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  • Chlamydia and gonorrhea are most common among 15- to 19-year-old women.
  • Throughout the United States, medical care for STDs can be provided to all adolescents without parental consent or knowledge.
  • Adolescent HIV testing and counseling can be performed without parental consent in the majority of U.S. states.
  • STDs in children may require official investigation for potential sexual abuse, if acquired after the neonatal period.
  • The presence of genital ulcers has been associated with an increased risk for HIV infection.
  • Many STDs occur concurrently. Therefore, evaluate and treat the patient appropriately at the initial examination.
  • Symptomatic trichomoniasis occurs primarily in women, but men may be silent carriers.
  • Treat sexual contacts of patients with primary, secondary, or early latent syphilis without waiting for clinical symptoms or a positive serologic test.
  • Diagnosis of genital herpes should not be based on clinical examination alone as other genital ulcerative lesions may have a similar appearance.
  • HIV screening is recommended for patients seeking STD treatment in all health care settings. The patient should be notified that testing will be performed unless the patient declines (opt-out screening).
  • Separate written consent for HIV testing should not be required. General consent for medical care should be considered sufficient consent for HIV testing.
  • If the cause of urethritis is unknown, treat with ceftriaxone 250 mg IM plus 10-day course of doxycycline.
  • Prepubertal boys presenting with epididymitis should be referred for investigation of congenital abnormalities of the urinary tract (i.e., vesicoureteral reflux).
  • Treatment of PID must include effective treatment of sex partners; HIV infection may be as high as 20%.

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Etiology

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Chlamydia is the most common sexually transmitted disease (STD) after human papillomavirus (HPV). It is the most common treatable STD in the United States, occurring in 10% or more of sexually active adolescent female patients attending STD clinics,1,2 with higher prevalence in patients living in inner cities or with lower socioeconomic status. Approximately 33% to 45% of patients with gonorrhea are co-infected with Chlamydia trachomatis. Patients with chlamydial infections are at increased risk of acquiring HIV infection.1

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Clinical Manifestations

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Presentation of symptoms is variable, but most women and many men are asymptomatic. Vaginal discharge, mild abdominal pain, dysuria, urinary frequency, or postcoital/intermenstrual bleeding is observed in women. Physical examination reveals pyuria without bacteruria, cervical edema, erythema, easily induced cervical bleeding, and mucopurulent discharge. In men, symptoms include dysuria, urethral itching, or clear to whitish urethral discharge. Often the discharge may be slight and noted as stained underwear in the morning resulting from minimal overnight discharge. Physical examination in men demonstrates meatal edema, erythema, and a whitish/clear discharge. Pyuria is common.3

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Diagnosis

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Culture of cervical swabs from women and urethral swabs in men for C. trachomatis remain the standard for diagnosis, but are labor-intensive and have variable sensitivity. It is still required for cases with medicolegal implications (i.e., sexual assault). When ...

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