Sexuality and Reproductive Health

Sexually Transmitted Infections

Sexually active teens have the highest rate of sexually transmitted infections (STIs) of any age group. If a person is identified to have one STI, it is always important to check for others as the risk factors are similar for all. Since it takes "two to tango", it is important for partners to get treated as well.

Common Clinical Presentations

1. In males, a common presentation of STI is urethritis (gonorrhea, Chlamydia, Trichomonas, Ureaplasma urealyticum). Symptoms may include dysuria, urgency, frequency, discharge and inflammation of the meatus. Less often, males develop orchitis or epididymitis with swelling and pain of the testis and epididymis.

2. Women may develop vaginal discharge, pruritus, or dysuria (Trichomonas). Many vaginal complaints are not related to sexually transmitted pathogens.







Well Mount




Physiologic "leucorrhea" (not STI)

Discharge Inconvenient

Clear, white, slightly yellow discharge that dries brown, otherwise normal

< 45

Epithelial cells,



May occur prior to menarch or during cycle

Candidiasis (Not STI)

Pruritius, Dysuria

Milky white, curded discharge, erythema, edema, may affect folds skin of thights

< 45


Epithelial cells, may see pseudohyphae. budding forms

Pseudohyphae budding forms


"azole" topical per label: fluconazole¹ 150mg po X 1 dose (¹avoid during pregnancy)

Increased risk if imunosuppressed, diabetic, recent antibiotics, pregnant.

Bacterial vaginosis

Mild pruritus, Mild dysuria, Odor

Graywhite discharge



Epithelial cells, > 20%
Clue cells, few white cells


"whif" test amine odor

Metronidazole 2gm po X 1 or 500 po bid X 7 days or topical qd x 5 days; clindamycin 300mg po bid X 7 days or topical qhs X 7 days

Related to hygiene as well as sexual activity; high concentrations of anaerobic bacteria (e.g., Prevotella sp., Mobiluncus sp.), G. vaginalis and Mycoplasma hominis)


Pruritius, Dysuria, Odor, Abdominal pain

green-gray frothy discharge, erythema, strawberry spots


Epithelial cells, white cells, Trichomonads



Metronidazole 500 po bid X 7 days

Treat partner, sensitivity of web mount 60-80%


3. Some sexually transmitted pathogens may cause cervicitis (gonorrhea, Chlamydia and Herpes Simplex Virus 1 or 2). The symptoms may include vaginal discharge, abdominal pain, irregular or painful bleeding with a mucopurulent discharge from the cervix.

4. Pelvic inflammatory disease often presents as cervical motion tenderness, and uterine or adnexal tenderness. It is an ascending infection involving the uterus, fallopian tubes, ovaries and/or peritoneal tissues. If the inflammation is around the liver, it is called perihepatitis or Fitz-Hugh-Curtis syndrome. The infection is thought to be initiated by sexually transmitted pathogens, but it often becomes polymicrobial. Only 50-70% of cases have a positive test for chlamydia or gonorrhea. The long term sequelae include infertility, ectopic pregnancy and chronic abdominal pain due to adhesions.

5. Ulcers and warts may present similarly in males and females. These include:

  • Genital herpes (Herpes simplex)
  • Chancre and condyloma lata (syphilis)
  • Chancroid (lymphgranuloma venereum)
  • Genital warts (condyloma acuminata)


More Information: ulcers and warts

Herpes Simplex Virus (HSV) in the genital areas is more commonly type 2 although type 1 occurs as well. Painful grouped vesicles develop into pustules and then erode into ulcers. Bilateral tender adenopathy usually occurs. Commonly, a primary genital outbreak is accompanied by flu-like symptoms in individuals without previous exposure to either HSV 1 or HSV 2. The diagnosis is made by Tzanck prep, viral culture or fluorescent antibody stains. The ulcers are self limited but antivirals such as acyclovir may be used to hasten resolution. HSV is not curable and a few individuals will have reoccurrences. Antivirals may be used to reduce the number and severity of recurrences.

The name of the ulcer caused by Treponema pallidum is "chancre." Classically, it is a single painless indurated ulcer with non-tender regional adenopathy. Unfortunately, the picture can become confused if the ulcer becomes secondarily infected. Blood tests such as Rapid Plasma Reagin (RPR) or Venereal Disease Research Laboratory (VDRL) may not be positive when the ulcer first occurs. The serous fluid from the base of the ulcer can be sent for dark field microscopy or fluorescent antibody staining. Although the ulcer is self limited, systemic infection may occur causing secondary and tertiary syphilis. The ulcer is usually treated with an intramuscular injection of penicillin.

Hemophilus ducreyi is the cause of chancroid. Usually there are multiple painful ulcerations with scalloped edges and a red halo. Tender regional adenopathy occurs in about 60% of cases and may suppurate forming buboes. Laboratory tests are not readily available. The Centers for Disease Control recommends presumptive treatment. A one time dose of azithromycin or ceftriaxone is often used.

Lymphogranuloma venereum (LGV) is rare in the United States. It is caused by LGV serovars of Chlamydia trachomatis. Often the initial papule or ulcer goes unrecognized. Buboes (swollen, fluctuant lymph nodes) may develop. The best test is the serum complement fixation titer but it is only 80% sensitive. Treatment consists of twenty-one days of doxycycline or erythromycin.

Most genital warts are condylomata acuminata, caused by the human papillomavirus (HPV). "Acuminata" refers to the finger-like papillae that compose most warts giving them their cauliflower like appearance. There are many different HPV types. Some types are predisposed to causing condylomas while others are more likely to cause cervical dysplasia and anogenital malignancies. Condylomas are often diagnosed clinically but specimens can be sent for pathology. They resolve over time but can be treated with lasers, chemicals (e.g., podophyllin, trichloroacetic acid), or liquid nitrogen.

Condyloma lata are a much less common cause of genital warts. They are a form of secondary syphilis and are usually flat and moist. They are diagnosed by clinical appearance along with a positive RPR. They resolve over time but may progress to tertiary syphilis and so are treated with a intramuscular injection of penicillin

Treatment of STIs

More info: Treatment of STI's from the CDC


Quick Check: STI's

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