Sexually Transmitted Diseases in the Female:

A Clinical Update

Chia-Ling Ttung, M.D.

(presented at the CAMS 2003 Annual Scientific Meeting)

The human papillomavirus still has the highest annual incidence of cases in the United States, followed closely by infections with trichomonas, and then chlamydia.  HPV has been implicated epidemiologically and molecularly in 99.8% of cases of cervical cancer that occur throughout the world.  HPV DNA has been detected in over 60% of young, sexually active females, although only 4-6% have cytological changes, and by 24 months, only 9% remained positive. Treatment cure rates are variable, ranging from 17-84% depending n the modality.  Trichomonas is an anaerobic parasite that typically presents with diffuse, malodorous, yellow-green discharge.  It's incidence has been on the rise; diagnosis is usually by microscopy with identification of the parasite; treatment is with Metronidazole.  Chlamydia is the most common bacterial STD in the United States, with 75% of infected women with few or no recognized symptoms.  About 40% of untreated women develop pelvic inflammatory disease.  Treatment is with Doxycycline or Levofloxacin or Ofloxacin.  The incidence of gonorrhea has been steadily decreasing in the United States, with the greatest concentration in the southeastern United States. The hallmark of infections is mucopurulent cervicitis.  Treatment is with Cefixime, Ceftriaxone, Ciprofloxacin, Ofloxacin, or Levofloxacin.  The incidence of herpes simplex virus infection also has been steadily rising; over 22% of adults over age 12 have HSV-2 antibodies.  Transmission rates from men to women is higher (17%) than from women to men (4%).  Fortunately, frequency of occurrences and asymptomatic viral shedding decreases over time.  What makes the diagnosis so difficult is that up to 90% of HSV-2 infected women have no clinical history of genital outbreaks.  No cure -- only control of symptoms and recurrences is possible with Acyclovir, Famcyclovir, or Valacyclovir.  Although the overall incidence of syphilis has declined, it still remains endemic in the Southeast African-American population.  Typically presents with primary and secondary stages; tertiary syphilis involves cardiovascular, neurological, and muscular symptoms.  Diagnosis is usually with serological testing; treatment is with Penicillin   Other STD's  --  including chancroid, molluscum contagiosum, lymphogranuloma venereum, and granuloma inguinale are fortunately rare in the United States.  Although condom use does prevent transmission of pathologic organisms transmitted by fluids through mucosal membranes, concurrent use of N-9 spermicides is NOT recommended as repeated use of the spermicides can result in genital lesions, thereby facilitating disease transmission.

(Dr. Tung is Clinical Assistant Professor of Obstetrics & Gynecology, Mt. Sinai Medical School.)