Sexually transmitted disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Carla Vorsatz, M.D.[2]; Associate Editor(s)-in-Chief: Tarek Nafee, M.D. [3]

Synonyms and keywords: Sexually transmissible disease; STD; VD; STI; sexually transmitted infection; venereal disease.

Overview

Sexually transmitted diseases (or STDs) are bacterial, viral, fungal, or protozoal infections that are transmitted via sexual contact. Sexual contact may entail non-penetrative contact of the genitalia, performing or receiving oral sex (cunnilingus, anilingus, or fellatio), and insertive or receptive vaginal or anal sexual intercourse. Sexually transmitted infections may have a variety of clinical presentations including dermatological manifestations, generalized symptoms, or urogenital tract symptoms such as discharge and dysuria. Some infectious agents may be transmitted primarily through sexual contact while others may less frequently be transmitted sexually.

The CDC reported updated Surveillance data on sexually transmitted diseases from 2018 in the United States, which included chlamydia, gonorrhea, and syphilis.^[1] Complications of STDs depend on the causative pathogen and may range from genital or oral pruritis and discomfort to more serious complications such as pelvic inflammatory disease, primary CNS lymphoma, cervical cancer, as well as cardiac and neurological complications. If left untreated, some STDs may progress to septic shock and death.

Most STDs have well-established risk factors and preventative measures. If followed appropriately, most STD transmissions can be avoided.

Classification

Table below provides a concise comparison of various sexually transmitted diseases:^[1]

Transmission	Clinical Presentation	Disease	Diagnosis		Mother to Child Transmission		Most Serious Complications
Transmission	Clinical Presentation	Disease	Laboratory Studies	Clinical Diagnosis	Vertical Transmission	Trans-vaginal Transmission	Most Serious Complications
Primarily sexually transmitted	Genital Dermatological Manifestation (e.g., ulcers, chancre, vesicles, warts, balanitis etc.)	HPV	✔	✔			Cervical Cancer
		”Herpes simplex” 1 and 2	✔	✔	✔	✔	Moderate to severe pruritis/discomfort, superinfection
		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)
	Generalized Symptoms (e.g., constitutional symptoms)	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”	✔	✔			PID
Less frequently sexually transmitted	Generalized Symptoms (e.g., constitutional symptoms)	Zika Virus	✔		✔		Vertical transmission and congenital abnormalities
		Hepatitis B	✔	✔	✔		Hepatocellular Carcinoma
		Hepatitis C	✔	✔	✔		Liver cirrhosis, 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

Differential Diagnosis

Table below provides differential diagnosis of sexually transmitted diseases:^[1]

Disease	Symptoms
Disease	Discharge	Dysuria	Vaginal odor	Dyspareunia	Genital skin lesion	Genital pruritis	Fever	Lymphadenopathy	Other symptoms
Chlamydia	✔	✔		✔		✔	✔	✔	Cough, shortness of breath, red eye with discharge (neonate), joint pain
Gonorrhea	✔	✔	✔	✔			✔		Sore throat, polyarthralgia, tenosynovitis, rash, eye discharge (neonates)
HIV	✔	✔					✔	✔	Fever, lymphadenopathy, rash, fatigue, myalgia, arthritic pain, headache
Herpes simplex	✔	✔			✔		✔	✔	Fatigue, myalgia, painful oral ulcers
HPV	✔	✔		✔	✔	✔			Weight loss, hoarseness (adults), altered cry, stridor (infants)
Hepatitis B							✔	✔	Fever, fatigue, nausea, vomiting, loss of appetite, abdominal pain, dark urine, clay-colored stools, joint pain, yellowish discoloration of the eyes and skin, skin rash, muscle pain
Hepatitis C							✔	✔	Fever, fatigue, anorexia, arthralgia, nausea, vomiting
Bacterial vaginosis	✔		✔						None
Mycoplasma genitalium	✔	✔		✔		✔			None
Zika virus							✔		Conjunctivitis, rash, joint pain, myalgia

Treatment

To view the treatment of chlamydia infection click here.
To view the detailed treatment of gonorrhea click here.
To view the detailed treatment of herpes simplex click here.
To view the detailed treatment of mycoplasma genitalium infection click here.
To view the detailed treatment of syphilis click here.
To view the detailed treatment of trichomoniasis click here.
To view the detailed treatment of bacterial vaginosis click here.
To view the detailed treatment of human papillomavirus click here.

References

↑ ^1.0 ^1.1 ^1.2 CDC Sexually Transmitted Disease Surveillance 2018 STDs in the United States. The Centers for Disease Control and Prevention. https://www.cdc.gov/std/stats18/toc.htm Accessed on January 25, 2020.

[CDCFact-1] 1.0 ^1.1 ^1.2 CDC Sexually Transmitted Disease Surveillance 2018 STDs in the United States. The Centers for Disease Control and Prevention. https://www.cdc.gov/std/stats18/toc.htm Accessed on January 25, 2020.

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