Sexually Transmitted Infections

Published on 06/06/2015 by admin

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Last modified 06/06/2015

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89 Sexually Transmitted Infections

Sexually transmitted infections (STIs) present a significant source of morbidity among adolescents, especially young women. According to 2007 surveillance data, adolescents represent 25% of the sexually active population but account for 50% of new STIs. The high incidence of STIs is associated with greater susceptibility of the adolescent female reproductive tract, poor access to STI prevention services, inconsistent use of barrier prophylaxis, and high prevalence among sexual partners.

STIs present with a wide range of symptoms and physical findings. Moreover, many infections are asymptomatic. Thus, regular screening among sexually active adolescents is highly recommended.

This chapter focuses on the most common clinical syndromes among adolescents: vaginitis, urethritis, cervicitis, human papillomavirus (HPV) infection, herpes genitalis, chlamydia, gonorrhea, and syphilis.

Urethritis and Cervicitis

Clinical Presentation

The clinical presentations of urethritis and cervicitis and their associated infections are detailed in Table 89-2 and Figure 89-1.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an important complication of cervicitis, most commonly caused by N. gonorrhoeae and C. trachomatis. Other vaginal and enteric pathogens may be involved, including Bacteroides spp., Ureaplasma urealyticum, and Mycoplasma hominis. Gonococcus, C. trachomatis, and other organisms may ascend into the uterus and fallopian tubes. Infected material in the fallopian tubes may result in tubo-ovarian abscess, and overflow may lead to peritonitis or perihepatitis. The risk of PID is associated with young age at first intercourse, multiple partners, vaginal douching, and use of intrauterine devices.

The presenting symptoms of patients with PID are described in Table 89-2. Some patients may have subclinical infection that is not diagnosed until evaluation for infertility reveals fallopian tube scarring. On examination, patients usually have lower abdominal tenderness. Pelvic examination may reveal cervical discharge; an inflamed cervix; cervical, adnexal, or uterine tenderness; or an adnexal mass. Timely diagnosis of PID is important to prevent infertility. Because the signs and symptoms of infection are not specific, the Centers for Disease Control and Prevention developed criteria to guide diagnosis and empiric treatment (Table 89-3). Fulfillment of minimal criteria indicates presumptive treatment.

Table 89-2 Signs and Symptoms of Urethritis, Cervicitis, and Associated Syndromes in Men and Women

  Men Women

     

PID, pelvic inflammatory disease; RUQ, right upper quadrant.

Table 89-3 Signs and Symptoms of Pelvic Inflammatory Disease

Minimal Criteria Additional Criteria Definitive Criteria

CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; WBC, white blood cell.