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STD Comparison Chart

Chlamydia Gonorrhea HPV Genital Warts Genital Herpes Syphillis
Transmission
Chlamydia
trachomatis most
common STD

Through
unprotected sex
(oral, vaginal, anal)

Neisseria gonorrhoeae
- relatively common
co-infection w
chlamydia

Through unprotected
sex (oral, vaginal, anal)
Caused by human
papilloma virus (HPV)

Sexual activity
Highly contagious

Herpes simplex 2


Sexual activity;
Skin-to-skin
contact;
Can also enter
through a
cut/break on skin
Treponema pallidum
(spirochete)


Sexual activity
direct skin contact
blood transfusion
Vertical transmission
Symptoms
Women
asymptomatic
(50%)

s/s in women
vaginal discharge,
dysuria,
intermenstrual
bleeding,
dyspareunia, low
abdominal pain,
nausea

s/s in men
white/cloudy/wate
ry discharge from
penis, dysuria,
testicular pain or
swelling

Women
asymptomatic (50%)

s/s thick, yellow-
green discharge from
penis or vagina

Throat can also be
infected

s/s in women
irritation/ discharge
from the anus,
abnormal vaginal
bleeding, low
abdominal/pelvic
tenderness, pain or
burning with
urination, nausea

s/s in men irritation
or discharge from the
anus, urethral itch,
pain or burning with
urination

May be asymptomatic

s/s visible painless
warts that are on the
genitals or anus (can
bunch and look like
cauliflower), may have
itching

Painful,ulcerating
blisters on genitals
or anus area that
itch, crust, and can
scar; can spread to
the mouth; fatigue,
fever

Women can also
have purulent
vaginal discharge
s/s Primary(at site of
infection) painless sores
or open ulcers (chancres)
on anus, vagina, penis,
mouth, or other places,
enlarged regional LN;
Secondary(generalized
infection) usually 6 wks
later, flu-like symptoms,
hair loss, generalized
polymorphic non-itchy
rash on palm/soles/face,
Less common-meningitis,
hepatitis,
glomerulonephritis;
Tertiary neurosyphilis,
cardiosyphilis(aortic
regurg, aortic aneurysm
etc.), gummata(locally
destructive inflammatory
nodules/plaques
commonly affecting
bone/skin)
2


Chlamydia Gonorrhea HPV Genital Warts Genital Herpes Syphillis
Lab Tests
Urine and discharge
culture
Nucleic acid
amplification test
(NAAT)
Enzyme
immunoassays
(EIA)

Chlamydia
Screening
Programme
- offer to sexually
active M/F at the
age of 25 or under.
- M: 1
st
-void urine
sample; F: self-
taken vaginal
swab/urine sample
-Repeat annually
OR when changing
partner

Urine and discharge
culture
NAAT
EIA


Women smears/
gram stains not helpful
b/c it looks a lot like
normal flora

Biopsy
Viral typing

Cant culture
Viral Culture;
PCR test (DNA
detection using
PCR of a swab from
base of an ulcer);
Blood test
Specific treponemal tests:
FTA-Abs(fluorescent
treponemal antibody
absorbed test)
TPPA(T.pallidum particle
agglutinin assays)
TPHA(T.pallidum
haemaglutinin assay)
EIA
(all the above can be used
for screening; if positive,
different test is used to
confirm)

If treponemal test +ve,
perfrom VDRL/RPR test.

Neurological s/s or failed
treatment - LP
3


Chlamydia Gonorrhea HPV Genital Warts Genital Herpes Syphillis
Treatment
7 days oral
100mg Doxycycline
2x/day or
1 dose oral 1g
azithromycin

Also need to treat
for gonorrhea

Ceftriaxone 500mg IM
stat + 1g azithromycin
PO stat.

Prophylaxis
-topical silver nitrate
or antibiotics (not
used in UK)
Gardasil vaccine for
females age 9-26 for
prevention (3 IM shots
over 6 months)

Mild/early lesions
topical
podophyllotoxin or
imiquimod;
cryotherapy,
electrocauterization,
CO2 laser treatment

5 days oral
acyclovir (can
continue to use as
suppressive tx)

No sex while there
are lesions

Must use latex
condoms even
when no lesions

Cotton underwear,
salts baths, keep
genitals dry

Primary, secondary
single dose IM benzathine
penicillin or single dose PO
azithromycin.

Late latent syphilis- benzyl
penicillin weekly for 3
weeks.

Neurosyphilis- IM procaine
penicillin once daily for
17days+oral probenecid
500mg 4x/day
Treat sex contacts for past
90 days
Cure
Yes wont come
back unless they
get reinfected

Yes wont come back
unless they get
reinfected

Do have some
resistant strains

No

No chronic and
recurrent (virus
hides in the nerve
endings)

Yes
Complications
Infertility
PID
Ectopic pregnancy
Chronic pelvic pain
Reiters syndrome
(inflammation of
joints, eyes,
urethra)
Testicular
inflammation
Greater risk for HIV
infection

Infertility
PID
Ectopic pregnancy
Chronic pelvic pain
Testicular
inflammation
Can develop heart,
brain, or liver infection
Arthritis
Cervical or bladder
cancer in women
Anorectal and penile
cancer in men
Does not affect fertility

Increased risk of
HIV infection;
Aseptic meningitis
Doesnt affect
fertility or cause
cervical cancer or
damage to uterus.

If untreated can lead to
damage to skin, bone,
heart, brain
Dementia
Blindness
Greater risk for HIV
infection
4


Chlamydia Gonorrhea HPV Genital Warts Genital Herpes Syphillis
Risk to
fetus/newborn
Can cause
PROM,premature
birth, neonatal
ophthalmic
infection/
pneumonia
Neonatal
conjunctivitis,
pharyngitis,
pneumonia

May be transmitted to
fetus


1
st
episode within
last 6 weeks or
around time of
delivery: C-section
is recommended.

Risk of miscarriage
if develop 1
st

episode of herpes
during 1
st
stage of
pregnancy.

Recurrence episode
has a low risk on
baby, usually can
go on with vaginal
delivery.
Jarisch-Heixheimer
reaction- fetal distress,
premature labour
Stillbirth
Serious birth defects

Advice
No sex for 7 days or
until course of
antibiotic is
completed.

Abx interfere with
COCP,so use other
methods of
contraception for 7
days or until course
of Abx is completed.


General Information for all STDs

Infection
Cant catch from toilet seats, simple kissing, sharing towels, sharing utensils/cups
Asymptomatic does not mean they are a carrier, they are still infected
All STDs can have a latent (asymptomatic but infected) phase in which transmission can still occur

Treatment
5

No sex until treatment complete (usu. takes 7 days even with single dose therapy)
No alcohol during treatment
If able to cure symptoms recur because of reinfection not treatment failure
Must treat sexual partners to avoid reinfection
Creams are not effective, give oral, IM, or IV (only in severe cases) antibiotics

Prevention
Condom (latex) use is the best protection
Oral contraceptives actually increase the risk of contracting STDs
Use of spermicidal jellies and creams will not prevent STDs

Assessment
Always ask about sexual partners (determines exposure and partners need treatment)
Ask how many partners, type of birth control used, condom use, history of STDs, use of IV drugs, sexual preference

Teaching
Clean genitals and urinate after sex
Take all antibiotics as directed
Return for follow-up and reculture to ensure you have been fully treated
Douching is contraindicated (can spread infection and decrease immune response)
Wear cotton underwear (not synthetic)

Gonorrhea, syphilis and oftentimes Chlamydia are reportable diseases
Screening programs are targeted to women because they are asymptomatic with the most common diseases