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Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach (Part 1)

Harrison's Internal Medicine Chapter 124. Sexually Transmitted Infections: Overview and Clinical Approach Classification and Epidemiology Worldwide, most adults acquire at least one sexually transmitted infection (STI), and many remain at risk for complications. Each year, for example, an estimated 6.2 million persons in the United States acquire a new genital human papillomavirus (HPV) infection, and many of these individuals are at risk for genital neoplasias. Certain STIs, such as syphilis, gonorrhea, HIV infection, hepatitis B, and chancroid, are most concentrated within "core populations" characterized by high rates of partner change, multiple concurrent partners, or "dense," highly connected sexual networks—e.g., involving. | Chapter 124. Sexually Transmitted Infections Overview and Clinical Approach Part 1 Harrison s Internal Medicine Chapter 124. Sexually Transmitted Infections Overview and Clinical Approach Classification and Epidemiology Worldwide most adults acquire at least one sexually transmitted infection STI and many remain at risk for complications. Each year for example an estimated 6.2 million persons in the United States acquire a new genital human papillomavirus HPV infection and many of these individuals are at risk for genital neoplasias. Certain STIs such as syphilis gonorrhea HIV infection hepatitis B and chancroid are most concentrated within core populations characterized by high rates of partner change multiple concurrent partners or dense highly connected sexual networks e.g. involving prostitutes and their clients some homosexual men and persons involved in the use of illicit drugs particularly crack cocaine and methamphetamine. Other STIs are distributed more evenly throughout societies. For example chlamydial infections genital infections with HPV and genital herpes can spread widely even in relatively low-risk populations. In general the product of three factors determines the initial rate of spread of any STI within a population rate of sexual exposure of susceptible to infectious people efficiency of transmission per exposure and duration of infectivity of those infected. Accordingly efforts to prevent and control STIs aim to decrease the rate of sexual exposure of susceptibles to infected persons e.g. through individual counseling and efforts to change the norms of sexual behavior to decrease the duration of infectivity through early diagnosis and curative or suppressive treatment and to decrease the efficiency of transmission e.g. through promotion of condom use and safer sexual practices and recently through male circumcision . In all societies STIs rank among the most common of all infectious diseases with 30 infections now classified as predominantly .