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This update reviews the latest diagnostic and therapeutic methods regarding sexually transmitted diseases caused by bacteria. The following mucocutaneous bacterial disorders will be discussed: syphilis, chancroid, lymphogranuloma venereum, granuloma inguinale, and gonorrhea.
Although most bacterial sexually transmitted diseases (STDs) can be effectively treated, currently available regimens are far from ideal. Increasingly widespread plasmid-mediated resistance to the penicillins limits the use of these agents in the treatment of Neisseria gonorrhoeae and Hemophilus ducreyi infections. Chromosomally mediated antimicrobial resistance to the tetracyclines, penicillins, erythromycins, and sulfonamides further limits therapeutic options in the treatment of gonorrhea, and plasmid-mediated resistance to sulfonamides and tetracyclines is frequent in H. ducreyi infections. In patients with Chlamydia trachomatis infections, effective regimens that can more easily be complied with (shorter duration, less frequent dosing) are needed, as are effective alternative regimens for use in pregnancy and in infants. In selected STDs that are polymicrobial (pelvic inflammatory disease and bacterial vaginosis, for example) or that often present simultaneously (gonorrhea-chlamydia, gonorrhea-syphilis, chancroid-syphilis), single-drug regimens that are effective against several genital pathogens would be ideal. Only limited therapeutic alternatives are available for some STDs, especially in pregnant women or in patients with penicillin allergy. Thus, antimicrobial resistance, drug toxicity, poor compliance, limited alternatives in pregnancy or allergy, and the lack of single agents possessing a broad spectrum of activity against multiple genital pathogens limit currently available therapy.
Testing for and treating sexually transmitted diseases (STDs) in pregnant women deserves special attention. Treatment possibilities are limited because of potential risks for the developing fetus, and because effects can differ in pregnant compared with non-pregnant women, re-infection may be missed because of the intrinsic delicacy of contact-tracing during pregnancy and because pregnant women are more reluctant to take the prescribed medication in its full dose, if at all. However, the devastating effects of some of these genital infections far outweigh any potential adverse effects of treatment. Although active syphilis has become a rarity in most Western countries, it is still prevalent in South America, Africa and South-East Asia. Benzathine benzylpenicillin (2.4 million units once or, safer, twice 7 days apart) is the treatment of choice, although patients with syphilis of longer standing require 3 weekly injections as well as extensive investigation into whether there has been any damage due to tertiary syphilis. Despite declining rates of gonorrhea, the relative rate of penicillinase-producing strains is increasing, especially in South-East Asia. The recommended treatment is intramuscular ceftriaxone (125 or 250 mg) or oral cefixime 400 mg. Despite good safety records after accidental use, fluoroquinolones are contraindicated during pregnancy. An alternative to a fluoroquinolone in pregnant women with combined gonorrhea and chlamydial infection is oral azithromycin 1 or 2 g. Azithromycin as a single 1 g dose is also preferable to a 7 day course of erythromycin 500 mg 4 times a day for patients with chlamydial infection. Eradication of Haemophilus ducreyi in patients with chancroid can also be achieved with these regimens or intramuscular ceftriaxone 250 mg. Trichomonas vaginalis, which is often seen as a co-infection, has been linked to an increased risk of preterm birth. Patients infected with this parasite should therefore received metronidazole 500 mg twice daily for 7 days as earlier fears of teratogenesis in humans have not been confirmed by recent data. Bacterial vaginosis is also associated with preterm delivery in certain risk groups, such as women with a history of preterm birth or of low maternal weight. Such an association is yet to be convincingly proven in other women. The current advice is to treat only women diagnosed with bacterial vaginosis who also present other risk factors for preterm delivery. The treatment of choice is oral metronidazole 1 g/day for 5 days. The possible reduction of preterm birth by vaginally applied metronidazole or clindamycin is still under investigation. In general, both test of cure and re-testing after several weeks are advisable in most pregnant patients with STDs, because partner notification and treatment are likely to be less efficient than outside pregnancy and the impact of inadequately treated or recurrent disease is greater because of the added risk to the fetus. Every diagnosis of an STD warrants a full screen for concomitant genital disease. Most ulcerative genital infections, as well as abnormal vaginal flora and bacterial vaginosis, increase the sexual transmission efficiency of HIV, necessitating even more stringent screening for and treating of STD during pregnancy.
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Recent advances in diagnostic tests for sexually transmitted diseases include the development of a synthetic Venereal Disease Research Laboratory reagent that will improve the sensitivity and stability of nontreponemal serologic tests for syphilis. A second generation user friendly and high throughput nucleic acid amplification test for Chlamydia trachomatis and Neisseria gonorrhoeae has also been developed.
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During the late 1980s and early 1990s, King County, Washington (1998 population: 1.6 million), experienced a substantial epidemic of infectious syphilis (i.e., primary, secondary, and early latent). Subsequently, reported cases of infectious syphilis declined to six cases in 1995 and one in 1996; five of the 1995 cases and the case in 1996 were believed to have been acquired outside King County. However, in 1997, sustained spread of syphilis was reestablished in King County. To determine whether this reemergence was associated with changes in the epidemiology of other sexually transmitted diseases (STDs), Public Health-Seattle and King County (PHSKC) analyzed notifiable STD data for 1997-1999. This report summarizes the results of this analysis, which indicate that infectious syphilis among men who have sex with men (MSM) in King County increased to 46 cases during January-June 1999, and chlamydia and gonorrhea also increased among MSM attending public health clinics.
Sexually transmitted diseases (STDs) have reached epidemic proportion in the United States and have captured the attention of both laypersons and health care professionals. Of special concern is that most STDs can be transmitted vertically to the offspring of infected mothers. Since the advent of acquired immunodeficiency syndrome, other STDs have been at risk of being relatively disregarded. This paper, the second of two parts, reviews issues of prevalence, morbidity, mortality, diagnosis, prevention, and treatment of group B streptococcal and chlamydial infections as they affect the maternal-fetal dyad.
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Despite the development of many antimicrobial drugs that are active against sexually transmitted bacterial pathogens, various problems limit the success of treatment of bacterial sexually transmitted diseases (STD). These problems include the evolution and spread of antibiotic-resistant pathogens, inconsistent therapeutic efficacy of some regimens despite in-vitro activity against the infecting organism, toxicity, inconvenience of administration, lack of compliance by patients, and cost. Diseases affected by one or more of these therapeutic problems include gonorrhea, chlamydial infections, pelvic inflammatory disease, bacterial vaginosis, syphilis, and chancroid. Ceftriaxone, a new cephalosporin, addresses some of these problems as they relate to gonorrhea, chancroid, and, possibly, syphilis.
Sexually transmitted diseases (STDs) are the most frequently reported bacterial infections. In 1990, slightly more than 700,000 cases of gonococcal disease were reported to the Centers for Disease Control, and the estimated incidence of chlamydial infections is 3 million to 4 million annually. Bacterial genital ulcer diseases such as syphilis and chancroid are increasing in epidemic proportions. The author reviews bacterial STDs in two categories: exudative mucosal infections and genital ulcer diseases.
The sexually transmitted diseases (STD) correspond to bacterial, viral, mycotic and parasitic disorders. They are present worldwide. However, their incidences and prevalences are higher and their complications are more severe in the intertropical belt.
Treatment regimens for sexually transmitted infections continue to evolve. The natural history of syphilis in HIV-infected patients is leading to more aggressive policies in terms of both investigation and treatment. In particular, treatment protocols for late syphilis, especially neurosyphilis, are under scrutiny. Epidemiological change typified by the spread of penicillinase-producing Neisseria gonorrhoeae (PPNG) has led to a search for new agents to treat gonorrhoea, with a more extensive use of cephalosporin and quinolone antibiotics emerging. The problem of compliance with the antibiotic courses presently required for chlamydial infection may be close to being solved with the development of newer macrolide agents. Single dose azithromycin, although expensive, seems to be as effective as longer courses with other agents. Furthermore, its efficacy in gonococcal infection is also encouraging. Increased understanding of the pathogenesis and natural history of pelvic inflammatory disease (PID) and bacterial vaginosis (BV) has led to rationalization of treatment policies for these conditions.
BACKGROUND: Among men who have sex with men (MSM), the number of newly diagnosed human immunodeficiency virus (HIV) infections has increased by approximately 60% since 1999. Factors that may be contributing to this resurgence include a widely reported increase in bacterial sexually transmitted diseases (STDs) among HIV-positive and HIV-negative MSM, as well as unsafe sexual practices. OBJECTIVE: This research was undertaken to learn more about risk behaviors associated with an incident STD among MSM. METHODS: A nested case-control study was conducted, using data from a cross-sectional Internet survey of MSM (N=2643), which investigated risk behaviors during a 6-month period in 2001. Chi-square and logistic regression methods were used to estimate the likelihood of acquiring an incident STD versus no STD. RESULTS: Eighty-five percent of the respondents were white, 46% were under age 30, and 80% had met sex partners online; 7% were HIV-positive. Men with an incident STD were more likely than men without an STD to report drug use (crystal methamphetamine odds ratio 3.8; 95% confidence interval 2.1-6.7; cocaine OR 2.3; 95% CI 1.2-4.2; ecstasy OR 2.2; 95% CI 1.3-3.8; Viagra OR 2.1; 95% CI 1.2-3.7), alcohol before or during sex (OR 1.9; 95% CI 1.2-2.9), and high-risk sexual behavior (unprotected anal intercourse OR 5.0; 95% CI 2.8-8.9; multiple sex partners OR 5.9; 95% CI 2.5-13.8). In the multivariate analysis, significant independent predictors associated with an incident STD were crystal methamphetamine use (adjusted OR 2.0; 95% CI 1.1-3.8), unprotected anal intercourse (adjusted OR 3.4; 95% CI 1.9-6.3), and 6 or more sex partners during the study period (adjusted OR 3.3; 95% CI 1.4-7.8). CONCLUSION: Identifying and treating MSM who have STDs, or who are at increased risk for acquiring STDs, is crucial in preventing the further spread of disease. In addition, there is a need to integrate HIV/STD and substance use prevention and education into Web-based and community-based venues.
Sexually transmitted diseases (STD) cause significant morbidity in the industrialized nations and, even more so in third world countries. Genital ulcerative STD such as herpes genitalis, syphilis, and chancroid have been identified as important risk factors for the spread of human immunodeficiency virus infection. Efficient and safe therapeutic regimen are therefore essential to cure the individual and to prevent spread of STD in the community. In this review, the current treatment guidelines for the bacterial STD gonorrhoea, chlamydial infections, syphilis, and chancroid are summarized and recent therapeutic developments are discussed.
Sexually transmitted diseases (STDs) have reached epidemic proportions in the United States and have captured the attention of both laypersons and health professionals. Of special concern is that most STDs can be transmitted vertically to the offspring of infected mothers. Since the advent of acquired immunodeficiency syndrome, other STDs have been at risk of being relatively disregarded. This paper, the first of two parts, reviews issues of prevalence, morbidity, mortality, prevention and treatment of syphilis and gonorrhea as they affect the maternal-fetal dyad.
BACKGROUND: We investigated associations between HLA class II DQ alleles, chlamydial and gonococcal cervicitis, endometritis, and infertility among women with pelvic inflammatory disease (PID). METHODS: Ninety-two women with clinical signs and symptoms of mild-to-moderate PID, enrolled in the PEACH Study, were evaluated. For all HLA class II DQ alleles with a prevalence of 10% or greater in the population, we assessed demographics, cervical infections, endometrial pathology, and fertility outcomes. RESULTS: Chlamydial cervicitis, gonococcal cervicitis, endometritis, and infertility were all more common among women carrying the DQA *0301 allele after adjustment for race. Endometritis and infertility were somewhat less common (or pregnancy more common) among women carrying the DQA *0501 and DQB *0402 alleles. CONCLUSION: Among women with signs and symptoms of PID, carriage of the DQA *0301, DQA *0501, and DQB *0402 alleles altered the occurrence of lower genital tract infection, upper genital tract inflammation, and infertility.