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Emerging Sexually Transmitted Diseases: Symptoms & Diagnosis

In a recent publication in Disease-a-Month, Catherine F. Decker, MD, from Walter Reed National Military Medical Center, Bethesda, Maryland, discussed some infections that have recently emerged as important sexually transmitted diseases (STDs)—in particular, hepatitis C, lymphogranuloma venereum (LGV), and Mycoplasma genitalium infections.
Hepatitis C is a viral liver disease caused by the blood-borne hepatitis C virus (HCV). HCV is transmitted mainly through blood exposure and was originally not thought to be efficiently transmitted through sexual intercourse. However, data in recent years have shown that sexual transmission of HCV can occur, especially among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM).
Acute HCV infection may be difficult to recognize because it produces few or no symptoms. Most infected individuals go on to develop chronic HCV infection, which ultimately results in liver injury. But, because these people are usually asymptomatic, their infection often goes undetected and they continue to represent a source of transmission to other individuals.
HCV testing recommendations are based on either the risk for HCV infection or a recognized exposure. This includes screening in all people born during 1945 to 1965, as well as in those born to a mother with HCV infection or who have a history of current or past injection drug use. Testing should be performed using a US Food and Drug Administration (FDA)-cleared test for antibody to HCV. In cases of a positive antibody result, nucleic acid amplification testing (NAAT) is also necessary to detect the presence of HCV ribonucleic acid (RNA) to confirm the diagnosis of current HCV infection. “Because some HIV-infected patients fail to develop HCV antibodies, HCV RNA testing should be performed in patients with unexplained liver disease who are anti-HCV negative, writes Dr. Decker. “The course of liver disease is more rapid in HIV/HCV co-infected persons, and the risk for cirrhosis is nearly twice that of persons with HCV infection alone.”
Although HCV is rarely transmitted sexually, the Centers for Disease Control and Prevention (CDC) does recommend the use of condoms by individuals who have multiple sexual partners, especially those who also have HIV infection. However, the CDC suggests that condom use by monogamous couples might not be necessary.

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