Sexually Transmitted Infections

Physicians in training and noninfectious disease clinicians can play a vital role in increasing awareness of sexual health issues, early disease recognition and diagnosis, and optimizing management of sexually transmitted infections (STIs). A practical approach to STIs requires knowledge of the main clinical syndromes in men and women, including urethritis, vaginitis, cervicitis, pelvic inflammatory disease (PID), epididymitis, and genital ulcer disease—and their associated pathogens. Newer point-of-care tests and nucleic acid amplification tests have significantly improved detection methods for STIs compared with culture methods for infections including gonorrhea, chlamydia, trichomonas, and genital herpes. Testing from multiple sites with multiple specimens (e.g., pharyngeal, urine, urethral, vaginal, cervical, and rectal) based on history of exposure or risk also increases the likelihood of detecting subclinical infections. However, diagnosis of syphilis continues to rely heavily on serologic assays, including nontreponemal and treponemal antibody tests, and monitoring after therapy is important to ensure appropriate response to treatment. Although empiric therapy is recommended for STI syndromes to prevent sequelae and transmission, targeted therapy based on diagnostic testing is best for persons who are asymptomatic, are likely to return for treatment as needed, and/or are not at high risk for complications (e.g., pregnant women, persons infected with human immunodeficiency virus). In addition to appropriate therapy, prevention methods such as vaccinations for human papillomavirus, condom use, and partner evaluation and treatment remain key components of STI management.