Chapter 53: Sexually Transmitted Diseases
Sexually transmitted diseases (STDs) are infectious diseases transmitted most commonly
through sexual contact.
Types of STD infections include bacterial (gonorrhea, chlamydia, syphilis) and viral (genital
herpes, genital warts).
Most infections start as lesions on the genitalia and other sexually exposed mucous membranes.
Wide dissemination to other body areas can then occur.
A latent, or subclinical, phase is present with all STDs. This can lead to a long-term persistent
infection and transmission of disease from asymptomatic (but infected) person to another
Different STDs can coexist within one person.
Gonorrhea is the second most frequently reported STD in United States.
It is caused by Neisseria gonorrhoeae, a gram-negative diplococcus.
Gonorrhea is spread by direct physical contact with an infected host, usually during sexual
activity (vaginal, oral, or anal).
The initial site of gonorrhea infection in men is usually the urethra.
Symptoms of urethritis consist of dysuria and profuse, purulent urethral discharge developing 2
to 5 days after infection.
Women with gonorrhea are often asymptomatic or have minor symptoms that are often
overlooked. A few women may complain of vaginal discharge, dysuria, or frequency of urination.
Complications of gonorrhea in men are prostatitis, urethral strictures, and sterility from orchitis
or epididymitis. Because women with gonorrhea who are asymptomatic seldom seek treatment, complications
are more common and include pelvic inflammatory disease (PID), Bartholin’s abscess, ectopic
pregnancy, and infertility.
Typical clinical manifestations of gonorrhea, combined with a positive finding in a Gram-stained
smear of the purulent discharge from the penis, gives an almost certain diagnosis in men. A
culture must be performed to confirm the diagnosis in women.
The most common treatment for gonorrhea is a single IM dose of ceftriaxone (Rocephin).
Patients with coexisting syphilis are likely to be cured by same drugs used for gonorrhea.
All sexual contacts of patients with gonorrhea must be evaluated and treated to prevent
reinfection after resumption of sexual relations.
The cause of syphilis is Treponema pallidum, a spirochete which enters the body through
very small breaks in skin or mucous membranes.
In addition to sexual contact, syphilis may be spread through contact with infectious
lesions and sharing of needles among IV drug users.
If syphilis is not treated, specific stages are characteristic of disease progression.
In the primary stage, chancres appear. During this time, draining of microorganisms into
lymph nodes causes regional lymphadenopathy. Genital ulcers may also be present.
Without treatment, syphilis progresses to a secondary (systemic) stage. Manifestations
include flu-like symptoms of fever, sore throat, headaches, fatigue, and generalized
The third stage is most severe stage. Manifestations include gummas, aneurysms, heart
valve insufficiency, and heart failure, and general paresis.
Syphilis is commonly diagnosed by a serologic test. Benzathine penicillin G (Bicillin) or
aqueous procaine penicillin G remains the treatment for all stages of syphilis.
Chlamydial infections are the most commonly reported STD in the United States.
They are caused by Chlamydia trachomatis, a gram-negative bacterium that is
transmitted during vaginal, anal, or oral sex.
Chlamydial infections are associated with gonococcal infections, which makes clinical differentiation difficult. In men, urethritis, epididymitis, and proctitis may occur in both
diseases. In women, bartholinitis, cervicitis, and salpingitis (inflammation of the fallopian
tube) can occur in both diseases. Therefore, both Chlamydia and gonorrhea are usually
treated concurrently even witho