Approximately 70% of high school seniors report having had sexual intercourse. Increased rates of antimicrobial resistance among pathogens causing sexually transmitted diseases (STDs) underscore the importance of awareness of updated STD treatment guidelines from the Centers for Disease Control and Prevention (CDC) (MMWR. 2015;64(3):1-136, http://1.usa.gov/1kKuc18).
Which two of the following statements regarding STDs are not correct?
- Male circumcision reduces the risk of HIV infection but does not influence the risk of HPV infection or genital herpes.
- All sexually active female adolescents younger than 25 years of age should be screened annually for Chlamydia trachomatis and Neisseria gonorrhoeae.
- Two-thirds of newly diagnosed cases of primary and secondary syphilis occur in men who have sex with men (MSM).
- Hepatitis C virus (HCV) transmission between heterosexual and homosexual partners is not efficient and seldom occurs.
- Chlamydial infection of the genitourinary tract is the most frequently reported infection in the United States.
- Most genital herpes infections are symptomatic.
Answer: a and f are not correct.
Among heterosexual men, circumcision has been shown to reduce the risk of HIV infection as well as HPV infection and genital herpes. The Academy recommends newborn male circumcision be available for families who wish to have the procedure.
Approximately 50 million people in the U.S. have experienced genital herpes simplex virus type 2 (HSV-2) infections. An increasing proportion of anogenital infections are attributed to HSV-1. However, evidence does not support the use of routine serologic screening for HSV-2, even among pregnant women. Most people infected with HSV-2 experience a mild or asymptomatic infection, but intermittently shed virus in the anogenital area. People unaware of their infection transmit the majority of HSV-2 infections.
An estimated 820,000 new N. gonorrhoeae infections occur each year in the U.S. Urethral infections caused by N. gonorrhoeae among men can produce symptoms that prompt them to seek curative treatment soon enough to prevent sequelae but often too late to prevent transmission to others. Among women, gonococcal infections are commonly asymptomatic or might not produce recognizable symptoms until complications such as pelvic inflammatory disease (PID) have occurred. PID can result in tubal scarring that can lead to infertility and ectopic pregnancy.
Expedited partner therapy or patient-delivered partner therapy refers to treatment of sex partners of heterosexual persons who are diagnosed with chlamydia or gonorrhea by providing prescriptions or medications to the patient. Partners within the past 60 days then receive treatment without being evaluated by a health care provider. Evidence suggests lower reinfection rates among the index-case patient when using this approach compared to patient referral.
HCV is the most common chronic bloodborne infection in the United States with an estimated 2.7 million people chronically infected. Sexual transmission between partners is rare but may occur among people with HIV co-infection. HCV is transmitted mainly through use of shared needles and uncommonly in a health care setting when infection-control practices are not followed. HCV transmission by blood products or organ transplantation has been rare since 1992 when routine screening was mandated. HCV transmission from infected mother to her infant is reported to occur with rates as high as six of every 100 deliveries.
Factors associated with an increased risk of syphilis among MSM are a history of substance abuse, multiple partners and seeking partners through the Internet. The risk of repeat infection by Treponema pallidum may be as high as 5.9% within two years among MSM, especially if HIV infected.
Women who have sex with women (WSW) may be at increased risk for HIV infection as well as other STDs depending on practice. HPV appears to be common among WSW, so routine vaccination should be offered to all women. Although bacterial vaginosis is common among WSW, limited data are available regarding transmission of other bacterial STDs among WSW. Health care providers should screen women for STDs and cervical cancer regardless of sexual preference.
Renée R. Jenkins, M.D., FAAP, an adolescent medicine specialist and AAP past president (2007-’08), offers the following perspective:
“The new STD guidelines will be especially helpful and informative for pediatricians who care for adolescents. The diagnostic update for urethritis in males brings more specificity to point-of-care management. The approval of nucleic acid amplification testing for T. vaginalis in women should increase detection rates in minimally symptomatic patients. There are new sections on the management of persons who are transgender. Treatment updates offer alternative treatment regimens for Neisseria gonorrhoeae and alternative treatment options for genital warts. The message to pediatricians seeing adolescents in any setting is to ask about sexual behavior, screen young men and women according to screening guidelines, follow up on patient and partners treated, report STDs according to state guidelines and provide risk-reduction and pregnancy prevention counseling when risks are identified.”
Dr. Meissner is professor of pediatrics at Floating Hospital for Children, Tufts Medical Center. He also is an ex officio member of the AAP Committee on Infectious Diseases and associate editor of the AAP Visual Red Book.