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Quick Reference Guide for Clinicians
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Hot Topics in Sexually Transmitted Infections and Associated Conditions

(Published November 2013)

Introduction

Despite decades of available prevention methods and treatment for most sexually transmitted infections [i](STIs), these infections continue to affect large numbers of youth and adults. More than 400 million cases of treatable STIs occur worldwide every year.1 In the United States, there are about 20 million new infections each year, with a total prevalence of about 110 million, estimated from 2008 data.2 These infections cost the US health care system almost $16 billion each year in direct medical costs.3 In addition to financial costs, STIs exact an enormous personal toll on quality of life, sexual health, and reproductive health¡ªand increase the risk of infection with human immunodeficiency virus (HIV).4

Significant racial and ethnic disparities persist in STI rates in the United States. For example, almost half of Black adolescents had one or more STIs, compared with only one in five White or Mexican American adolescents, even when adjusted for income level and the number of sexual partners, and the rates of chlamydial infection, gonorrhea, and syphilis are several fold higher in Blacks than in Whites or Asian Americans.2

Many STIs remain undiagnosed and therefore untreated.5 In some cases, the gap exists because the STI is asymptomatic, as is often the case with chlamydial infection in women. In other cases, it is because providers have not considered the possibility of STI or are unaware of the guidelines for screening of asymptomatic individuals. Other STIs, such as genital infection with human papillomavirus (HPV) and herpes simplex virus (HSV), are incurable, although symptoms can be controlled and serious outcomes prevented. Untreated STIs can result in chronic pelvic pain, infertility, pregnancy complications, cancer, and death. It is estimated that untreated STIs are responsible for infertility in more than 24,000 women each year.6

This Quick Reference Guide provides a focused, clinically oriented resource for managing the aspects of STIs that practicing clinicians often find difficult or perplexing. It provides essential practical information, or "clinical pearls" about screening, diagnosis, and treatment of the most common STIs: chlamydial infections, gonorrhea, genital herpes, HIV infection, genital HPV infections, syphilis, and trichomoniasis. The Guide also discusses bacterial vaginosis (BV), a common sexually associated condition. This Guide is not meant to be a comprehensive resource for STI treatment and management. Its guidance is based largely on recommendations of the Centers for Disease Control and Prevention's (CDC's) Sexually Transmitted Diseases Treatment Guidelines [D1].

Abbreviations and acronyms used in this Guide:

  • ASC-US: atypical squamous cells of undetermined significance
  • BCA: bichloroacetic acid
  • BV: bacterial vaginosis
  • CDC: Centers for Disease Control and Prevention
  • CIN: cervical intraepithelial neoplasia
  • CT: Chlamydia trachomatis
  • ELISA: enzyme-linked immunosorbent assay
  • EPT: expedited partner therapy
  • GC: Neisseria gonorrhoeae or gonococcus
  • HIV: human immunodeficiency virus
  • HPV: human papillomavirus
  • HSV: herpes simplex virus
  • HSV-1: herpes simplex virus type 1
  • HSV-2: herpes simplex virus type 2
  • LSIL: low-grade squamous intraepithelial lesion
  • MSM: men who have sex with men
  • NAAT: nucleic acid amplification test
  • PID: pelvic inflammatory disease
  • POCT: point-of-care test
  • STI: sexually transmitted infection
  • USPSTF: United States Prevention Services Task Force

i The term sexually transmitted infection is used; in this Guide it is synonymous with sexually transmitted disease,
with no intended significant difference in meaning.