Consensus statement
Consensus document on the diagnosis and treatment of sexually transmitted diseases in adults, children and adolescentsDocumento de consenso sobre diagnóstico y tratamiento de las infecciones de transmisión sexual en adultos, niños y adolescentes

https://doi.org/10.1016/j.eimc.2017.06.004Get rights and content

Abstract

Sexually transmitted diseases (STDs) are one of the most common and universal problems of public health. Human immunodeficiency virus (HIV) and STD infections are clearly interrelated, and share risks, incidence and transmission mechanisms.

The aim of this document is to inform health professionals about the current situation and management of STDs, which, because of their relevance, need greater care, both in the general population and in the population with HIV.

These guidelines for STD treatment, although clinically oriented and focused especially on treatment, contain other aspects related to assessing and evaluating patients, as well as recommendations for diagnosis.

Resumen

Las infecciones de transmisión sexual (ITS) son uno de los problemas más frecuentes y universales de Salud Pública. La infección por el virus de la inmunodeficiencia humana y las ITS están claramente interrelacionadas, compartiendo riesgos, incidencia y mecanismos de transmisión.

El objetivo de este documento es dar a conocer a los profesionales sanitarios la situación actual y el manejo de aquellas ITS, que por su relevancia necesitan una mayor atención, tanto en población general como en población infectada por el virus de la inmunodeficiencia humana.

Estas directrices para el tratamiento de las ITS, aunque orientadas desde el punto de vista clínico y centrado especialmente en el tratamiento, también recogen otros aspectos relacionados con la evaluación y valoración del paciente así como recomendaciones de diagnóstico.

Introduction

Sexually transmitted diseases (STD) are one of the most frequent and universal problems of Public Health. Their high morbidity and the possibility of medium and long term sequelae demands health professionals to have basic but sufficient knowledge to manage them properly, both for their prevention and approach as for their diagnosis, treatment, contact search and monitoring. Infection by human immunodeficiency virus (HIV) and STD are clearly interrelated, sharing risks, incidence and transmission mechanisms.

These guidelines for STD treatment, although oriented from a clinical viewpoint and focused especially on treatment, gather other aspects related to assessment and evaluation of the patient, as well as recommendations for diagnosis.1

Recommendations contained in this guide are based on scientific evidence and on expert opinion. Each recommendation is rated with a letter indicating its power [A (should always be offered), B (should generally be offered) or C (should optionally be offered) and a number expressing the evidence supporting said recommendation [I (results obtained from one or more randomized clinical trials on clinical or laboratory aspects or from a meta-analysis); II (from one or more non-randomized clinical trials or observational data from cohorts); and III (expert opinion)].

Section snippets

General measures for STD prevention and control

The assessment of STD individual risk requires compiling a medical history including questions about sexual behavior and other risk factors.

Table 1 shows the most common STD screenings based on populations at risk. An HIV infection should be ruled out in all populations with STD risk practices.

Assessment of the patient

It should be characterized by being comprehensive and detailed. Most commonly, the patient's history is reviewed “by systems”, with special attention to skin, mucous membranes and skin appendages. Physical examination must be equally comprehensive.

To test a culture, samples must be collected: before establishing anti-microbe treatment, from active lesions. They must be transported without delay and stored at the appropriate temperature conditions for each case. When using nucleic acids

A) Urethritis and cervicitis

STD are the most common cause for infectious urethritis and cervicitis. It is frequent to find coinfection by various agents, Neisseria gonorrhoeae and Chlamydia trachomatis are mostly involved. Other microorganisms are Mycoplasma genitalium (with a growing interest) Trichomonas vaginalis, Adenovirus or HSV. Regarding symptoms, urethritis is characterized by urethral inflammation, presenting dysuria, discomfort and mucous, mucopurulent or purulent urethral discharge as the most frequent

Syphilis

Primary syphilis is characterized by the presence of ulcers and adenopathy. The HIV infection has a very small influence on the symptoms, with multiple ulcers being observed more frequently.

Diagnosis is usually indirect, by serology (treponemal/non-treponemal). Some laboratories may perform direct diagnosis (dark field, direct fluorescent antibody test or PCR), which allows for immediate diagnosis, even before seroconversion. As a general rule, diagnosis is made following the same criteria for

Human papillomavirus infection

HPV infection is the most common STD in the world; up to three quarters of the world's population will get infected by HPV at some point. HIV-infected patients have a higher prevalence of HPV infection, together with a decrease in virus clearance by immunosuppression.

Liquid environment cytology is the test used for cervical and anal dysplasia screening, due to its low cost and its simple conducting. Because of cytology's variable sensitivity, certain authors suggest associating HPV-RA's PCR to

Children

STD detection in children who have not yet started puberty requires an in-depth study, where sexual abuse should be ruled out first and in an exhaustive way, although other ways of transmission, such as perinatal or accidental, by auto- or hetero-inoculation, should be considered. In girls, endocervical samples are not usually taken, so vulvar or vaginal swabs should be sampled.

In case of sexual abuse or suspicion thereof, the intervention of members from attention mechanisms against violence

Funding

The preparation of this document has been financed with the funds from the SPNS (Spanish National AIDS Plan Secretariat).

Conflicts of interests

In order to avoid and/or minimize any conflicts of interests, the individuals who make up this Expert Group have made a formal declaration of interests. In this declaration, some of the authors have received funding to take part in conferences and to conduct research, as well as having received payments as speakers for public institutions and pharmaceutical companies. These activities do not affect the clarity of the present document as the fees and/or grants received do enter into the

Acknowledgements

The National Plan on AIDS and the Boards of the participating Scientific Societies, are grateful for the support and opinions of Emely García Carrasco, Gabriela Fagúndez, Saúl Barreales and Aurora Limia, that have contributed to improve the writing and enrich the contents of the document.

Reference (1)

  • Documento de consenso sobre diagnóstico y tratamiento de las infecciones de transmisión sexual en adultos, niños y...

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The entire version of the document can be found online as supplementary material in the journal official website (Appendix B).

See writing committee in Appendix A. All members of the panel are authors of this publication.

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