Currently, substantial numbers of adolescents engage in sexual
intercourse: 34% have experienced their sexual debut by
ninth grade and 63% by 12th grade.1 Although
these rates have slowly decreased from 15 years ago the adolescent
age group continues to be at the highest risk for STIs.
This chapter provides an overview of common STIs including the
pathogenesis, common clinical syndromes, diagnostic approach and
treatment for bacterial, fungal and viral infections (see Table 233-1), and for clinical For the most
contemporary guidelines on treatment regimens it is useful to refer
to the Centers for Disease Control and Prevention (CDC) web site
since alterations in optimal treatment approaches may change as
antibiotic-resistance patterns and the availability of specific
Table 233-1. Common Sexually Transmitted Diseases in Adolescents |Favorite Table|Download (.pdf)
Table 233-1. Common Sexually Transmitted Diseases in Adolescents
|Neisseria gonorrhoeae (Gonorrhea)
Gram (–) diplococcus ||Genetic ability to frequently change antigenic
surface structures||Uncomplicated||Male: Urethritis||See Table 233-2||Many asymptomatic infections in men and women|
|Urethritis||Gram stain [Gram (–) intracellular
|Endocervicitis||Screen all gonorrhea patients for syphilis,
chlamydia; R/O HIV|
|(See Chapter 274)||Pharyngitis||Culture|
|Proctitis||Female: Cervicitis||Treat all gonorrhea patients empirically for
|Complicated||Gram stain but ↓ sensitivity|
|Disseminated gonococcal infection||DNA probe and NAATs applied to genital and
|Pelvic inflammatory disease (PID)|
|Chlamydia trachomatis (Chlamydia) ||Obligate intracellular bacteria that cause
cell damage directly at end of their growth cycle and indirectly by
stimulation of inflammatory host immune response||Uncomplicated||Male: Non-gonococcal urethritis (NGU)||See Table 233-2||Many asymptomatic infections in men and women; most
common cause of urethritis in adolescent boys and cervicitis in adolescent
|Endocericitis||Negative gonococcal culture and/or |
|(See Chapter 259)||Urethritis||Gram stain > 4 PMNs/oil (mean of
5 hpf × 1000×) immersion
and no GNID|
|Urethral culture (+)|
|PID||DNA probe and NAATs applied to genital and FCU specimens|
|Pharyngitis||Female: Endocervicitis |
|Epididymitis||Mucopus and/or > 10–30 PMNs/hpf
on Gram stain (confirm with specific chlamydia test)|
|DNA probe and NAATs applied to genital and FCU specimens|
|Treponema pallidum (Syphilis) ||Enters through small abrasions in mucosa during
intercourse and stimulates a local immune response and spreads hematogenously (secondary)||Primary: chancre||Primary: treponemes on dark-field
G: 2.4 × 106 UI IM or, if penicillin
allergy, Doxycycline 100 mg PO b.i.d. or Tetracycline 500 mg PO
qid × 14 days||Screen with VDRL or RPR if contact history,
at diagnosis of any STI, or in population with high syphilis rate;
penicillin in pregnancy; screen for HIV|
|(See Chapter 288)||Secondary: generalized skin rash,
especially palms and soles|
|Secondary: VDRL or RPR, confirmed
by fluorescent antibody test (FTA–ABS) or microhemagglutination assay
|Early, late latent, and tertiary: rare in
|Herpes simplex virus (HSV)||Enters host through mucosa or ...|
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