Sexually Transmitted Infections Part 2: Discharge Syndromes and Pelvic Inflammatory Disease

Diana Lemly; Nupur Gupta

doi:10.1542/pir.2019-0078

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Diana Lemly, MD*,‡,§
Nupur Gupta, MD, MPH*,†,§

^*Division of Adolescent and Young Adult Medicine and
^†Division of Global Health, MassGeneral Hospital for Children, Boston, MA
^‡Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
^§Harvard Medical School, Boston, MA

AUTHOR DISCLOSURE
Dr Lemly has disclosed no financial relationships relevant to this article. Dr Gupta is a co-editor of The MassGeneral Hospital for Children Handbook of Pediatric Global Health. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Abstract

Sexually transmitted infections (STIs) disproportionately affect young people, with more than half of the infections occurring in youth aged 15 to 25 years. (1)(2) This review, the second in a 2-part series on STIs, focuses on infections that may cause abnormal vaginal or penile discharge, including trichomonas, chlamydia, gonorrhea, and pelvic inflammatory disease (PID). Most infected persons, however, are asymptomatic. Nucleic acid amplification tests are the most sensitive and specific for the detection of chlamydia, gonorrhea, and trichomoniasis, and they can be performed on provider- or patient-collected swabs. Providers should have a low threshold for diagnosing and treating PID because untreated PID can have serious long-term complications for young women. Indications for hospitalization for PID include the presence of a tubo-ovarian abscess, severe illness with systemic symptoms, pregnancy, human immunodeficiency virus infection, and failure to respond to outpatient oral treatment (within 48–72 hours) or inability to tolerate the oral treatment.