STD update: screening and therapeutic options

Sexually transmitted diseases (STDs) are some of the most common causes of illness worldwide. Prevention and educational programs have helped to curb the rise of syphilis, gonorrhea, non-gonococcal urethritis, chancroid, granuloma inguinale and lymphogranuloma venereum within most of the United States. However, there are still "hot spots" in the southern U.S. and in non-Caucasian and urban populations, and these diseases continue to be prevalent in underdeveloped countries. Molluscum contagiosum and condyloma acuminata are increasing throughout the world. Herpes simplex is in the midst of an epidemic, having increased in the United States by 30% in the last 15 years. The failure of preventive programs to halt or reverse these epidemics stems from a combination of factors involving both patients and the medical profession. Patient and sexual partner ignorance, denial and deliberate deception play an important role. However, healthcare professional ignorance and failure to keep a high index of suspicion are also crucial. These issues are compounded by the quick-visit concept propagated by managed care, which dilutes most educational efforts. Teens particularly suffer from the lack of an unhurried discussion of sexual practices, and the sharp rise in STDs in this population reflects failure in the medical system. This paper will review the classical presentations of the various STDs, and will detail in what ways the coexistence of HIV disease alters clinical appearance and disease progress. Subtle variations in presentations that often lead to misdiagnosis are discussed. Diagnosis and treatment of STDs change rapidly as new developments occur, and the latest recommendations are examined. The ways in which these therapies differ in special need groups such as HIV and pregnancy are specifically detailed. The goal of this review is to arm the clinician with all of the necessary ingredients for timely and accurate diagnosis and treatment, as well as ways to assist the patient in dealing with these difficult topics. Patient education is highlighted, as it, along with practitioner expertise, is the key to disease eradication. We are the missing link in STD eradication.