Diagnosis and Treatment of Sexually Transmitted Infections | Infectious Diseases | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Diagnosis and Treatment of Sexually Transmitted InfectionsA Review

Educational Objective
To review recommended approaches to the diagnosis and treatment of sexually transmitted infections.
Abstract

Importance  Approximately 1 in 5 adults in the US had a sexually transmitted infection (STI) in 2018. This review provides an update on the epidemiology, diagnosis, and treatment of gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, trichomoniasis, and genital herpes.

Observations  From 2015 to 2019, the rates of gonorrhea, chlamydia, and syphilis increased in the US; from 1999 to 2016, while the rates of herpes simplex virus type 1 (HSV-1) and HSV-2 declined. Populations with higher rates of STIs include people younger than 25 years, sexual and gender minorities such as men and transgender women who have sex with men, and racial and ethnic minorities such as Black and Latinx people. Approximately 70% of infections with HSV and trichomoniasis and 53% to 100% of extragenital gonorrhea and chlamydia infections are asymptomatic or associated with few symptoms. STIs are associated with HIV acquisition and transmission and are the leading cause of tubal factor infertility in women. Nucleic acid amplification tests have high sensitivities (86.1%-100%) and specificities (97.1%-100%) for the diagnosis of gonorrhea, chlamydia, M genitalium, trichomoniasis, and symptomatic HSV-1 and HSV-2. Serology remains the recommended method to diagnose syphilis, typically using sequential testing to detect treponemal and nontreponemal (antiphospholipid) antibodies. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles, such as metronidazole, are effective treatments for gonorrhea, chlamydia, syphilis, M genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral treatment options for gonorrhea and M genitalium. No cure is available for genital herpes. Effective STI prevention interventions include screening, contact tracing of sexual partners, and promoting effective barrier contraception.

Conclusions and Relevance  Approximately 1 in 5 adults in the US had an STI in 2018. Rates of gonorrhea, chlamydia, and syphilis in the US have increased, while rates of HSV-1 and HSV-2 have declined. Ceftriaxone, doxycycline, penicillin, moxifloxacin, and the nitroimidazoles are effective treatments for gonorrhea, chlamydia, syphilis, Mycoplasma genitalium, and trichomoniasis, respectively, but antimicrobial resistance limits oral therapies for gonorrhea and Mycoplasma genitalium, and no cure is available for genital herpes.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Khalil G. Ghanem, MD, PhD, Johns Hopkins University Bayview Medical Center, 5200 Eastern Ave, MFL Center Tower No. 378, Baltimore, MD 21224 (kghanem@jhmi.edu).

Accepted for Publication: December 10, 2021.

Author Contributions: Drs Tuddenham and Hamill contributed equally to this article.

Conflict of Interest Disclosures: Dr Tuddenham reported serving as a consultant for Luca Biologics, Roche Molecular Diagnostics, and Biofire; receiving royalties from UpToDate, and receiving speaker honoraria from Roche Molecular Diagnostics and Medscape. Drs Ghanem and Hamill reported receiving royalties from UpToDate. No other disclosures were reported.

Funding/Support: Dr Tuddenham is supported by grant K23-AI125715 from the National Institute of Allergy and Infectious Diseases.

Role of the Funder/Sponsor: The National Institute of Allergy and Infectious Diseases had no role in the preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank Barbara Wilgus, MSN, CRNP, at the Johns Hopkins University School of Medicine for her thoughtful comments, for which she received no compensation.

References
1.
Centers for Disease Control and Prevention.  Sexually Transmitted Disease Surveillance 2019. Dept of Health and Human Services; 2021.
2.
Chesson  HW , Spicknall  IH , Bingham  A ,  et al.  The estimated direct lifetime medical costs of sexually transmitted infections acquired in the United States in 2018.   Sex Transm Dis. 2021;48(4):215-221. doi:10.1097/OLQ.0000000000001380 PubMedGoogle ScholarCrossref
3.
Kreisel  KM , Spicknall  IH , Gargano  JW ,  et al.  Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2018.   Sex Transm Dis. 2021;48(4):208-214. doi:10.1097/OLQ.0000000000001355 PubMedGoogle ScholarCrossref
4.
Kabapy  AF , Shatat  HZ , Abd El-Wahab  EW .  Attributes of HIV infection over decades (1982-2018): a systematic review and meta-analysis.   Transbound Emerg Dis. 2020;67(6):2372-2388. doi:10.1111/tbed.13621 PubMedGoogle ScholarCrossref
5.
Malekinejad  M , Barker  EK , Merai  R ,  et al.  Risk of HIV acquisition among men who have sex with men infected with bacterial sexually transmitted infections: a systematic review and meta-analysis.   Sex Transm Dis. 2021;48(10):e138-e148. doi:10.1097/OLQ.0000000000001403 PubMedGoogle ScholarCrossref
6.
Tsevat  DG , Wiesenfeld  HC , Parks  C , Peipert  JF .  Sexually transmitted diseases and infertility.   Am J Obstet Gynecol. 2017;216(1):1-9. doi:10.1016/j.ajog.2016.08.008 PubMedGoogle ScholarCrossref
7.
Whelan  J , Eeuwijk  J , Bunge  E , Beck  E .  Systematic literature review and quantitative analysis of health problems associated with sexually transmitted Neisseria gonorrhoeae infection.   Infect Dis Ther. 2021;10(4):1887-1905. doi:10.1007/s40121-021-00481-z PubMedGoogle ScholarCrossref
8.
Olaleye  AO , Babah  OA , Osuagwu  CS , Ogunsola  FT , Afolabi  BB .  Sexually transmitted infections in pregnancy—an update on Chlamydia trachomatis and Neisseria gonorrhoeae.   Eur J Obstet Gynecol Reprod Biol. 2020;255:1-12. doi:10.1016/j.ejogrb.2020.10.002 PubMedGoogle ScholarCrossref
9.
He  W , Jin  Y , Zhu  H , Zheng  Y , Qian  J .  Effect of Chlamydia trachomatis on adverse pregnancy outcomes: a meta-analysis.   Arch Gynecol Obstet. 2020;302(3):553-567. doi:10.1007/s00404-020-05664-6 PubMedGoogle ScholarCrossref
10.
Detels  R , Green  AM , Klausner  JD ,  et al.  The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries.   Sex Transm Dis. 2011;38(6):503-509. doi:10.1097/OLQ.0b013e318206c288 PubMedGoogle ScholarCrossref
11.
Unemo  M , Seifert  HS , Hook  EW  III , Hawkes  S , Ndowa  F , Dillon  JR .  Gonorrhoea.   Nat Rev Dis Primers. 2019;5(1):79. doi:10.1038/s41572-019-0128-6 PubMedGoogle ScholarCrossref
12.
Nettleton  WD , Kent  JB , Macomber  K ,  et al.   Ongoing cluster of highly related disseminated gonococcal infections—southwest Michigan, 2019.   MMWR Morb Mortal Wkly Rep. 2020;69(12):353-354. doi:10.15585/mmwr.mm6912a5 PubMedGoogle ScholarCrossref
13.
Cantor  A , Dana  T , Griffin  JC ,  et al.  Screening for chlamydial and gonococcal infections: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. 2021;326(10):957-966. doi:10.1001/jama.2021.10577 PubMedGoogle ScholarCrossref
14.
Doernberg  SB , Komarow  L , Tran  TTT ,  et al.  Simultaneous evaluation of diagnostic assays for pharyngeal and rectal Neisseria gonorrhoeae and Chlamydia trachomatis using a master protocol.   Clin Infect Dis. 2020;71(9):2314-2322.PubMedGoogle Scholar
15.
Workowski  KA , Bachmann  LH , Chan  PA ,  et al.  Sexually transmitted infections treatment guidelines, 2021.   MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1 PubMedGoogle ScholarCrossref
16.
Chan  PA , Robinette  A , Montgomery  M ,  et al.  Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: a review of the literature.   Infect Dis Obstet Gynecol. 2016;2016:5758387. doi:10.1155/2016/5758387 PubMedGoogle Scholar
17.
Centers for Disease Control and Prevention.  Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae—2014.   MMWR Recomm Rep. 2014;63(RR-02):1-19.PubMedGoogle Scholar
18.
Klausner  JD , Bristow  CC , Soge  OO ,  et al.  Resistance-guided treatment of gonorrhea: a prospective clinical study.   Clin Infect Dis. 2021;73(2):298-303. doi:10.1093/cid/ciaa596 PubMedGoogle ScholarCrossref
19.
Harding  AS , Ghanem  KG .  The performance of cerebrospinal fluid treponemal-specific antibody tests in neurosyphilis: a systematic review.   Sex Transm Dis. 2012;39(4):291-297. doi:10.1097/OLQ.0b013e31824c0e62 PubMedGoogle ScholarCrossref
20.
Poncin  T , Fouere  S , Braille  A ,  et al.  Multidrug-resistant Neisseria gonorrhoeae failing treatment with ceftriaxone and doxycycline in France, November 2017.   Euro Surveill. 2018;23(21). doi:10.2807/1560-7917.ES.2018.23.21.1800264 PubMedGoogle Scholar
21.
Kirkcaldy  RD , Weinstock  HS , Moore  PC ,  et al.  The efficacy and safety of gentamicin plus azithromycin and gemifloxacin plus azithromycin as treatment of uncomplicated gonorrhea.   Clin Infect Dis. 2014;59(8):1083-1091. doi:10.1093/cid/ciu521 PubMedGoogle ScholarCrossref
22.
Romano  A , Gaeta  F , Valluzzi  RL , Maggioletti  M , Caruso  C , Quaratino  D .  Cross-reactivity and tolerability of aztreonam and cephalosporins in subjects with a T cell-mediated hypersensitivity to penicillins.   J Allergy Clin Immunol. 2016;138(1):179-186. doi:10.1016/j.jaci.2016.01.025 PubMedGoogle ScholarCrossref
23.
Romano  A , Valluzzi  RL , Caruso  C , Maggioletti  M , Quaratino  D , Gaeta  F .  Cross-reactivity and tolerability of cephalosporins in patients with IgE-mediated hypersensitivity to penicillins.   J Allergy Clin Immunol Pract. 2018;6(5):1662-1672. doi:10.1016/j.jaip.2018.01.020 PubMedGoogle ScholarCrossref
24.
Savaris  RF , Fuhrich  DG , Maissiat  J , Duarte  RV , Ross  J .  Antibiotic therapy for pelvic inflammatory disease.   Cochrane Database Syst Rev. 2020;8(8):CD010285.PubMedGoogle Scholar
25.
Petousis-Harris  H , Paynter  J , Morgan  J ,  et al.  Effectiveness of a group B outer membrane vesicle meningococcal vaccine against gonorrhoea in New Zealand: a retrospective case-control study.   Lancet. 2017;390(10102):1603-1610. doi:10.1016/S0140-6736(17)31449-6 PubMedGoogle ScholarCrossref
26.
de Vries  HJC .  Lymphoganuloma venereum in the Western world, 15 years after its re-emergence: new perspectives and research priorities.   Curr Opin Infect Dis. 2019;32(1):43-50. doi:10.1097/QCO.0000000000000519 PubMedGoogle ScholarCrossref
27.
Stoner  BP , Cohen  SE .  Lymphogranuloma venereum 2015: clinical presentation, diagnosis, and treatment.   Clin Infect Dis. 2015;61(suppl 8):S865-S873. doi:10.1093/cid/civ756 PubMedGoogle ScholarCrossref
28.
Geisler  WM , Uniyal  A , Lee  JY ,  et al.  Azithromycin versus doxycycline for urogenital Chlamydia trachomatis infection.   N Engl J Med. 2015;373(26):2512-2521. doi:10.1056/NEJMoa1502599 PubMedGoogle ScholarCrossref
29.
Dombrowski  JC , Wierzbicki  MR , Newman  LM ,  et al.  Doxycycline versus azithromycin for the treatment of rectal chlamydia in men who have sex with men: a randomized controlled trial.   Clin Infect Dis. 2021;73(5):824-831. doi:10.1093/cid/ciab153 PubMedGoogle ScholarCrossref
30.
Lau  A , Kong  FYS , Fairley  CK ,  et al.  Azithromycin or doxycycline for asymptomatic rectal Chlamydia trachomatis.   N Engl J Med. 2021;384(25):2418-2427. doi:10.1056/NEJMoa2031631 PubMedGoogle ScholarCrossref
31.
Simons  R , Candfield  S , French  P , White  JA .  Observed treatment responses to short-course doxycycline therapy for rectal lymphogranuloma venereum in men who have sex with men.   Sex Transm Dis. 2018;45(6):406-408. doi:10.1097/OLQ.0000000000000772 PubMedGoogle ScholarCrossref
32.
Ghanem  KG , Ram  S , Rice  PA .  The modern epidemic of syphilis.   N Engl J Med. 2020;382(9):845-854. doi:10.1056/NEJMra1901593 PubMedGoogle ScholarCrossref
33.
Towns  JM , Leslie  DE , Denham  I , Azzato  F , Fairley  CK , Chen  M .  Painful and multiple anogenital lesions are common in men with Treponema pallidum PCR-positive primary syphilis without herpes simplex virus coinfection: a cross-sectional clinic-based study.   Sex Transm Infect. 2016;92(2):110-115. doi:10.1136/sextrans-2015-052219 PubMedGoogle ScholarCrossref
34.
Ropper  AH .  Neurosyphilis.   N Engl J Med. 2019;381(14):1358-1363. doi:10.1056/NEJMra1906228 PubMedGoogle ScholarCrossref
35.
Tucker  JD , Li  JZ , Robbins  GK ,  et al.  Ocular syphilis among HIV-infected patients: a systematic analysis of the literature.   Sex Transm Infect. 2011;87(1):4-8. doi:10.1136/sti.2010.043042 PubMedGoogle ScholarCrossref
36.
Ramchandani  MS , Litvack  JR , Marra  CM .  Otosyphilis: a review of the literature.   Sex Transm Dis. 2020;47(5):296-300. doi:10.1097/OLQ.0000000000001155 PubMedGoogle ScholarCrossref
37.
Gayet-Ageron  A , Lautenschlager  S , Ninet  B , Perneger  TV , Combescure  C .  Sensitivity, specificity and likelihood ratios of PCR in the diagnosis of syphilis: a systematic review and meta-analysis.   Sex Transm Infect. 2013;89(3):251-256. doi:10.1136/sextrans-2012-050622 PubMedGoogle ScholarCrossref
38.
Theel  ES , Katz  SS , Pillay  A .  Molecular and direct detection tests for Treponema pallidum subspecies pallidum: a review of the literature, 1964-2017.   Clin Infect Dis. 2020;71(suppl 1):S4-S12. doi:10.1093/cid/ciaa176 PubMedGoogle ScholarCrossref
39.
Park  IU , Tran  A , Pereira  L , Fakile  Y .  Sensitivity and specificity of treponemal-specific tests for the diagnosis of syphilis.   Clin Infect Dis. 2020;71(suppl 1):S13-S20. doi:10.1093/cid/ciaa349 PubMedGoogle ScholarCrossref
40.
Tuddenham  S , Katz  SS , Ghanem  KG .  Syphilis laboratory guidelines: performance characteristics of nontreponemal antibody tests.   Clin Infect Dis. 2020;71(suppl 1):S21-S42. doi:10.1093/cid/ciaa306 PubMedGoogle ScholarCrossref
41.
Magnarelli  LA , Anderson  JF , Johnson  RC .  Cross-reactivity in serological tests for Lyme disease and other spirochetal infections.   J Infect Dis. 1987;156(1):183-188. doi:10.1093/infdis/156.1.183PubMedGoogle ScholarCrossref
42.
Riviere  GR , Wagoner  MA , Baker-Zander  SA ,  et al.  Identification of spirochetes related to Treponema pallidum in necrotizing ulcerative gingivitis and chronic periodontitis.   N Engl J Med. 1991;325(8):539-543. doi:10.1056/NEJM199108223250803 PubMedGoogle ScholarCrossref
43.
Shore  RN .  Lupus erythematosus and reactive tests for syphilis: update.   Cutis. 1976;17(4):745-748.PubMedGoogle Scholar
44.
Ortiz  DA , Shukla  MR , Loeffelholz  MJ .  The traditional or reverse algorithm for diagnosis of syphilis: pros and cons.   Clin Infect Dis. 2020;71(suppl 1):S43-S51. doi:10.1093/cid/ciaa307 PubMedGoogle ScholarCrossref
45.
Lin  JS , Eder  ML , Bean  SI .  Screening for syphilis infection in pregnant women: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. 2018;320(9):918-925. doi:10.1001/jama.2018.7769 PubMedGoogle ScholarCrossref
46.
Centers for Disease Control and Prevention, US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update: a clinical practice guideline. Published December 2021. Accessed December 9, 2021. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf
47.
Clement  ME , Okeke  NL , Hicks  CB .  Treatment of syphilis: a systematic review.   JAMA. 2014;312(18):1905-1917. doi:10.1001/jama.2014.13259 PubMedGoogle ScholarCrossref
48.
Butler  T .  The Jarisch-Herxheimer reaction after antibiotic treatment of spirochetal infections: a review of recent cases and our understanding of pathogenesis.   Am J Trop Med Hyg. 2017;96(1):46-52. doi:10.4269/ajtmh.16-0434 PubMedGoogle ScholarCrossref
49.
Buitrago-Garcia  D , Martí-Carvajal  AJ , Jimenez  A , Conterno  LO , Pardo  R .  Antibiotic therapy for adults with neurosyphilis.   Cochrane Database Syst Rev. 2019;5(5):CD011399.PubMedGoogle Scholar
50.
Bolan  RK , Beymer  MR , Weiss  RE , Flynn  RP , Leibowitz  AA , Klausner  JD .  Doxycycline prophylaxis to reduce incident syphilis among HIV-infected men who have sex with men who continue to engage in high-risk sex: a randomized, controlled pilot study.   Sex Transm Dis. 2015;42(2):98-103. doi:10.1097/OLQ.0000000000000216 PubMedGoogle ScholarCrossref
51.
Molina  JM , Charreau  I , Chidiac  C ,  et al; ANRS IPERGAY Study Group.  Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial.   Lancet Infect Dis. 2018;18(3):308-317. doi:10.1016/S1473-3099(17)30725-9 PubMedGoogle ScholarCrossref
52.
Manhart  LE , Gaydos  CA , Taylor  SN ,  et al.  Characteristics of mycoplasma genitalium urogenital infections in a diverse patient sample from the united states: results from the Aptima Mycoplasma genitalium Evaluation Study (AMES).   J Clin Microbiol. 2020;58(7):e00165-e20. doi:10.1128/JCM.00165-20 PubMedGoogle ScholarCrossref
53.
Gaydos  CA , Manhart  LE , Taylor  SN ,  et al.  Molecular testing for Mycoplasma genitalium in the United States: results from the AMES prospective multicenter clinical study.   J Clin Microbiol. 2019;57(11):e01125-e19. doi:10.1128/JCM.01125-19 PubMedGoogle ScholarCrossref
54.
Seña  AC , Lensing  S , Rompalo  A ,  et al.  Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy.   J Infect Dis. 2012;206(3):357-365. doi:10.1093/infdis/jis356 PubMedGoogle ScholarCrossref
55.
Soni  S , Horner  P , Rayment  M ,  et al.  British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018).   Int J STD AIDS. 2019;30(10):938-950. doi:10.1177/0956462419825948 PubMedGoogle ScholarCrossref
56.
Lis  R , Rowhani-Rahbar  A , Manhart  LE .  Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis.   Clin Infect Dis. 2015;61(3):418-426. doi:10.1093/cid/civ312 PubMedGoogle ScholarCrossref
57.
Read  TRH , Murray  GL , Danielewski  JA ,  et al.  Symptoms, sites, and significance of Mycoplasma genitalium in men who have sex with men.   Emerg Infect Dis. 2019;25(4):719-727. doi:10.3201/eid2504.181258 PubMedGoogle ScholarCrossref
58.
Latimer  RL , Vodstrcil  L , De Petra  V ,  et al.  Extragenital Mycoplasma genitalium infections among men who have sex with men.   Sex Transm Infect. 2020;96(1):10-18. doi:10.1136/sextrans-2019-054058 PubMedGoogle ScholarCrossref
59.
Getman  D , Jiang  A , O’Donnell  M , Cohen  S .  Mycoplasma genitalium prevalence, coinfection, and macrolide antibiotic resistance frequency in a multicenter clinical study cohort in the United States.   J Clin Microbiol. 2016;54(9):2278-2283. doi:10.1128/JCM.01053-16 PubMedGoogle ScholarCrossref
60.
Dionne-Odom  J , Geisler  WM , Aaron  KJ ,  et al.  High prevalence of multidrug-resistant Mycoplasma genitalium in human immunodeficiency virus-infected men who have sex with men in Alabama.   Clin Infect Dis. 2018;66(5):796-798. doi:10.1093/cid/cix853 PubMedGoogle ScholarCrossref
61.
Xiao  L , Waites  KB , Van Der Pol  B , Aaron  KJ , Hook  EW  III , Geisler  WM .  Mycoplasma genitalium infections with macrolide and fluoroquinolone resistance-associated mutations in heterosexual African American couples in Alabama.   Sex Transm Dis. 2019;46(1):18-24. doi:10.1097/OLQ.0000000000000891 PubMedGoogle ScholarCrossref
62.
Durukan  D , Read  TRH , Murray  G ,  et al.  Resistance-guided antimicrobial therapy using doxycycline-moxifloxacin and doxycycline-2.5 g azithromycin for the treatment of Mycoplasma genitalium infection: efficacy and tolerability.   Clin Infect Dis. 2020;71(6):1461-1468. doi:10.1093/cid/ciz1031 PubMedGoogle ScholarCrossref
63.
Gnann  JW  Jr , Whitley  RJ .  Genital herpes.   N Engl J Med. 2016;375(19):1906. doi:10.1056/NEJMc1611877 PubMedGoogle Scholar
64.
McQuillan  G , Kruszon-Moran  D , Flagg  EW , Paulose-Ram  R .  Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14-49: United States, 2015-2016.   NCHS Data Brief. 2018;(304):1-8.PubMedGoogle Scholar
65.
Ayoub  HH , Chemaitelly  H , Abu-Raddad  LJ .  Characterizing the transitioning epidemiology of herpes simplex virus type 1 in the USA: model-based predictions.   BMC Med. 2019;17(1):57. doi:10.1186/s12916-019-1285-x PubMedGoogle ScholarCrossref
66.
Bernstein  DI , Bellamy  AR , Hook  EW  III ,  et al.  Epidemiology, clinical presentation, and antibody response to primary infection with herpes simplex virus type 1 and type 2 in young women.   Clin Infect Dis. 2013;56(3):344-351. doi:10.1093/cid/cis891 PubMedGoogle ScholarCrossref
67.
Stanberry  LR , Rosenthal  SL , Mills  L ,  et al.  Longitudinal risk of herpes simplex virus (HSV) type 1, HSV type 2, and cytomegalovirus infections among young adolescent girls.   Clin Infect Dis. 2004;39(10):1433-1438. doi:10.1086/425307 PubMedGoogle ScholarCrossref
68.
Corey  L , Adams  HG , Brown  ZA , Holmes  KK .  Genital herpes simplex virus infections: clinical manifestations, course, and complications.   Ann Intern Med. 1983;98(6):958-972. doi:10.7326/0003-4819-98-6-958 PubMedGoogle ScholarCrossref
69.
Bernstein  DI , Lovett  MA , Bryson  YJ .  Serologic analysis of first-episode nonprimary genital herpes simplex virus infection: presence of type 2 antibody in acute serum samples.   Am J Med. 1984;77(6):1055-1060. doi:10.1016/0002-9343(84)90188-8 PubMedGoogle ScholarCrossref
70.
Arshad  Z , Alturkistani  A , Brindley  D , Lam  C , Foley  K , Meinert  E .  Tools for the diagnosis of herpes simplex virus 1/2: systematic review of studies published between 2012 and 2018.   JMIR Public Health Surveill. 2019;5(2):e14216. doi:10.2196/14216 PubMedGoogle Scholar
71.
LeGoff  J , Péré  H , Bélec  L .  Diagnosis of genital herpes simplex virus infection in the clinical laboratory.   Virol J. 2014;11:83. doi:10.1186/1743-422X-11-83 PubMedGoogle ScholarCrossref
72.
Agyemang  E , Le  QA , Warren  T ,  et al.  Performance of commercial enzyme-linked immunoassays for diagnosis of herpes simplex virus-1 and herpes simplex virus-2 infection in a clinical setting.   Sex Transm Dis. 2017;44(12):763-767. doi:10.1097/OLQ.0000000000000689 PubMedGoogle ScholarCrossref
73.
Hollier  LM , Eppes  C .  Genital herpes: oral antiviral treatments.   BMJ Clin Evid. 2015;2015:1603.PubMedGoogle Scholar
74.
Tronstein  E , Johnston  C , Huang  ML ,  et al.  Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection.   JAMA. 2011;305(14):1441-1449. doi:10.1001/jama.2011.420 PubMedGoogle ScholarCrossref
75.
Magaret  AS , Mujugira  A , Hughes  JP ,  et al; Partners in Prevention HSV/HIV Transmission Study Team.  Effect of condom use on per-act HSV-2 transmission risk in HIV-1, HSV-2-discordant couples.   Clin Infect Dis. 2016;62(4):456-461.PubMedGoogle Scholar
76.
Martin  ET , Krantz  E , Gottlieb  SL ,  et al.  A pooled analysis of the effect of condoms in preventing HSV-2 acquisition.   Arch Intern Med. 2009;169(13):1233-1240. doi:10.1001/archinternmed.2009.177 PubMedGoogle ScholarCrossref
77.
Corey  L , Wald  A , Patel  R ,  et al; Valacyclovir HSV Transmission Study Group.  Once-daily valacyclovir to reduce the risk of transmission of genital herpes.   N Engl J Med. 2004;350(1):11-20. doi:10.1056/NEJMoa035144 PubMedGoogle ScholarCrossref
78.
 Management of genital herpes in pregnancy: ACOG practice bulletin, number 220.   Obstet Gynecol. 2020;135(5):e193-e202. doi:10.1097/AOG.0000000000003840 PubMedGoogle ScholarCrossref
79.
Patel  EU , Gaydos  CA , Packman  ZR , Quinn  TC , Tobian  AAR .  Prevalence and correlates of Trichomonas vaginalis infection among men and women in the United States.   Clin Infect Dis. 2018;67(2):211-217. doi:10.1093/cid/ciy079 PubMedGoogle ScholarCrossref
80.
Muzny  CA , Rivers  CA , Austin  EL , Schwebke  JR .  Trichomonas vaginalis infection among women receiving gynaecological care at an Alabama HIV clinic.   Sex Transm Infect. 2013;89(6):514-518. doi:10.1136/sextrans-2012-050889 PubMedGoogle ScholarCrossref
81.
Kissinger  P .  Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues.   BMC Infect Dis. 2015;15:307. doi:10.1186/s12879-015-1055-0 PubMedGoogle ScholarCrossref
82.
Herbst de Cortina  S , Bristow  CC , Joseph Davey  D , Klausner  JD .  A systematic review of point of care testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis.   Infect Dis Obstet Gynecol. 2016;2016:4386127. doi:10.1155/2016/4386127 PubMedGoogle Scholar
83.
Lara-Torre  E , Pinkerton  JS .  Accuracy of detection of Trichomonas vaginalis organisms on a liquid-based Papanicolaou smear.   Am J Obstet Gynecol. 2003;188(2):354-356. doi:10.1067/mob.2003.8 PubMedGoogle ScholarCrossref
84.
Kissinger  P , Muzny  CA , Mena  LA ,  et al.  Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: an open-label, randomised controlled trial.   Lancet Infect Dis. 2018;18(11):1251-1259. doi:10.1016/S1473-3099(18)30423-7 PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close