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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Analyze the behavioral considerations and assess the importance of contraception with regard to the contributing factors of sexually transmitted infections (STIs).

  2. Apply the "expedited partner treatment" method when recommending treatment for STIs.

  3. Identify the patient populations that are typically affected by specific STIs.

  4. Identify causative organisms for STIs.

  5. Devise a list of the clinical signs and symptoms corresponding to each type of STI and classify patients based on recommended criteria.

  6. Select appropriate diagnostic procedures for STIs.

  7. Identify STI treatment regimens and recommend therapy when appropriate.

  8. Design a patient care plan based on the monitoring parameters.

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KEY CONCEPTS

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  • Image not available. Optimal detection and treatment of sexually transmitted infections (STIs) depends on counseling by a patient-friendly and knowledgeable clinician who can establish open communication with the patient. Patients, especially adolescents, should be counseled on the importance of using condoms, spermicides, and diaphragms properly.

  • Image not available. Generally, when treating an STI, the patient being treated should be provided with a sufficient quantity of medication for his/her partner, increasing the probability that the initial infection will be cured in both individuals. Counseling regarding the appropriate use of condoms, cervical diaphragms, spermicides, and emergency contraception is also important to mitigate the occurrence of reinfection.

  • Image not available. Patients treated for gonorrhea should be assumed to be coinfected with Chlamydia trachomatis; treatment recommendations should cover both organisms. Treatment of Neisseria gonorrhoeae with fluoroquinolones is inadvisable in those with a history of recent foreign travel, infections acquired in California or Hawaii, infections in other areas with increased gonococcal resistance, or in men who have sex with men (MSM). Additionally, treatment on gonorrhea over time has resulted in drug resistance to some cephalosporins.

  • Image not available. Parenterally administered penicillin G is recommended for all stages of syphilis.

  • Image not available. Metronidazole and tinidazole are the standard agents for trichomoniasis; advise patients to avoid the consumption of alcohol during treatment.

  • Image not available. Due to the variable appearance of genital warts, treatment may be based on the size, site, and morphology of the lesions. Treatment options include podofilox, imiquimod, sinecatechins, podophyllin resin, and bichloro- and trichloroacetic acid. The Gardasil® vaccine was FDA approved for the prevention of vulvar, vaginal, and cervical cancer and genital warts.

  • Image not available. Acyclovir, valacyclovir, and famciclovir may be prescribed to treat first and intermittent episodes of genital herpes and to suppress active herpetic infections.

  • Image not available. Bacterial vaginosis (BV) is a clinical syndrome categorized by an overgrowth of polymicrobial anaerobic organisms, such as Gardenella vaginalis, Prevotella species, Mycoplasma hominis, and Mobiluncus species. BV infection leads to the replacement of the normal hydrogen peroxide–producing lactobacillus and an increase in vaginal pH from 4.5 to 7.

  • Image not available. In patients with pelvic inflammatory disease (PID), resolution of infection (i.e., N. gonorrhoeae, C. trachomatis, Streptococcus spp., and gram-negative facultative bacteria) and mitigation of sequelae should be the main goal of pharmacologic therapy.

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Though we have made progress in medicine, age-old problems of ...

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