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The term sexually transmitted diseases (STDs) is used to describe disorders spread by intimate contact. Although this usually means sexual intercourse, it also includes close body contact, kissing, cunnilingus, anilingus, fellatio, mouth–breast contact, and anal intercourse. Many STDs can also be transmitted to the fetus in utero by transplacental spread or passage through the birth canal and via lactation during the neonatal period. The organisms involved are adapted to growth in the genital tract and are present in body secretions or blood. Having one STD increases the risk of coinfection with other STDs; therefore, full screening should be offered to all patients with a new STD diagnosis.

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Physicians have a critical role in the prevention and treatment of STDs. The clinician's role is to understand the microbiology of STDs in order to appropriately diagnose and treat patients. Treatment is aimed at alleviating symptoms and preventing future sequelae, as well as the prevention of transmission to others and providing appropriate patient education and counseling, as the mainstay of prevention is through lifestyle and behavioral modification. Multiple cohort studies have demonstrated the protective effects of both male and female condoms in the prevention of most STDs.

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Most treatment regimens detailed below are based on guidelines issued by the US Center for Disease Control and Prevention (CDC).

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Vulvar Lesions & Genital Ulcers

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Genital herpes, syphilis, and, less commonly, chancroid are the most prevalent genital ulcerative lesions in the United States. The diagnosis is difficult to make by physical examination alone. Thus the workup for all genital ulcers should include serologic screening for syphilis, culture/antigen testing for herpes simplex virus (HSV)-1 and HSV-2, and culture for Haemophilus ducreyi in areas where chancroid is prevalent. More than 1 infectious etiology may be present in a single lesion.

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Herpes Simplex

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Essentials of Diagnosis
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  • Most commonly caused by HSV-2 but increasingly also caused by HSV-1
  • Painful genital ulcers
  • Chronic, lifelong, relapsing condition
  • Transmissible even in the absence of lesions
  • Antivirals improve symptoms, speed healing of lesions, and may decrease asymptomatic viral shedding

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Pathogenesis
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Genital herpes simplex virus (HSV) is a chronic viral infection cause by 2 types of virus: HSV-1 and HSV-2. Most cases of recurrent genital herpes are caused by HSV-2, and at least 50 million persons in the United States are infected with this type of genital herpes. However, an increasing proportion of genital herpes infections in some populations (eg, young women and men who have sex with men) have been attributed to infection by HSV-1.

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Most patients infected with HSV-2 have not been diagnosed with genital herpes. Many of these patients have mild or unrecognized infections but shed virus intermittently in the genital tract. As a result, the majority of genital herpes infections are transmitted by persons unaware that they have the infection or who are asymptomatic ...

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