1049
exually transmitted infections (STIs) encompass a
broad range of infectious diseases that are spread
by sexual contact.
1,2
Although the incidence of syphi-
lis and gonorrhea as reported in the professional
literature and public health statistics has decreased
slightly, the incidence of other STIs is increasing. The
actual figures are probably much higher than those
reported because many STIs are not reportable or not
reported. The agents of infection include bacteria,
viruses, fungi, and other microorganisms (see Chapter
14). The initial site of an STI may be the urethra, gen-
italia, rectum, or oral pharynx. The organisms that
cause these infections tend to be short lived outside
the host, so they usually depend on person-to-person
spread. The rates of many STIs are highest among
adolescents; more common in persons who have more
than one sexual partner; and it is not uncommon for
a person to be concurrently infected with more than
one type of STI.
Many factors contribute to the increased prevalence
and the continued spread of STIs, including the fact
that STIs are frequently asymptomatic, which promotes
the spread of infection by persons who are unaware
that they are carrying the infection. Furthermore, part-
ners of infected persons are often difficult to notify
and treat. Condoms could prevent the spread of many
STIs, but they often are not used or are used improp-
erly. In addition, there currently are no cures for viral
STIs (e.g., human immunodeficiency virus [HIV], her-
pes simplex virus, and human papilloma virus [HPV]);
although there are drugs available that may help to
manage the infections, they do not entirely control the
spread. Also, drug-resistant microorganisms are rap-
idly emerging, making treatment of many STIs more
difficult.
This chapter discusses the manifestations of STIs in
men and women in terms of infections of the external
genitalia, vaginal infections, and infections that have
genitourinary as well as systemic manifestations. HIV
infection is presented in Chapter 16.
S
Sexually
Transmitted
Infections
41
C h a p t e r
Infections of the External Genitalia
Human Papillomavirus Infection and Genital
Warts
Etiology and Pathogenesis
Diagnosis and Treatment
Genital Herpes
Etiology and Pathogenesis
Diagnosis and Treatment
Maternal/Neonatal Transmission
Chancroid
Lymphogranuloma Venereum
Vaginal Infections
Candidiasis
Trichomoniasis
Bacterial Vaginosis
Vaginal-Urogenital-Systemic Infections
Chlamydial Infections
Etiology and Pathogenesis
Diagnosis and Treatment
Gonorrhea
Etiology and Pathogenesis
Diagnosis and Treatment
Syphilis
Etiology and Pathogenesis
Diagnosis and Treatment
