Q&A: Treatment Of Sexually Transmitted Disease

Sexually transmitted infections (STIs) are a major public health problem in both resource-rich and limited settings. STIs are frequently asymptomatic and can lead to various complications. The immediate goal of screening for STIs is to identify and treat infected persons before they develop complications and to identify, test, and treat their sex partners to prevent transmission and reinfections.

This article is for Medical Students & Professionals

This is a Question & Answer revision article designed for medical students and professionals preparing for the PLAB, MRCP or USMLE examinations. They are based on actual questions from these examinations. You may find the Sexually Transmitted Infection (STI) article more useful, or one of our many articles on Diseases & Conditions, Medical Syndromes, Health & Wellness or Home Remedies.

In this article:
Sexually transmitted infections Vs Cervicitis
MCQ exam: clinical scenario
MCQ exam: answer
MCQ exam: explanation

Sexually transmitted infections Vs Cervicitis

A sexually transmitted infection (STI) is an infection that can be passed from person to person when having sex. Complications of untreated sexually transmitted infections (STIs) include upper genital tract infections, infertility, chronic pelvic pain, cervical cancer, and chronic infection with hepatitis viruses and HIV. The approach to STI diagnosis and management is based upon disease or symptom-specific syndromes, including vaginal discharge, urethral discharge, ulcerative genital disease, nonulcerative genital disease, and pelvic pain. However, many patients have asymptomatic disease, which increases the risk of complications and sustained transmission in the community. Thus, screening is an important approach to identify and treat infected individuals, who would otherwise go undetected. Routine screening for all potential STIs in all patients is cost-prohibitive; targeted screening of asymptomatic patients in specified risk groups is more feasible.

Cervicitis refers to inflammation of the uterine cervix. The inflammation primarily affects the columnar epithelial cells of the endocervical glands but can also affect the squamous epithelium of the ectocervix. It may be due to an infectious or noninfectious etiology and may be acute or chronic. Acute cervicitis is often due to infection (eg, chlamydia, gonorrhea), although a specific infection cannot be determined in a large proportion of cases. Chronic cervicitis usually has a noninfectious source.

MCQ exam: clinical scenario

A 35 year old sexually promiscuous woman has painful lower abdominal cramps, fever and increased vaginal discharge. A pelvic examination demonstrates adnexal tenderness.

The most appropriate treatment would include:

a) Zidovudine (ZDV) plus lamivudine (3TC) plus IDV
b) Intravenous Trimethoprim/Sulfamethoxazole
c) Combination of ticarcillin and gentamicin
d) One-time dose of metronidazole
e) IM ceftriaxone plus doxycycline

MCQ exam: answer

The correct answer is E

MCQ exam: explanation

Distinguish pelvic inflammatory disease (PID) from simple cervicitis. Though the causative bacterial species are similar, outpatient PID should not be treated with single-dose oral agents but with IM ceftriaxone (250 mg) plus doxycycline for 14 days.

Reference(s)
1). UpToDate: Screening for sexually transmitted infections. Available online: https://www.uptodate.com/contents/screening-for-sexually-transmitted-infections
2). UpToDate: Acute cervicitis. Available online: https://www.uptodate.com/contents/acute-cervicitis
3). Medical Notes: Sexually Transmitted Infections (STIs). Available online: https://www.medicalnotes.info/2020/08/sexually-transmitted-infections-stis.html