Be prepared to recognize STIs in women

About 20 million new STIs are diagnosed each year in the United States, with half occurring in young people aged 15 to 25 years.

New treatment guidelines for female STIs
New treatment guidelines for female STIs

Nashville – Clinicians need to keep up with the growing prevalence of sexually-transmitted infections (STIs) in the female patient population, a presenter at the American Association of Nurse Practitioners 2014 meeting recommended.

There are about 20 million new cases of STIs each year in the United States, with half occurring in young people aged 15 to 25 years, CDC data indicate. Estimates suggest that a quarter of all teenagers and 50% of black teens have at least one STI.

Mimi Secor, MS, FAANP, a nurse practitioner based in Massachusetts and co-author of the book Fast Facts About the Gynecologic Exam for Nurse Practitioners, gave an overview on the changing epidemiology and treatment guidelines for STIs, primarily in those most commonly found in sexually-active females.

Among the conditions she covered were herpes, chlamydia, gonorrhea, pelvic inflammatory disease, vulvovaginitis, yeast, bacterial vaginosis, and trichomonas.

Herpes: Most herpes transmissions are asymptomatic with atypical symptoms. Secor advises that because the condition is so highly-stigmatized, NPs should make an effort to counsel their patients in getting the proper care.

Serology IgG with PCR testing was recommended for diagnosis, as well as suppressive therapy for treatment.

Chlamydia: In a total of nearly 3 million estimated cases of chlamydia, about 75% occurred in women, but only 42% are screened. Most cases are asymptomatic, undiagnosed, and can lead to pelvic inflammatory disease if left untreated.

CDC guidelines state that any woman, regardless of age, should be screened if they display risk factors or are sexually-active. Females who are diagnosed should be retested at least 3 months after initial treatment.

Gonorrhea: While gonorrhea is largely uncommon in females, Secor warns against the “era of untreatable gonorrhea” as evidenced by a new strain that is largely resistant to current cephalosporin antibiotics. However, ongoing clinical trials using Cempra (solithromycin) are showing early signs of being able to stave off this growing trend.

Pelvic Inflammatory Disease: It is recommended that NPs issue a low threshold for diagnosis due to the difficulty of diagnosis and potential for damage from even mild cases. The condition has nonspecific symptoms and is oftentimes difficult to recognize.

Minimum criteria for screening includes pain or tenderness in the abdomen, cervix, or adnexa.  

Vulvovaginitis: Cases involving inflammation of the vulva should involve a “Less is More” approach. Patients should wash using only warm water without soap, using topical products such as Vaseline or Crisco to prevent itching. They should also refrain from having sex and wear clothing that doesn't irritate the vagina.

Yeast: Yeast found in the vagina should be identified using pH swab testing, Affirm testing, vaginal microscopy, fungal culture examination, or PCR testing. Examining vaginal cultures or discharge is not recommended.

Bacterial Vaginosis: BV is linked with an increased risk of herpes, infertility, cystitis, preterm delivery, and chlamydia. Chronic cases of BV are common and complex, with a 30% chance of recurrence at 1 to 3 months as well as an 80% chance at 9 months. Pap and vaginal culture testing are not reliable, and it is recommended that NPs identify cases using pH, Affirm or PCR when correlated with other criteria.

Trichomoniasis: As of yet, there are no official screening guidelines for trichomoniasis, which carries risks in connection with preterm labor, HIV, and other STIs. Variable symptoms include a profuse, yellow, green, watery discharge. In females, the condition is more commonly found in women 40 years of age and older. Affirm and the OSOM test should be used in place of Pap.

References

  1. Secor M. “STI Update 2014: Focus on the Female – New Research, Trends an Treaments. What's Up, Down There?” Presented at: AANP 2014 Meeting. June 17-22, 2014; Nashville, Tenn.
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