II. Risk Factors: High Risk Groups for STD

  1. Adolescents
    1. Multiple partners
    2. Sequential monogamy
    3. Unconcerned
    4. Uniformity
  2. Racial or ethnically skewed
    1. Black: Chlamydia more common
  3. Homosexual men or women
  4. Coasts or Ports of entry
  5. Prostitutes
  6. Teenage runaways
  7. Immigrants
  8. Low income in urban setting
  9. Prison Inmate (current or former)
  10. Military recruits
  11. Mental Illness
  12. Injection drug user (IV Drug Abuse)
  13. Sexual Abuse history

III. Pathophysiology: Transmission

  1. Contact
    1. Secretions
    2. Mucus membrane
    3. Skin Abrasion
  2. Intercourse not necessary for STD transmission
    1. Herpes Simplex Virus
    2. Condyloma
    3. Gonorrhea
    4. Chlamydia

IV. Causes

  1. Sexually Transmitted Disease Genital Ulcers
    1. See Genital Ulcers (Mnemonic: CHISEL)
      1. E in CHISEL is drug eruption
    2. Painful Ulcers
      1. Chancroid
      2. Herpes Genitalis
      3. Trichomonas may also cause labial ulcerations
    3. Non-Painful Ulcers
      1. Granuloma Inguinale
      2. Syphilis (Early)
      3. Lymphogranuloma venereum
  2. Sexually Transmitted Disease Non-ulcerative
    1. Non-Gonococcal Urethritis
    2. Pelvic Inflammatory Disease
    3. Gonorrhea
    4. Chlamydia
    5. Syphilis (Secondary or tertiary)
    6. Human Papillomavirus (HPV) and Cervical Dysplasia
    7. Human Immunodeficiency Virus (HIV)
    8. Hepatitis BVirus
    9. Parasitic Infection
      1. Pediculosis Pubis
      2. Scabies (pruritic genital bumps awaken patient)

V. Symptoms: Women

  1. Vaginal Discharge
  2. Postcoital spotting
  3. Dyspareunia

VI. Signs: Women

  1. Genital Ulcers
  2. Cervicitis
    1. Erythema of Cervix
      1. GynCervicalColposcopyVaginoCervicitis.jpg
    2. Mucopurulent discharge from Cervical os

VII. Lab: Screening

  1. First-line studies
    1. Chlamydia DNA Probe
    2. Gonorrhea DNA probe
    3. Vaginal Wet prep
    4. Consider Urinalysis
  2. Additional studies to consider
    1. HIV Test
    2. Syphilis (RPR)
    3. Hepatitis B Testing (if not immunized)

VIII. Lab: Wet Mount microscopic exam of cervical swab

  1. Positive: Polymorphonuclear Leukocytes (PMNs) >10/hpf
  2. Positive test should be followed by specific testing
    1. Chlamydia trachomatis
    2. Neisseria gonorrhoeae
  3. Efficacy
    1. Test Sensitivity: 90%
    2. Test Specificity: 87%
  4. Reference
    1. Bohmer (1999) Am J Obstet Gynecol 181:283-7 [PubMed]

X. Management

  1. Emergency department empiric treatment
    1. Initiating empiric treatment for suspected STD prior to results (often delayed days) is appropriate
    2. Despite risk of overtreatment, treat for suspected Chlamydia and Gonorrhea (prevents spread, complications)
      1. Gonorrhea management
        1. Ceftriaxone 500 mg IM/IV for 1 dose (1 gram IM/IV if weight > 150 kg, dose increased in 2020) OR
        2. Gentamicin 240 mg IM and Azithromycin 2 g orally for one dose OR
        3. Cefixime 800 mg orally once is an alternative but NOT recommended due to Antibiotic Resistance
      2. Chlamydia management if not excluded (not indicated for Gonorrhea treatment without Chlamydia as of 2020)
        1. Doxycycline 100 mg twice daily for 7 days (preferred as of 2020) OR
        2. Azithromycin 1 g orally for 1 dose
      3. References
        1. Cyr (2020) MMWR Morb Mortal Wkly Rep 69(50): 1911-6 [PubMed]
          1. https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
  2. Rescreening
    1. Routinely Rescreen positive STD cases in 3 months to identify new STD infections
    2. Peterman (2006) Ann Intern Med 145:654-72 [PubMed]
  3. Expedited Partner Treatment
    1. Precaution: Legality of Expedited Partner Treatment varies by State in the United States
      1. http://www.cdc.gov/std/ept/legal/
    2. Patients may anonymously notify their partner
      1. https://tellyourpartner.org/
    3. Ideally sexual partners are seen for their own medical evaluations
      1. However: Delaying their treatment until evaluation risks re-exposing treated patients
    4. CDC asks physicians to consider treating sexual partners of STD patients without a visit
      1. Employ in cases where sexual partner is unlikely to present for medical care
      2. Prescription for sexual partner's STD treatment is given to the patient being treated
      3. Some states may allow prescription labeled for "EPT" or "partner"
      4. Do not double up on prescription quantity for one patient (write 2 separate prescriptions)
    5. Example protocol for partner (prescriptions given to patient to bring to partner)
      1. Provider should ask about partner's medication allergies, other medications and pregnancy
      2. Cefixime 800 mg (if partner will be seen, Ceftriaxone 500 mg IM/IV is preferred) AND
      3. Azithromycin 1 gram orally (or preferred option is Doxycycline 100 mg twice daily for 7 days)
      4. Patient and their partner should abstain from sex for 7 days after completing course
    6. References
      1. (2015) Presc Lett 22(8)
      2. Golden (2005) N Engl J Med 352:676-85 [PubMed]
      3. (2015) MMWR Recomm Rep 64(RR-03): 1-137 +PMID:26042815 [PubMed]

XI. Prevention: Screening Asymptomatic Patients (USPTF guidelines)

  1. See Risk Factors listed above
  2. Behavioral counseling (proper Condom use, safe sex, difficult sexual situations)
    1. All sexually active adolescents
    2. Adults at risk for Sexually Transmitted Infection
  3. Gonorrhea and Chlamydia screening
    1. Sexually active adolescents 24 years old and younger
    2. Women at risk for Sexually Transmitted Infection
  4. HIV Screening
    1. All patients ages 15 years old to 65 years old (or if risks)
    2. All pregnant women at first Prenatal Visit (or at time of delayed presentation)
  5. Hepatitis B Virus Screening
    1. All pregnant women at first Prenatal Visit (or at time of delayed presentation)
    2. Patients at risk of infection
      1. Immigrants from sub-sahara Africa, Central and Southeast Asia, China (esp. unimmunized)
      2. Household HBV Contacts
  6. Syphilis
    1. All pregnant women at first Prenatal Visit (or at time of delayed presentation)
    2. Patients at risk of infection
  7. Herpes Simplex Virus Infection
    1. USPTF and AAFP
      1. Do NOT routinely screen HSV Serology in asymptomatic patients
    2. CDC and ACOG
      1. Consider type-specific Serology in women at time of STI evaluation (esp. if multiple partners)
  8. References
    1. Lee (2016) Am Fam Physician 94(11): 907-15 [PubMed]

XII. Resources: Patients

  1. CDC National STD Hotline (CDC)
    1. http://www.cdc.gov/std/
    2. Phone: 800-232-4636
  2. Expedited Partner Treatment (CDC)
    1. http://www.cdc.gov/std/ept/
  3. Information from your Family Doctor: Prevent AIDS
    1. http://www.familydoctor.org/healthfacts/005/
  4. Inspot.Org (annonymously notify others of STD exposure)
    1. https://inspot.org/
  5. DontSpreadIt.Com (annonymously notify others of STD exposure)
    1. https://dontspreadit.com/

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Related Studies

Ontology: Sexually Transmitted Diseases (C0036916)

Definition (MEDLINEPLUS)

Sexually transmitted diseases (STDs) are infections that you can get from having sex with someone who has the infection. The causes of STDs are bacteria, parasites and viruses. There are more than 20 types of STDs, including

Most STDs affect both men and women, but in many cases the health problems they cause can be more severe for women. If a pregnant woman has an STD, it can cause serious health problems for the baby.

If you have an STD caused by bacteria or parasites, your health care provider can treat it with antibiotics or other medicines. If you have an STD caused by a virus, there is no cure. Sometimes medicines can keep the disease under control. Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STDs.

Centers for Disease Control and Prevention

Definition (NCI_FDA) Any contagious disease acquired during sexual contact; e.g. syphilis, gonorrhea, chancroid.
Definition (NCI) A disorder acquired through sexual contact.
Definition (CSP) diseases due to or propagated by sexual contact.
Definition (MSH) Diseases due to or propagated by sexual contact.
Concepts Disease or Syndrome (T047)
MSH D012749
ICD9 099.9
ICD10 A50-A64.9 , A64, A50-A64
SnomedCT 8098009, 186831003, 186949002, 266208003, 187367009, 154378004, 187348005, 276972005
LNC MTHU026192
English Disease, Sexually Transmitted, Diseases, Sexually Transmitted, Diseases, Venereal, Sexually Transmitted Disease, Sexually Transmitted Diseases, Venereal Diseases, Disease, Venereal, VD, Disea w predom sex mod transm, Infections with a predomin, Infections with a predominantly sexual mode of transmiss, Infections with a predominantly sexual mode of transmission, STD - Sexually transmitted dis, Unspcf sexual transmitd dis, Unspecified sexually transmitted disease, Venereal disease NOS, Venereal disease, unspecified, [X]Infections with a predomin, [X]Infections with a predominantly sexual mode of transmiss, [X]Infections with a predominantly sexual mode of transmission, [X]Unspcf sexual transmitd dis, [X]Unspecified sexually transmitted disease, SEX TRANSM DIS, VENEREAL DIS, Sexually transmitted disease, NOS, sexually transmitted disease (diagnosis), venereal disease, sexually transmitted disease, VD (venereal disease), Sexually transmitted infection, Sexually transmitted disease NOS, Sexually Transmitted Diseases [Disease/Finding], sexually transmitted diseases, vds, diseases venereal, sexually transmitted diseases (STDs), disease sexually transmit, disease venereal, sexually transmitted disease (STD), Disease;sexually transmitted, venereal diseases, disease sexually transmitted, diseases sexually transmitted, Infections with a predominantly sexual mode of transmission (A50-A64), Sexually Transmitted Infection, Venereal Disease, Sexually transmitted infections, Venereal disease NOS (disorder), Venereal diseases, [X]Infections with a predominantly sexual mode of transmission (disorder), [X]Unspecified sexually transmitted disease (disorder), Venereal disease (disorder), Sexually transmitted diseases, VENEREAL DISEASE (VD), VENEREAL DISEASE, DISEASE (VD), VENEREAL, VD, VENEREAL DISEASE, Venereal disease, Disease with a predominantly sexual mode of transmission, STD - Sexually transmitted disease, Sexually transmitted disease, Sexually transmissible disease, Sexually transmitted infectious disease (disorder), Sexually transmitted infectious disease, disease (or disorder); infectious, sexually transmitted, disease (or disorder); sexually transmitted, disease (or disorder); venereal, infectious; disease, sexually transmitted, sexual; transmitted disease, venereal; disease, Venereal disease, NOS, Sexually transmitted infectious disease, NOS, Diseases (Venereal), STD, Sexually Transmitted Disorder, Statutory venereal disease, VD - Venereal disease, STDs, Disease;venereal
Italian Malattia sessualmente trasmessa, Malattia venerea non specificata, Malattia sessualmente trasmessa NAS, Malattia venerea NAS, Malattia venerea, Malattie veneree, Malattie sessualmente trasmesse, Infezione trasmessa per via sessuale
Dutch seksueel overdraagbare aandoening NAO, VD, venerische ziekte NAO, geslachtsziekte, niet-gespecificeerd, seksueel overdraagbare infectie, aandoening; infectieus, seksueel overdraagbaar, aandoening; seksueel overdraagbaar, aandoening; venerisch, infectieus; aandoening, seksueel overdraagbaar, seksueel; overdraagbare aandoening, venerisch; aandoening, Niet gespecificeerde seksueel overdraagbare aandoening, seksueel overdraagbare aandoening, Aandoening, seksueel overdraagbare (SOA), Aandoeningen, seksueel overdraagbare (SOA), Geslachtsziekte, SOA, Seksueel overdraagbare aandoening (SOA), Seksueel overdraagbare aandoeningen (SOA)
French Maladie vénérienne SAI, Maladie vénérienne, non précisée, MV, Maladie sexuellement transmissible SAI, Infection sexuellement transmissible, Maladie sexuellement transmissible, MST, Maladies sexuellement transmissibles, Maladies vénériennes, Maladies sexuellement transmises
German Geschlechtskrankheit NNB, VD, Geschlechtskrankheit, unspezifisch, Sexuell übertragbare Erkrankungen, STD (Sexuell übertragbare Krankheiten), Durch Geschlechtsverkehr uebertragene Krankheiten, nicht naeher bezeichnet, sexuell uebertragene Infektion, Geschlechtskrankheit, Geschlechtskrankheiten, Venerische Krankheiten, Sexuell übertragbare Krankheiten
Portuguese Doença transmitida sexualmente NE, Doença venérea, Doença venérea NE, Infecção sexualmente transmissível, Infecções Sexualmente Transmitidas, Doenças Sexualmente Transmitidas, IST, Infecções Sexualmente Transmissíveis, Doenças de Transmissão Sexual, DST, Doenças trasmitidas por via sexual, Doenças Sexualmente Transmissíveis, Doenças Venéreas, DSTs
Spanish Enfermedad venérea no especificada, Enfermedad de transmisión sexual NEOM, EV, Enfermedad venérea NEOM, enfermedad venérea (trastorno), enfermedad venérea, SAI, [X]enfermedad de transmisión sexual no especificada (trastorno), [X]enfermedad de transmisión sexual no especificada, [X]infecciones con modo de transmisión predominantemente sexual, enfermedad venérea, SAI (trastorno), [X]infecciones con modo de transmisión predominantemente sexual (trastorno), Enfermedades Sexualmente Transmisibles, ITS, Infecciones de Transmisión Sexual, Enfermedades Sexualmente Transmitidas, Infecciones Sexualmente Transmitidas, ETS, [X]infecciones de transmisión predominantemente sexual (trastorno), [X]infecciones de transmisión predominantemente sexual, enfermedad de transmisión sexual, enfermedad infecciosa transmitida por vía sexual (trastorno), enfermedad infecciosa transmitida por vía sexual, enfermedad venérea, Enfermedad de transmisión sexual, enfermedad infecciosa transmitida sexualmente, Enfermedades Venéreas, ETSs, Enfermedades de Transmisión Sexual
Japanese 性行為感染症NOS, 性病、詳細不明, 性病NOS, セイコウイカンセンショウ, セイビョウショウサイフメイ, セイコウイカンセンショウNOS, セイビョウNOS, セイビョウ, 性行為感染症, 性感染症, 性病, 性的感染症
Swedish Könssjukdomar
Czech sexuálně přenosné nemoci, pohlavní nemoci, Pohlavní nemoc, Pohlavně přenosné onemocnění, Pohlavně přenosné onemocnění NOS, Pohlavní nemoc, blíže neurčená, Pohlavní nemoc NOS, Sexuálně přenosné choroby, pohlavně přenosné nemoci, STD, pohlavně přenosné nákazy
Finnish Sukupuolitaudit
Korean 상세불명의 성행위로 전파되는 질환
Polish Choroby przenoszone drogą płciową, Choroby weneryczne
Hungarian szexuálisan átvitt betegség, Szexuálisan közvetített fertőzés, nemibetegség, nem meghatározott, Nemibetegség k.m.n., szexuálisan átvitt betegség k.m.n., VD
Norwegian Veneriske sykdommer, Seksuelt overførbare sykdommer, SOS, Kjønnssykdommer