Sexually transmitted disease

Disease Description (Causes and Symptoms)

• Definition: Sexually transmitted diseases (sexually transmitted infections, STDs) is a collective term for infectious diseases that can be transmitted through sexual contact. This includes both infections transmitted through direct sexual intercourse (e.g., gonorrhea, syphilis, HIV, chancroid) and infections that may be transmitted through sexual contact (kissing, skin-to-skin contact, oral sex, anal sex, etc.) (e.g., herpes simplex, HPV, trichomoniasis, candidiasis, scabies, and pubic lice).
• Causes (major pathogens): Bacteria (gonococcus, Chlamydia, Treponema, etc.), viruses (HSV, HPV, HIV, HBV, etc.), parasites (Trichomonas), fungi (Candida), and ectoparasites (pubic lice, scabies), among others.
• Pathophysiology summary: Pathogens invade mucous membranes (the genital tract, urethra, anus, and oral cavity), causing local inflammation; some pathogens cause systemic infection or leave latent or chronic infections (e.g., HIV, HPV, and HSV). Some infections pass without symptoms, and asymptomatic carriers may become sources of transmission.
• Major symptoms: Abnormal vaginal discharge or urethral discharge, itching (pruritus), pain (painful urination, painful intercourse), rash, blisters, ulcers, perineal swelling and tenderness, foul odor, and fever or systemic symptoms (in some cases). Symptoms vary depending on the pathogen, and the infection may be asymptomatic.

Treatment Methods

• Diagnostic principles: Diagnosis is confirmed through symptom-specific tests (NAAT/PCR, culture, microscopic examination (wet mount), and serologic tests (syphilis, HIV, HBsAg, etc.)) together with a medical history and physical examination.
• Examples of major medications and treatments
  • Gonococcal infection (gonorrhea): The current standard is injectable ceftriaxone plus oral concurrent treatment when necessary (varies according to guidelines). Testing and antibiotic resistance should be taken into consideration.
  • Chlamydia: Azithromycin (single dose) or doxycycline (for at least 7 days).
  • Syphilis: Intramuscular benzathine penicillin G — the dosage and follow-up testing depend on the stage.
  • Trichomoniasis: Oral metronidazole or tinidazole.
  • Vulvovaginal candidiasis: Topical or oral antifungal agents (such as clotrimazole and fluconazole).
  • Herpes simplex (HSV): Antiviral drugs such as acyclovir and valacyclovir (short-term treatment for outbreaks or suppressive treatment to prevent recurrences).
  • HPV (human papillomavirus): There are no antiviral drugs that eliminate the virus itself. Condylomata (warts) are treated with topical treatments (such as podophyllotoxin and imiquimod), cauterization, or excision. Prevention includes vaccination (HPV vaccine).
  • HIV: Antiretroviral therapy (ART) — early treatment is recommended after infection.
  • Pubic lice and scabies: Topical or oral prescriptions such as permethrin and ivermectin.
• Procedures/surgery: Removal procedures may be needed for HPV-related lesions or complications (such as severe condylomatous lesions), and surgical treatment may be required for severe complications.
• Lifestyle management and additional considerations:
  • Avoid sexual intercourse before and during completion of treatment (condom use alone may not completely prevent transmission of some infections).
  • Testing for coinfections (HIV, HBV, etc.) is recommended.
  • Medication choices and treatment plans differ during pregnancy and breastfeeding — be sure to consult a healthcare professional.

Precautions (Points to Note, Risk of Complications, and Self-Care Considerations)

• Points to note
  • Regardless of whether symptoms have disappeared, medication must be taken or treatment completed through the end of the prescribed treatment period.
  • Sexual partners should be notified and encouraged to undergo examination and treatment together to prevent reinfection.
  • Condoms reduce the risk of transmission of many STDs, but may not completely block some lesions transmitted through skin-to-skin contact, such as HPV and herpes.
  • Before and during pregnancy, diagnosis and treatment of certain STDs are important (e.g., syphilis, HIV, and trichomoniasis can affect the fetus or newborn).
• Complications
  • Pelvic inflammatory disease (PID) → increased risk of infertility and ectopic pregnancy (mainly due to Chlamydia and gonococcus).
  • Chronic pelvic pain, sexual dysfunction, and neonatal infection (obstetric transmission: neonatal HSV infection, neonatal effects of syphilis and gonorrhea, etc.).
  • Chronic infection (the association between HPV and cervical cancer, and the need for chronic management of HIV).
• Self-care considerations
  • Douching is not recommended (it may increase the risk of infection and interfere with diagnosis).
  • Make a habit of monitoring genital and systemic symptoms and visit a medical institution immediately if changes occur.
  • Vaccines (HPV and hepatitis B) are effective for prevention, so determine whether they are recommended for you.

Outpatient Visit Checklist (Including Items to Bring and Example Questions)

• Items to bring (recommended)
  • A list of medications and supplements currently being taken (including dosage and duration of use)
  • Allergy history (medications and drugs)
  • Results of recently performed tests (records and values, if possible)
  • Sexual history (when recent sexual contact occurred, number of partners, types of sexual intercourse (vaginal, anal, oral), and whether condoms were used)
  • When symptoms began and their progression (color, amount, and odor of discharge; pain; presence or absence of a rash, etc.)
  • Possibility of pregnancy or whether currently pregnant (women)
• Precautions before testing
  • When planning a urine NAAT test, avoiding urination within 1 hour before the test may help improve test sensitivity (varies according to guidelines).
  • To improve accuracy, avoid sexual intercourse, douching, and use of vaginal medications within 24–48 hours before collection of a vaginal or urethral specimen.
• Information that is helpful to provide to the healthcare professional during the visit
  • Whether the recent partner has symptoms (and, if possible, the partner's diagnosis and treatment status)
  • Plans for pregnancy or current pregnancy status
• Questions to make a note of before the visit (including examples):
  • What diagnosis is suspected based on my current symptoms?
  • What tests are needed? (Does this include HIV, syphilis, and HBsAg?)
  • What are the treatment options and expected treatment duration?
  • What activities should be prohibited or approached with caution during treatment (including when to resume sexual intercourse)?

Examples of General Questions to Ask the Doctor

• What are the expected side effects of this medication (or treatment), and what should I do if side effects occur?
• What is the prognosis of this disease? How likely is it to recur?
• Is follow-up testing (timing and type of test) needed after treatment?
• By when should I notify my sexual partner, and when should we undergo testing and treatment together?
• How does treatment differ if I am planning a pregnancy or am currently pregnant?

Examples of Disease-Specific Questions (1–2)

• If syphilis is suspected: "How will treatment effectiveness be monitored using the serologic test results (RPR/VDRL and treponemal-specific tests)? How many months after treatment should I have follow-up testing, and which indicators will be used?"
• If gonorrhea or chlamydia is suspected: "My test results are negative, but my symptoms persist. What additional tests should be performed (such as culture or specimens from other sites)?"

(The above information is provided for reference based on general medical guidelines. Diagnosis and treatment plans may vary depending on an individual's condition, so decisions should be made in consultation with the attending physician during an actual medical visit.)