Sexually transmitted infections

The term "sexually transmitted infections" (STIs) refers to a group of infections that are mainly transmitted via sexual intercourse. The most common symptoms of STIs are pain in the suprapubic and genital area, urethral or vaginal discharge, and genital lesions, which may or may not be painful. Some STIs (e.g., HPV) may induce or predispose to malignant changes. The majority of STIs are asymptomatic, and therefore easily spread. If a patient is already infected with an STI, they are predisposed to coinfections with further STIs. There are various treatment options for each STI, with simultaneous treatment of the partner often necessary to prevent recurrent infections. In some cases, health care providers are required by law to report cases of STIs to county and health state departments (e.g., HIV, hepatitis B).

The following applies to patients diagnosed with a bacterial STI or trichomoniasis; patients with viral STIs (herpes simplex, HPV, HIV, hepatitis B, hepatitis C) need to take lifelong precautions. See the respective articles for more information.

• Contact tracing of all sexual partners within the last 60 days (even if asymptomatic)
  • Offer expedited partner therapy (see below) when possible. ^[3][4]
  • If expedited partner therapy is not possible, advise affected sexual partners to receive STI testing.
• Expedited partner therapy: the treatment of sexual partners of patients who have been diagnosed with STIs by giving prescriptions to the index patients
  • If chlamydia has been ruled out in the patient (only gonorrhea test reported positive): single-dose cefixime PO
  • If chlamydia has not been ruled out: single-dose cefixime PO PLUS doxycycline PO for 7 days ^[2]
• Avoid unprotected sex until all of the following criteria are met:
  • Completion of 7-day treatment regimen OR 7 days have passed since a single-dose treatment.
  • All symptoms have resolved.
  • Any current sexual partners have also met the above criteria.
• Prevent STIs in patients and partners: See “Prevention” below.
• Retest individuals to check for reinfection.
  • In patients with HIV: Test at 3, 6, 9, 12, and 24 months.
  • Genitourinary chlamydia, LGV, gonorrhea, or (in patients with female genitalia) trichomoniasis: at 3 months
  • Syphilis: 6 and 12 months
  • Latent syphilis: additional test at 24 months

Sexual partners must be treated simultaneously to avoid reinfections.

• Preexposure prophylaxis
  • Safe sex practices
    • Abstinence
    • Condom use during vaginal sex or anal sex
    • Dental dam use during oral sex
    • Mutual monogamy
    • Reducing number of sex partners
  • Vaccination
    • HPV, HBV, and HAV vaccine
    • See “ACIP immunization schedule” for details.
  • Disease-specific prophylaxis: See “HIV preexposure prophylaxis” for details.
• Adherence to screening guidelines for STIs
• Postexposure prophylaxis
  • HIV postexposure prophylaxis
  • Hepatitis B postexposure prophylaxis
  • Antibiotic postexposure prophylaxis (e.g., doxycycline for chlamydia or syphilis) ^[5]
  • Self-sampling/-testing and pooled sampling
  • Expedited partner therapy

• One-Minute Telegram 70-2023-2/3: USPSTF reaffirms: Do not screen asymptomatic patients for HSV!

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