Sexually Transmitted Diseases
With the emergence of acquired immunodeficiency syndrome (AIDS) in the 1980s, sexually transmitted diseases (STDs) received increased attention, although they have long been a major public health problem in all population groups and social strata. The most common agents are Chlamydia trachomatis, papillomavirus, herpes simplex virus, Neisseria gonorrhoeae, and the most worrisome, human immunodeficiency virus (HIV).Additional agents spread by sexual contact include hepatitis B, cytomegalovirus, syphilis, chancroid, and lymphogranuloma venereum. Table 70 – 1 lists the major sexually trans-mitted pathogens and the disease syndromes associated with them.
Depending on the pathogen, the disease produced may be local or systemic. For the lo-calized STDs, due to chlamydia for example, the most common manifestations are inflam-mation (eg, urethritis, cervicitis), which may or may not be noticed by the patient. In some cases, deeper structures become involved when the infection spreads beyond the local site by direct extension (eg, epididymitis, salpingitis). As with other infectious diseases, some of these can gain access to the bloodstream and produce systemic symptoms and spread to other organs. The systemic STDs produce infection beyond the genital site as part of their basic pathogenesis (eg, HIV, hepatitis B, and syphilis); syphilis does and HIV and hepatitis B do not produce a local genital lesion. The most common clinical syndromes are discussed next.