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The 5 “P’s” of taking a Sexual HistoryPartnersPrevention of pregnancyProtection from STDsPracticesPast history of STDs
Risk Factors for STDsAge 15-24African-AmericanUnmarriedGeographical residenceNew sex partner in past 60 daysMultiple sexual partnersHistory of prior STDIllicit drug useAdmission to a correctional facility or juvenile detentionMeeting partners on the internetContact with sex workers
Common STDsChlamydiaGonorrheaHIVSyphilisHSV (herpes simplex)HPV (human Papilloma)HepatitisTrichomoniasisPediculosis Pubis
Chlamydia Pathogenesis and TransmissionCaused by bacterium called Chlamydia trachomatisInfection occurs when bacterium invades the mucous membranes of mouth, anus, throat, vagina, or urethraEjaculation is not necessary for transmission
Chlamydia EpidemiologyThe most common reported infectious disease in the US1.2 million cases reported in 2008 (estimated 2.8 million total cases annually)Women rates 3 times higher than menAfrican-American women rates 8 times that of white womenWomen ages 15-24 have highest rates
Chlamydia Symptoms30% of men have no symptoms when infectedSymptoms in men can be discharge from the penis, testicular pain, prostate pain50% of women have symptoms including; vaginal discharge, pelvic pain, irregular bleeding, burning with urination, or pain with intercourse
Chlamydia DiagnosisSwab of the urethra or cervix or rectum for culture or urine sample for DNA probe testingAnnual testing is recommended for all women <26 years of age as well as for those older that have risk factorsMen are not routinely tested if asymptomatic
Additional Screening RecommendationsCDC recommends annual screening for MSM (men who have sex with men)Urethral and rectal Gonorrhea and Chlamydia culture Pharyngeal Gonorrhea culture
Chlamydia Complications40% of untreated in women will develop Pelvic Inflammatory Disease (PID) which can lead to scarring of the fallopian tubes causing infertility and increased risk for ectopic pregnancyComplications for untreated men are fewInfants can become infected at birth causing blindness and serious lung infection
Chlamydia TreatmentTreatment is the same for men and womenOne time treatment with antibiotic, azithromycin or doxycyclineSexual partners should be treated2008 guidelines recommend retesting women who have been treated in three monthsPatients are often treated for both GC and Chlamydia at the same time
Gonorrhea Pathogenesis and TransmissionCaused by a bacterium known as Neisseria gonorrhoeaeInfection occurs when bacteria invades the mucous membranes of the mouth, throat, anus, urethra, or vaginaEjaculation is not necessary for transmissionCan not be spread by toilet seats!
Gonorrhea EpidemiologySecond most common reported infectious disease in the US