Key concepts

Optimal detection and treatment of sexually transmitted diseases depends on counseling by a patient-friendly and knowledgeable clinician who can establish open communication with the patient. Patients, especially adolescents, should be counseled on the importance of using condoms, spermicides, and diaphragms properly.

O1 Generally, when treating a sexually transmitted infection (STI), the patient being treated should be provided with a sufficient quantity of medication for his/her partner also, increasing the probability that the initial infection will be cured in both individuals.

Patients treated for gonorrhea should be assumed to be coinfected with Chlamydia trachomatis; treatment recommendations should cover both organisms. Treatment of Neisseria gonorrhoeae with fluoroquinolones is inadvisable in those with a history of recent foreign travel, infections acquired in California or Hawaii, infections in other areas with increased gonococcal resistance, or in men who have sex with men (MSM).

Ö1 Parenteral penicillin is the drug of choice for treatment of all stages of syphilis. Though the dose may vary with the stages of syphilis, benzathine penicillin is the drug of choice.

© Metronidazole and tinidazole are the standard agents for trichomoniasis; advise patients to avoid the consumption of alcohol during treatment.

© Due to the variable appearance of genital warts, treatment may be based on the size, site, and morphology of the lesions. Treatment options include podofilox, imiquimod, podophyllin resin, and bichloro-and trichloroacetic acid.

Acyclovir, valacyclovir, and famciclovir may be prescribed to treat first and intermittent episodes of genital herpes and to suppress active herpetic infections.

© Bacterial vaginosis (BV) is caused by overgrowth of anaerobic organisms and may be treated with oral or intravaginal metronidazole or intravaginal clindamy-cin.

© In patients with pelvic inflammatory disease (PID), resolution of infection (i.e., N. gonorrhoeae, C. trachomatis, Streptococcus spp., and gram-negative facultative bacteria) and mitigation of sequelae should be the main goal of pharmacologic therapy.

© Approximately 10% of persons who have chancroid acquired in the United States are coinfected with Treponema pallidum or herpes simplex virus.

Though we have made progress in medicine, age-old problems of infectious disease continue to plague us.1 Even with the discovery of newly improved antibiotics, few sexually transmitted infections (STIs) have been completely eradicated. Many have reemerged secondary to modern social trends of sexual activity, and some as a result of the HIV epidemic, socioeconomic concerns, and the global lack of preventive education. Educating the public decreases the probability of infection in some individuals; however, this tactic alone may not be sufficient. Optimal detection and treatment of sexually transmitted diseases depends on counseling by a patient-friendly and knowledgeable clinician who can establish open communication with the patient.

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