Please confirm that you would like to log out of Medscape.
If you log out, you will be required to enter your username and password the next time you visit.
Log outCancel
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023
| Contributor Information
Swipe to advance
Adapted image from the Centers for Disease Control and Prevention (CDC). [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Significant Health Concern
Sexually transmitted infections (STIs) remain a significant, underrecognized US public health crisis that requires greater awareness and prevention. Even the banner on the CDC landing page for STIs notes, "Infections Continue to Forge Ahead, Compromising the Nation's Health." Despite the pandemic, 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported in 2021 (the most recent data available as of publication).[1] Of new US cases of STIs diagnosed or reported annually, about half of new infections occur among persons aged 15-24 years.[2]
Men who have sex with men (MSM) have a disproportionately higher risk for human immunodeficiency (HIV) infection (MSM, 1:6; heterosexual men, 1:524; heterosexual women, 1:253).[3] These disparities are further heightened by race and ethnicity, with African American/Black MSM having a 1 in 2 and Hispanic/Latino MSM having a 1 in 4 lifetime risk for HIV infection.[3] The 2022 spread of monkeypox, with over 94% of cases associated with MSM, represents another crisis for this at-risk population.[4]
STIs are best known for their anogenital manifestations. However, involvement of the skin, eyes, oral cavity, and other areas occurs.
Image of a gonorrhea-associated mucopurulent discharge from the penis from Dr P Marazzi | Science Source.
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Gonorrhea
Gonorrhea ("the clap") accounted for a reported 696,764 STI cases in 2021, up 25% since 2017.[1] Transmission can occur through vaginal, anal, and oral intercourse, as well as perinatally. Nonspecific or asymptomatic cases can lead to delayed diagnosis, raising the risk of complications.[5] MSM have a 42-fold higher gonorrhea rate than men who have sex with women only (MSW).[6,7]
Women are usually asymptomatic, but when symptoms are present, they often occur within 10 days of exposure,[8] may present like a urinary tract infection, and commonly infect the endocervix and the urethra.[9] Men with gonorrhea typically present 1-14 days after exposure with urethritis and copious mucopurulent penile discharge,[9] which may progress to epididymitis and often cause testicular or scrotal pain. Rectal infection may occur in both sexes; symptoms include rectal pain, painful bowel movements, discharge, soreness, and bleeding.
Nucleic acid amplification testing (NAAT) is preferred and is commonly available as a swab or urine test.[9] Concurrent testing for chlamydia is recommended; consider HIV and syphilis testing in at-risk persons.[5,9,10] Ceftriaxone remains first-line therapy; dual therapy with doxycycline is recommended when chlamydial infection is anticipated or has not been excluded.[11] Note that antibiotic resistance continues to increase. Alternative medications are referenced by the CDC.[11,12]
Image from the CDC. [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Gonococcal ophthalmia neonatorum
Transmission of gonorrhea during the birthing process commonly presents days later as a purulent conjunctivitis in the newborn (gonococcal ophthalmia neonatorum [shown]), with swelling of the eyelids.[13] Maternal prenatal STI screening and routine application of prophylactic erythromycin ointment on the eyes of newborns has significantly reduced transmission.
If not treated promptly, further ophthalmic complications such as perforation of the globe and blindness can occur.[13] Lack of treatment can also lead to systemic infections, including sepsis and meningitis. Newborns with these infections should undergo evaluation for additional STIs, including HIV infection.
Left: Image of genital herpes lesion on the vulva from Dr P Marazzi | Science Source. Right: Image of genital herpes on male genitalia from the CDC. [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Genital Herpes
Genital herpes (US population: ~30-55% seropositive for herpes simplex virus type 1 [HSV-1]; 2-28% for HSV-2[14]) presents as a painful eruption of grouped vesicles or erosions on a base of surrounding erythema in the genital or anal region (shown) and may take 2-4 weeks to resolve.[15] Asymptomatic infection is common, and transmission can occur in the absence of lesions. Additional symptoms can include painful genital ulcers, dysuria, fever, headache, malaise, and tender lymphadenopathy.[15]
Extragenital symptoms may occur after the primary outbreak, although systemic symptoms are less common, and prodromal tingling or shooting pains may occur prior to skin eruptions. HSV infection may increase transmission of other STIs, such as HIV (2- to 4-fold increased risk).[15]
Vertical transmission of genital herpes may occur during childbirth (1 of every 3,200-10,000 live births).[16] Neonatal infection can present as skin, eye, mouth, disseminated (25%), or central nervous system disease (30%).[16] Symptoms range from localized vesicular eruptions to multisystem organ failure and death.[16,17]
Diagnosis by NAAT or viral culture is common.[15] There is no cure, but antivirals can be preventive or shorten outbreaks.
Image of throat warts resulting from human papillomavirus (HPV) infection from GalliasM | Wikimedia Commons. [Creative Commons Attribution-ShareAlike 4.0 International License (CC by-SA 4.0 International).]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Human Papillomavirus
HPV infection is the most common STI in the United States (~79M infected),[18] and it also affects hundreds of millions globally.[19] HPV often causes anogenital warts, which are usually asymptomatic and typically flat, papular, or pedunculated growths on the genital mucosa. Benign and malignant neoplasms can develop, including condylomata acuminata, bowenoid papulosis, some anal cancers, and cervical cancer (fourth most common cause of cancer worldwide[19]).[18-20] HPV-16 and -18 are the most common oncogenic strains.[19-21]
Subclinical infection is common. However, a classic presentation typically involves the appearance of warts in the external genitalia, perineum, and/or perianal area, as well as in the adjacent areas of skin.[19-21] Lesions may be just a few millimeters in size or large cauliflower-like tumors several centimeters in size.[22] They may be flesh colored, pink, brown, or white, and they may appear macerated in the moist mucosal area of the genitalia (vs the keratotic lesions seen in other areas).[23]
Approximately 10% of men and 3.6% of women have oral HPV.[24] The presence of HPV-16 (~1% of cases) in the oral cavity has been associated with oropharyngeal cancer, with HPV causing over 10,000 new cases of oropharyngeal cancers annually.[19] The cauliflower appearance of intraoral eruptions is similar to that of venereal warts; they typically develop on nonkeratinized mucosa. Genital HPV leads to oral HPV via orogenital intercourse.[18,21]
Image of perianal warts courtesy of Chaher Theeb, MD | Medscape Consult.
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Vaccination
No treatment exists for HPV itself. However, there are three approved HPV vaccines in the United States, all given in three doses: a bivalent vaccine (Cervarix) that targets HPV-16 and -18 (responsible for 70% of cervical cancers)[25,26]; a quadrivalent vaccine (Gardasil) for HPV types 6, 11 (responsible for 90% of genital warts), 16, and 18[25]; and a nine-valent vaccine (Gardasil 9) for HPV types 6 and 11 and for oncogenic HPV types 16, 18, 31, 33, 45, 52, and 58.[25,27]
Although the quadrivalent vaccine can reduce the incidence of cervical cancer, the nine-valent vaccine may prevent about 90% of cervical, vulvar, vaginal, and anal cancers.[25,28] The most recent HPV vaccination recommendations can be found at: https://www.cdc.gov/vaccines/vpd/hpv/hcp/index.html.
Image from the CDC. [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Syphilis
Syphilis (176,713 new cases in 2021[29]) is known as "the great imitator/pretender/imposter" due to its nonspecific presenting features, and it remains underdiagnosed.[29,30] Transmission is via person-to-person contact of sores infected with the spirochete Treponema pallidum; left untreated, syphilis progresses through primary, secondary, latent, and late/tertiary stages.[29,30]
The classic lesion of primary syphilis is a painless, rubbery ulcer (chancre) with raised edges (shown), which typically occurs 21 days after inoculation.[29,30] Regional lymphadenopathy may occur. The chancre typically lasts 3-6 weeks and may heal faster with treatment. Although chancres are typically solitary, multiple primary lesions may occur in HIV-infected individuals or as "kissing" lesions on opposing skin surfaces.
Image from the CDC. [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Secondary syphilis manifestations include fever, headache, malaise, anorexia, sore throat, patchy hair loss, myalgias, weight loss, and adenopathy.[29,30] The kidneys, liver, and joints may also be affected.
Diffuse 1-cm papulosquamous eruptions are a common, highly contagious skin manifestation of this stage, occurring weeks to months after chancre development.[31] The trunk and extremities are involved (including palms and soles [shown]), and the lesions can range in color from pink or reddish brown to violaceous.[29] The rash may include mucosal surfaces (eg, groin, armpits, inner thighs, under breasts), characteristically appearing as raised, gray to white papules (condyloma lata).[29,32] If untreated, the rash will resolve within several weeks but may recur.[32]
Image of a gumma from late congenital syphilis from Taghy A, Hassam B. Pan Afr Med J. 2013;16:29. PMID: 24570790; PMCID: PMC3932133. [CC by 4.0 International.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Latent syphilis follows the disappearance of primary and secondary syphilis symptoms (early latent: infection ≤1 year ago; late latent: infection >1 year ago).[29,30] While asymptomatic, serologic tests remain positive. If untreated, the infection progresses to late or tertiary syphilis.
Late/tertiary syphilis encompasses cardiovascular syphilis (especially aortitis), gummatous syphilis (shown), and neurosyphilis.[29] Cardiovascular syphilis typically causes vasculitis in the vasa vasorum, leading to weakening of the wall of the aortic root.[33] Inflammation of the ascending thoracic aorta can result in aortic dilatation and regurgitation. The onset typically occurs over a long period and can be difficult to detect, as patients often present with an asymptomatic murmur.[33]
Gummatous syphilis is very uncommon; it describes a granulomatous reaction occurring anywhere, including in the skin, bones, or internal organs.[32]
Images from a patient with neurosyphilis before and after treatment from Omer TA, Fitzgerald DE, Sheehy N, Doherty CP. J Med Case Rep. 2012;6:389. PMID: 23171511; PMCID: PMC3514352. [CC by 2.0.] MRI = magnetic resonance image; PET-CT = positron emission tomography/computed tomography scan.
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Early neurosyphilis encompasses an asymptomatic state, as well as syphilitic meningitis, meningovascular syphilis, and syphilis involving the eyes and ears.[30] Late neurosyphilis encompasses tabes dorsalis and general paresis.
Nontreponemal tests are for initial screening due to their low cost and ease of testing. Any person with a reactive nontreponemal test should receive a follow-up treponemal test to confirm the diagnosis. Penicillin remains the treatment of choice for all stages of syphilis.[29,30]
Image of a newborn displaying signs of congenital syphilis from the CDC. [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Congenital syphilis
Between 2017 and 2021, rates of congenital syphilis rose 219%.[34] Many neonates with congenital syphilis are asymptomatic and, if left untreated, are vulnerable to serious health complications, including death.[35] The onset of early-stage congenital syphilis is within 2 years of age, whereas late-stage congenital syphilis presents after this 2-year time frame.[36,37]
Common findings among symptomatic infants at birth include rash, nasal discharge, jaundice, generalized lymphadenopathy, hepatomegaly, and skeletal abnormalities.[36] In late-stage congenital syphilis, corneal connective tissue inflammation causes interstitial keratitis, leading to a diffuse stromal haze and blindness.[32,37,38]
To prevent the transmission of syphilis to newborns, pregnant individuals should be screened for syphilis early in pregnancy.[38] Patients at high risk or who live in communities with a high prevalence of congenital syphilis should also be screened at 28 weeks and again at delivery.[38]
Image from the CDC. [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Molluscum Contagiosum
Molluscum contagiosum is a common, self-limited poxvirus skin infection that is spread via skin-to-skin contact.[39,40] It is a common finding on nongenital skin in the pediatric population. In adults, however, it can be an STI. The typical lesion is an umbilicated, well-demarcated, dome-shaped, flesh-colored or pink papule (shown) that may persist for 6 months or longer.[39]
First-line therapy typically involves physical destruction with substances such as liquid nitrogen, cantharidin, salicylic acid, podophyllotoxin, and trichloroacetic acid.[41] Imiquimod, an immune-response modulator, is also sometimes used, as is physical removal (curettage, manual extrusion) or oral therapy with cimetidine.
Image from the CDC. [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Chancroid
Chancroid is caused by Haemophilus ducreyi.[12,42] The disease was previously endemic in Asia, Africa, and the Caribbean; it is uncommon in the United States outside of networks with high rates of sex partner change (eg, sex work/trafficking).[12,42] The CDC reported only three US cases in 2021.[43] Men are three times more likely to be infected than women, although it is not clear if this is a true discrepancy or a result of ease of male diagnosis.[42] Chancroid remains a cofactor of HIV and syphilis transmission.[12,44]
Chancroid produces multiple soft and painful ulcers with ragged, undermined borders (shown)—some with a gray overlying membrane.[42] Inguinal lymphadenitis may also occur; involved nodes may undergo liquefaction and present as painful, fluctuant buboes.[44] Typically, no systemic manifestations are associated with the infection. Diagnosis is clinical after syphilis and HSV have been ruled out.[45] Incise and drain any buboes, and manage with short courses of azithromycin, ceftriaxone, erythromycin, or ciprofloxacin.[12] Symptoms should improve within 3 days of therapy.
Image from the CDC. [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Granuloma Inguinale (Donovanosis)
Granuloma inguinale is a slowly progressive genital ulcer disease caused by Klebsiella granulomatis.[12] It is rare in the United States, with sporadic cases in India, Australia, South America, and South Africa.[12]
Repeated exposure is likely required for clinical infection to occur; although it is primarily transmitted sexually, it can be spread through nonsexual contact.[46] Lesions appear as papules or nodules, usually in the genital region; ulcerate; and evolve into painless, beefy red ulcers with raised edges (shown). The lesions are typically highly vascularized and tend to bleed; bacterial superinfection may occur. Lesions are also often associated with pseudobuboes, due to granulomatous involvement of the subcutaneous tissue.[46] Severe cases may result in lymphedema (including genital elephantiasis) and, rarely, hematogenous dissemination to the spleen, lungs, liver, bones, and orbits.[46]
Diagnosis requires visualization of dark-staining Donovan bodies from a biopsy or tissue sample. No federally approved molecular tests currently exist to detect the pathogen.[12] Prolonged treatment with at least 3 weeks of azithromycin, trimethoprim-sulfamethoxazole, doxycycline, or erythromycin therapy is required—although antibiotic resistance exists and, despite optimal therapy, relapses may occur within 6-18 months.[12]
Left and center, respectively: Conjunctivitis due to chlamydia infection; chlamydial infection of the cervix. Both from SOA-AIDS Amsterdam via Wikimedia Commons. [CC by-SA 3.0.] Right: Histologic image of cervical intraepithelial neoplasia with HPV on ThinPrep from Flickr | Ed Uthman. [CC by 2.0.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Chlamydia
Chlamydia trachomatis infection is the most frequently reported infectious disorder in the United States (1.6 million cases in 2021).[1,34] The characteristic clinical picture of chlamydia frequently overlaps that of gonorrhea, concurrent infections are common, and the two diseases often cannot be differentiated without diagnostic testing.[12,47]
Both sexes can experience conjunctivitis, pharyngitis, and lymphogranuloma venereum (LGV). In women, cervical and urethral infections occur. Left untreated, multiple sequelae can ensue, including pelvic inflammatory disease (PID), ectopic pregnancy, and infertility.[12]C trachomatis-related PID is associated with higher rates of infertility, ectopic pregnancy, and chronic pelvic pain than N gonorrhea-related PID. Perihepatitis (Fitz-Hugh–Curtis syndrome) may also occur.[48] If symptomatic, men with chlamydia often present with urethritis with a mucoid or watery discharge.[48] Discharge is scant compared to that of gonococcal infections. Epididymitis may occur and frequently presents with unilateral testicular pain and tenderness. Prostatitis and proctitis can develop.[48]
The diagnostic test of choice is NAAT of vaginal swabs for women and urine samples for men.[12,48] Management with doxycycline, azithromycin, or levofloxacin is recommended for infected individuals and their sex partners.[12,48] Infected persons should refrain from sexual activity for 7 days after the completion of their treatment.
Image of a right-sided inguinal bubo due to LGV infection from the CDC. [Public domain.]
Visual Findings of 9 Sexually Transmitted Infections
Michael Payette, MD, MBA, FAAD; Kristen Russomanno, MD | September 19, 2023 | Contributor Information
Lymphogranuloma Venereum
LGV (C trachomatis serovars L1, L2, and L3) presents classically as a lymphadenopathy syndrome often consisting of tender, unilateral, possibly suppurative, self-limited genital ulcers, and/or inguinal and/or femoral lymphadenopathy.[12] While rectal LGV may be asymptomatic, individuals exposed through receptive anal sex may present with symptoms and signs of proctocolitis, characterized by bleeding, tenesmus, and fever.[12] Outbreaks of LGV proctitis have been described in the MSM population and can be confused with inflammatory bowel disease.[12]
Untreated LGV will progress to a late stage of the disease. Manifestations of this stage are secondary to scarring and include genital elephantiasis, anal fistulae and strictures, and infertility.[12,49] Clinical suspicion, testing, and treatment are essential.
If LGV is the suspected diagnosis, treatment should begin as soon as possible with a 3-week course of doxycycline and remaining abstinent throughout the treatment course.[12]
Commenting is limited to medical professionals. To comment please Log-in.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Close
Contributor Information
Authors
Michael Payette, MD, MBA, FAAD
Founding Partner
Central Connecticut Dermatology
CCD Research
Cromwell, CT
Disclosure: Michael Payette, MD, MBA, FAAD, has disclosed the
following financial relationships:
Served as an advisor and/or consultant for: FIDE, AbbVie, Amgen, Eli
Lily, Janssen, Novartis, ONVIV Atopic Dermatitis Expert Panel,
Sanofi-Genzyme/Regeneron, UCB.
Kristen Russomanno, MD
MedStar Georgetown University Hospital/Washington Hospital Center
Departments of Internal Medicine and Dermatology
Washington, DC
Disclosure: Kristen Russomanno, MD, has disclosed no relevant
financial relationships.
Contributor
Dina Strachan, MD
Assistant Clinical Professor
Ronald O. Perelman Department of Dermatology
New York University Langone Medical Center;
Director
Aglow Dermatology
New York, NY
Disclosure: Dina Strachan, MD, has disclosed no relevant financial
relationships.
Reviewer
Bret A Nicks, MD, MHA, FACEP
Professor and Executive Vice Chair, Emergency Medicine
Director, Masters of Healthcare Leadership
Wake Forest University;
Director, EM Administrative and Leadership Fellowship
Director, EM Global Health Fellowship
Wake Forest Baptist Health
Winston-Salem, NC
Disclosure: Bret A Nicks, MD, MHA, FACEP, has disclosed no relevant
financial relationships.
Editor
Olivia Wong, DO
Section Editor
Medscape Drugs & Diseases
New York, NY
Disclosure: Olivia Wong, DO, has disclosed no relevant financial relationships.
Close
References
Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2021. Reviewed: April 11, 2023. Available at: https://www.cdc.gov/std/statistics/2021/default.htm. Accessed September 13, 2023.
Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Detection of STIs in special populations. Men who have sex with men (MSM). Reviewed: July 22, 2021. Available at: https://www.cdc.gov/std/treatment-guidelines/msm.htm. Accessed September 13, 2023.
Philpott D, Hughes CM, Alroy KA, et al, for the CDC Multinational Monkeypox Response Team. Epidemiologic and clinical characteristics of monkeypox cases - United States, May 17-July 22, 2022. MMWR Morb Mortal Wkly Rep. 2022 Aug 12;71(32):1018-22. PMID: 35951487.
Unemo M, Seifert HS, Hook EW 3rd, Hawkes S, Ndowa F, Dillon JR. Gonorrhoea. Nat Rev Dis Primers. 2019 Nov 21;5(1):79. PMID: 31754194.
Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021: gonococcal infections among adolescents and adults. Reviewed: September 21, 2022. Available at: https://www.cdc.gov/std/treatment-guidelines/gonorrhea-adults.htm. Accessed September 13, 2023.
Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021: gonococcal infections among neonates. Reviewed: September 21, 2022. Available at: https://www.cdc.gov/std/treatment-guidelines/gonorrhea-neonates.htm. Accessed September 13, 2023.
Spicknall IH, Flagg EW, Torrone EA. Estimates of the prevalence and incidence of genital herpes, United States, 2018. Sex Transm Dis. 2021 Apr 1;48(4):260-5. PMID: 33492103.
Feltner C, Grodensky C, Ebel C, et al. Serological screening for genital herpes: an evidence review for the U.S. Preventive Services Task Force [Internet]. Rockville, MD: Agency for Healthcare Research and Quality (US); 2016 Dec. Evidence syntheses, no. 149. Available at: https://www.ncbi.nlm.nih.gov/books/NBK409119/. Accessed September 13, 2023.
Slutsker JS, Schillinger JA. Assessing the burden of infant deaths due to herpes simplex virus, human immunodeficiency virus, and congenital syphilis: United States, 1995 to 2017. Sex Transm Dis. 2021 Aug 1;48(8S):S4-S10. PMID: 33967231.
Meites E, Gee J, Unger E, Markowitz L. Human papillomavirus. In: Hall E, Wodie AP, Hamborsky J, Morelli V, Schillie S, eds. The Pink Book. Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases. Washington, DC: Public Health Foundation; 2021. Available at: https://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html. Accessed September 13, 2023.
Bruni L, Albero G, Serrano B, et al. Human Papillomavirus and Related Diseases in the World. Summary report 10 March 2023. Barcelona, Spain: ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre); 2023. Available at: https://hpvcentre.net/statistics/reports/XWX.pdf. Accessed September 13, 2023.
Centers for Disease Control and Prevention. Human papillomavirus (HPV). Genital HPV infection – basic fact sheet. Reviewed: April 12, 2022. Available at: https://www.cdc.gov/std/hpv/stdfact-hpv.htm. Accessed September 13, 2023.
Lei J, Ploner A, Elfstrom KM, et al. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med. 2020 Oct 1;383(14):1340-8. PMID: 32997908
Centers for Disease Control and Prevention. Sexually transmitted diseases (STDs). Syphilis – CDC detailed fact sheet. Reviewed: April 11, 2023. Available at: https://www.cdc.gov/std/syphilis/stdfact-syphilis-detailed.htm. Accessed September 13, 2023.
Radolf JD, Tramont EC, Salazar JC. Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier. 2020;239: 2684-709.
Ngan V, Vanousova D, Bray S. Syphilis. DermNet. Updated: January 2020. Available at: https://dermnetnz.org/topics/syphilis. Accessed September 14, 2023.
Somers K. Cardiovascular syphilitic. In: Firth J, Conlon C, Cox T, eds. Oxford Textbook of Medicine. 6th ed. Oxford, UK: Oxford University Press; 2020:ch 16.9.4.
Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2021. National overview of STDs, 2021. Reviewed: May 16, 2023. Available at: https://www.cdc.gov/std/statistics/2021/overview.htm. Accessed September 14, 2023.
Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2021. Table 1. Sexually transmitted diseases— reported cases and rates of reported cases*, United States, 1941-2021. Reviewed: April 12, 2022. Available at: https://www.cdc.gov/std/statistics/2021/tables/1.htm. Accessed September 15, 2023.
Fiala KH, Swall R. Dermatologic manifestations of chancroid. Medscape Drugs & Diseases from WebMD. Updated: March 23, 2022. Available at: https://emedicine.medscape.com/article/1052141-overview. Accessed September 15, 2023.
Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. Chancroid. Reviewed: July 22, 2021. Available at: https://www.cdc.gov/std/treatment-guidelines/chancroid.htm. Accessed September 15, 2023.
Ballard RC. Klebsiella granulomatis (donovanosis, granuloma inguinale). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2015:2664-6.
Mohseni M, Sung S, Takov V. Chlamydia. Updated: August 8, 2023. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2023 Jan-. PMID: 30725971. Available at: https://www.ncbi.nlm.nih.gov/books/NBK537286/. Accessed September 15, 2023.
Dooley-Hash S, Herman NWC. Sexually transmitted infections and anorectal conditions. In: Knoop KJ, Stack LB, Storrow AB, Thurman RJ, eds. Atlas of Emergency Medicine. 5th ed. New York, NY: McGraw-Hill; 2020:249.
Please do not use this form to submit personal or patient medical information or to report adverse drug events. You are encouraged to report adverse drug event information to the FDA.
Comments