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Chapter 228: Sexually Transmitted Infections

Loris Y. Hwang; Anna-Barbara Moscicki

INTRODUCTION

Sexual activity is common among adolescents. A large ongoing national survey of US high school students reported that 24% of adolescents have had sexual intercourse by ninth grade and 58.1% by 12th grade, based on data collected in 2014 to 2015. Although rates of sexual activity have slowly decreased during 1991 to 2015, the adolescent age group continues to be at the highest risk for common sexually transmitted infections (STIs) compared to other age groups.

This chapter provides an overview of STIs including the common clinical presentations, screening guidelines, and treatment for bacterial, fungal, protozoal, and viral infections. For the most up-to-date clinical guidelines on treatment regimens, readers are strongly advised to refer to the Centers for Disease Control and Prevention (CDC) web site since the optimal treatment regimens are frequently updated based on antibiotic resistance patterns and logistical availability of specific medications in the United States. Table 228-1 summarizes the major points about chlamydia, gonorrhea, human papillomavirus (HPV), Trichomonas, and Candida. Detailed discussions of syphilis, human immunodeficiency virus (HIV), and herpes simplex virus (HSV) infections are found in Chapters 283, 310, and 304, respectively.

TABLE 228-1COMMON SEXUALLY TRANSMITTED INFECTIONS (STIS) AND VAGINITIS IN ADOLESCENTS
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TABLE 228-1COMMON SEXUALLY TRANSMITTED INFECTIONS (STIS) AND VAGINITIS IN ADOLESCENTS
STI Clinical Presentations Screening/Diagnosis Recommended Treatmenta Alternative Treatmenta Comments
Chlamydia trachomatis (chlamydia)

Females:

Endocervicitis

Pelvic inflammatory disease

Males:

Epididymitis

Both females and males:

Urethritis

Pharyngitis

Proctitis

Conjunctivitis

Females:

NAATs: self-collected or clinician-collected vaginal specimen preferred, endocervical site acceptable, urine is less sensitive

 

Males:

NAATs: urine preferred, urethral specimen acceptable

 

Extragenital sites:

NAATS: rectal, oropharyngeal, if validated according to CLIA regulations

 

Suspected sexual abuse cases in younger children:

Culture (better specificity than NAAT in younger children), recommend referral to clinic for specialized medicolegal evaluation

Uncomplicated Chlamydia:

Azithromycin 1 g orally single dose

OR

Doxycycline 100 mg orally 2 times a day for 7 days

Uncomplicated Chlamydia:

Erythromycin base 500 mg orally 4 times a day for 7 days

OR

Erythromycin ethylsuccinate 800 mg orally 4 times a day for 7 days

OR

Levofloxacin 500 mg orally once daily for 7 days

OR

Ofloxacin 300 mg orally 2 times a day for 7 days

 Abstain from sex at least 7 days after single-dose treatment or after 7-day antibiotic course and until all partners treated; recommend prompt evaluation and treatment of all partners from past 60 days; offer testing for other STIs; encourage consistent condom use; retest in 3 months to monitor for reinfection
Neisseria gonorrhoeae (gonorrhea)

Females:

Endocervicitis

Pelvic inflammatory disease

Males:

Epididymitis

Both females and males:

Urethritis

Pharyngitis

Proctitis

Conjunctivitis

Disseminated gonococcal infection

Females:

NAATs: self-collected or clinician-collected vaginal specimen preferred, endocervical site acceptable, urine is less sensitive

Males:

NAATs: urine preferred, urethral specimen acceptable

Extragenital sites:

NAATS: rectal, oropharyngeal, if validated according to CLIA ...

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