Sexually Transmitted Disease Syndromes

Introduction

A constellation of symptoms and signs is characteristic of specific sexually transmitted disease syndromes. Common lower genital tract syndromes in women include urethritis, vaginitis, endocervicitis, and bacterial vaginosis (Table 3-16 and Fig. 3-7). In men, urethritis is the most common STD syndrome (Table 3-16, and Fig. 3-6), but epididymitis also occurs. Proctitis occurs in both sexes.

Bacterial Vaginosis

Bacterial vaginosis (BV) results from the replacement of vaginal Lactobacillus spp. with a number of anaerobic bacteria in high concentrations including Bacteroides spp., Mobiluncus spp., and other bacteria such as G. vaginalis and Mycoplasma hominis. Although BV is responsible for a majority of cases of abnormal vaginal discharge (half the women who meet the clinical criteria for the diagnosis have no symptoms), it is not exclusively sexually transmitted. The diagnosis criteria and treatment are outlined in Table 3-16 and Fig. 3-7.

Treatment of nonpregnant women is linked only to relief of symptoms; male partners of infected women are asymptomatic, and treating men does not affect the woman's disease course. Metronidazole, 500 mg orally BID for 7 days, yields a 95% cure rate compared to the alternative regimen of 2 g orally in a single dose (84% cure rate). Although experience is limited, use of intravaginal clindamycin cream, 2%, one applicator at bedtime for 7 days and metronidazole gel, 0.75%, one applicator BID for 7 days appear efficacious. Because BV may be related to prematurity and postpartum endometritis, treatment of pregnant women is encouraged using intravaginal clindamycin.

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