The impact of antimicrobial resistance on the treatment of sexually transmitted diseases

E. Erbelding, T. C. Quinn

Research output: Contribution to journalArticlepeer-review

Abstract

During the past 2 decades, sexually transmitted diseases (STDs) have continued to escalate worldwide and nationally. Currently, the World Health Organization (WHO) estimates that the global incidence in 1995 of new cases of selected curable STDs such as gonorrhea, chlamydia, syphilis, and trichomoniasis was 335 million, and the global prevalence of these diseases was 250 million. The global prevalence of active or latent infection with common chronic viral STDs such as genital herpes simplex virus, genital human papillomavirus (HPV), hepatitis B virus, and more recently, the human immunodeficiency virus (HIV) is now estimated to be in the billions of cases, because in some populations the majority of adults become infected with one or more of these pathogens. STDs are severe social, health, and economic burdens worldwide. The World Bank estimates that STDs, excluding AIDS, are the second leading cause of healthy life lost among women between the ages of 15 and 44 in the developing world. In the United States, of the top 10 most frequently reported diseases in 1995, 5 are STDs. With approximately 12 million new cases of STDs occurring annually, the rates of curable STDs in the United States are the highest in the developed world. For example, the reported incidence of gonorrhea in 1995 was 150 cases per 100,000 persons in the United States versus 3 cases per 100,000 in Sweden. A recent Institute of Medicine report emphasized that the scope and impact of the STD epidemic are underappreciated and that the STD epidemic largely is hidden from public discourse, despite the tremendous health and economic burden of STDs. The disproportionate impact of STDs on women has not been widely recognized, and adolescents and young adults are at greatest risk of acquiring STDs even though the STD prevention efforts for adolescents remained unfocused and controversial in the United States. Each year, approximately 3 million American teenagers acquire an STD in the United States. Adolescents and young adults are the age group at greatest risk of acquiring an STD for a number of reasons: they are more likely to have multiple sex partners; they may be more likely to engage in unprotected intercourse; and their partners may be at higher risk of being infected. Compared with older adult women, female adolescent and young women also are more susceptible to cervical infections such as gonorrhea and chlamydia. In addition, adolescents and young people are at greater risk than older persons for substance use and other behaviors that also may increase the risk for STDs. More than 25 infectious organisms are known to be transmitted through sexual activity and may be responsible for a wide variety of clinical syndromes. Complications of STDs are more severe and occur more frequently among women than men. Several STDs, such as gonorrhea and chlamydia, are responsible for pelvic inflammatory disease, ectopic pregnancies, and infertility. Human papilloma virus (HPV) infections may result in cervical cancer and several STDs have been associated with adverse outcomes of pregnancy and in perinatal transmission to the newborn infant. With the recent recognition of escalating heterosexual transmission of HIV infection, multiple studies have shown that both ulcerative STDs such as chancroid, syphilis, and genital herpes, and inflammatory STDs such as gonorrhea, chlamydia, and trichomoniasis increase the risk of HIV transmission. Early detection and treatment of STDs also have been shown to have a major impact on decreasing the sexual transmission of HIV. Consequently, a renewed interest in diagnosis and treatment of STDs as an effort of controlling their epidemic spread, including HIV infection, has been encouraged strongly by public health officials worldwide and nationally. Major advances have been made in the clinical recognition microbiologic diagnosis, and treatment of many STDs. New clinical algorithms have been developed for early detection of pelvic inflammatory disease, urethritis, cervicitis, and vaginal infections. More sensitive and specific assays also have become available for early diagnosis of specific etiologic agents. With the recent introduction of nucleic acid amplification as a diagnostic tool, it is now possible to identify early infection before clinical symptoms have developed. Finally, new antimicrobial agents have markedly advanced the effective treatment of these infections. The focus of this article is to review the development of antimicrobial resistance among several STDs and to discuss the frequency and mechanisms of resistance and recommendations for treatment of selected STDs where resistance to certain antimicrobial agents has increased. For a number of STDs such as Chlamydia trachomatis and syphilis, no evidence of antimicrobial resistance has developed over the years, although management of these diseases such as in the case of pelvic inflammatory disease or syphilis in HIV-infected individuals requires intensive treatment and follow-up to assure effectiveness of treatment. The treatment of HIV and the development of resistance to antiretroviral agents will be discussed in a separate chapter.

Original languageEnglish (US)
Pages (from-to)889-903
Number of pages15
JournalInfectious disease clinics of North America
Volume11
Issue number4
DOIs
StatePublished - Jan 1 1997

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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