Diagnosis and Treatment of Sexually Transmitted Infections

Abstract

In 2019, an estimated 2.55 million new sexually transmitted infections (STIs) were reported in the US, 1 with a projected direct medical cost of approximately $1.1 billion for gonorrhea, chlamydia, and syphilis in 2018. 2 In 2018, there were approximately 67.6 million prevalent infections in the US, suggesting that an estimated 1 in 5 adults had an STI. 3 People with STIs are at greater risk of transmitting HIV to others. Among people without HIV, STIs increase rates of HIV acquistion. 4,5 STIs also increase rates of infertility, chronic pelvic pain, ectopic pregnancy, miscarriage, fetal death, and congenital and neonatal infections. [6][7][8][9] This review summarizes current evidence regarding the epidemiology, diagnosis, treatment, and prevention of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes. For the purposes of clarity, in this article, the terms male and female refer to those assigned male or female at birth, respectively (see eTable 1 in the Supplement for additional clinician resources). MethodsWe searched PubMed and Cochrane databases using Medical Subject Headings for English-language studies of the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia (including lymphogranuloma venereum), syphilis, Mycoplasma genitalium, trichomoniasis, and herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) between October 1, 2010, and October 31, 2021. We manually searched the references of selected articles for additional relevant studies (including older studies). Randomized clinical trials, meta-analyses, systematic reviews, and national and international clinical practice guidelines were prioritized for inclusion. Of 1896 reports identified, 81 were included, consisting of 8 randomized trials, 7 meta-analyses, 27 systematic reviews, 5 clinical practice guidelines, 28 observational studies, 3 modeling studies, and 3 retrospective case series. IMPORTANCE Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes.OBSERVATIONS From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia,...

Increasing incidence rates of sexually transmitted infections from 2010 to 2019: an analysis of temporal trends by geographical regions and age groups from the 2019 Global Burden of Disease Study

“…Additionally, getting treatment for partners may be effective in reducing STI incidence in youth [ 32 ]. Second, effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception [ 33 ]. STI counseling and testing lead to positive sexual behavior changes [ 34 ].…”

A Case Report of Secondary Syphilis Co-Infected with Measles: A Diagnostic Dilemma with Fever and Rash

“…Interestingly, macules over the palms and soles rapidly resolved with no residual scarring. We therefore cannot precisely say whether empirical antibiotics administered on admission were effective in terms of bactericidal actions against the treponemes, as previously described [ 77 ]. Nevertheless, weekly intramuscular injections with benzathine benzylpenicillin G were planned for three consecutive weeks to achieve radical cure and prevent the development of tertiary syphilis.…”

Update on the Epidemiological Features and Clinical Implications of Human Papillomavirus Infection (HPV) and Human Immunodeficiency Virus (HIV) Coinfection

“…The incidence of several STIs has increased in recent years [ 126 ]. Treponema pallidum , Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and HPV are the most common sexually transmitted pathogens in the United States, and their incidence rate increased by 30% to 60% from 2015 to 2019 [ 127 ]. Coinfection of HIV, HPV, and other STIs such as NG or Mycoplasma genitalium (MG) is common [ 128 ], and the risk of contracting an STI is increased according to the number of sexual partners [ 129 ], condomless receptive anal intercourse [ 130 ] and drug consumption [ 131 ].…”