C h a p t e r 4 1
Sexually Transmitted Infections
1061
Venereal Disease Research Laboratory (VDRL) or the
rapid plasma reagin (RPR) tests. The tests, which are
easy to perform, rapid, and inexpensive, are frequently
used as screening tests for syphilis. Because these tests
are nonspecific, positive results can occur for diseases
other than syphilis. Results become positive 4 to 6 weeks
after infection or 1 to 3 weeks after the appearance of
the primary lesion. The disease’s incubation period may
delay test sensitivity; therefore, serologic tests usually
are repeated after 6 weeks if the initial test results were
negative.
The
specific treponemal
tests measure antibodies capa-
ble of reacting with
T. pallidum
antigens. These tests are
used to determine whether a positive result on a non-
specific test such as the VDRL is attributable to syphilis.
Some clinical laboratories and blood banks have begun
to screen samples using automated treponemal tests,
the enzyme-linked immunosorbent (EIA) or chemoilu-
minescence (CIA) assays, and then follow-up with a
nontreponemal test (VDRL or RPR).
4
The CDC recom-
mends that persons with a positive screening test should
have a standard nontreponemal titer performed by the
laboratory. If the test is negative, it is recommended that
the laboratory perform a different test using a different
antigen.
4
The treatment of choice for syphilis is penicillin.
8
Because of the spirochetes’ long generation time, effec-
tive tissue levels of penicillin must be maintained for
several weeks. Long-acting injectable forms of penicil-
lin are used. Tetracycline or doxycycline is used for
treatment in persons who are sensitive to penicillin,
but these medications cannot be used in pregnancy.
Sexual partners should be evaluated and treated pro-
phylactically even though they may show no sign of
infection. All treated individuals should be reexam-
ined clinically and serologically at 6 and 12 months
after completing therapy; more frequent monitoring
(3-month intervals) is suggested for individuals with
HIV infection.
8
R E V I EW E X E R C I S E S
1.
A 25-year-old woman has been told that her Pap
test indicates infection with HPV type 16.
A.
What are the possible implications of infection
with HPV 16?
B.
How might she have acquired this infection?
C.
What treatments are currently available for
treatment of this infection?
2.
A 35-year-old woman presents with vulvar
pruritus, dysuria, dyspareunia, and an odorless,
thick, cheesy vaginal discharge. She has diabetes
mellitus and has recently recovered from a
respiratory tract infection, which required
antibiotic treatment.
A.
Given that these manifestations are consistent
with a
Candida
infection, what tests might be
used to confirm the diagnosis?
B.
What risk factors does this woman have that
predispose her to this type of vaginitis?
C.
How might this infection be treated?
R E F E R E N C E S
1. Frenkl TL, Potts J. Sexually transmitted diseases.
Urol Clin
North Am.
2008;35:33–46.
2. Beckmann CRB, Ling FW, Barzansky BM, et al.; for American
College of Obstetrics and Gynecology.
Obstet Gynecol
. 3rd ed.
Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins; 2010:241–258.
3. Centers for Disease Control and Prevention. Incidence,
prevalence, and cost of sexually transmitted infections in the
United States. 2013. Available at:
STI-Estimates-Fact-Sheet-Feb-2013.pdf. Accessed July 24,
2013.
4. Centers for Disease Control and Prevention. Sexually transmitted
diseases: treatment guidelines 2010.
MMWR Morb Mortal Wkly
Rep.
2010;59(RR12):1–116.
5. Stanley MA. Genital human papillomavirus infections: current
and prospective therapies.
J Gen Virol.
2012;93:681–695.
6. Hariri S, Dunna E, Saralya M, et al. Human papillomavirus. In:
Centers for Disease Control and Prevention.
VPD Surveillance
Manual
. 5th ed. Chapter 5. 2011. Available at:
.
gov/vaccines/pubs/surv-manual/chpt05-hpv.pdf. Accessed July 29,
2013.
7. Center for Disease Control and Prevention. FDA licensure of
bivalent human papillomavirus vaccine (HPV2, Cervarix) for
use in females and updated HPV vaccination recommendations
from the Advisory Committee on Immunization Practices
(ACIP).
MMWR Morb Mortal Wkly Rep.
2010;59(20):
626–629.
8. Center for Disease Control and Prevention. FDA Licensure
of qualivalent vaccine (HPV4, Gardasil) for use in males and
guidance from the Advisory Committee on immunization
practices (ACIP).
MMWR Morb Mortal Wkly Rep.
2010;59(20):630–632.
9. McAdam AJ, Sharpe AH. Infectious diseases. In: Kumar V,
Abbas AK, Fausto N, eds.
Robbins and Cotran Pathologic Basis
of Disease
. 8th ed. Philadelphia, PA: Saunders Elsevier; 2010:
351–352, 366, 374–377, 380.
SUMMARY CONCEPTS
■■
The vaginal-urogenital systemic STIs—chlamydial
infections, gonorrhea, and syphilis—can severely
affect the genital structures and manifest as
systemic infections.
■■
Gonorrheal and chlamydial infections can cause
a wide variety of genitourinary complications
in men and women, and both can cause ocular
disease and blindness in neonates born to
infected mothers.
■■
Syphilis is caused by a spirochete, T. pallidum.
It can produce widespread systemic effects and
is transferred to the fetus of infected mothers
through the placenta.
