Asymptomatic bacteriuria

Sexually transmitted disease (STD)

1) Disease description (causes and symptoms)

• Definition: A general term for various infectious diseases that can be transmitted through sexual activity. In the narrow sense, it refers to infections transmitted directly through sexual intercourse; in the broad sense, it includes infections that can also be transmitted through sexual contact (kissing, skin-to-skin contact, shared bedding, etc.).
• Main types of pathogens: Bacteria (gonococcus, Chlamydia, syphilis bacteria, etc.), viruses (HIV, HPV, herpes simplex virus (HSV), etc.), parasites (Trichomonas), fungi (Candida), and ectoparasites (pubic lice, scabies), among others.
• Pathophysiology summary: Pathogens enter through mucous membranes (genitals, anus, and oral cavity) or microscopic skin damage, causing local inflammation or systemic infection and immune responses. Some viruses (e.g., HPV and HIV) can result in chronic or latent infections.
• Main symptoms: Abnormal vaginal/urethral discharge, pruritus (itching), pain (during urination or sexual intercourse), redness, blisters, ulcers, warts, or swelling of the genitals, anus, or oral cavity, foul odor, fever, and generalized fatigue (in disseminated or severe cases). Symptoms vary greatly depending on the pathogen, and many cases are asymptomatic.

2) Treatment methods and precautions

• General principles
  • Targeted treatment based on accurate identification of the pathogen through testing takes priority.
  • Treatment is determined considering symptoms, pathogen, pregnancy status, and medication allergies.
  • Testing and simultaneous treatment of sexual contacts (contact tracing and treatment) are important for preventing reinfection.
  • Avoid sexual intercourse during the infection period (until treatment is completed or the treating physician confirms that it is safe).
• Drug treatment (examples; may vary according to local guidelines and the patient's condition)
  • Gonorrhea (urethritis/cervicitis): Injectable antibiotics such as ceftriaxone, plus treatment for accompanying infections if necessary
  • Nongonococcal urethritis (such as Chlamydia): Doxycycline or azithromycin
  • Syphilis: Intramuscular benzathine penicillin G (dosage and number of doses vary by stage)
  • Trichomoniasis: Metronidazole or tinidazole
  • Candidiasis (vaginal candidiasis): Topical antifungal agents or oral fluconazole
  • Herpes simplex (HSV): Acyclovir/valacyclovir (episodic or suppressive therapy may be used)
  • HPV-related lesions: Primarily lesion removal through cryotherapy, electrocautery, topical treatment, etc. The HPV vaccine has preventive effects.
  • HIV: Antiretroviral therapy (ART) — long-term medication treatment under specialist management
• Lifestyle management and prevention
  • Seek medical attention and testing immediately when symptoms occur.
  • Avoid sexual intercourse until the treatment period is complete and cure has been confirmed.
  • Condom use reduces risk but does not completely prevent all sexually transmitted diseases (HPV and HSV can be transmitted through skin-to-skin contact).
  • Those for whom HPV and hepatitis B vaccination is recommended should consider vaccination.
• Complications (precautions)
  • If treatment is delayed: pelvic inflammatory disease (PID), infertility, ectopic pregnancy, chronic pelvic pain, neonatal infection (transmission during delivery), and cancer (HPV-related cervical cancer), among others.
  • Be aware of side effects of certain antibiotics and medications (such as drug allergies and gastrointestinal symptoms).

3) Checklist before an outpatient visit (items to bring and records)

• Items to bring

  • A list of medications currently being taken (including English and Korean names) and a history of allergies
  • Recent test results, if available — urinalysis, blood tests, and previous sexually transmitted disease test results
  • Confirmation of pregnancy status (for women, menstrual cycle and possibility of pregnancy)
  • Insurance information and identification (as instructed by the hospital)

• Symptom-related records

  • When symptoms began and their progression (when they occurred, what symptoms were present, and patterns of worsening or improvement)
  • The color, amount, and odor of discharge, and the location and nature of pain (such as pain during urination or sexual intercourse)
  • Recent sexual contact history (number of recent partners, whether there was a new partner, whether condoms were used, and types of sexual intercourse: vaginal, anal, oral, etc.)
  • Whether the partner has symptoms and whether the partner can be contacted (necessary for contact treatment)

• Preparation for testing

  • Be advised that a genitourinary examination (visual inspection, palpation, smear, and specimen collection) may be performed during the visit.
  • Report any alcohol consumption or antibiotic use before testing (these may affect some tests).

• Examples of questions the doctor may ask during the outpatient visit (for preparing for the consultation)

  • "How many sexual partners have you had recently? Have you had a new partner?"
  • "What types of sexual intercourse (vaginal, anal, or oral) have you had recently? Did you use condoms?"
  • "Could you be pregnant? Are you pregnant?"

4) Examples of general questions to ask the doctor

• What side effects can be expected from this medication? What should I do if I have an allergic reaction?
• How long will it take for my infection to be cured? When should I have a follow-up test after treatment?
• Can I resume sexual intercourse during treatment? By when should my partner receive treatment and testing?
• Are there any additional tests I should have (e.g., HIV, hepatitis B, hepatitis C, or cervical cancer screening)?
• Do I need vaccinations (HPV or hepatitis B), and when is the recommended time to receive them?

5) Examples of disease-specific questions

• (If symptoms include vaginal discharge or urethral symptoms) What tests are used to identify the causative organism (NAAT, smear, or culture)? When will the test results be available?
• (If pregnancy is possible or the patient is pregnant) What impact can this infection have on pregnancy or childbirth, and what treatment options are available?
• (If an HPV-related lesion is suspected) Is there a risk that my lesion could progress to cancer? Do I need cervical cancer screening (or colposcopy or biopsy)?
• (After a positive/negative result) How should I inform my contacts, and what measures should be taken? By when is contact treatment recommended?

Note: Diagnosis and treatment vary depending on the individual's condition, pathogen, and local guidelines. Please consult your treating medical team to determine an accurate testing and treatment plan.