STIs and Vaginitis Sexually Transmitted Infections. There are some populations at higher risk for sexually transmitted infections (STIs) than others. The highest rates of gonorrhea/chlamydia (GC) is seen in females 15 to 24 years of age. Fifty million people in the United States have genital herpes simplex virus (HSV) (Woo & Robinson, 2016). Thanks to commercials, many people are aware of the connection between Human papilloma virus (HPV) and cervical cancer. However, people may not realize that cervical cancer is the leading cause of female cancer death worldwide (Woo & Robinson, 2016). There are several contributing factors to the contraction and spread of STIs. Some of these factors include but are not limited to:
- Vaginal flora
- Disturbance of normal vaginal flora increases risk of contracting STI.
- Sex of patient
- Women more than men
- Number of sexual partners
- Immune system status
- Coexisting infections
Once a patient has contracted a STI, the focus is then on treatment and prevention of further spread of the infection. There are 4 goals in treating STIs.
Diagnosis, Treatment, & Prevention
Rational Drug Selection
- Use current Centers for Disease Control (CDC) or Canada Health Guidelines.
- Updated frequently
- Extensive guidelines for all patient populations including pregnant women
See: www.cdc.gov/std; www.hc-sc.gc.ca
Test your knowledge of STI treatment options in the interactive below by selecting the STI to the appropriate treatment options list.
Diagnosing vaginal discharge and vulvar conditions requires examination of the area affected and microscopic examination of vaginal secretions. Vaginitis may or may not be sexually transmitted. Cytolytic vaginosis is an overgrowth of Lactobacillus and typically occurs late in the menstrual cycle. Treatment with intravaginal sodium bicarbonate capsules twice weekly should occur in the last week of the menstrual cycle. Atrophic vaginitis typically occurs with a secondary infection. Cultures should guide treatment of this type of vaginitis. Goals of treatment for vaginitis include treating the infection or inflammation, preventing reinfections and preventing complications of the infection or inflammation. Accurate diagnosis is essential for effective treatment. Attempting to diagnose vaginitis over the phone is not always accurate.
When treating vaginitis, use the correct drug for the pathogen according to the culture. Consider any resistance that may be possible. Ordering a sensitivity with the culture is recommended. Consider costs of treatments. Over the counter antifungals are typically inexpensive, but be familiar with your patient’s abilities to cover cost either with insurance or other means. Intravaginal medications have the fewest drug interactions. Pregnancy may affect available treatment choices. If the patient does not respond to therapy consider a referral. There is no ongoing monitoring required unless a known chronic infection exists.