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Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy: Pharmacotherapy Principles and Practice. Email User Services ( for more information.



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 “patient-delivered partner therapy” 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.


Though we have made significant progress in science and medicine, longstanding 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 human immunodeficiency virus (HIV) epidemic, socioeconomic concerns, and the global lack of preventive education. image Optimal detection and treatment of sexually transmitted diseases depend on counseling by a patient-friendly and knowledgeable clinician who can establish open communication with the patient.

Since the correlation between risky sexual behavior and STIs is well documented,2 most sexually active individuals will ­contract an infection at some point in their lives. Though inconsistent and incorrect condom use increases the probability of new STIs, counseling patients on the consistent use of condoms, spermicides, or diaphragms is an important component in reducing overall incidence.3 Additionally, health care providers who manage persons at risk for STIs should counsel women in a timely fashion concerning the option for emergency contraception, when indicated. Mifepristone, misoprostol, oxytocin, and levonorgestrol have been employed in the United States for the prevention of unintended pregnancy.4

In addition to an increasing number of adolescents engaging in unsafe sexual practices, there 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. In fact, MSM is documented as the risk group most severely affected by HIV in the United States. However, new infections within this group recently stabilized at approximately 26,000 new infections each year.5 Although limited data are available with regard to STIs in WSW, transmission generally occurs through fisting, fingering, oral sex, or the use of sexual toys. Sharing penetrative items or employing practices involving digital vaginal or digital anal contact most likely represent the most 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 ...

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