ITEMS IN AFP WITH MESH TERM:
Sexually Transmitted Diseases
Sexually Transmitted Disease: A Private Matter? - Curbside Consultation
Advance Provision for Emergency Oral Contraception - Cochrane for Clinicians
ABSTRACT: Hematospermia can be a distressing symptom for patients, but most cases are effectively managed by a primary care physician. Although the condition is usually benign, significant underlying pathology must be excluded by history, physical examination, laboratory evaluation, and, in select cases, other diagnostic modalities. In men younger than 40 years without risk factors (e.g., history of cancer, known urogenital malformation, bleeding disorders) and in men with no associated symptoms, hematospermia is often self-limited and requires no further evaluation or treatment other than patient reassurance. Many cases are attributable to sexually transmitted infections or other urogenital infections in men younger than 40 years who present with hematospermia associated with lower urinary tract symptoms. Workup in these patients can be limited to urinalysis and testing for sexually transmitted infections, with treatment as indicated. In men 40 years and older, iatrogenic hematospermia from urogenital instrumentation or prostate biopsy is the most common cause of blood in the semen. However, recurrent or persistent hematospermia or associated symptoms (e.g., fever, chills, weight loss, bone pain) should prompt further investigation, starting with a prostate examination and prostate-specific antigen testing to evaluate for prostate cancer. Other etiologies to consider in those 40 years and older include genitourinary infections, inflammations, vascular malformations, stones, tumors, and systemic disorders that increase bleeding risk.
Sexual Assault of Women - Article
ABSTRACT: Sexual violence affects up to one third of women during their lifetime. Sexual assault is underreported, and more than one half of assaults are committed by someone known to the survivor. Although both men and women can be sexually assaulted, women are at greatest risk. Some groups are more vulnerable, including adolescents; survivors of childhood sexual or physical abuse; persons who are disabled; persons with substance abuse problems; sex workers; persons who are poor or homeless; and persons living in prisons, institutions, or areas of military conflict. Family physicians care for sexual assault survivors immediately and years after the assault. Immediate care includes the treatment of injuries, prophylaxis for sexually transmitted infections, administration of emergency contraception to prevent pregnancy, and the sensitive management of psychological issues. Family physicians should collect evidence for a “rape kit” only if they are experienced in treating persons who have been sexually assaulted because of the legal ramifications of improper collection and storage of evidence. Sexual assault may result in long-term mental and physical health problems. Presentations to the family physician may include self-destructive behaviors, chronic pelvic pain, and difficulty with pelvic examinations. Prevention of sexual assault is societal and should focus on public health education. Safety and support programs have been shown to reduce sexual assaults.
Behavioral Counseling to Prevent Sexually Transmitted Infections: Recommendation Statement - U.S. Preventive Services Task Force
ABSTRACT: Human papillomaviruses cause the most common sexually trans- mitted infection in the world and are responsible for nearly all cases of cervical cancer. Genital human papillomavirus infection can be divided into low-risk infections (causing genital warts) and high-risk infections (causing cervical intraepithelial neoplasia, and cervical and other cancers). Exposure to human papilloma- virus typically produces a sexually transmitted infection that may progress to a clinically apparent process, such as genital warts and cervical intraepithelial neoplasia lesions of the lower genital tract. Although most human papillomavirus infections resolve spontane- ously within two years, some high-risk infections persist and are considered cancer precursors. Risk factors for persistent infection include multiple sex partners, sex at an early age, history of sexually transmitted infections, and smoking. Condom use is only partially protective against human papillomavirus infection. The two human papillomavirus vaccines are most effective if given to girls before the onset of sexual activity.
CDC Releases the 1998 Guidelines for the Treatment of Sexually Transmitted Diseases - Special Medical Reports
A Troubled Teen: Matters of Confidentiality - Curbside Consultation
ABSTRACT: In 1998, the Centers for Disease Control and Prevention released guidelines for the treatment of sexually transmitted diseases. Several treatment advances have been made since the previous guidelines were published. Part I of this two-part article describes current recommendations for the treatment of genital ulcer diseases, urethritis and cervicitis. Treatment advances include effective single-dose regimens for many sexually transmitted diseases and improved therapies for herpes infections. Two single-dose regimens, 1 g of oral azithromycin and 250 mg of intramuscular ceftriaxone, are effective for the treatment of chancroid. A three-day course of 500 mg of oral ciprofloxacin twice daily may be used to treat chancroid in patients who are not pregnant. Parenteral penicillin continues to be the drug of choice for treatment of all stages of syphilis. Three antiviral medications have been shown to provide clinical benefit in the treatment of genital herpes: acyclovir, valacyclovir and famciclovir. Valacyclovir and famciclovir are not yet recommended for use during pregnancy. Azithromycin in a single oral 1-g dose is now a recommended regimen for the treatment of nongonococcal urethritis.