Sexually transmitted diseases
By: editors, King K. Holmes ... [et al.] ; associate editors, Willard Cates, Jr., Stanley M. Lemon, Walter E. Stamm.
Contributors: Holmes, King K.
Edition: 2nd ed.
Publisher: McGraw-Hill
Published: 1990
Place of publication: New York
Language: eng
Number of pages: 1115
Subjects: Sexually transmitted diseases.; Sexually Transmitted Diseases.
Description: This chapter in a book on sexually transmitted diseases (STDs) considers the development of STD prevention and control programs in developing countries. The chapter opens by noting that the major public health problem posed by STDs in developing countries differs from the epidemiology seen in developed countries in higher incidence and prevalence rates, higher prevalence of genital ulcer diseases, higher incidence of complications and sequelae, and in facilitating the higher rate of heterosexual transmission of HIV infection. Priorities for STD control are seen to include 1) "safe sex" promotion, 2) adequate case management, 3) screening in high-risk groups, 4) case finding in prenatal populations, and 5) ocular prophylaxis in newborns. An adequate surveillance system to evaluate health promotion activities will depend upon clinician reporting, laboratory reporting, sentinel surveillance, and periodic surveys. The review continues by pointing to the importance of health education in changing sexual behavior and then turns to a practical approach to clinical care which includes diagnosing based on history, physical examination, and laboratory tests (if possible); speedy management; rational treatment choices; and only rare patient referral. Problem-oriented approaches to STD management are outlined for cases presenting with urethral discharge in settings where more than 80% of cases are due to gonorrhea and in settings where there is a laboratory available and for cases of pelvic inflammatory disease with no laboratory tests possible. Other topics considered are patient counseling and partner notification, early detection, mass treatment, and ocular prophylaxis at birth. In conclusion, the role of STD prevention in HIV prevention is underscored.

The complex clinical manifestation of urogenital infections in women impedes the prompt diagnosis and treatment of many sexually transmitted diseases (STDs), especially in developing countries where gynecologists may lack the requisite training or instruments. However, it is becoming increasingly possible to presumptively identify many common and potentially serious STDs in women on the basis of clinical observation of signs and symptoms supplemented with the selective use of relatively simple screening and confirmatory laboratory tests. This chapter sets forth an etiologic classification of female urogenital inflammatory syndromes and outlines the epidemiology, etiology, diagnosis, and treatment of cystitis/urethritis, vulvovaginitis, and cervicitis. Age-dependent differences in vaginal anatomy, physiology, and flora are discussed. Also presented is an algorithm for the management of sexually active women with dysuria.
Notes: Includes bibliographies and index.