Update in Sexually Transmitted Infections
Preface S e x u a l l y Tr a n s m i t t e d Infections
Jeanne M. Marrazzo, MD, MPH Editor
The need for effective prevention and management of sexually transmitted diseases (STI) continues to be as compelling as it was in the pre-AIDS era. In the United States, most new HIV infections continue to occur in men who have sex with men (MSM), a population that also now has the highest incidence of syphilis—an infection many clinicians had experience with primarily in the pre-AIDS era, and one completely new to many young clinicians. This protean disease continues to present diagnostic and management challenges to those who care for patients at risk, particularly when coinfection with HIV is involved. Rates of other reportable STI either have not declined or have actually increased in the last decade. In 2011, more than 1.4 million cases of Clamydia trachomatis were reported to the Centers for Disease Control and Prevention (CDC). Despite this, interventions to detect this common infection in populations most at risk are infrequently performed. Rates of routine annual screening for genital chlamydial infections in young women, especially adolescents, remain suboptimal, and many women at low risk (primarily those over age 30 years without other indications) are tested unnecessarily. Moreover, recommendations to routinely retest infected persons 4 to 6 months after treatment (a practice termed repeat testing, which is distinct from test-of-cure) are not frequently adhered to—despite the fact that this approach detects repeat infection in approximately 15% to 40% of those tested. The relentless evolution of antimicrobial resistance in Neisseria gonorrhoeae continues to present a major challenge. Fluoroquinolones are no longer effective due to widespread resistance, a trend especially notable in MSM. We are now effectively left with only a single class of antibiotics—the cephalosporins—that reliably treat this infection. Concern for nascent development of resistance to this class is looming. Finally, sexual transmission of hepatitis C has been increasingly recognized in MSM who report sexual practices involving exposure to blood or even minimal trauma to the rectal mucosa.
Infect Dis Clin N Am 27 (2013) ix–x http://dx.doi.org/10.1016/j.idc.2013.09.007 0891-5520/13/$ – see front matter Ó 2013 Elsevier Inc. All rights reserved.
id.theclinics.com
x
Preface
These worrisome trends emphasize the need for physicians to be aware of emerging STI-related challenges, and of the availability of guidelines and tools to help manage their patients. The CDC Sexually Transmitted Disease Treatment Guidelines are available at www.cdc.gov/std/treatment and are an invaluable resource. As reviewed in the following articles, positive developments include the licensure immunization against several common genital human papillomavirus types for women and men. Against the backdrop of providing key epidemiologic trends for each disease, the authors have emphasized that clinical recognition and diagnosis of these infections are not always straightforward. Moreover, therapeutic management of some STI can be complicated by limited diagnostic capability, coinfections, and immune compromise due to HIV infection. In addition to biomedical management of the individual patient who is affected by STI, clinicians must remember that prevention of these infections requires combinations of biomedical, behavioral, and structural interventions. Jeanne M. Marrazzo, MD, MPH Division of Allergy & Infectious Diseases Seattle STD/HIV Prevention Training Center University of Washington Box 359932, Harborview Medical Center, 325 9th Avenue Seattle, WA 98104, USA E-mail address: [email protected] SELECTED READINGS
Centers for Disease Control and Prevention. Sexually transmitted disease treatment guidelines. MMWR Recomm Rep 2010;59. Wandeler G, Gsponer T, Bregenzer A, et al. Hepatitis C virus infections in the Swiss HIV Cohort Study: a rapidly evolving epidemic. Clin Infect Dis 2012;55:1408–16. Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59:1–110.
Preface S e x u a l l y Tr a n s m i t t e d Infections
Jeanne M. Marrazzo, MD, MPH Editor
The need for effective prevention and management of sexually transmitted diseases (STI) continues to be as compelling as it was in the pre-AIDS era. In the United States, most new HIV infections continue to occur in men who have sex with men (MSM), a population that also now has the highest incidence of syphilis—an infection many clinicians had experience with primarily in the pre-AIDS era, and one completely new to many young clinicians. This protean disease continues to present diagnostic and management challenges to those who care for patients at risk, particularly when coinfection with HIV is involved. Rates of other reportable STI either have not declined or have actually increased in the last decade. In 2011, more than 1.4 million cases of Clamydia trachomatis were reported to the Centers for Disease Control and Prevention (CDC). Despite this, interventions to detect this common infection in populations most at risk are infrequently performed. Rates of routine annual screening for genital chlamydial infections in young women, especially adolescents, remain suboptimal, and many women at low risk (primarily those over age 30 years without other indications) are tested unnecessarily. Moreover, recommendations to routinely retest infected persons 4 to 6 months after treatment (a practice termed repeat testing, which is distinct from test-of-cure) are not frequently adhered to—despite the fact that this approach detects repeat infection in approximately 15% to 40% of those tested. The relentless evolution of antimicrobial resistance in Neisseria gonorrhoeae continues to present a major challenge. Fluoroquinolones are no longer effective due to widespread resistance, a trend especially notable in MSM. We are now effectively left with only a single class of antibiotics—the cephalosporins—that reliably treat this infection. Concern for nascent development of resistance to this class is looming. Finally, sexual transmission of hepatitis C has been increasingly recognized in MSM who report sexual practices involving exposure to blood or even minimal trauma to the rectal mucosa.
Infect Dis Clin N Am 27 (2013) ix–x http://dx.doi.org/10.1016/j.idc.2013.09.007 0891-5520/13/$ – see front matter Ó 2013 Elsevier Inc. All rights reserved.
id.theclinics.com
x
Preface
These worrisome trends emphasize the need for physicians to be aware of emerging STI-related challenges, and of the availability of guidelines and tools to help manage their patients. The CDC Sexually Transmitted Disease Treatment Guidelines are available at www.cdc.gov/std/treatment and are an invaluable resource. As reviewed in the following articles, positive developments include the licensure immunization against several common genital human papillomavirus types for women and men. Against the backdrop of providing key epidemiologic trends for each disease, the authors have emphasized that clinical recognition and diagnosis of these infections are not always straightforward. Moreover, therapeutic management of some STI can be complicated by limited diagnostic capability, coinfections, and immune compromise due to HIV infection. In addition to biomedical management of the individual patient who is affected by STI, clinicians must remember that prevention of these infections requires combinations of biomedical, behavioral, and structural interventions. Jeanne M. Marrazzo, MD, MPH Division of Allergy & Infectious Diseases Seattle STD/HIV Prevention Training Center University of Washington Box 359932, Harborview Medical Center, 325 9th Avenue Seattle, WA 98104, USA E-mail address: [email protected] SELECTED READINGS
Centers for Disease Control and Prevention. Sexually transmitted disease treatment guidelines. MMWR Recomm Rep 2010;59. Wandeler G, Gsponer T, Bregenzer A, et al. Hepatitis C virus infections in the Swiss HIV Cohort Study: a rapidly evolving epidemic. Clin Infect Dis 2012;55:1408–16. Workowski KA, Berman S, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59:1–110.
