Current Approaches in the Diagnosis and Treatment of Sexually Transmitted Diseases

Yıl 2021, Cilt: 23 Sayı: 1, 143 - 156, 30.04.2021

Gökçe Ayvaz Sedat Kaygusuz

https://doi.org/10.24938/kutfd.884916

Öz

The term sexually transmitted infection includes various diseases caused by pathogens transmitted through sexual activity. The diseases can be acute or chronic, resulting in lesions with varying characteristics as well as infertility, weakness or even death. While some sexually transmitted diseases progress with ulcers, some of them can present with discharge or both clinical presentations. Syphilis, genital herpes infection, chancroid, granuloma inguinale and lymphogranuloma venereum usually progress with ulcers while gonococcal and chlamydia infections, bacterial vaginosis, trichomonas vaginalis and vulvovaginal candidiasis usually progress with discharge.

While culture is successful in diagnosis for some diseases, the diagnosis of others are based on clinical criteria. In many of the diseases, direct microscopic examination of the exudate taken from the tissue or lesion, nucleic acid amplification tests and serological tests are more successful.

The goals of treatment are to eliminate the pathogen, to eliminate lesions and symptoms, to reduce the risk of contagiousness and recurrent infection, and to eliminate complications that may occur in the late period. Along with appropriate antimicrobial therapy, partner treatment and management is also very important.

Anahtar Kelimeler

Sexually transmitted infection, ulcer, discharge, culture, nucleic acid amplification test, serological test

CİNSEL YOLLA BULAŞAN HASTALIKLARIN TANI VE TEDAVİSİNDE GÜNCEL YAKLAŞIMLAR

Öz

Cinsel yolla bulaşan enfeksiyon terimi, cinsel aktivite yoluyla bulaşan patojenlerin neden olduğu, akut ya da kronik olabilen, değişik özelliklerde lezyonlarla seyreden, infertilite, düşkünlük hatta ölümle sonuçlanabilen çeşitli hastalıkları kapsamaktadır. Cinsel yolla bulaşan enfeksiyonların bir kısmı döküntü ve ülserle seyrederken, bir kısmı da akıntı ya da her iki klinik tablo ile birlikte görülebilmektedir. Sifilis, genital herpes enfeksiyonu, şankroid, granuloma inguinale ve lenfogranuloma venereum genellikle ülser ile seyrederken; gonokok ve klamidya enfeksiyonları, bakteriyel vajinozis, trikomonas vajinalis ve vulvovajinal kandidiazis gibi bazı hastalıklar genellikle akıntı ile seyretmektedir.

Tanı için bir kısım hastalıkta kültür altın standart iken, bir kısmının tanısı klinik kriterlere dayanmakta, birçoğunda ise doku veya lezyondaki eksudanın direkt mikroskopik incelemesi, nükleik asit amplifikasyon testleri ve serolojik testler (antijen veya antikor tarama) öne çıkmaktadır.

Tedavinin amaçları patojenin elimine edilmesi, lezyon ve semptomların ortadan kalkması, bulaştırıcılık ve rekürren enfeksiyon riskinin azaltılması ile geç dönemde görülebilecek komplikasyonların ortadan kalkmasıdır. Uygun antimikrobiyal tedavi ile birlikte partner tedavisi ve yönetimi de kür için önemlidir.  

Anahtar Kelimeler

Cinsel yolla bulaşan enfeksiyon, ülser, akıntı, kültür, nükleik asit amplifikasyon testi, serolojik test

Kaynakça

• 1. World Health Organization, Global incidence and prevalence of selected curable sexually transmitted infections 2008. Accessed date: 2012: http://www.who.int/reproductivehealth/publications/rtis/stisestimates/en/.
• 2. Workowski KA, Bolan GA. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):25-94.
• 3. Augenbraun MH. Genital skin and mucous membrane lesions. In: Mandell GL, Bennett JE, Dolin R. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 8th ed. Philadelphia PA. Elsevier Saunders, 2015:1340-70.
• 4. Uptodate.com. Syphilis: Screening and diagnostic testing. Accessed date: 09 February 2021:https://www.uptodate.com/contents/syphilis-screening-and-diagnostic-testing?search=sifilis%20darkfield&sectionRank=1&usage_type=default&anchor=H7&source=machineLearning&selectedTitle=1~150&display_rank=1#H7.
• 5. Romanowski B, Sutherland R, Fick GH, Mooney D, Love EJ. Serologic response to treatment of infectious syphilis. Ann Intern Med. 1991;114(12):1005-9.
• 6. CDC. Syphilis testing algorithms using treponemal tests for initial screening-four laboratories, New York City, 2005-2006. MMWR. 2008;57(32):872-5.
• 7. CDC. Discordant results from reverse sequence syphilis screening-five laboratories, United States, 2006-2010. MMWR. 2011;60(5):133-7.
• 8. Golden MR, Marra CM, Holmes KK. Update on syphilis. JAMA. 2003;290(11):1510-14.
• 9. Cohen SE, Klausner JD, Engelman J, Philip S. Syphilis in the modern era. Infect Dis Clin North Am. 2013;27(4):705-22.
• 10. Clement ME, Okeke NL, Hicks CB. Treatment of syphilis: a systematic review. JAMA. 2014;312(18):1905-17.
• 11. Wong T, Singh AE, De P. Primary syphilis: serological treatment response to doxycycline/tetracycline versus benzathine penicillin. Am J Med. 2008;121(10):903-8.
• 12. Hook 3rd EW, Roddy RE, Handsfield HH. Ceftriaxone therapy for incubating and early syphilis. J Infect Dis. 1988;158(4):881-4.
• 13. Shann S, Wilson J. Treatment of neurosyphilis with ceftriaxone. Sex Transm Infect. 2003;79(5):415-6.
• 14. Korkusuz R. Şenoğlu S. Syphilis seroprevalence and associated risk factors in HIV-infected individuals. Mediterr J Infect Microb Antimicrob. 2020;9:13.
• 15. Vestergaard T. [Genital herpes]. Ugeskr Laeger. 2018;180(20):V01180024.
• 16. Romero L, Huerfano C, Grillo-Ardila CF. Macrolides for treatment of Haemophilus ducreyi infection in sexually active adults. Cochrane Database Syst Rev. 2017;12(12):CD012492.
• 17. Belda Junior W. Donovanosis. An Bras Dermatol. 2020;95(6):675-83.
• 18. McLean CA, Stoner BP, Workowski KA. Treatment of lymphogranuloma venereum. Clin Infect Dis. 2007;44(Suppl 3):S147-52.
• 19. Uptodate.com. Clinical manifestations and diagnosis of Neisseria gonorrhoeae infection in adults and adolescents. Accessed date: 09 February 2021. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-neisseria-gonorrhoeae-infection-in-adults-and-adolescents?search=gonokok%20diagnose&sectionRank=2&usage_type=default&anchor=H1235604945&source=machineLearning&selectedTitle=1~150&display_rank=1#H790871084.
• 20. Rice PA, Shafer WM, Ram S, Jerse AE. Neisseria gonorrhoeae: Drug resistance, mouse models, and vaccine development. Annu Rev Microbiol. 2017;71:665-86.
• 21. Unemo M, Shafer WM. Antimicrobial resistance in Neisseria gonorrhoeae in the 21st century: past, evolution, and future. Clin Microbiol Rev. 2014;27(3):587-613.
• 22. Fuchs W, Brockmeyer NH. Sexually transmitted infections. J Dtsch Dermatol Ges. 2014;12(6):451-63.
• 23. Kirkcaldy RD, Weinstock HS, Moore PC, Philip SS, Wiesenfeld HC, Papp JR et al. The efficacy and safety of gentamicin plus azithromycin and gemifloxacin plus azithromycin as treatment of uncomplicated gonorrhea. Clin Infect Dis. 2014;59(8):1083-91.
• 24. LeFevre ML. USPSTF: screening for chlamydia and gonorrhea. Ann Intern Med. 2014;161(12):902-10.
• 25. Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. Prevention of pelvic inflammatory disease by screening for cervical chlamydial infection. N Engl J Med. 1996;334(21):1362-6.
• 26. Kamwendo F, Forslin L, Bodin L, Danielson D. Decreasing incidences of gonorrhea- and chlamydia-associated acute pelvic inflammatory disease: a 25-year study from an urban area of central Sweden. Sex Transm Dis. 1996;23(5):384-91.
• 27. Masek BJ, Arora N, Quinn N, Aumakhan B, Holden J, Hardick A et al. Performance of three nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae by use of self-collected vaginal swabs obtained via an Internet-based screening program. J Clin Microbiol. 2009;47(6):1663-7.
• 28. McCormack D, Koons K. Sexually transmitted infections. Emerg Med Clin North Am. 2019;37(4):725-38.
• 29. Moncada J, Schachter J, Liska S, Shayevich C, Klausner JD. Nucleic acid amplification tests in the diagnosis of chlamydial and gonococcal infections of the oropharynx and rectum in men who have sex with men. Sex Transm Dis. 2008;35(7):637-42.
• 30. Bachmann LH, Johnson RE, Cheng H, Markowitz L, Papp JR, Palella Jr FJ et al. Nucleic acid amplification tests for diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis rectal infections. J Clin Microbiol. 2010;48(5):1827-32.
• 31. Renault CA, Israelski DM, Levy V, Fujikawa BK, Kellogg TA, Klausner JD. Time to clearance of Chlamydia trachomatis ribosomal RNA in women treated for chlamydial infection. Sex Health. 2011;8(1):69-73.
• 32. Hosenfeld CB, Workowski KA, Berman S, Zaidi A, Dyson J, Mosure D et al. Repeat infection with chlamydia and gonorrhea among females: a systematic review of the literature. Sex Transm Dis. 2009;36(8):478-89.
• 33. Fung M, Scott KC, Kent CK, Klausner JD. Chlamydial and gonococcal reinfection among men: a systematic review of data to evaluate the need for retesting. Sex Transm Infect. 2007;83(4):304-9.
• 34. Golden MR, Whittington WL, Handsfield HH, Hughes JP, Stamm WE, Hogben M et al. Effect of expedited treatment of sex partners on recurrent or persistent gonorrhea or chlamydial infection. N Engl J Med. 2005;352(7):676-85.
• 35. Kissinger P, Mohammed H, Richardson-Alston G, Leichliter J, Taylor S, Martin D et al. Patient delivered partner treatment for male urethritis: a randomized, controlled trial. Clin Infect Dis. 2005;41(5):623-9.
• 36. Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M et al. The prevalence of bacterial vaginosis in the United States, 2001-2004: associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis. 2007;34(11):864-9.
• 37. Fethers KA, Fairley CK, Morton A, Hocking JS, Hopkins C, Kennedy LJ et al. Early sexual experiences and risk factors for bacterial vaginosis. J Infect Dis. 2009;200(11):1662-70.
• 38. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74(1):14-22.
• 39. Uptodate. Bacterial vaginosis: Clinical manifestations and diagnosis. Accessed date; 09 February 2021:https://www.uptodate.com/contents/search?search=clue%20cell&sp=0&searchType=PLAIN_TEXT&source=USER_INPUT&searchControl=TOP_PULLDOWN&searchOffset=1&autoComplete=false&language=tr&max=10&index=&autoCompleteTerm=
• 40. Mehta SD. Systematic review of randomized trials of treatment of male sexual partners for improved bacteria vaginosis outcomes in women. Sex Transm Dis. 2012;39(10):822-30.
• 41. Briggs GC, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation, 9th ed. Philadelphia PA. Lippincott Williams & Wilkins, 2011.
• 42. Sena AC, Miller WC, Hobbs MM, Schwebke JR, Leone PA, Swygard H et al. Trichomonas vaginalis infection in male sexual partners: implications for diagnosis, treatment, and prevention. Clin Infect Dis. 2007;44(1):13-22.
• 43. Van Der Pol B, Williams JA, Orr DP, Batteiger BE, Fortenberry JD. Prevalence, incidence, natural history, and response to treatment of Trichomonas vaginalis infection among adolescent women. J Infect Dis. 2005;192(12):2039-44.
• 44. Edwards T, Burke P, Smalley H, Hobbs G. Trichomonas vaginalis: Clinical relevance, pathogenicity and diagnosis. Crit Rev Microbiol. 2016;42(3):406-17.
• 45. Helms DJ, Mosure DJ, Secor WE, Workowski KA. Management of Trichomonas vaginalis in women with suspected metronidazole hypersensitivity. Am J Obstet Gynecol. 2008;198:e371-7.
• 46. Erickson SH, Oppenheim GL, Smith GH. Metronidazole in breast milk. Obstet Gynecol. 1981;57(1):48-50.
• 47. Uptodate. Candida vulvovaginitis: Clinical manifestations and diagnosis. Accessed date; 21 February 2021. https://www.uptodate.com/contents/candida-vulvovaginitis-clinical-manifestations-and-diagnosis?search=vulvovaginal%20candidiasis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H6.
• 48. Ünal E, Gönül M, Çakmak S, Iydal AY, Kılıç A, Gül Ü et al. Serological test results of sexually transmitted diseases in patients with condyloma acuminata. Postepy Dermatol Alergol. 2015;32(4):286-289.