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Introduction

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He who immerses himself in sexual intercourse will be assailed by premature ageing, his strength will wane, his eyes will weaken, and a bad odour will emit from his mouth and his armpits, his teeth will fall out and many other maladies will afflict him.

Moses ben Maimon (1135–1204), Mishneh Torah

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Sexually transmitted infections (STIs) are a group of communicable infections, usually transmitted by sexual contact. Their incidence has been of widespread significance during the past 30 years and they are a major public health problem in all countries.

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The STIs have developed a high profile in modern society with the advent of HIV infection, hepatitis B, Chlamydia trachomatis as a major cause of PID, the emergence of penicillin-resistant gonorrhoea and the increasing frequency of the human papilloma (wart) virus infection with its association with cervical cancer. STIs are summarised in Table 119.1.

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Table Graphic Jump Location
Table 119.1

Sexually transmitted or acquired infections: causative organisms and treatment2,4

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Key facts and guidelines

  • In Western society most patients with STIs are in the 15–30 years age group.

  • Gonorrhoea and syphilis are no longer the commonest STIs.

  • Chlamydial infection, hepatitis B, human papillomavirus and genital herpes are now common infections.

  • Not all STIs are manifest on the genitals.

  • Not all genital lesions are STIs.

  • The 5% rule:1

    • 5% of urethritis (STI) in males is lower UTI

    • 5% of lower UTI in females is urethritis (STI)

  • Chlamydia trachomatis is now the commonest cause of urethritis.

  • Chlamydia typically causes dysuria in men but may be asymptomatic. It usually causes no symptoms in women.

  • Gonorrhoea may cause no symptoms, especially in ...

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