Sexually Transmitted Diseases

Overview

Sexually transmitted diseases (STDs) are disease processes that occur as a result of close physical contact between men and females and are spread through sexual interaction. Sexually transmitted diseases afflict people of all backgrounds and may be avoided with basic education and barrier control.

In the United States and Canada, STDs are the second most frequent infection. (The most prevalent ailment is a cold.) Every year, about a million people get STDs.

Anyone who has sex can get an STD. It is true that if you have only had one lover in your life, you are less vulnerable. However, keep in mind that you never know for sure if your lover has other partners. When you have sex with someone, you have sex with everyone your partner has ever had sex with.

What are Sexually transmitted diseases?

Sexually transmitted infections, also known as sexually transmitted illnesses, are the transfer of an organism between sexual partners by various routes of sexual contact, such as oral, anal, or vaginal contact. As many infections go untreated and lead to problems, STIs become a worry and a cost on healthcare systems, as will be described in this review article. We will cover the natural history and patterns of the transmission of the most prevalent sexually transmitted illnesses.

Epidemiology

In an ideal world, healthcare practitioners would have access to a centralized data gathering system that would allow them to study and completely assess the frequency and spread of sexually transmitted illnesses. We utilize numerous published studies, an official government, or health organizations to analyze the statistical significance of STI, such as incidence, distribution, and statistical data, as health professionals.

Sexually transmitted diseases (STDs) are common in most nations, particularly among those aged 15 to 50, including babies. The utilization of this data and information assists physicians in better forecasting and treating STIs. Providers must understand that STIs, in the majority of cases, correlate with patient behavior and should be addressed during clinical examination.

Etiology

Sexually transmitted infections (STIs) are a global health issue that should be addressed by all public health institutions. We will investigate the etiology of the most prevalent STIs, including comorbidities, physical and emotional burdens imposed on affected individuals. STIs are underrecognized and more common in medically deprived groups.

The exact organism, route, signs, and symptoms of the disease all influence the presenting state or sickness. Unprotected sexual contact with several partners, a history of STIs, sexual assault, the use of alcohol, recreational drugs, and intravenous drug usage are all risk factors for STI transmission.

Pathophysiology

Pathophysiology is the study of the physiologic consequences of a disease process within an infected individual. In this part, we will go through the most prevalent STIs and give a link to further investigate other STIs that may be of concern. Sexually transmitted illnesses can be bacterial, viral, or parasitic, and they are spread through sexual activity and the exchange of body fluids from the affected partner.

STIs enter the human body via minute abrasions in the mucosal membranes of the penis, vagina, anus, or any other mucosal surface. Transmission of STIs can occur through the use of intravenous medications, vaginal exposure during delivery, or nursing. Organisms infiltrate normal cells and overload the immune system, resulting in the disease's classic signs and symptoms.

We will go through basic symptomatology, including genital, extragenital, and diffused symptoms, as well as how a history and physical exam may help with differential diagnosis and suggested therapies. To get a broad understanding of sexually transmitted diseases, we will analyze current treatment regimens from the Centers for Disease Control and Prevention as well as statistics from other data sets. As a provider on the front lines of STI diagnosis, it is critical to grasp the difference between treatable and incurable sexually transmitted illnesses. We will discuss the most common STIs to be aware of as a provider, as well as other STIs based on area prevalence.

Types of Sexually transmitted diseases

Human Immunodeficiency Virus (HIV) Acquired Immunodeficiency Syndrome (AIDS)

Retrovirus encased in an envelope containing two single-stranded RNAs.
Primary HIV symptoms are described as flu-like, and are frequently diagnosed as an acute viral illness.
The time it takes for symptoms to appear ranges from 4 to 10 weeks.
The late stage of HIV illness is referred to as AIDS.

Gonorrhea

Neisseria gonorrhoeae is a gram-negative diplococci bacterium.
In comparison to Chlamydia trachomatis, this is the second most frequent sexually transmitted infection.
Glucose is used by gonorrhea to infiltrate mucus epithelial cells. Gonorrhea alters cellular proteins, allowing other species to infiltrate farther.
The spread of gonorrhea causes a localized inflammatory response, resulting in the signs and symptoms of a sexually transmitted illness.

Chlamydia

Chlamydia trachomatis is a Gram-negative obligate, nonmotile intracellular bacterium.
According to the CDC and WHO, the most frequent sexually transmitted illness in the United States.
There are two infectious forms: the elementary body (EB) and the reticulate body (RB) (RB). The EB form infiltrates the cell, and the RB form produces more infectious EB, which infects other non-infectious forms.

Human Papillomavirus (HPV)

HPV is a DNA virus with two strands that replicates in the basal cell layer of stratified squamous epithelial cells. This replication cycle causes hyperplasia to progress to cancer.

HPV types 16 and 18 are carcinogenic strains that cause neoplasms to arise. HPV types 6 and 11 are frequent strains that cause condyloma acuminata, or anogenital warts.

Syphilis

Treponema pallidum is a spirochete bacteria.
According to the CDC, syphilis infections are on the rise in comparison to past figures.
Syphilis manifests as a chancre, a painless, well-defined lesion at the site of inoculation.
Syphilis manifests as Primary, Secondary, or Tertiary infection, depending on the length of infection.

Genital Herpes

Herpes simplex virus 1 (HSV-1) or herpes simplex virus 2 (HSV-2) causes genital herpes (HSV-2).
HSV-1/HSV-2 is a double-stranded DNA virus with a predilection for infecting target cells that is covered with a lipoglycoprotein.
HSV-1 is often connected with orolabial infections, however the CDC reports that it is currently the major cause of genital herpes among young and gay individuals.

Trichomoniasis

Trichomonas vaginallis is a single-celled flagellated anaerobic protozoa.
Trichomoniasis causes direct epithelial injury. Micro ulcerations develop as a result of the injuries, particularly in the vagina, cervix, urethra, and paraurethral glands.

Symptoms for sexually transmitted diseases

Medical practitioners are taught how to successfully interact with patients, spouses, and families in order to comprehend their principal complaint and establish a differential diagnosis. At the same time, whether at a primary care office or the Emergency Department, a thorough history must be taken. Our responsibility as providers is to interact with patients who have signs and symptoms of an undetected sexually transmitted illness or diseases. You should be aware, as a provider, that all teenagers under the age of 18 have the right to a STI screening and treatment without parental agreement.

Further information should be sought from particular state health care systems, or the CDC's "Sexually transmitted illness treatment recommendations 2015" could be consulted. During the sexual history collection, recall the "other 5 P's" as a simple pneumonic to assist direct your inquiries.

Partners
Practices
Prevention against pregnancy
Protection against sexually transmitted infections
Past history of sexually transmitted infections

The physical exam should be guided by the presenting primary complaint and symptoms gathered during the system review. Physical exams should be performed in a private area with a chaperone at the bedside, whose identity should be documented in your EHR. The physical exam, in conjunction with the history, will offer a succinct differential diagnosis and will lead the examination, therapy, and management strategy for the suspected disease process. Present the patient with an open-ended question at the end of your exam to ensure an open discourse, and if the patient has any more specifics regarding their sexual practice, you as the provider should be aware of them.

The physical exam will be divided into sections based on the most prevalent signs and symptoms, physical exam findings, and diagnosis.

HIV

Females and Males:

Patients may present asymptomatic or with an acute viral syndrome that includes systemic symptoms such as malaise, tiredness, anorexia, fever, chills, arthralgias, myalgias, or cutaneous manifestations.
Physical Exam: The physical exam will be guided by the major complaint. In general, pt should have a comprehensive history and physical exam to rule out a wide range of possibilities.

Gonorrhea

Females:

Patients may have dysuria, urgency, urine frequency, lower pelvic discomfort, and irregular vaginal bleeding.
Physical Exam: If a systemic infection is suspected, a comprehensive physical exam should be undertaken.
Genitourinary exam: Inflammation of the external vagina generating excoriations from pruritus, mucopurulent discharge, and friable inflammatory mucosal tissue of the cervix are all possibilities.

Males:

Signs and symptoms: Patients may appear with testicular discomfort, dysuria, purulent discharge from the meatus, pain with feces due to rectal inflammation, and/or prostate inflammation. Although the provider should look for systemic signs and symptoms of disseminated gonococcal infection, such as sore throat, redness of the eyes, joint discomfort, and cutaneous lesions.
Physical Exam: Genitourinary exam: Palpable soreness over the epididymis, purulent discharge from the meatus, and palpable tenderness to the prostate or rectum are all possible. If you and your physician are worried about disseminated gonococcal infection, the provider should do a complete physical exam.

Chlamydia

Females:

Signs and symptoms: Most infections are asymptomatic, although they may be accompanied by vaginal discharge, irregular vaginal bleeding, lower pelvic discomfort, urine frequency, or dysuria. If the patient has a systemic infection, he or she may be feverish, with stomach discomfort, nausea, vomiting, lethargy, and malaise.
Physical Exam: Genitourinary exam: cervical inflammation with mucopurulent discharge, ectropion, vaginal discharge, cervix discomfort, adnexal tenderness, and abdominal soreness. If systemic and Fitz-Hugh-Curtis syndrome are on your list of possibilities, right upper quadrant soreness due to perihepatitis may be present.

Males:

Signs and symptoms: The most frequent presenting symptoms are dysuria, testicular discomfort, and pain with feces caused by rectal or prostate inflammation.
Physical Exam: Tenderness to the testicles, particularly over the epididymis, and tenderness on palpation to the prostate or rectum area.

HPV:

Females and Males:

Signs and symptoms: Because HPV types 6 and 11 are asymptomatic, the majority of complaints are aesthetic in character or an accidental discovery. Patients with oncogenic HPV types 16 and 18 may also appear with ulcerative lesions.
Physical Exam: On examination, an exophytic lesion characterized as a cauliflower-like growth known as condylomata acuminata may be seen. Lesions in the external genital region, perineum, and/or perianal area might be seen. A speculum exam is performed on females, along with screening to rule out cervical cancer.

Syphilis:

Females and males:

Signs and symptoms: The symptoms of a syphilis infection vary on the stage of the illness at the time of examination. Primary, secondary, latent, and tertiary phases of symptoms are best explained and explored in the linked article "Syphilis."
Physical Exam: The physical exam is dependent on the presenting phase of the syphilis infection.

Primary: Presents with a painless well-demarcated lesion/ulcer known as a chancre at the site of inoculation.
Secondary: A cutaneous lesion and rash are present, as well as systemic signs. Condylomata lata lesions are wart-like lesions that appear and resolve during the secondary phase. The rash only affects the palmar areas of the hands and feet.
Latent: Seroconversion of the patient to have positive syphilis serum screenings.
Tertiary: Presentation might occur months or years after inoculation. Systemic symptoms include cardiovascular, neurologic, and cutaneous signs such as gummatous lesions. Neurosyphilis can cause stroke-like symptoms, cranial nerve impairments, mental status changes, general paresis, or tabes dorsalis.

Herpes

Females and males:

Signs and symptoms: Systemic symptoms associated with primary infections include vesicular sores across afflicted regions, pruritus, dysuria, fever, headaches, malaise, and lymphadenopathy. Reactivation is often preceded by a prodromal phase characterized by tingling, itching, and a rash associated with vesicular lesions. Recurrent infections are usually less severe and last for a shorter period of time.
Physical Exam: Whether the problem is limited or systemic, the provider should concentrate on it. A primary herpes infection is more severe and symptomatic, comprising a variety of symptoms. Females may develop diffuse vesicular lesions in the interior and exterior vaginal areas. Diffuse vesicular lesions on the glans of the penis, penile shaft, scrotum, perineal/perianal area, and external/internal rectum can occur in men. A recurring herpes infection caused vesicular lesions to form along a neural pathway where the virus is latent.

Trichomoniasis

Females:

Signs and symptoms: Females with trichomonas vaginalis infection can be asymptomatic, although they may present with complaints of foul-smelling discharge, itching, dyspareunia, dysuria, and vaginal spotting.
Physical Exam: The exam will reveal external and internal vaginal discomfort, as well as the characteristic physical finding "strawberry cervix," also known as colpitis macularis. On the exam, a nasty frothy vaginal discharge may be seen.

Males:

Signs and symptoms: Males with trichomonas vaginalis infections can be asymptomatic, but they can also present with testicular discomfort, dysuria, or rectal pain.
Physical Exam: On rectal examination, there is tenderness with palpation to the epididymis and prostate. There will be no visible overlaying skin lesions or inflammatory processes.

How to be tested for Sexually transmitted diseases?

Screening suggestions may be obtained in a full presentation via the CDC's "Sexually transmitted illness treatment guidelines 2015." The information supplied is derived from the recommendations and should be utilized at the provider's discretion in collaboration with the patient.

Depending on the patient's clinical presentation and acuity, a patient with a primary complaint of a sexually transmitted illness should be evaluated to rule out a localized vs a systemic infection. The presenting sexually transmitted infection will drive first diagnostic tests, as will the CDC Sexually transmitted illness treatment guidelines, which were revised in 2015.

Most common laboratory testing performed include:

Nucleic Acid Amplification Test (NAAT)
Cerebrospinal Fluid (CSF)
Fluorescent Treponemal Antibody Absorption Test (FTA-ABS)
Rapid Plasma Reagin (RPR)
Treponema pallidum Particle Agglutination (TP-PA)
Venereal Disease Research Laboratory (VDRL)

Chlamydia:

Female: Diagnosis with the use of NAAT vaginal swab or first catch urine sample or self endocervical swab.
Male: Diagnosis with the use of NAAT of a first catch urine sample or uz-rethral sample.

Gonorrhea

Female: Diagnosis with the use of NAAT vulvovaginal or endocervical swab.
Male: Diagnosis with the use of NAAT of a first catch urine sample or urethral sample.

Trichomoniasis

Female: Diagnosis with the use of NAAT of the vagina, endocervical swab, urine analysis, or urethral sample. A wet mount will show motile flagellated protozoa to assist with the diagnosis.

Genital Herpes

Female/Male: Diagnosis by clinical examination, NAAT from genital ulceration, or viral culture.

Genital Warts

Female/Male: Diagnosis by clinical examination or biopsy if warranted.

Syphilis

Female/Male: Dark field microscopy and serologic assays such as RPR, VDRL, FTA-ABS, or TP-PA will be used to aid the diagnosis. Each test is run using an automated procedure. Patients who appear with neurosyphilis will require a cerebral spinal fluid sample to aid in the diagnosis.

HIV

Female/Male: Diagnosis begins with a blood sample or saliva for antibodies as a preliminary test, followed by more specific testing such as PCR or specific assays. PCR is used to diagnose and confirm HIV infection. For confirmation, specialised tests are used to identify antibodies or particular viral antigens.

Management

When it comes to the treatment and management of a sexually transmitted infection (STI), formerly known as a sexually transmitted illness (STD). The Centers for Disease Control and Prevention (CDC) set a goal in 2013 to update the Sexually Transmitted Treatment Guidelines 2015 with experts in the field.

This treatment guideline includes parts that direct particular care for certain groups such as pregnant women, teenagers, people in correctional institutions, men who have sex with men, women who have sex with women, and transgender men/women. These topics should be investigated and assessed on a case-by-case basis.

The history and physical exam should support the patient's therapy and management, whether the patient is examined in the Emergency Department or a primary care office. Primary therapies will be covered, and other reference papers will be mentioned to offer doctors with further management alternatives. If the primary therapy is poorly tolerated or the patient is allergic, clinicians should seek advice from their pharmacy department.

HIV:

The primary treatment and management entail determining the patient's viral load and CD4 count, as well as initiating highly active antiretroviral medication (HAART).

HAART. Should drugs be started under the supervision of an infectious disease physician? If a patient is evaluated for an immediate issue, such as sexual assault or exposure to a STI through high-risk sexual behavior, a single combination drug with careful primary care followup should be initiated.

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
NRTI fixed-dose combinations
Integrase inhibitors
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
CC chemokine receptor five inhibitors (CCR5 Inhibitor)
Protease Inhibitors

Chlamydia:

The history, physical exam, and clinical presentation should all be used to support primary therapy and care. Coinfections with the most prevalent sexually transmitted infections should be addressed and treated concurrently.

For seven days, one dose of azithromycin 1 gram or 100 milligrams of doxycycline must be given orally. Other formulations can be used, but they should be reviewed on a case-by-case basis, along with the patient's concerns.

Gonorrhea:

One dosage of a third-generation cephalosporin, namely ceftriaxone 250 milligrams, to be administered intramuscularly. One gram of azithromycin must be administered orally to treat potential chlamydia coinfection.
Following the initial therapy, the patient should be talked with regard to follow-up examinations.

Syphilis:

Secondary, latent, and tertiary syphilis therapy and care should be separate from primary syphilis treatment.

Penicillin G Benzathine 2.4 million units, administered intramuscularly, can cure primary, secondary, and early syphilis infections.
Because of the three doses of penicillin G benzathine 2.4 million units once a week for three weeks, tertiary syphilis should be treated as an inpatient.
For a total of 14 days, neurosyphilis should be treated as an inpatient with intravenous penicillin G aqueous 18-24 million units daily split into 3 to 4 million units every 4 hours or a continuous infusion.

Genital Herpes:

A initial infection should be treated and managed as a systemic infection, followed by symptomatic therapy and the administration of antiviral medicines. The practitioner and patient should talk about pharmaceutical alternatives, including any financial constraints that may prevent adequate therapy. The medicine that works best for the patient should be used to treat reactivation herpes infection.

Three forms of primary therapy can be initiated on patients: acyclovir, valacyclovir, and famciclovir. After discussing the optimal care strategy with the patient, several formulations and therapy regimens should be initiated.

Trichomoniasis:

Treatment and management should be established with that patient after diagnosis.

One dose of metronidazole 2 grams to be taken by mouth
Metronidazole 500 mg by mouth twice daily with food for seven days
One dose of tinidazole 2 grams to be taken by mouth

Prognosis

Throughout this article and the research examined, the prognosis is determined by the disease's diagnosis and course at the time of diagnosis. If the disease process is detected in its acute phase and can be adequately treated with antivirals, antibiotics, or antifungals, the result is determined by the treatment regimen. Medication adherence is critical in the prognosis of a curable infection or chronic illness such as HIV, HSV-1/HSV-2, partly treated STIs, or asymptomatic STIs that go untreated.

Complications

Untreated sexually transmitted infections (STIs) cause systemic infections, which can lead to delayed medical recuperation as well as psychological, financial, and general health difficulties. Complications of STIs result from infections that have been partially or completely cured.

Because they lack access to a healthcare system, medically disadvantaged communities experience an increase in undiagnosed and untreated STIs. If resources are not committed to the public sector, such as planned parenthood, to offer critical resources to educate individuals about safe sex practices, such as prevention, treatment, and health promotion, difficulties will grow.

If left untreated, STIs can lead to a variety of complications. Females are more likely than men to have STI complications such as systemic infection from untreated PID, sterility, and infertility from complex gonorrhea/chlamydial infections.

Females who test positive for certain STIs while pregnant have a higher risk of preterm labor. Females and males are both at risk of developing neoplasms as a result of specific HPV strain types. If HIV infections are not treated effectively, they can proceed to AIDS, a lethal late consequence of the virus caused by a highly weakened state.

Conclusion

Sexually transmitted diseases are a worldwide problem and issue because when they go untreated, people suffer the devastating consequences, which include health, financial burden, psychological, and physical repercussions. Data collection for STIs is geographically constrained. Having access to a nationwide data gathering program can aid in determining the prevalence and incidence of certain STIs and allocating resources for prevention and treatment.

To deliver these services, ongoing resources such as planned parenthood would need an interprofessional team and care coordinators. Patient-centered care should be prioritized whether patients are treated in the emergency room or their regular care office.