Sexually transmitted infections (STIs) remain a significant public health concern in the United States. Recent data indicates that approximately one in five adults in the US had an STI in 2018, highlighting the widespread impact of these infections. This review provides an updated overview of the epidemiology, diagnosis, and treatment strategies for several key STIs, including gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes.
Epidemiological trends reveal a concerning increase in the rates of gonorrhea, chlamydia, and syphilis between 2015 and 2019. While these infections are on the rise, rates of herpes simplex virus type 1 (HSV-1) and HSV-2 have shown a decline from 1999 to 2016. Certain populations are disproportionately affected by STIs, including individuals under 25 years of age, sexual and gender minorities such as men who have sex with men and transgender women, and racial and ethnic minorities, particularly Black and Latinx communities. A significant challenge in STI management is that many infections, such as HSV and trichomoniasis (approximately 70%), and extragenital gonorrhea and chlamydia (53% to 100%), are asymptomatic or present with minimal symptoms. This lack of noticeable symptoms can delay diagnosis and contribute to onward transmission. Furthermore, STIs are known to increase the risk of HIV acquisition and transmission and are a leading cause of tubal factor infertility in women, underscoring the serious long-term health consequences associated with these infections.
Accurate and timely diagnosis is crucial for effective STI management. Nucleic acid amplification tests (NAATs) have emerged as highly sensitive (86.1%-100%) and specific (97.1%-100%) diagnostic tools for gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2. For syphilis diagnosis, serology remains the gold standard, typically involving sequential testing to detect both treponemal and nontreponemal (antiphospholipid) antibodies.
Effective treatments are available for many common STIs. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and nitroimidazoles like metronidazole are effective antimicrobial agents for the treatment of gonorrhea, chlamydia, syphilis, M genitalium, and trichomoniasis, respectively. However, the increasing threat of antimicrobial resistance is limiting oral treatment options, particularly for gonorrhea and M genitalium. It is also important to note that there is currently no cure for genital herpes, and treatment focuses on managing symptoms and preventing outbreaks.
Effective STI prevention strategies are essential to curb the ongoing epidemic. These strategies include routine screening, diligent contact tracing of sexual partners to prevent further spread, and consistent promotion of effective barrier contraception methods.
In conclusion, STIs pose a persistent and evolving public health challenge. Despite effective treatments being available for many STIs, rising rates of infection and increasing antimicrobial resistance necessitate ongoing public health efforts focused on enhanced prevention, early diagnosis, and effective treatment strategies to mitigate the impact of these infections on individual and population health.
