PHARMACOTHERAPY PRINCIPLES AND PRACTICE CARE PLANS & CASES
Upon completion of the chapter, the reader will be able to:
Analyze the behavioral considerations and assess the importance of contraception with regard to the contributing factors of sexually transmitted infections (STIs).
Apply the “expedited partner treatment” method when recommending treatment for STIs.
Identify the patient populations that are typically affected by specific STIs.
Identify causative organisms for STIs.
Devise a list of the clinical signs and symptoms corresponding to each type of STI and classify patients based on recommended criteria.
Select appropriate diagnostic procedures for STIs.
Identify STI treatment regimens and recommend therapy when appropriate.
Design a patient care plan based on the monitoring parameters.
Though we have made progress in medicine, age-old problems of infectious disease continue to plague us.1 Even with the discovery of newly improved antibiotics, sexually transmitted infections (STIs) have not been eradicated. Many have reemerged secondary to modern social trends of sexual activity, and some as a result of the HIV epidemic, socioeconomic concerns, and the global lack of preventive education. KEY CONCEPT Optimal detection and treatment of sexually transmitted diseases depends on counseling by a patient-friendly and knowledgeable clinician who can establish open communication with the patient.
The correlation between risky sexual behavior and STIs is well documented.2 Inconsistent and incorrect condom use increases the incidence of new STIs. KEY CONCEPT However, counseling patients on the consistent use of condoms, spermicides, or diaphragms is an important component in reducing the overall incidence of STIs.3 Health care providers who manage persons at risk for STIs should counsel women concerning the option for emergency contraception, if indicated, and provide it in a timely fashion if desired by the woman or the couple. Plan B (two 750 mcg levonorgestrol) is approved in the United States for the prevention of unintended pregnancy.4
In addition to the increasing number of adolescents engaging in unsafe sexual practices is a high incidence of men who have sex with men (MSM) and women who have sex with women (WSW). Many MSM do not disclose their HIV status. This “don’t ask, don’t tell” practice has been linked to an upsurge in newly diagnosed HIV infections and STIs among previously noninfected people.5 Although limited data are available with regard to STIs in WSW, risk of transmission probably varies by the specific STI and sexual techniques. Sharing penetrative items or employing practices involving digital vaginal or digital anal contact most likely represent common modes of transmission. This possibility is supported by reports of metronidazole-resistant trichomoniasis and genotype-specific HIV transmitted sexually between women who reported such behaviors and an increased prevalence of bacterial vaginosis (BV) among monogamous WSW.6
Sexual abuse in adolescents and children is becoming prevalent in the ...