Sexually transmitted infections (STIs) are a major public health problem in developed and developing countries. Complications of untreated STIs include upper genital tract infections, infertility, cervical cancer, and enhanced transmission and acquisition of herpesviruses, hepatitis viruses, and the human immunodeficiency virus (HIV).
The approach to STI diagnosis and management is based upon disease or symptom-specific syndromes, including vaginal discharge, urethral discharge, ulcerative genital disease, nonulcerative genital disease, and pelvic pain. However, many patients have asymptomatic disease, which increases the risk of complications and sustained transmission in the community. Unfortunately, routine screening for all potential STIs in all patients is cost-prohibitive, particularly in resource-poor countries . Targeted screening of asymptomatic patients in specified risk groups is important and has been shown to be effective.
STI screening, including targeted screening and prevention, will be discussed here. In its 2010 guidelines on the treatment of sexually transmitted infections, the United States Centers for Disease Control and Prevention (CDC) also made recommendations on screening . The recommendations in this topic are largely consistent with those guidelines.
The approaches to patients with specific genitourinary symptoms and signs are discussed elsewhere (see "Approach to women with symptoms of vaginitis" and "Clinical features and diagnosis of pelvic inflammatory disease" and "Approach to the patient with genital ulcers" and "Acute uncomplicated cystitis and pyelonephritis in women"). The prevention of STIs is discussed elsewhere. (See "Prevention of sexually transmitted infections".)
Information on the clinical presentation, diagnosis, and treatment of specific STIs are reviewed in detail separately. (See related topics). Sexually transmitted infections and HIV infection in adolescents are also discussed separately. (See "Sexually transmitted diseases: Overview of issues specific to adolescents" and "The adolescent with HIV infection".)