disease	Diagnosis		Mother to Child Transmission		Most Serious Complications
			Laboratory studies	Clinical Diagnosis	Vertical Transmission	Trans-vaginal transmission
Primarily sexually transmitted	Genital Dermatological Manifestation (e.g., ulcers, chancre, vesicles, warts, balanitis etc.)	HPV	✔	✔			Cervical Cancer
		HSV	✔	✔	✔	✔	Severe pruritis/discomfort
		Syphilis	✔	✔	✔		*Neurosyphilis *Cardiosyphilis
		Scabies	✔	✔			Moderate to Severe pruritis/discomfort
		Pubic lice	✔	✔			Moderate to Severe pruritis/discomfort
		Candidiasis (in males)		✔			Mild to moderate pruritis/discomfort
	Generalized Symptoms (e.g. constitutional symptoms)	HIV	✔		✔		*Primary CNS Lymphoma *Immunosuppression (AIDS)
		Syphilis	✔	✔	✔		*Neurosyphilis *Cardiosyphilis
	Urogenital infections (e.g.,Vaginitis, Urethritis, Cervicitis, and PID)	Gonorrhea	✔	✔		✔	PID
		Chlamydia	✔	✔		✔	PID
		Syphilis	✔	✔	✔		*Neurosyphilis *Cardiosyphilis
		Mycoplasma genitalium	✔	✔	unknown	unknown	PID
		Trichomonas vaginalis	✔	✔			Mild to moderate pruritis/discomfort
Less frequently sexually transmitted	Generalized Symptoms (e.g. constitutional symptoms)	Zika Virus	✔		✔		Vertical transmission and Congenital abnormalities
		Hepatitis B	✔	✔	✔		Liver cirrhosis
		Hepatitis C	✔	✔	✔		Hepatocellular Carcinoma
	Urogenital Infections (e.g.,Vaginitis, Urethritis, Cervicitis, and PID)	Gardnerella vaginalis	✔	✔			Moderate to severe discomfort
		Candidiasis (in females)		✔			Moderate to severe pruritis/discomfort
		Ureaplasma urealyticum	✔	✔			Moderate to severe pruritis/discomfort

Symptoms

Disease	Symptoms
	Discharge	Dysuria	Vaginal odor	Dyspareunia	Genital skin lesion	Genital pruritis	Fever	Lymphadenopathy	Other symptoms
Chlamydia
Gonorrhea
HIV
Herpes simplex
HPV
Hepatitis B
Hepatitis C
Bacterial vaginosis
Mycoplasma genitalium
Zika virus

Risk Factors

Risk factors for acquiring a sexually transmitted disease may vary depending on the disease. However, most sexually transmitted diseases share common risk factors including:

• Multiple sexual partners
• Prostitution
• Illicit drug use or I.V. drug use
• Unprotected sex
• Men who have sex with men
• Residence in highly prevalent areas
• Underlying HIV infection as a risk for other STDs
• Presence of other STIs
• Previous history of STIs
• Intravenous drug use
• Low socioeconomic status
• Health care professionals who are predisposed to occupational risk with infected patients

Prevention

The most effective way to prevent sexual transmission of STIs is to avoid contact of body parts or fluids which can lead to transfer. Abstinence is one method of avoiding contact. Ideally, both partners should get tested for STIs before initiating sexual contact, or if a partner engaged in contact with someone else.

Vaccines

Vaccines are available that protect against some viral STIs, such as Hepatitis A, Hepatitis B, Herpes simplex vaccine (both Herpevac and ImmunoVex), and some types of HPV. Vaccination before initiation of sexual contact is advised to assure maximal protection.

Barrier Protection

Condoms only provide protection when used properly as a barrier and to and from the area that it covers. Uncovered areas are still susceptible to many STD's. In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin, thus properly shielding the insertive penis with a properly worn condom from the vagina and anus effectively stops HIV transmission. An infected fluid to broken skin borne direct transmission of HIV would not be considered "sexually transmitted", but can still theoretically occur during sexual contact, this can be avoided simply by not engaging in sexual contact when having open bleeding wounds.

Condoms are designed, tested, and manufactured to never fail if used properly. There has not been any documented case of an HIV transmission due to an improperly manufactured condom. However, there have been cases of condom recall, as in a case in South Africa.

Proper usage entails:

• Not putting the condom on too tight at the end, and leaving 1.5 cm (3/4 inch) room at the tip for ejaculate. Putting the condom on snug can and often does lead to failure.
• Wearing a condom too loose can defeat the barrier.
• Avoiding inverting, spilling a condom once worn, whether it has ejaculate in it or not.
• Avoiding condoms made of substances other than latex or polyurethane, as they don't protect against HIV.
• Avoiding the use of oil based lubricants (or anything with oil in it) with latex condoms, as oil can cause thinning and perforation of the material.

Not following the five guidelines above perpetuates the common misconception that condoms are not appropriately designed or tested.

In order to best protect oneself and the partner from STI's, a condom used by an infected individual and its contents should be assumed to be still infectious. Therefore the used condom must be properly disposed off. A new condom should be used for each act of intercourse, as multiple usage increases the chance of breakage, defeating the primary purpose as a barrier and increases risk of disease transmission.