A Review of Sexually Transmitted Diseases

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An ongoing CE program of The University of Florida College of Pharmacy and DRUG TOPICS

The history of sexually transmitted diseases (STDs) is far-reaching, with medical writings identified as far back as 2500 BC. However, the term venereal disease originated in the 15th century from the Latin term Venus, meaning "from sexual love or desire." Although most individuals seek and desire love, they must remember that this pursuit may come with a potential risk for a number of sexually transmitted diseases. Certain STDs continue to pose a public health threat. But while resistance to treatment is of increasing concern, a number of new or potentially existing pathogens have been identified.

There are approximately 19 million new cases of STDs per year in the United States, most of which occur in the age group from 15 to 24 years. However, it would be unfair to present this topic without identifying the success of medical research on treatment and prevention.

Some may recall posters or stories told of World War II soldiers being treated for syphilis with the new miracle drug penicillin. As of 2007, not only are a number of treatment options available for various STDs, but a number of vaccines are available for disease prevention. These vaccines have been successful in limiting infection from accidental or intentional disease exposure.

In August of 2006, the Centers for Disease Control & Prevention (CDC) updated its treatment guidelines for sexually transmitted diseases. This continuing education article will review some common STDs as well as their recommended treatment options. The entire set of guidelines is available at www.cdc.gov/std.

Genital ulcers

Genital ulcers are often associated with a number of sexually transmitted diseases. These ulcers not only serve as a means of disease transmission, but they also increase the risk of acquiring other sexually transmitted diseases by limiting the physical barriers of the skin itself. Therefore, in many cases, these ulcers may be the result of more than one type of infectious pathogen, making specific diagnosis more challenging. As such, treatment recommendations for these infections may include a regimen that is active against multiple infectious processes.

The most common STDs in the United States that present with genital ulcers include herpes, syphilis, and chancroid. However, it is important to remember that other non-sexually transmitted diseases can also result in genital lesions. Lesions that appear within one day of an exposure are not likely a sexually transmitted disease, as most ulcers secondary to an STD do not appear until at least two days after the exposure. Herpes. There are currently 50 million people in the United States infected with herpes. Herpes is a result of two types of viral infections, herpes simplex virus-1 (HSV-1) and herpes simplex virus-2 (HSV-2). Both of these subtypes may result in painful genital lesions, but recurrent episodes are much less frequent with HSV-1, with an incidence of less than one outbreak per year compared with four or more with HSV-2. In fact, while not all virally infected individuals display symptoms of their infection, transmission of this virus is possible even when no symptoms are present. For this reason, transmission may occur via an undiagnosed HSV-infected individual who may be asymptomatic.

Some infected individuals remain asymptomatic for long periods, limiting the opportunities for diagnosis. It is during these asymptomatic periods in the HSV-infected individual that most transmission occurs. At present, a cure is unavailable. Viral treatment is limited to providing a shorter duration of symptoms, decreasing the risk of viral transmission, and in some cases limiting recurrence. Even with the first episode of herpes, options for treatment should be discussed in order to decrease symptoms and minimize future outbreaks. By utilizing continuous therapy, even in mild cases, the risk of viral transmission during asymptomatic periods will be decreased by 70% to 80%. …