Health and medical information

Genital warts can usually be diagnosed on clinical grounds and may be confirmed by histology. Cervical HPV infection will commonly be diagnosed by cervical cytology with or without colposcopy and biopsy. There are no suitable serological tests and the virus cannot be isolated from clinical material by cultural methods. HPV may be undetectable except by hybridisation using nucleic acid probes.

Warts must be distinguished from the condylomata lata of secondary

syphilis by serological tests for syphilis and dark ground examination. If the lesion is large, fungating or ulcerated, a biopsy should be taken to exclude carcinoma. Warts should also be differentiated from molluscum contagiosum (p.45), vulval skin tags and penile papules (sebaceous glands).

Genital HPV infection is usually sexually acquired but autoinoculation can occur. Lesions may develop from one to six months or more after infection. HPV infection may be subclinical. Latent infection is usual after spontaneous regression or treatment and there is considerable recurrence.

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Herpes is an increasingly common sexually transmitted infection caused by herpes simplex virus (HSV). There are two types, HSV-1 and HSV-2, which are clinically and epidemiologically similar. HSV-1 is often associated with lesions on the face and fingers and sometimes with genital lesions; it is usually acquired during childhood. HSV-2 is usually acquired after sexual activity commences and is almost entirely associated with genital herpes.

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For treatment failures and for patients for whom tetracyclines are contraindicated, erythromycin (e.g. erythromycin stearate or ethyl succinate 500 mg every 8 hours 1 hour before food for 10 days for simple infections and longer in complicated cases) may be used.

In patients with persistent or recurrent urethral symptoms, repeated antibiotic prescriptions should not take the place of careful clinical evaluation and laboratory investigation.

Sexual partners of patients with NGU or NGC should be assessed and treated where necessary. Women with silent infection may develop pelvic inflammatory disease especially when using an IUCD. Males may develop prostatitis. Epidemiological treatment is recommended for the female contacts of a male with recent onset of NGU.

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Whether patients are treated for one or other of these infections or for both will depend on an assessment of the clinical features, laboratory investigations and local disease patterns. Many venereologists recommend that patients with gonorrhoea also be treated for chlamydia.

Sexual partners of patients with gonorrhoea or NGU or NGC should be investigated and treated on epidemiological grounds. Women with silent infection may develop pelvic inflammatory disease. Asymptomatic male partners may develop prostatitis or epididymitis. Failed treatment or recurrence may be due to reinfection by an infected partner.

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The effective management of STDs has four components, namely treatment, counselling, follow-up and contact tracing.

The management of bacterial STDs is one field of medicine where there is

a substantial degree of standardisation of drug therapy. Single dose treatments are available for some STDs and are of particular use for patients unlikely to comply with daily regimens or to attend follow-up. Where specific treatment is available, a full course in accordance with an authoritative recommendation should be prescribed.