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]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

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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

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

Transmission  | Clinical Presentation  | Disease  | Diagnosis  | Mother to Child Transmission  | Most Serious Complications

|
|
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|

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
''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)

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

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

Disease  | Symptoms

|

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

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* 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

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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.