Sexually Transmitted Diseases (STDs)

Description

Sexually transmitted diseases (STDs) are the infections and resulting clinical syndromes caused by more than 25 infectious organisms transmitted through sexual activity. Because STDs are communicable diseases with far-reaching public health consequences, early detection and treatment are important for the sexual and reproductive health of the individual as well as the community. STDs can often result in serious long-term complications, including pelvic inflammatory disease, infertility, stillbirths and neonatal infections, genital cancers, and an increased risk for HIV acquisition and transmission.

Occurrence

Sexually transmitted diseases are among the most common infections with an estimated 18.9 million new infections annually in the United States and 340 million infections worldwide. Travellers who have sexual interactions with core groups of efficient STD transmitters (commercial sex workers) in endemic areas may have high rates of acquisition of an STD, such as gonorrhea. Some STDs are more prevalent in developing countries (e.g., chancroid, lymphogranuloma venereum, and granuloma inguinale) and may be more likely to be exported into developed countries by travellers.

Risk for Travellers

International travellers are at risk of contracting STDs, including HIV, if they have sexual contact with partners in locales with high STD prevalence. Increased sexual promiscuity and casual sexual relationships tend to occur during travel abroad to foreign countries and are frequently reported in long-term overseas travellers. Commercial sexual service in various destinations (e.g., Southeast Asia) attracts many foreign travellers. Worldwide, increased rates of infectious syphilis and quinolone-resistant gonorrhea have recently been reported among men who have sex with men (MSM).

Clinical Presentation

Any traveller who might have been exposed to an STD and who develops a vaginal or urethral discharge, an unexplained rash or genital lesion, or genital or pelvic pain should be advised to cease sexual activity and promptly seek medical care. Screening for asymptomatic infection should be encouraged among travellers who have had casual sexual activity.

Prevention

The prevention and control of STDs are based on education and counselling; specific measures the traveller can take to avoid acquiring or transmitting STDs should be part of the health advice given to travellers. Abstinence or mutual monogamy is the most reliable way to avoid acquisition and transmission of STDs. For persons whose sexual behaviours place them at risk for STDs, correct and consistent use of the male latex condom can reduce the risk of HIV infection and STD transmission during sexual contact. Only water-based lubricants (e.g., K-Y Jelly or glycerine) should be used with latex condoms, because oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, or massage oils) can weaken latex condoms. Vaginal spermicides containing nonoxynol-9 are not recommended in STD/HIV prevention.

Preexposure vaccination is an effective method for prevention of sexually acquired hepatitis A and B infections. Hepatitis A vaccine is recommended for all unvaccinated persons using injection drugs and MSM. Hepatitis B vaccine is recommended for all unvaccinated persons with a history of STD, multiple sexual partners, use of injection drugs or partner who uses them, or MSM. Vaccines for herpes simplex virus and human papillomavirus are currently in clinical trials and may become available in the next several years.

Treatment

Knowledge of the clinical presentation, frequency of infection, and antimicrobial resistance patterns (e.g., quinolone-resistant Neisseria gonorrhoeae) are important in the management of STDs that occur in travellers to specific destinations. Treatment directed toward a specific pathogen is the historical norm for most STDs in industrialized countries. Syndromic management, of interest in developing countries, requires only broad clinical manifestations with risk assessment, followed by treatment of the main causes of the syndrome without identification of a specific pathogen. Evaluation and management of STDs should be based on standard guidelines (CDC, WHO) with consideration of the high frequency of antimicrobial resistance in different geographic areas.

Bibliography

• Abdullah AM, Ebrahim SH, Fielding R, et al. Sexually transmitted infections in travellers: implications for prevention and control. Clin Infect Dis. 2004;39:533-8.
• CDC. Sexually transmitted diseases treatment guidelines 2002. MMWR Morbid Mortal Wkly Rep 2002;51(RR-6):1-78.
• CDC. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae among men who have sex with men- United States, 2003, and revised recommendations for gonorrhea treatment, 2004. MMWR Morbid Mortal Wkly Rep. 2004;53:335-8.
• Memish ZA, Osoba AO. Sexually transmitted diseases and travel. Int J Antimicrob Agents. 2003;21:131-4.
• Matteelli A, Carosi G. Sexually transmitted diseases in travellers. Clin Infect Dis. 2001;32:1063-7.
• Mulhall BP. Sexual behaviour in travellers. Lancet. 1999;353:595-6.
• Workowski KA, Levine WC, Wasserheit JN. U.S. Centers for Disease Control and Prevention guidelines for the treatment of sexually transmitted diseases: an opportunity to unify clinical and public health practice. Ann Intern Med. 2002;137:255-62.

- Kimberly Workowski