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21.4: Sexually Transmitted Infections - Biology

21.4: Sexually Transmitted Infections - Biology


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Columbian Exchange

This artwork is entitled “Columbus and the Indian Maiden.” It was painted around 1875 by Constantino Brumidi, an Italian-American historical painter. It is a good image to represent the concept of Columbian exchange. This concept refers to the exchange of pathogens during initial contact between Europeans and Native Americans, starting when Columbus arrived in the New World in 1492. One of those pathogens may have been the sexually transmitted bacterium that causes syphilis. Syphilis is thought to have originated in the New World, and there is some evidence that Columbus himself was infected with it. The first recorded European outbreak of syphilis occurred in 1494. The outbreak began in Italy and quickly swept across the entire European continent. When Europeans were first exposed to syphilis, it was a much more virulent disease than it would eventually become. Back then, pustules covered the body of people with syphilis, and they caused the flesh to fall away from the face. The disease was also usually quickly fatal. In that first European epidemic, syphilis killed an estimated 5 million people.

Introduction to Sexually Transmitted Infections (STIs)

Syphilis is one of many sexually transmitted infections. A sexually transmitted infection (STI)is an infection caused by a pathogen that spreads mainly through sexual contact. This generally involves direct contact between mucous membranes or their secretions. To be considered an STI, an infection must have only a small chance of spreading naturally in other ways. Some infections that can spread through sexual contact, such as the common cold, spread much more commonly by other means, such as airborne transmission. These infections are not considered STIs.

You may have heard sexually transmitted infections (STIs) referred to as sexually transmitted diseases (STDs). The disease terminology is no longer used to avoid the misconception that STIs cannot be transmitted unless one has symptoms of the disease. In fact, many STIs do not cause symptoms but can still be spread by infected people, most of whom are unlikely to even realize they are infected. An even older term for STIs is a venereal disease (VD). The term comes from Venus, the Roman goddess of love. The World War I-era anti-VD poster shown below appeals to patriotism to encourage soldiers to avoid becoming infected. During that war, STIs caused the U.S. Army to lose the services of 18,000 servicemen per day.

Transmission of STIs

Most of the pathogens that cause STIs are either bacteria or viruses that enter the body through mucous membranes of the reproductive organs and often through the oral and anal mucosa as well. Pathogens that can only infect the body via direct contact between mucous membranes generally cannot spread through non-sexual skin contact, such as touching, hugging, or shaking hands. All sexual behaviors that involve contact between mucous membranes put a person at risk for infection with STIs. This includes vaginal, anal, and oral sexual behaviors. Some of the pathogens that cause STIs can also be transmitted through body fluids such as blood and breast milk. Therefore, sharing drug injection needles as well as the processes of childbirth and breastfeeding are other ways these STIs can potentially be spread. Most of the information in this section is about cis-gendered individuals because of the lack of data and information about the spread of STIs in the LGBTQ community.

Symptoms of STIs

Common symptoms of STIs include sores or rashes on the genitals, a vaginal or penile discharge, and painful urination. Many STIs are asymptomatic or cause such mild symptoms that they go unnoticed. Such infections are called “silent” infections. However, even in asymptomatic people, the pathogens can usually be transmitted to other people. Asymptomatic infections may also eventually cause serious health problems if they go untreated.

Diagnosis and Treatment of STIs

Most STIs are treatable if not curable, but the correct treatment depends on diagnosing the pathogen that is causing the infection. STIs caused by bacteria can generally be cured with antibiotics, although some bacteria may be evolving antibiotic resistance. STIs caused by viruses cannot be successfully treated or cured with antibiotics. Instead, viral STIs are treated with antiviral drugs, which may help control but usually not eliminate the virus. If the immune system cannot eliminate the virus, it may remain in the body for life.

Prevention of STIs

Vaccinations are available to prevent just a few STIs (including human papillomavirus and hepatitis infections). The only completely effective way to prevent other STIs is to avoid all sexual contact and other risky behaviors. Safe sex practices — such as using condoms, having few sexual partners, and maintaining mutually monogamous relationships — can reduce the risk of STIs but not prevent them for certain. Condoms, for example, are not foolproof. Pathogens may be present on areas of the body not covered by condoms, and condoms can also break or be used incorrectly. (See the Feature: My Human Body for the correct way to use condoms.) Practices that cannot prevent the transmission of STIs include washing the genitals, urinating, and/or douching after sexual contact.

Pathogens that Cause STIs

STIs are caused by many different types of pathogens. More than 30 different pathogens have been identified. Most are bacteria or viruses. A few of the pathogens are sexually transmitted parasites.

Parasites that Cause STIs

A very common sexually transmitted parasite is the crab louse (Pthirus pubis), pictured in Figure (PageIndex{3}). It lives in human pubic hair where it bites the skin and sucks on blood. This may cause itching and irritation.

Another common sexually transmitted parasite is the single-celled protozoan named Trichomonas vaginalis. It infects the vagina and urethra, causing the STI called trichomoniasis. It may cause burning and itching at the site of infection but is often asymptomatic. It is easily cured with prescription drugs.

Bacterial STIs

Many STIs are caused by bacteria. Some of the most common bacterial STIs are chlamydia, gonorrhea, and syphilis.

Chlamydia

Chlamydia is an STI caused by infection with the bacterium Chlamydia trachomatis. It is the most frequently reported bacterial STI in the United States. In 2015, an estimated 2.9 million chlamydia infections occurred in the United States. Chlamydia is most common among young people, with about two-thirds of new cases occurring in people between the ages of 15 and 24. The high rates in young people are apparent in Figure (PageIndex{4}). More young females than young males are diagnosed with chlamydia each year, largely because of sex differences in testing for the infection.

Chlamydia is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected sexual partner. Ejaculation of semen does not have to occur for chlamydia to be transmitted or acquired. People who have been treated and cured of chlamydia do not become immune to the bacteria and may become infected again if they have sexual contact with an infected person. Chlamydia can also spread from an untreated mother to her baby during childbirth. In infants infected at birth, the bacteria may infect the eyes, lungs, anus, or genitals.

In women, Chlamydia bacteria usually infect the cervix and sometimes the urethra. If symptoms occur, they are likely to include vaginal or urethral discharge or bleeding. Urination may also be painful. The infection may spread from the cervix to the upper reproductive tract, including the uterus and Fallopian tubes, causing pelvic inflammatory disease (PID). PID may also be asymptomatic, but even without symptoms, it can lead to permanent damage and increase the risk of ectopic pregnancy (in which the embryo implants outside of the uterus) or infertility. In men, chlamydia bacteria usually infect the urethra and sometimes the epididymis. If symptoms occur, they typically include a urethral discharge and pain in urinating. Occasionally, there is pain, tenderness, or swelling in one of the testes. In both sexes, the rectum can also be infected. If there are rectal symptoms, they may include rectal discharge, bleeding, or pain.

Chlamydia is easily cured with antibiotics. Because chlamydia is usually asymptomatic; screening is necessary to identify most infections so they can be treated and cured. Screening programs routinely test as many people as possible in high-risk groups using lab tests of patient specimens, such as urine samples or swabs of vaginal, oral, or anal discharge. Screening programs have been shown to reduce the adverse sequela of chlamydia in women (PID, ectopic pregnancy, infertility), so annual chlamydia testing is recommended for women in high-risk groups. These include all sexually active women younger than 25 as well as older women with certain risk factors, such as a new sexual partner, multiple sexual partners, or a sexual partner who has an STI. Pregnant women are also tested during their first prenatal care visit and sometimes again during the third trimester. Routine chlamydia screening is not generally recommended for men because the costs are thought to outweigh the potential benefits.

Gonorrhea

Gonorrhea is a common STI caused by the bacterium Neisseria gonorrhoeae. An estimated 820,000 new cases of gonorrhea occur in the United States each year, but fewer than half of them are actually diagnosed and reported. Approximately 70 percent of cases occur in people aged 15 to 24 years, as indicated by the graph in Figure (PageIndex{5}) for the year 2014. The blue bars on the left represent the number of infected males and on the right, the red bars represent the number of females infected per 100,000 individuals. Again, sex differences in testing for the disease are reflected in higher rates for females.

Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to spread. After being cured of gonorrhea, a person can get the disease again through sexual contact with an infected partner. Gonorrhea can also be transmitted from an untreated mother to her baby when the infant passes through the birth canal. The bacteria may infect the baby’s eyes (Figure (PageIndex{6})) and possibly cause blindness. The baby can also develop a joint infection or a life-threatening blood infection.

Gonorrhea is often asymptomatic, especially in females. If symptoms do occur, they typically include a discharge from the penis or vagina and painful urination. Even when women do not have symptoms of gonorrhea, they are at risk of developing complications from the infection, such as PID and infertility. If left untreated, gonorrhea can also spread to the blood and cause a life-threatening systemic disease.

Because gonorrhea is so often asymptomatic, the majority of cases are diagnosed during routine screening. The Centers for Disease Control and Prevention (CDC) recommend annual gonorrhea screening for all sexually active females younger than 25 years old, as well for older women with risk factors such as new or multiple sex partners. Gonorrhea bacteria are detected with lab analysis of urine or of genital, oral, or rectal specimens. Gonorrhea usually can be cured with proper treatment. Successful treatment has become more difficult as the bacteria have started to evolve resistance to the most commonly used antibiotics. The CDC advises taking two different antibiotics concurrently for the best chances of a cure

Syphilis

Syphilis is an STI caused by the bacterium Treponema pallidum. During 2015, there were almost 75,000 new cases of syphilis reported in the United States. In some of these cases, the disease was diagnosed for the first time in people with long-term infections.

Syphilis is transmitted from person to person by direct contact with a syphilitic sore, known as a chancre. Chancres occur mainly on the external genitals or in the vagina or anus, but they may also occur on the lips or in the mouth (as shown in Figure (PageIndex{7})). Transmission of syphilis can occur during vaginal, anal, or oral sex. After being cured of syphilis, a person can get the disease again through sexual contact with an infected partner. A pregnant woman with untreated syphilis can pass the disease to her unborn child at any time during pregnancy or childbirth. Depending on when the bacteria are transmitted to the fetus, the outcome may be stillbirth or early infant death. Untreated syphilis in pregnant women results in infant death in up to 40 percent of cases.

Without treatment, syphilis typically progresses through several stages. The progression of the disease is likely to be stopped only if a person receives appropriate antibiotic therapy. Barring such treatment, an infected person may eventually progress through all of the stages of the disease, a process that may take a decade or more.

  1. Primary syphilis is the first stage of the disease. It begins with the appearance of at least one chancre. The chancre is usually firm, round, and painless. It appears at the location where the syphilis bacteria entered the body. The chancre lasts from 3 to 6 weeks and then heals, regardless of whether the person is treated.
  2. Secondary syphilis is the second stage of the disease. It is the most contagious of all the stages and is characterized by the spread of the bacteria throughout the body, causing systemic symptoms such as skin rashes (Figure (PageIndex{8})) and/or sores on the mucous membranes. Other symptoms may include fever and swollen lymph glands. This stage typically begins about 4 to 10 weeks after the initial infection and generally lasts 3 to 6 weeks.
  3. Latent syphilis is the third stage of the disease. This stage begins when the symptoms of secondary syphilis resolve, which generally occurs even without treatment. There are no symptoms during the latent stage, but the bacteria are still present in the body. The latent stage of syphilis can last for years.
  4. Tertiary syphilis is the final stage of the disease. In this stage, the disease may infect and damage internal organs, such as the brain, heart, liver, or bones. A severe joint infection in a person with tertiary syphilis is pictured below. Symptoms of the tertiary stage may include paralysis, blindness, seizures, and dementia. The damage may be serious enough to cause death

Syphilis is usually diagnosed on the basis of a blood test that detects antibodies that are specific for the syphilis bacterium. Because of the severity of infection in fetuses and the high risk of fetal death, it is recommended that all pregnant women be tested for syphilis at the first prenatal visit. Women at high risk of syphilis should be tested again during the third trimester and at the time of delivery. If a pregnant woman tests positive for syphilis, she is prescribed the antibiotic penicillin, which has a 98 percent success rate at preventing mother-to-fetus transmission. If the pregnant woman is allergic to penicillin, desensitization is required before treatment is given.

Penicillin is also the drug of choice for treating syphilis in the general population. A single intramuscular injection of long-acting penicillin can cure primary, secondary, or early latent syphilis. For people with late latent or tertiary syphilis, three doses of penicillin administered at weekly intervals are generally required for a cure. If patients are allergic to penicillin, other antibiotics may be used, but they tend to less effective and require retesting for syphilis after treatment to ensure that a cure has occurred. Antibiotics kill the syphilis bacteria and prevent further damage, but they do not repair any damage that is already done

Viral STIs

Two of the very common viral STIs, genital herpes and HPV infection are described below. Another important viral STI is HIV infection, which causes the disease known as AIDS. HIV infection is covered in the concept HIV and AIDS.

Genital Herpes

Genital herpes is a viral STI caused by a herpes simplex virus. The cause of genital herpes is most often herpes simplex virus type 2 (HSV-2). Increasingly, however, genital herpes is caused by herpes simplex virus type 1 (HSV-1). HSV-1 more commonly causes herpes infections of the mouth, resulting in “cold sores,” and is typically acquired during childhood. Genital herpes infections are very common in the United States, with about three-quarters of a million new cases occurring each year. HSV-2 infection is more common in women than men due to sex differences in transmission of the virus: genital herpes is more easily transmitted from males to females than from females to males.

Generally, a person can get an HSV-2 infection only through sexual contact with someone who has an infection with the virus. Transmission occurs through contact with lesions, mucosal surfaces, or genital or oral secretions. Transmission can occur even when the infected person does not have visible sores because the virus can be shed from body surfaces that appear normal. Genital herpes can also be passed from mother to child during pregnancy, childbirth, or shortly after birth.

Most people who are infected with genital herpes are unaware of their infection. In fact, in the United States, almost 90 percent of 14-49-year-olds infected with HSV-2 have never received a clinical diagnosis. That’s because most genital herpes infections are asymptomatic or have very mild symptoms that go unnoticed. When noticeable symptoms do occur, they typically appear as one or more blisters on or around the genitals (Figure (PageIndex{10})), rectum, or mouth. When the blisters break, they leave painful ulcers that take up to a month to heal. Sometimes the initial outbreak is accompanied by systemic symptoms such as fever and swollen lymph nodes. Recurrent outbreaks of blisters are common, especially during the first year of infection. Although the virus is likely to stay in the body indefinitely, the number, duration, and severity of outbreaks tend to decrease over time. Rare but serious complications of HSV-1 or HSV-2 infections may include blindness, encephalitis, or meningitis.

Herpes infections can be diagnosed with blood tests that detect antibodies to the virus. There is no cure for herpes infections, but antiviral medications can prevent or shorten outbreaks and lessen the risk of transmission during the time the patient is taking the medicine. Several clinical trials have tested vaccines against genital herpes, but none has yet been found to be effective. Pregnant women with genital herpes are usually prescribed antiviral medication during the last month of pregnancy to reduce the risk of an outbreak around the time of birth when the transmission is most likely. If an outbreak does occur, a cesarean delivery is recommended to prevent HSV transmission to the infant.

HPV Infection

The most common sexually transmitted infection in the United States is infection with the human papillomavirus (HPV). Almost 80 million Americans are estimated to be infected with HPV, and about 14 million people are thought to become infected each year. HPV is so common that nearly all sexually active people are eventually infected by it. There are more than 40 different types of HPV, but only some of them are likely to cause health problems.

HPV is acquired through vaginal, anal, or oral sex with someone who is infected with the virus. The infected person can transmit the virus even without showing any signs or symptoms of infection. In most cases, the immune system naturally clears HPV from the body before it causes any symptoms — generally within a couple of years of the original infection. However, in some cases, HPV is not naturally cleared. These cases may develop health problems years after the infection was first acquired. Some types of HPV can cause genital warts, and certain other types can cause cancer.

  • Genital warts appear as one or more bumps on the skin or mucosa in the genital area. Warts may be small, like the genital wart in the photo below, or they may be much larger. Warts may be raised or flat; sometimes they are shaped like a cauliflower.
  • Primary cancer caused by HPV is cervical cancer. However, HPV can also cause other cancers, including cancer of the vulva, vagina, penis, anus, or throat and mouth. It generally takes years or even decades for cancer to develop after a person is infected with HPV.

There is no cure for HPV infection. Once a person is infected, if the immune system does not clear the virus, it may remain in the body for life. There is also no general screening test to determine whether someone is infected with HPV. However, there are specific HPV tests that can identify the most common types of HPV that cause cervical cancer. These tests are recommended for women aged 30 and older. Women aged 21 to 65 should also receive routine Pap tests every 3 years to screen for cervical cancer, which has a high cure rate if it is discovered early.

Genital warts can usually be diagnosed visually by a healthcare provider. There is typically no need to treat warts unless they are unsightly or bothersome. Treatment consists of topical medications that cause warts to slowly resorb and disappear. However, treatment of genital warts does not get rid of the patient’s HPV infection, and warts may return. If genital warts are not treated, they may or may not eventually go away on their own.

Unlike the other STIs described above, infection with the most common and dangerous types of HPV can be prevented with a vaccine. The HPV vaccine is recommended for all girls and boys between the ages of 11 and 12 years. Young people who do not get vaccinated at those ages can still get the vaccine through age 21 (for males) or 26 (for females). The main purpose of the vaccine is to protect people from developing HPV-related cancers later in life.

Feature: My Human Body

Proper use of condoms can significantly reduce the risk of transmission of STIs. For infection protection, the best condoms to use are latex condoms, because some pathogens are able to pass through the tiny pores in natural skin condoms. When using male condoms, follow these guidelines for the most effective prevention of STI transmission:

  • Always use a new condom; never reuse a condom, even if it does not contain ejaculate.
  • Avoid putting on a condom tightly at the end. Leave about 1.5 cm (3/4 in.) of empty space at the tip of the condom to allow room for ejaculate. Otherwise, the force of ejaculation may cause the condom to fail.
  • Avoid inverting or spilling a condom once worn, whether or not it contains ejaculate.
  • If the user attempts to unroll the condom over the penis but realizes it is on the wrong side, the condom should be discarded and a new one used.
  • Be careful when handling a condom, especially with long fingernails.
  • Avoid using oil-based lubricants with latex condoms because the oil can weaken the latex.
  • Avoid using flavored condoms, especially for vaginal intercourse, because the sugar in the flavoring may encourage yeast infections.

Review

  1. Define the sexually transmitted infection.
  2. Describe how sexually transmitted pathogens are spread.
  3. Give examples of different types of sexually transmitted pathogens.
  4. Describe common symptoms of STIs.
  5. Contrast treatments for bacterial and viral STIs.
  6. Why is it important to treat STIs even if they do not cause symptoms?
  7. Discuss the role of vaccines in preventing STIs.
  8. What are ways to prevent the transmission of STIs for which there are no vaccines?
  9. Name two STIs that often go unnoticed because they commonly do not cause symptoms, or cause only very mild symptoms.
  10. True or False. Proper use of condoms can completely prevent the transmission of STIs.
  11. True or False. Antibiotics can be used to treat genital herpes.
  12. What is the most common STI in the United States?
  13. Describe the relationship between cancer and an STI.
  14. What are two reasons why the number of diagnosed cases of some STIs is higher in females than in males?

STI/STD List – Different Types of Viral STDs

There are 3 different kinds of STIs/STDs: bacterial, viral, and parasitic.

Like bacterial STIs/STDs, viral STIs/STDs often give no warning signs or symptoms. This means you can contract it and infect a sexual partner without knowing it and serious complications which can cause irreversible damage can progress silently before you ever recognize a problem.

Viral STIs/STDs are caused by viruses passed from person-to-person and depending on the STI/STD, can be transmitted during sexual activity during non-sexual contact with another individual from mother to infant during pregnancy, birth, or breastfeeding blood transfusions or sharing IV drug equipment and in some instances, from towels, straws, or other objects that come in contact with someone who has the infection (see STI/STD in-depths for details about how each STI/STD is transmitted).

In general, viral infections can involve many different parts of the body at the same time.

Viral STIs/STDs, especially herpes, hepatitis B and C, and HIV infections, usually persist for life. Antiviral drugs can control but not yet cure all of these infections, except hepatitis C, which can be cured in some people after prolonged treatment.

Other viral STIs must be “waited out” or allowed to run their course, at which point, the body will have developed antibodies to fight the infection and reduce or completely eliminate symptoms. For those viral STIs, it’s important to remember one can transmit or contract them even when symptoms are not present and because testing is not always available or 100% accurate, one can transmit or contract the virus after it’s believed to have cleared.


Epidemiology of HIV Infection

Rennatus Mdodo , . Kevin M. De Cock , in Infectious Diseases (Fourth Edition) , 2017

Sexual Transmission

Heterosexual transmission is the primary contributor to the scale of the HIV epidemic in low-income countries. 1 However, risk factors for heterosexual transmission can vary by setting. Most heterosexual transmission in low-income countries occurs both in the context of transactional sex , and in longer-term sexual relationships, including marriage or cohabiting relationships. Women, especially younger women, are biologically more susceptible to HIV infection in heterosexual relationships. 5 Globally, young women are twice as likely to become infected with HIV as their male counterparts, and female sex workers (FSW) are 14 times as likely to be living with HIV as other women globally. 6 Changes in sexual behavior to prevent sexual transmission of HIV, such as delayed sexual debut, condom use and reductions in sexual partners, have resulted in significant declines in high-prevalence countries. In Zimbabwe, for example, declines in new HIV infections among segments of the population were driven by behavioral shifts, notably a reduction in multiple sexual partners. 7–9

Structural issues, including gender inequalities, restricted access to services and criminalization of high-risk behaviors, increase vulnerability to HIV. Sex workers experience high levels of exposure to HIV through behavioral risk, such as high numbers of sexual partners, often occurring concurrently, exacerbated by inconsistent condom use, and lower condom use with regular clients and with boyfriends and spouses. Based on a systematic meta-analysis conducted in 2011, the overall pooled prevalence of HIV among FSW in all regions of the world was approximately 12%, and an odds ratio for HIV infection of 13.5 compared to other women of reproductive age. 10 A recent study showed a higher global HIV prevalence among FSW, attributing 15% of HIV infections to female sex work. The greatest HIV burden among FSW is in those living in sub-Saharan Africa, with 18% of HIV prevalence attributable to this risk 11 and more than 50% of HIV prevalence in sex workers globally. 12 Of the 106 000 cases of HIV attributed to FSW globally, 98 000 occur in sub-Saharan Africa.

High odds of HIV infection (between 7% and 9%) were also found in FSW in South and South East Asia, Latin America and the Caribbean regions. In East Asia, and North Africa and the Middle East, the prevalence of HIV attributable to FSW was estimated to be 3% and below 2% in Europe, North America and Oceania. 12 Based on mathematical modeling, in West Africa 10–32% of new HIV infections were from commercial sex work. In Uganda, Swaziland and Zambia 7–11% of new infections were attributable to FSWs, their clients and clients' regular partners. 10 The proportion of new HIV infections due to sexual transmission in sex work is estimated to be a third of new infections in Ghana and 14% in Kenya. 12 To date, limited data exist on the burden of HIV among FSWs in Eastern Europe, the Middle East and North Africa to make firm conclusions on their contribution to the HIV epidemic in these regions.

Men who have sex with men (MSM) carry a disproportionate disease burden of HIV due to the high probability of transmission through receptive anal intercourse. Male-to-male sexual transmission has been an important driver of the HIV epidemic, particularly in regions with concentrated HIV epidemics such as Asia and the Pacific, Latin America and the Caribbean, the USA, Canada, Australia and Western Europe. In Latin America and the Caribbean, MSM represent the largest source of new infections, ranging from 33% in Dominican Republic to 56% in Peru. 2 The Caribbean region has the highest burden of HIV among MSM with a prevalence of 25.4% (21.4–29.5%). 11 In South East Asia MSM transmission is still significant. The incidence of HIV per 100 person-years among MSM in Thailand ranges between 5.9 (95% CI 5.2–6.8 n = 1744) and 8.2 (95% CI 3.7–18.3 n = 81). HIV prevalence among MSM in Thailand ranges from 8.2% to 68.2%. In sub-Saharan Africa, where heterosexual transmission is the predominant mode of transmission, there is increasing recognition of the role of male-to-male sex in transmission dynamics in the region. 2,11 Mostly because of criminalization of homosexuality, data on the burden of HIV among MSM in this region are limited. Since 2001, at least 14 countries in sub-Saharan Africa have conducted behavioral or HIV prevalence surveys among MSM. 12 These studies and meta-analysis reports have shown that wherever male-to-male sex has been studied in Africa, MSM carry a substantially high burden of HIV. 13–15 In Kenya HIV prevalence among MSM is between 12.3% and 43.0% and the incidence per 100 person-years ranges between 6.8 (95% CI 4.9–9.2 n=327) and 20.9 (95% CI 6.7–64.9 n=60), and HIV prevalence among MSM in South Africa ranges from 10.0% to 40.7%. 16


Gonorrhea

Gonorrhea, otherwise known as "the clap," is another common bacterial STD.   It generally infects the same organs as chlamydia and has similar long-term effects.

Symptoms of gonorrhea include burning when urinating and, in men, white, yellow, or green discharge from the penis. Just as with chlamydia, many people with gonorrhea don't have symptoms.

The Centers for Disease Control and Prevention (CDC) estimates that there are more than 120 cases of gonorrhea for every 100,000 people in the United States alone, and that number has been growing for several years.

Be aware, too, that gonorrhea can also infect the throat and be passed via oral sex. Currently, one of the biggest concerns about gonorrhea is treating it, as there is a growing problem of antibiotic-resistant gonorrhea.  


Diagnosis of STIs

Accurate diagnostic tests for STIs are widely used in high-income countries. These are especially useful for the diagnosis of asymptomatic infections. However, in low- and middle-income countries, diagnostic tests are largely unavailable. Where testing is available, it is often expensive and geographically inaccessible and patients often need to wait a long time (or need to return) to receive results. As a result, follow up can be impeded and care or treatment can be incomplete.

The only inexpensive, rapid tests currently available for STIs are for syphilis and HIV. The rapid syphilis test is already in use in some resource-limited settings. A rapid dual HIV/syphilis test is not available whereby a person can be tested for HIV and syphilis from a single finger-stick and using a single testing cartridge. These tests are accurate, can provide results in 15 to 20 minutes, and are easy to use with minimal training. Rapid syphilis tests have been shown to increase the number of pregnant women tested for syphilis. However, increased efforts are still needed in most low- and middle-income countries to ensure that all pregnant women receive a syphilis test.

Several rapid tests for other STIs are under development and have the potential to improve STI diagnosis and treatment, especially in resource-limited settings.


Sexually Transmitted Infections: Adopting a Sexual Health Paradigm (2021)

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Summary1 Sexual and reproductive health is of critical importance to overall health and well-being. The prevention and control of sexually transmitted infec- tions (STIs)—a major component of sexual and reproductive health—how- ever, has been chronically underfunded, stigmatized, and too frequently left out of national conversations around health. STIs are among the most common infections affecting humans and cause significant morbidity and mortality in the United States and globally. The Centers for Disease Control and Prevention (CDC) estimates that one in five people in the United States had a sexually transmitted infection (STI) on any given day in 2018, totaling nearly 68 million estimated infections. Furthermore, an estimated 26 million new STIs occurred in 2018, representing an array of more than 30 viral, bac- terial, and protozoal pathogens (see Box S-1 for key STI facts and statistics and Figure S-1 for STI rates over time). Chlamydia, gonorrhea, and syphilis lead the list of reportable U.S. STI infections they are all preventable, easily diagnosed, and treatable with antibiotics. Although diagnosed STI rates have increased across all populations in the United States, marginalized groups—youth women lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people and Black, Latino/a, American Indian/Alaska Native (AI/AN), and Native Hawaiian/other Pacific Islander people—continue to experience a disproportionate share of STI cases in the United States. Given the long-term sequelae, as well as 1 This Summary does not include references. Citations for the discussion presented in the Summary appear in the subsequent report chapters. 1 PREPUBLICATION COPY—Uncorrected Proofs

2 SEXUALLY TRANSMITTED INFECTIONS BOX S-1 STI Facts and Statistics • U.S. reported case rates of the three most common reportable STIs (chlamydia, gonorrhea, and syphilis) have been increasing over the past two decades. Since 2000, the overall case rate of chlamydia has doubled, gonorrhea has increased nearly 1.4-fold, and primary and secondary syphilis is up 5-fold. • Long-term effects of STIs include chronic pelvic pain, infertility, miscarriage or newborn death, and increased risk of HIV infection, genital and oral cancers, neurological and rheumatological consequences, and possible death in per- sons not being screened or whose care is not well managed. • The rise in reported STIs underestimates the full scope of the STI epidemic in the United States, in part because many cases can be asymptomatic and are therefore often undiagnosed and unreported. Asymptomatic individuals may not know they are infected, yet they can still transmit an infection to their sexual partners or offspring. • Congenital syphilis is passed to a fetus with severe and often fatal conse- quences for newborns. While it is fully preventable with prenatal care, the number of cases in the United States has increased 2.6-fold from 2013 to 2018. • Young people aged 15–24 years account for about 25 percent of the sexually active population, yet they account for about half of all reported STIs annually. • Gay, bisexual, and other men who have sex with men represent an estimated 2–3 percent of the adolescent/adult population, yet they account for 54 percent of reported primary and secondary syphilis cases. • STIs, including HIV, imposed an estimated nearly $16 billion in lifetime direct medical costs in the United States in 2018. the direct medical and economic costs resulting from STIs, these condi- tions merit attention as a greater health priority, yet blame, embarrass- ment, shame, and stigma mean that STI epidemics are too often hidden or ignored. In 1997, the Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Although great scien- tific advances have been made since then, demonstrating that efforts to prevent and treat STIs are not futile, many of the problems and barriers described in that report persist today. STIs remain an underfunded and comparatively neglected field of public health practice and research. CDC, through the National Association of County and City Health Officials (NACCHO), asked the National Academies to review the cur- rent state of STIs in the United States, including the economic burden, current public health strategies and programs (including STI diagnostics, vaccines, monitoring and surveillance, and treatment), and barriers in the health care system, to provide advice on future public health programs, PREPUBLICATION COPY—Uncorrected Proofs

PREPUBLICATION COPY—Uncorrected Proofs FIGURE S-1  Notifiable sexually transmitted infections—rates of reported cases per 100,000 population (per 100,000 live births for congenital syphilis), United States, 1999–2018. 3

4 SEXUALLY TRANSMITTED INFECTIONS policy, and research in STI prevention and control. This report follows three studies commissioned by the National Coalition of STD Directors in 2018–2019, and the first STI National Strategic Plan that was developed by the Department of Health and Human Services (HHS) and released in December 2020. The release of these reports and the synergies among them presents a timely opportunity to execute the recommendations pro- vided in this National Academies report. COMMITTEE’S APPROACH The committee’s primary emphasis is on addressing the growing epidemics of chlamydia, gonorrhea, and syphilis, but the framework and recommendations presented in this report are intended to strengthen the response to a broad range of STIs. Although HIV is an STI of significant concern, the committee’s charge precludes it from providing HIV-specific recommendations (the report sponsors—CDC and NACCHO—asked the committee to focus its recommendations on STIs other than HIV, given the alarming increases in rates of STIs). Thus, the committee’s consider- ation of HIV focused on understanding the interplay between HIV and other STIs and how current public health programs can integrate and leverage separate HIV and STI prevention, care, and research programs. The committee’s conceptual framework is depicted in Figure S-2. The framework’s core elements emphasize the importance of interrelated social ecological factors in the varied manifestations of STI pathogens, social and structural determinants of health and health inequities, inter- sectionality, and the recognition that sexual health is inextricably linked to overall health and well-being across the life span. The committee views human sexuality as a vital element of mutually consensual love and pleasure, as well as the fundamental prerequisite for procreation. Pre- vention and control efforts for STIs that are nested within a sexual health paradigm are more likely to prevent and control STIs than efforts nested within a risk framework, as the latter are steeped in and proliferate vic- tim blaming, stigma, marginalization, and discrimination. Therefore, the committee concludes that biomedical approaches to STI prevention and control cannot be optimally effective without also addressing root causes of poor health and STI risk, namely, the structural and social determi- nants of health, such as poverty, unequal access to quality health care, stigma, racism, and discrimination. Moreover, successful application of this framework requires a shift in current siloed funding mechanisms to an integrated and sustained funding approach that not only addresses STIs as discrete health outcomes but also addresses interpersonal, com- munity, institutional, and other societal factors that influence STI risk, prevention, health care access, delivery, and treatment. PREPUBLICATION COPY—Uncorrected Proofs

SUMMARY 5 Structural Social and Community- Community Level Factors Institutional Interpersonal Factors Interpersonal Individual- Individual Level Factors Biological Effect Pathway Systems and elements impact across all stages of the life course These intersecting factors have an impact across all stages of the life span Pregnancy/In-utero Preconception Pregnancy Childhood Childhood Adolescents/Young Adults Middle Adults Middle Adults Older Adults/Seniors Sexual Health and STIs Across the Life Span FIGURE S-2  Modified social ecological framework of sexual health and sexually transmitted infection (STI) prevention, control, and treatment. NOTE: This figure illustrates the multiple interrelated influences on STI risk, pre- vention, health care access, delivery, and treatment across the life span. The committee is concluding its work as the nation and the world continue to grapple with the acute COVID-19 and chronic HIV/AIDS pandemics. There is a growing challenge of misinformation that is exac- erbating the decline of trust in public institutions in general, including public health agencies. Adhering to public health guidance has life-or- death implications, whether for prevention of COVID-19, HIV, congeni- tal syphilis, or other STIs with potentially lifelong consequences. The burden of responding to the COVID-19 pandemic has been felt heavily by STI programs. Under-resourced STI programs have had to compete for resources with a major new public health threat, and their staff have been diverted to the COVID-19 response. This has translated into less attention to STI services and fewer critical services being delivered. The nation pays an increasing price for neglecting to fund public health and thereby neglecting STIs or placing them in funding competition with other urgent infectious diseases control priorities. The COVID-19 pan- demic has exposed weaknesses in public health preparedness due to weak PREPUBLICATION COPY—Uncorrected Proofs

6 SEXUALLY TRANSMITTED INFECTIONS infrastructure, an under-capacitated and under-resourced workforce, and limited surge capacity. Because STIs are infectious diseases that also require testing, treatment, and partner notification, and the STI workforce has deep expertise of relevance to pandemic responses, strengthening STI infrastructure and expanding its workforce offers the dual benefits of achieving stronger STI control and better positioning the nation for future public health threats. The largest federal source of funding to respond to STIs is appropri- ated to CDC’s Division of STD Prevention (DSTDP). DSTDP’s funding over the past two decades has remained flat (with a 40 percent reduction in inflation-adjusted dollars). Although the committee’s charge did not specifically ask it to make recommendations related to funding levels and other necessary resource allocations for STIs, the committee notes that some of the recommendations will require new or substantial realign- ment of resources to implement and the authority and political support to modify existing systems and policies. Furthermore, because the com- mittee’s primary focus was on providing clear policy guidance and a framework for action, it does not uniformly offer specific implementation steps or metrics for each recommendation. The committee understands that resources, policies, and stakeholders vary across the country and that additional voices, including public stakeholders and STI program staff at all levels of government, will be needed to guide implementation of the committee’s recommendations. The committee has organized its recommendations under four action areas: 1. Adopt a sexual health paradigm. 2. Broaden ownership and accountability for responding to STIs. 3. Bolster existing systems and programs for responding to STIs. 4. Embrace innovation and policy changes to improve sexual health. 1. ADOPT A SEXUAL HEALTH PARADIGM2 Integrating Sexual Health as a Key Dimension of Healthy Living The nation’s response to STIs has mostly focused on individual risk factors, and individual behavior change and has failed to address structural and social elements that foster infection and disease. Since the beginning of the 20th century, approaches focusing on infectious disease sequelae have tended to fuel stigma and shame and therefore have not 2 Note that recommendations are not presented in numerical order, as the Summary has grouped them by topic however, all report recommendations are presented. PREPUBLICATION COPY—Uncorrected Proofs

SUMMARY 7 been successful in fully addressing STI prevention and control. A holistic approach that focuses on sexual health in the context of broader health and well-being is needed. To carry out this change, significant work is needed to eradicate stigma and educate the U.S. population on what it means to be sexually healthy and where and how individuals can access comprehensive sexual health services. The committee acknowledges that the United States is a diverse coun- try of almost 330 million people, and how one operationalizes a sexual health paradigm will inevitably vary. This paradigm shift is needed, how- ever, given the history of how marginalization has contributed to the proliferation of STIs. Society is paying a cost for this marginalization, and significantly shifting the cultural environment to be supportive of a sexual health framework will take significant dedication and investment and the strategic actions outlined in this report (for more on this topic, see Chapter 12). The committee does not view this as a political issue or one that needs to be in conflict with religious beliefs or ethical standards. For example, promoting sexual health in a manner that facilitates STI prevention, diag- nosis, and treatment does not constrain faith communities from discuss- ing sexual responsibility and sexual health in a way that is consistent with their own faith traditions and ethical frameworks. The committee holds an inclusive vision of respect and appreciation for diversity in religious belief, culture, gender, and sexual orientation. The clinical focus in the current health system emphasizes the harmful effects of STIs on women and newborns without adequately addressing the health of others, including sexual and gender minority and non-binary or gender-expansive individuals. The committee notes, in particular, the striking negligence toward promoting the health of men, including their roles in transmitting STIs. Too often, public policies have failed to encour- age men to consider their own health-seeking behaviors, in terms of both shaping a conception of what sexual health means for them and offering clear guidance for when and how men should access health services. Recommendation 12-1: The Department of Health and Human Ser- vices (HHS) should develop a vision and blueprint for sexual health and well-being that can guide the incorporation of a sexual health paradigm across all HHS programs, including the major public insurance programs (Medicaid, Medicare, and the Children’s Health Insurance Program), as well as the public health programs operated throughout the department including the Centers for Disease Con- trol and Prevention, the Health Resources and Services Administra- tion, the Indian Health Service, and the Substance Abuse and Men- tal Health Services Administration). The plan should align sexual health and well-being with other dimensions of health—physical, mental, and emotional. PREPUBLICATION COPY—Uncorrected Proofs

8 SEXUALLY TRANSMITTED INFECTIONS • A holistic approach to sexual health programs should include new approaches and strategies for specifically engaging men (including men who have sex with men) with readily available male-centered sexual health specialty services and the imple- mentation of sexual and reproductive health services in primary care. • The plan should include strategies for improving sexual health services that address the needs of priority populations, such as women, adolescents, and young adults, and expand atten- tion and resources to underserved populations including Black, Latino/a, and Indigenous populations people who use drugs people who engage in sex work transgender and gender- expansive populations. HHS has an important role in catalyzing the shift the committee rec- ommends, but it is imperative that other partners and leaders within the federal government, health systems, and society help to adopt and imple- ment these changes. The vision and action plan should include a course of action for individuals, health care providers, and community members to promote positive sexual health over the life span by giving individuals more agency over their personal preferences and choices, acknowledging the role of culture in influencing these choices, and highlighting structural inequities and barriers to optimal health. Reorienting popular conceptions of well-being to include sexual health is the overarching framework for all recommendations in this report and establishes a new foundation for successful STI prevention and control. 2. BROADEN OWNERSHIP AND ACCOUNTABILITY FOR RESPONDING TO STIs Better Support for Parents and Guardians to Model Sexual Health Although maturing children learn information about sexual health in many ways (including via social media), parents and guardians (hereafter “parents”) play a central role in supporting adolescent and young adult sexual and reproductive health and STI prevention. The committee recog- nizes that not all young people can rely on understanding parents to offer this guidance, and supporting parents does not negate the need to create additional sources to complement or substitute for supportive parents. Nonetheless, to fully leverage their role, parents need evidence-based guidance on effective parenting strategies for sexual health promotion and STI prevention. PREPUBLICATION COPY—Uncorrected Proofs

SUMMARY 9 Recommendation 12-2: Federal agencies and relevant professional organizations should equip parents with evidence-based guid- ance to engage in developmentally appropriate, comprehensive sexual health education and dialogue and to identify actionable steps for their children. Specifically, the committee recommends the following: • The Department of Health and Human Services (HHS), through the Centers for Disease Control and Prevention (CDC) Division of STD Prevention, CDC Division of Adolescent Health and School Health, the Indian Health Service, and other key pub- lic health service agencies, should develop a national, parent- focused communication campaign to promote and guide paren- tal communication with adolescents regarding sexual health and sexually transmitted infection (STI) prevention. • HHS, including CDC, the Health Resources and Services Administration, and the National Institutes of Health, should develop a compendium of existing evidence-based resources and programs for parental education and skills training on ado- lescent and young adult sexual health and STI prevention. In addition, there should be continued research investments to improve existing, and to develop new, evidence-based resources and programs. • Guidelines should be developed for pediatric and adolescent health care to support skills training and educate parents in promoting adolescent and young adult sexual health, including the prevention of STIs. This would include the following: o Delivering evidence-based programs for parental education and skills training that are co-located as an extension of regular care o Providing training resources for providers that facilitate direct communication with parents regarding sexual health and STI prevention in their children Engage Community Stakeholders to Create Opportunities for Dialogue About Sexual Health A limitation of the historical response to STI prevention and control is that community stakeholders (e.g., families, schools and educators, faith-based organizations, and workplaces) lack the resources and capac- ity to engage in sexual health dialogue to improve STI outcomes. Thus, the committee concludes that elevating the promotion of sexual health in partnership with community stakeholders could create a fruitful avenue for improving STI outcomes. Nonetheless, more direction and support PREPUBLICATION COPY—Uncorrected Proofs

10 SEXUALLY TRANSMITTED INFECTIONS are needed to empower communities to engage in such dialogue and to provide resources for tailoring messages and information to be appropri- ate for communities’ specific contexts, needs, and priorities. Recommendation 12-3: The Centers for Disease Control and Pre- vention Division of STD Prevention should take steps to expand community knowledge of sexual health and promote actions that lead to a greater understanding of healthy sexuality by encouraging and supporting public dialogue and the adoption of evidence-based interventions in various community settings (families, schools, faith communities, community-based organizations, and workplaces). 3. BOLSTER EXISTING SYSTEMS AND PROGRAMS FOR RESPONDING TO STIs Enhance Federal Leadership and Support DSTDP provides critical leadership in guiding the nation’s federal STI response. The committee supports maintaining and enhancing this role, including encouraging DSTDP to be more assertive and, in some cases, more prescriptive in its grants to states and local jurisdictions to establish minimum national standards of data reporting and STI care. Furthermore, STI professionals, especially within state and local health departments, have critical knowledge and expertise that need to be the foundation of any efforts to improve the national response to STI prevention and control. For CDC and states to effectively prevent and control STIs, accu- rate STI surveillance is essential for understanding the epidemiology of reportable STIs. The surveillance data, however, are difficult to interpret because they rely on case reporting, which is ecologic, and periodic popu- lation-based studies are too small for meaningful subpopulation analyses. Recommendation 12-4: The Centers for Disease Control and Preven- tion (CDC) should modernize its core sexually transmitted infection (STI) activities to strengthen the timely monitoring of STIs with less reliance on estimated rates based on case reports, to inform proper treatment of persons with STIs, and to increase consistency and accountability across jurisdictions. The committee recommends a three-pronged approach: 1. Modernize surveillance activities to enable more rapid release of data: • Automate case reporting of reportable STIs. • Release a preliminary STD Surveillance Report within 6 months of the reporting period, with a revised report later in the year. PREPUBLICATION COPY—Uncorrected Proofs

SUMMARY 11 • Explore the use of new data sources to capture STI incidence (critically, both cases and numbers tested), such as electronic medical records, commercial databases, such as health informa- tion exchanges, clinical and pharmacy data, social media/online searches, and artificial intelligence, and invest in better data inte- gration efforts within the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP). • Develop a publicly available STI dashboard to raise public aware- ness and accountability. 2. Improve timeliness of the STI treatment guidelines: • The CDC STI treatment guidelines should be updated and dis- seminated annually, and more frequently if necessary, to bet- ter address real-time changes to the STI epidemic and emerg- ing treatments and technologies. The entirety of the guidelines should undergo comprehensive reviews no less frequently than every 5 years. 3. Increase accountability and establish new funding requirements: • CDC should engage in a data standardization partnership across NCHHSTP and with grantees to develop and publish a core set of STI indicators with standardized definitions of terms. To promote the use of these standardized data, CDC should set a condition of awards for its funding programs to require that every grantee report surveillance and other data to CDC consistent with these new data standards. • CDC should also make a condition of awards the requirement that states engage in a broad and meaningful stakeholder engage- ment process. This should include representatives of local health departments, heavily affected communities, health insurance programs and exchanges, federally qualified and other health centers, Ryan White HIV/AIDS Program recipients, Substance Abuse and Mental Health Services Administration recipients, and others to develop a multi-year state or major municipalities STI prevention and control plan that: o leverages disparate assets within the state or major munici- palities for establishing STI prevention and care priorities, aligning STI and HIV priorities o establishes benchmarks and o creates a process for monitoring and reporting on progress toward achieving established benchmarks. PREPUBLICATION COPY—Uncorrected Proofs

12 SEXUALLY TRANSMITTED INFECTIONS The committee recognizes the large differences in staff capacity across health departments and other impediments to rapid integration of report- ing standards. Therefore, the proposed partnership should consider the current starting point and recommend phased implementation (if needed) to account for current serious limitations in the capacity to carry out sur- veillance and monitoring efforts at the state or local levels. Furthermore, the committee is not recommending a specific model for stakeholder engagement. HIV programs have long experience with HIV prevention community planning, as well as Ryan White services planning. DSTDP may consider ways to integrate STI consultation and resource allocation processes within these existing mechanisms or may determine that such an approach is inappropriate or not the best model, as critical STI stake- holders not involved in HIV planning processes would be excluded (see Chapter 12 for additional discussion). Strengthen Local Efforts to Plan and Coordinate the STI Response To ensure the delivery of comprehensive sexual health services, local jurisdictions need to conduct, and be held accountable for, a broad and meaningful stakeholder engagement process to identify the range of avail- able community assets to support the STI response and establish preven- tion and care priorities for their jurisdictions based on needs assessments. Working in tandem with the preceding recommendation for CDC to require statewide STI prevention and control plans, the committee recommends: Recommendation 12-5: The Centers for Disease Control and Preven- tion (CDC) should encourage local health departments to develop and implement comprehensive plans for sexually transmitted infec- tion (STI) prevention and control. This should be done by fund- ing key partners, such as the National Association of County and City Health Officials (NACCHO) and the National Coalition of STD Directors (NCSD), to develop resources and provide technical assistance to state and local health departments on how to conduct a meaningful stakeholder consultation process, how to develop a plan that offers strategic support for improving STI outcomes leveraging all available community assets, and how to monitor implementation and keep the public informed of progress toward achieving the plan’s objectives. The plans should do the following: • Include community-wide needs assessments, oversampling high-priority populations, that determine the adequacy of avail- able sexual health services in their jurisdictions and explore the creation of new, improved, and easier access points for sexual PREPUBLICATION COPY—Uncorrected Proofs

SUMMARY 13 health promotion in a stigma-free environment, including STI screening and treatment services that take advantage of current rapid and self-testing technologies. • Identify mechanisms to meet the needs of underserved and highly impacted populations. • Establish formalized, funded relationships with trusted com- munity-based organizations to deliver critical STI prevention and care services. CDC, in collaboration with the National Network of STD Preven- tion Training Centers, NACCHO, and NCSD, should develop STI Resource Centers (SRCs) for clinical consultation, workforce devel- opment, and technical assistance to support the planning process and provide consultation to individual clinical STI providers. At a minimum, these SRCs should be operational at the level of state and large municipal jurisdictions. Establish New Payment and Coverage Options to Close Gaps in Access to STI Coverage and Services Effective public health efforts to control the transmission of infectious diseases benefit the whole population, yet many people are not reached by the current fragmented health care system. Many individuals experi- ence financial barriers to STI screening and treatment services because of their insurance status, immigration status, and/or ability to afford copay- ments or coinsurance for treatment and services. Recommendation 10-1: The Department of Health and Human Ser- vices and state governments should identify and support innova- tive programs to ensure that sexually transmitted infection (STI) prevention and treatment services are available through multiple venues and ensure that federal and state governments maximize access opportunities for individuals who face health care access barriers. Priority populations for these efforts should include per- sons ineligible for coverage, persons who face affordability bar- riers (including high out-of-pocket costs), and persons who will not access STI services without confidentiality guarantees (such as adolescents and young adults with insurance coverage through parents or guardians). Approaches to be explored include special Medicaid initiatives, such as incentives to expand Medicaid or other options to fill coverage gaps, state plan amendments and waivers, the establishment of a federally PREPUBLICATION COPY—Uncorrected Proofs

14 SEXUALLY TRANSMITTED INFECTIONS supported supplemental grant program to provide STI testing and treat- ment at no cost through various safety net programs, promulgation of new 340B Drug Pricing Program guidance to expand coverage for STI services (including for population-based expedited partner therapy and HIV PrEP services), and funding initiatives to support comprehensive sexual health clinics and new access points for sexual health services. Support and Expand the STI Workforce The workforce for STI prevention and treatment has not been ade- quately supported to meet the needs of the nation. Beyond STI special- ists, the existing clinical health care workforce includes a large subset of practitioners and stakeholders who are traditionally not involved directly in sexual health service delivery. Recommendation 11-1: Sexual health promotion should be opera- tionalized and prioritized in practice guidelines and training cur- ricula for U.S. health professionals. Sexually transmitted infection (STI) prevention and management should be incentivized and facil- itated as a focus area of practice for both the clinical workforce and important segments of nonclinical public health and social services professionals. The committee recommends five programmatic pri- orities for implementing this recommendation: 1. Clinical practice guidelines and benchmarks developed by health professional organizations should more heavily empha- size the importance of consistent delivery of recommended sexual health services (e.g., sexual histories, vaccinations, and routine STI screening). Relevant professional organizations include but are not limited to the American Medical Associa- tion, the National Medical Association, the American Nurses Association, the National League for Nursing, the Association of Nurse Practitioners, the American Academy of Physician Assistants, the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, the American College of Phy- sicians, the American Academy of Family Physicians, the Amer- ican College of Obstetrics and Gynecology, the Infectious Dis- eases Society of America, and the HIV Medicine Association. 2. Licensing bodies for primary care generalists (i.e., primary care physicians, nurse practitioners, physician assistants, and nurses) and behavioral health specialists should formulate a minimum sexual health skill set (e.g., taking a sexual history and understanding the basics of STI prevention, being aware PREPUBLICATION COPY—Uncorrected Proofs

SUMMARY 15 of guidelines for STI screening and treatment, and understand- ing HIV prevention and care) to be reflected in formal training programs and yearly continuing medical education, continuing medical units, and continuing education requirements. 3. The Centers for Disease Control and Prevention (CDC) and state and local health departments, in collaboration with STI/ HIV expert providers and the regional STI prevention training centers, should serve as a resource of clinical expertise for pri- mary care providers and nonclinical health and social services professionals and paraprofessionals. This should be accom- plished through consultation, technical assistance, and continu- ing education (see also Recommendation 12-5). 4. CDC should identify federal and state policy actions that would most effectively expand the available workforce to address STI prevention, screening, and treatment. Policies that identify new reimbursement models and promote the ability of advance practice clinicians, pharmacists, community health workers, and other health care workers to provide STI services should be identified and communicated to state policy makers and to encourage state legislatures to reduce or eliminate the scope of practice barriers. 5. The Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, CDC, and other agen- cies should explore public–private partnerships to address logistical and regulatory barriers to workforce expansion. The use of emerging technologies (e.g., point-of-care STI testing and treatment referrals) and delivery models (e.g., telehealth services, pharmacy-based health care) for sexual health services are two innovative examples that can extend the reach of the STI workforce. Accelerate Research and Development for Biomedical Interventions Recent scientific advances provide the means for improving STI diag- nosis, but they are currently underused. Continuing evolution of antimi- crobial resistance has threatened the continued efficacy and ease of STI treatment, especially for Neisseria gonorrhoeae. In addition, the pipeline for developing both new antimicrobials and vaccines for STI prevention has been constrained by an unfavorable business case that suggests the need for public engagement of the private sector, as has been done with HIV/AIDS and COVID-19. In the absence of ready access to reliable diag- nostic tests, syndromic diagnosis for persons with genitourinary symp- toms remains common, but it is imprecise, fails to address the frequent PREPUBLICATION COPY—Uncorrected Proofs

16 SEXUALLY TRANSMITTED INFECTIONS occurrence of unrecognized infection, and is contrary to principles of good antimicrobial stewardship. Recommendation 7-1: To improve the efficacy and reach of tools for sexually transmitted infection (STI) management and prevention, the National Institutes of Health should prioritize development of point-of-care (POC) diagnostic tests development of diagnostic tests for active syphilis promotion of public–private partnerships (PPPs) to develop new antimicrobials and expedited development of vaccines. Specifically: • POC diagnostics: Prioritize development of POC diagnostic tests to reduce the interval between testing and treatment. Use of these POC tests should be promoted to reduce opportunities for trans- mission. Optimally, POC tests should be inexpensive, rapid, and receive a Clinical Laboratory Improvement Amendments waiver to permit increased testing at sites providing health care or at home. • New diagnostics for syphilis: Promote development of new, innovative diagnostic tests for active syphilis that distinguish untreated, active syphilis from previously treated infection, which is required to effectively control syphilis. • Antimicrobials and vaccines for STI treatment and prevention: Subsidize and encourage PPPs with the goals of developing new, readily accessible antimicrobials for STI treatment and expediting development of vaccines for prevention of high-priority STIs such as chlamydia, gonorrhea, syphilis, and herpes. Deploy Psychosocial and Behavioral Interventions for Sexual Health Psychosocial and behavioral interventions to promote sexual health and prevent STIs are underused and have not been adopted and sustained in clinical or community practice. These interventions, in conjunction with biomedical, structural, informatics/technological, and health service interventions, are integral to a comprehensive strategy for sexual health and STI prevention and control. In addition, comprehensive sexual health education taught in schools is effective in delaying the initiation of sexual behavior, promoting sexual health, and reducing risk for STIs in students. School-based sexual health education programs across the United States are highly variable, with no nationwide policy on the subject. Community intervention strategies also can promote sexual health and prevent STIs, PREPUBLICATION COPY—Uncorrected Proofs

SUMMARY 17 including in racial and ethnic minorities and marginalized groups who live and socialize in high-STI-prevalence, low-resourced communities. Such approaches require sustained funding, however, and other support- ive resources for them to be effective. Recommendation 8-1: The Department of Health and Human Ser- vices (HHS) should take steps to expand the reach of psychosocial and behavioral interventions to prevent and control sexually trans- mitted infections at the individual, interpersonal, and community level. This can be accomplished by developing sustainable funding mechanisms to deliver those interventions establishing standard guidelines for school-based comprehensive sexual health educa- tion and developing, evaluating, and disseminating community- based approaches: 1. HHS should develop new mechanisms that provide sustain- able funding for dissemination, adoption, and scale up of evi- dence-based psychosocial and behavioral interventions by a wide range of stakeholders, including community-based orga- nizations, parent–teacher associations, workplaces, faith-based organizations, and pediatric and primary care practices. 2. The Centers for Disease Control and Prevention (CDC) Divi- sion of Adolescent and School Health should work in partner- ship with parents and guardians, parent–teacher associations, states, districts, and local school boards to establish standard evidence-based guidelines for school-based comprehensive sexual health education that is grounded in psychosocial and behavioral theories and research. To ensure that each student receives medically accurate, age-appropriate, and culturally inclusive comprehensive sexual health education in elemen- tary, middle, and high school, dedicated staff, including school- based nurses and health educators should be trained, provided adequate time, and given necessary resources. 3. CDC, in collaboration with state and local departments of health, should develop and evaluate the efficacy of promising community-based approaches that are grounded in psychoso- cial and behavioral research, extend reach into affected com- munities, foster ongoing collaboration with community stake- holders for capacity building and sustainability, and provide allocation of sustained dedicated resources for formative work, intervention implementation, evaluation, replication, and scale up of evidence-based interventions. PREPUBLICATION COPY—Uncorrected Proofs

18 SEXUALLY TRANSMITTED INFECTIONS 4. EMBRACE INNOVATION AND POLICY CHANGE TO IMPROVE SEXUAL HEALTH Address Structural Inequities, Including Structural Racism, That Hinder STI Prevention and Control Structural inequities related to sexual orientation, gender identity, race and ethnicity, and national origin, among others, are pervasive, increase STI risk, perpetuate stigma, and undermine access to STI pre- vention and treatment among marginalized populations. Very few struc- tural interventions that address STIs, including the effect of intermediary social determinants of health influenced by structural racism and other health inequities, have been developed. Examining and addressing the structural determinants of STIs and STI inequities will require bold vision. This vision needs to be bolstered by a long-term commitment with multi- disciplinary, intersectoral, and interagency collaboration and supported through dedicated cross-agency funding from the National Institutes of Health, CDC, Health Resources and Services Administration, and private foundations and funders. This will demand steadfast political will at all levels of government and sustained community engagement and mobi- lization. Due to their focus on addressing the root causes of poor health and their downstream social determinants, these efforts stand to have the greatest impact on preventing STIs and STI inequities in the United States. Recommendation 9-1: The Secretary of Health and Human Services (HHS) should acknowledge structural racism and other forms of structural inequities as root causes of sexually transmitted infec- tion (STI) outcomes and inequities and as threats to sexual health. HHS should lead a whole-of-government response that engages all relevant federal departments and agencies to develop a coordinated approach to reduce negative STI outcomes and address inequities in the U.S. population by promoting sexual health and eliminating structural inequities that are barriers to STI prevention, testing, and treatment among marginalized groups. In mounting this response, the Secretary should: • consult broadly with affected communities and critical stake- holders to conduct a national landscape analysis that assesses social and structural barriers that prevent access to STI services. The focus should be on identifying communities with high morbidity and limited access to affordable and desirable STI prevention and care services and resources in order to develop PREPUBLICATION COPY—Uncorrected Proofs

SUMMARY 19 a national holistic plan for ongoing monitoring of the national STI infrastructure and STI burden, including interrelated social and structural determinants of health inequities • establish a priority research agenda, including a data-collection strategy that organizes data on STI outcomes and their struc- tural and social determinants among marginalized populations • strengthen partnerships with, funding for, and technical assis- tance to state and local health departments and community- based organizations • foster greater collaboration across health and human services agencies and • report regularly to the public on progress for addressing STI outcomes and inequities. Harness Technological Innovation to Improve STI Prevention and Control To keep pace with the rapid advancements in technology and its effects on sexual health, it is essential that the field of public health imple- ments policy based on three important considerations: (1) social media and mobile-app-based technological innovations have been primarily created by industry, and industry experts and companies needed to be included in the public health response to STIs (2) tools based on artificial intelligence (AI) will become increasingly better at targeting individuals and changing their behaviors and (3) the ethical considerations around technological tools are evolving faster than policies that can address issues of concern. Public health agencies need to frequently and regularly evalu- ate new tools and public views about them to determine the best course of action for the changing ethical landscape. The question of whether new technologies pose STI transmission risk is no longer relevant, given that they are nearly ubiquitous and impos- sible to prevent. Instead, the relevant questions are how, why, when, and where these technologies increase risk how, when, and where they can be leveraged to promote sexual health and how public health can integrate this knowledge into daily STI prevention and control efforts to ensure safe and ethical oversight (see Chapter 6 for a discussion of implementation, cost, and feasibility considerations). Recommendation 6-1: The Centers for Disease Control and Pre- vention (CDC) should expand its capacity to use technology for sexually transmitted infection (STI) prevention and control. To accomplish this, CDC should recruit seasoned individuals from the private and public sectors with experience in digital behavior PREPUBLICATION COPY—Uncorrected Proofs

20 SEXUALLY TRANSMITTED INFECTIONS change and team science to work collaboratively with agency public health and marketing staff. It should develop timely and open data systems and deploy artificial intelligence–based mass marketing strategies to advance STI prevention. Achieving this recommendation would entail that CDC undertake regular dialogue with leading industry and nonprofit experts, along with STI providers and community representatives assess its STI data manage- ment capacity and partner with state and local health departments to use highly targeted AI-based digital mass communication strategies to better address STIs. CONCLUSION Despite the dedicated commitment of many individuals and agencies, STI research, policy, and services continue to suffer from neglect. Rela- tively flat federal investments and declining state and local investments in the face of all-time high numbers of reported cases of STIs underscore the failure of the STI crisis to capture the attention of the public and policy makers. The committee’s exploration of the complexities of the challenge, however, has instilled in its members a firm belief that it is possible to cre- ate a different and better future where fewer people are infected, fewer babies are born with STIs, and people entering adolescence and continu- ing across the life span are taught the language and skills to conceptualize and enact their own vision for what it means to be sexually healthy. The committee’s recommended changes are challenging, yet it is pos- sible to reduce the impact of STIs on society and take the bold actions recommended in this report to prevent and control STIs in the immediate future and long term. In turn, this can create a positive and comprehen- sive sexual health platform, so that the United States can return to the ulti- mate task of planning for the elimination of these serious health threats. PREPUBLICATION COPY—Uncorrected Proofs


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Human Immunodeficiency Virus Infection in Women

Efficiency of Transmission

Globally, heterosexual transmission accounts for the spread of HIV infection in approximately 90% of persons living with AIDS. 2 Mechanisms of heterosexual transmission, however, remain poorly understood. 46 HIV has been isolated from semen of HIV-infected men and from cervicovaginal secretions of HIV-infected women. Although heterosexual transmission seems more efficient from men to women than from women to men, HIV-infected women can spread HIV to their uninfected sexual partners. 47-49 The most likely explanation for this difference in ease of HIV spread from men to their partners relates to the larger volume of semen compared with cervicovaginal secretions and to the higher concentration of HIV on average in seminal fluid.

HIV is not transmitted consistently by sexual contact. Although some persons become infected after a single sexual exposure or artificial insemination with HIV-infected semen, 32 others remain uninfected despite hundreds of exposures. 50-52 This lack of transmission may be due to the amount of virus, the host immune response, the relative virulence of HIV isolates, or some combination thereof.

The efficiency of heterosexual transmission of HIV between women and men has not been characterized fully. The efficiency of transmission of gonorrhea, a well-studied sexually transmitted disease (STD), is approximately 25% after a single male contact with an infected woman and close to 90% for transmission by infected men to uninfected female partners. 53,54 HIV is much less efficiently transmitted however, the extremely long incubation period of HIV disease has hindered specific inferences about the relative rates and efficiency of sexual transmission because many persons do not learn of their infection until years after the relevant exposure. Estimates of infectivity for each sexual contact have ranged from 3 per 100 for the most efficient transmitters in a male homosexual cohort study 55 to less than 1 per 10,000 contacts in studies of heterosexual couples discordant for HIV serostatus. 47,50,56 In a California study of heterosexual HIV serostatus-discordant couples, the risk for male-to-female transmission was 17 times higher than the risk for female-to-male transmission. 48 An Italian study of 730 discordant heterosexual couples found the transmission of HIV from men to women to be twice as efficient as from women to men. 57 More recent studies of monogamous HIV-discordant partners in Uganda suggest that the efficiency of HIV spread may be more similar between men and women than was appreciated initially. 56


Protecting Yourself and Others

You can greatly reduce your risk of getting sexually transmitted infections by practicing safer sex. Some STIs such as genital warts, herpes, and syphilis can be spread through contact with infected skin. Here are some tips for protecting yourself:

  • Use a latex condom for vaginal and anal sex or a plastic condom if you are sensitive to latex
  • The internal (female) condom can also prevent many sexually transmitted infections
  • Use condoms without lubricant for oral sex on a man
  • Use latex or plastic barriers, such as a dental dams or plastic wrap, for oral sex on a woman or for oral-anal sex use latex or plastic gloves if you have cuts or sores on your hands
  • Use water-based lubricants (KY, Astroglide) with latex condoms or barriers
  • DO NOT use oil-based products (Vaseline, body lotions) because they destroy latex
  • Do not use lubricants or condoms that contain nonoxynol-9 (N-9), which can damage the lining of the vagina or anus and increase the chances of getting HIV
  • Wash shared sex toys (dildos, vibrators) or put on a fresh condom between users
  • Know that some methods of birth control, such as birth control pills, shots, implants, or diaphragms, will not protect you from sexually transmitted infections. If you use one of these methods, also use a latex condom.
  • Talk with your sex partner(s) about sexually transmitted infections and using condoms
  • Talk honestly with your health care provider and your sex partner(s) about any sexually transmitted infections you or your partner has or has had
  • Have regular pelvic exams and cervical cancer screenings, but remember that cervical cancer screening tests do not screen for sexually transmitted infections other than HPV
  • Talk to your health care provider about having routine sexually transmitted infection screening as part of your annual physical or gynecological exam
  • Do not share needles or syringes for injecting drugs or other substances if you do share drug equipment, be sure to clean your works

Bacterial STI/STD List:

Chancroid

Chancroid is caused by a type of bacteria called Haemophilus ducreyi. It is almost always spread through sexual contact.

Uncircumcised penises are at much higher risk than circumcised penises for getting chancroid.

Most people in the U.S. who are diagnosed with chancroid have traveled outside the country to areas where the infection is known to occur more often.

Chlamydia

Chlamydia is a disease caused by the bacteria Chlamydia trachomatis.

It is most commonly sexually transmitted. Chlamydia can infect the penis, vagina, cervix, anus, urethra, eye, or throat.

Donovanosis

Donovanosis or granuloma inguinale is a rare bacterial infection that is spread through oral, vaginal, and anal sex.

Affecting far more people who have penises than those who have vulvas/vaginas, it is hard to diagnose, because the bacteria is hard to detect from a culture or biopsy. Symptoms include beefy, red ulcers on the genitals, and it is often mistaken for Chancroid or LGV.

Gonorrhea (“The Clap”)

Gonorrhea is caused by the bacteria Neisseria gonorrhoeae.

Anyone who has any type of sex can catch gonorrhea. The infection can be spread by contact with the mouth, vagina, penis, or anus.

Lymphogranuloma Venereum (LGV)

Lymphogranuloma Venereum (LGV) is a chronic (long-term) infection of the lymphatic system caused by three different types of the bacterium Chlamydia trachomatis.

The bacteria spreads through sexual contact. The infection is not caused by the same bacteria that causes genital chlamydia.

Mycoplasma Genitalium

Mycoplasma Genitalium is a bacterium that can infect the urethra, cervix, throat and anus.

Mycoplasma genitalium is often associated with bacterial vaginosis (BV) and pelvic inflammatory disease (PID), and is a common cause of non-gonococcal urethritis. It has only recently been identified as a sexually transmitted infection (STI).

It is spread through vaginal, anal or oral sex. It can also be transmitted by sex toys and hands and fingers if they have been in contact with a person’s genitals or anus.

Nongonococcal Urethritis (NGU)

NGU (Nongonococcal Urethritis) is an infection of the urethra caused by pathogens (germs) other than gonorrhea. Pathogens that can cause NGU include but are not limited to: Chlamydia (most common), Herpes simplex virus (rare), & Mycoplasma genitalium.

Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID) occurs when bacteria moves from the vagina or cervix into the uterus, fallopian tubes, ovaries, or pelvis.

Most cases of PID are due to the bacteria that causes chlamydia and gonorrhea.

Syphilis

Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases.

Syphilis is passed from person to person through direct contact with a syphilis sore through vaginal, anal, or oral sex.

Vaginitis (BV, Yeast, Etc.) – Can also be viral and parasitic

Vaginitis can affect people of all ages and is extremely common.

It can be caused by bacteria, yeasts, viruses, and other parasites. Some sexually transmitted infections (STIs) can also cause vaginitis, as can various chemicals found in bubble baths, soaps, and perfumes. Environmental factors such as poor hygiene and allergens may also cause this condition.

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      • Andersson, Nirina, Jens Boman, and Elisabet Nylander. “Rectal chlamydia–should screening be recommended in women?.” International journal of STD & AIDS 28.5 (2017): 476-479.
      • Davies, Bethan, et al. “Risk of reproductive complications following chlamydia testing: a population-based retrospective cohort study in Denmark.” The Lancet Infectious Diseases9 (2016): 1057-1064.
      • Naimer, Michelle S., et al. “The effect of changes in cervical cancer screening guidelines on chlamydia testing.” The Annals of Family Medicine4 (2017): 329-334.
      • Price, Malcolm J., Paddy J. Horner, and A. E. Ades. “Risk of reproductive complications following chlamydia testing.” The Lancet Infectious Diseases11 (2016): 1223-1224.
      • Sharman, Natasha, et al. “Chlamydia testing: reaching high-risk sexually active young people in the community.” (2016): 78-79.
      • Woodhall, Sarah C., et al. “Is chlamydia screening and testing in Britain reaching young adults at risk of infection? Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).” Sex Transm Infect3 (2016): 218-227.
      • Foster, Rosalind, et al. “Does living outside of a major city impact on the timeliness of chlamydia treatment? A multicenter cross-sectional analysis.” Sexually transmitted diseases8 (2016): 506-512.
      • Yoon, Jungwon, et al. “Does Nonmetropolitan Residence Impact Timely Chlamydia Treatment in Massachusetts?.” Sexually transmitted diseases 45.8 (2018): e52-e56.
      • Wood, Helen, et al. “Barriers and facilitators of partner treatment of chlamydia: A qualitative investigation with prescribers and community pharmacists.” Pharmacy1 (2018): 17.
      • Eaton, Susan Elizabeth. Integrating novel digital technology for the testing & treatment of chlamydia into mainstream sexual health services in England. Diss. University of Warwick, 2017.
      • World Health Organization. “WHO guidelines for the treatment of Chlamydia trachomatis.” (2016).
      • Yu, Hong, et al. “Subunit vaccines for the prevention of mucosal infection with Chlamydia trachomatis.” Expert review of vaccines8 (2016): 977-988.
      • Estcourt, Claudia S., et al. “The eSexual Health Clinic system for management, prevention, and control of sexually transmitted infections: exploratory studies in people testing for Chlamydia trachomatis.” The lancet Public health4 (2017): e182-e190.
      • Di Pietro, Marisa, et al. “Chlamydia pneumoniae and oxidative stress in cardiovascular disease: state of the art and prevention strategies.” International journal of molecular sciences1 (2015): 724-735.
      • Naimer, Michelle S., et al. “The effect of changes in cervical cancer screening guidelines on chlamydia testing.” The Annals of Family Medicine4 (2017): 329-334.
      • Jerlström, Charlotta, and Annsofie Adolfsson. “Prevention of Chlamydia Infections With Theater in School Sex Education.” The Journal of School Nursing (2018): 1059840518811912.
      • Rönn, Minttu M., et al. “The use of mathematical models of chlamydia transmission to address public health policy questions: a systematic review.” Sexually transmitted diseases5 (2017): 278-283.
      • van Wees, Daphne A., et al. “Double trouble: modelling the impact of low risk perception and high-risk sexual behaviour on chlamydia transmission.” Journal of The Royal Society Interface141 (2018): 20170847.
      • Enns, Eva Andrea, et al. “Using Multiple Outcomes of Sexual Behavior to Provide Insights Into Chlamydia Transmission and the Effectiveness of Prevention Interventions in Adolescents.” Sexually transmitted diseases10 (2017): 619-626.
      • Rönn, Minttu M., et al. “The Impact of Screening and Partner Notification on Chlamydia in the United States, 2000 to 2015: Evaluation of Epidemiological Trends Using a Pair-Formation Transmission Model.” (2019).
      • Den Daas, C., Kretzschmar Me, and J. C. Heijne. “P3. 230 Double trouble: the impact of low risk perception and high risk sexual behaviour on chlamydia transmission.” (2017): A179-A179.
      • Symptoms
        • De La Torre-Almaráz, R., V. Pallas, and JESUS ANGEL Sánchez-Navarro. “First report of Cucumber mosaic virus (CMV) and CARNA-5 in carnation in Mexico.” Plant Disease 100.7 (2016): 1509-1509.
        • Wong, Yu Jun, et al. “Cytomegalovirus (CMV) hepatitis: an uncommon complication of CMV reactivation in drug reaction with eosinophilia and systemic symptoms.” Singapore medical journal 59.2 (2018): 112.
        • Mizukawa, Y., et al. “Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms severity score: A useful tool for assessing disease severity and predicting fatal cytomegalovirus disease.” Journal of the American Academy of Dermatology 80.3 (2019): 670-678.
        • Marin, Lauro Juliano, et al. “Prevalence and clinical aspects of CMV congenital Infection in a low-income population.” Virology journal 13.1 (2016): 148.
        • Liu, Yingna, et al. “Diagnostic utility of ocular symptoms and vision for cytomegalovirus retinitis.” PloS one 11.10 (2016): e0165564.
        • Bergevin, Anna, et al. “Cost–benefit analysis of targeted hearing directed early testing for congenital cytomegalovirus infection.” International Journal of pediatric otorhinolaryngology 79.12 (2015): 2090-2093.
        • Boeckh, Michael, et al. “Cytomegalovirus (CMV) DNA quantitation in bronchoalveolar lavage fluid from hematopoietic stem cell transplant recipients with CMV pneumonia.” The Journal of infectious diseases 215.10 (2017): 1514-1522.
        • Lee, Edward R., and Dylan K. Chan. “Implications of dried blood spot testing for congenital CMV on management of children with hearing loss: A preliminary report.” International journal of pediatric otorhinolaryngology 119 (2019): 10-14.
        • Johnson, Jessica, et al. “CMV Disease in IBD: comparison of diagnostic tests and correlation with disease outcome.” Inflammatory bowel diseases 24.7 (2018): 1539-1546.
        • Reitter, A., et al. “Incidence of CMV co-infection in HIV-positive women and their neonates in a tertiary referral centre: a cohort study.” Medical microbiology and immunology 205.1 (2016): 63-71.
        • Goodman, A. L., et al. “CMV in the gut: a critical review of CMV detection in the immunocompetent host with colitis.” European Journal of Clinical Microbiology & Infectious Diseases 34.1 (2015): 13-18.
        • Schulz, Uwe, et al. “CMV immunoglobulins for the treatment of CMV infections in thoracic transplant recipients.” Transplantation 100.Suppl 3 (2016): S5.
        • Maffini, Enrico, et al. “Treatment of CMV infection after allogeneic hematopoietic stem cell transplantation.” Expert review of hematology 9.6 (2016): 585-596.
        • Maertens, Johan, et al. “Maribavir versus Valganciclovir for preemptive treatment of cytomegalovirus (CMV) viremia: a randomized, dose-ranging, phase 2 study among hematopoietic stem cell transplant (SCT) and solid organ transplant (SOT) recipients.” Open Forum Infectious Diseases. Vol. 3. No. suppl_1. Oxford University Press, 2016.
        • Smith, Davey M., et al. “Asymptomatic CMV replication during early human immunodeficiency virus (HIV) infection is associated with lower CD4/CD8 ratio during HIV treatment.” Clinical Infectious Diseases 63.11 (2016): 1517-1524.
        • Rawlinson, William D., et al. “Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy.” The Lancet Infectious Diseases 17.6 (2017): e177-e188.
        • Revello, Maria Grazia, et al. “Prevention of primary cytomegalovirus infection in pregnancy.” EBioMedicine 2.9 (2015): 1205-1210.
        • Fernández‐Ruiz, Mario, et al. “Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice.” Transplant International 28.9 (2015): 1042-1054.
        • Naing, Zin W., et al. “Congenital cytomegalovirus infection in pregnancy: a review of prevalence, clinical features, diagnosis and prevention.” Australian and New Zealand Journal of Obstetrics and Gynaecology 56.1 (2016): 9-18.
        • Boeckh, Michael, et al. “Valganciclovir for the prevention of complications of late cytomegalovirus infection after allogeneic hematopoietic cell transplantation: a randomized trial.” Annals of internal medicine 162.1 (2015): 1-10.
        • AABB, Clinical Transfusion Medicine Committee, et al. “AABB Committee Report: reducing transfusion‐transmitted cytomegalovirus infections.” Transfusion 56.6pt2 (2016): 1581-1587.
        • Hamprecht, Klaus, and Rangmar Goelz. “Postnatal cytomegalovirus infection through human milk in preterm infants: Transmission, clinical presentation, and prevention.” Clinics in perinatology 44.1 (2017): 121-130.
        • Kagan, Karl Oliver, et al. “Prevention of maternal-fetal transmission of CMV by hyperimmunoglobulin (HIG) administered after a primary maternal CMV infection in early gestation.” Geburtshilfe und Frauenheilkunde 78.10 (2018): FV43.
        • Rawlinson, William D., et al. “Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy.” The Lancet Infectious Diseases 17.6 (2017): e177-e188.
        • Schleiss, Mark R. “Preventing congenital cytomegalovirus infection: protection to a ‘T’.” Trends in microbiology 24.3 (2016): 170-172.
        • Symptoms
          • Passos, Mauro Romero Leal. “Donovanosis.” Atlas of Sexually Transmitted Diseases. Springer, Cham, 2018. 161-172.
          • De Barros, Luisa Kelmer Côrtes, Marcio Lobo Jardim, And Omar Lupi. “Donovanosis (Granuloma Inguinale).” Tropical Dermatology E-Book (2016): 328.
          • Tarrahi, Mohammad Javad, Sina Kianersi, and Maryam Nasirian. “Latent class analysis of symptoms for sexually transmitted infections among Iranian women: Results from a population-based survey.” Health care for women international (2019): 1-15.
          • O’Farrell, Nigel, and Harald Moi. � European guideline on donovanosis.” International journal of STD & AIDS 27.8 (2016): 605-607.
          • De Carvalho Bezerra, Sarita Martins, Marcio Martins Lobo Jardim, and Juliana Uchiyama. “Donovanosis.” Diagnostics to Pathogenomics of Sexually Transmitted Infections (2018): 167-179.
          • Raffe, Sonia, and Suneeta Soni. “Diagnostic tests for sexually transmitted infections.” Medicine5 (2018): 277-282.
          • O’Farrell, Nigel, and Harald Moi. � European guideline on donovanosis.” International journal of STD & AIDS8 (2016): 605-607.
          • HAJARE, SUMIT ASHOK, et al. “Donovanosis in Central India: A Series of Six Cases and Review of Literature.” Journal of Clinical & Diagnostic Research4 (2019).
          • Santiago-Wickey, Jenna N., and Brianna Crosby. “Granuloma Inguinale (Donovanosis).” StatPearls [Internet]. StatPearls Publishing, 2018.
          • Ramdial, P. K., et al. “Nodal donovanosis as the sentinel clue to acquired immunodeficiency syndrome.” Journal of AIDS and Clinical Research9 (2016).
          • De Carvalho Bezerra, Sarita Martins, Marcio Martins Lobo Jardim, and Juliana Uchiyama. “Donovanosis.” Diagnostics to Pathogenomics of Sexually Transmitted Infections (2018): 167-179.
          • Magalhães, Bárbara Machado, et al. “Donovanosis in a child victim of sexual abuse: response to doxycycline treatment.” Anais brasileiros de dermatologia4 (2018): 592-594.
          • Ahmed, Nadia, et al. “Donovanosis causing lymphadenitis, mastoiditis, and meningitis in a child.” The Lancet9987 (2015): 2644.
          • O’Farrell, Nigel, Anwar Hoosen, and Margaret Kingston. � UK national guideline for the management of donovanosis.” International journal of STD & AIDS10 (2018): 946-948.
          • Maness, Lisa. “Donovanosis Infection Watch.” Journal of Continuing Education Topics & Issues1 (2019): 2-7.
          • Ornelas, Jennifer, et al. “Granuloma inguinale in a 51-year-old man.” Dermatology online journal4 (2016).
          • Ronald, Allan. 󈬮. Genital ulcer adenopathy syndrome.” Clinical Infectious Disease (2015): 406.
          • Maness, Lisa. “Donovanosis Infection Watch.” Journal of Continuing Education Topics & Issues 21.1 (2019): 2-7.
          • Oliveira, Giselly Oseni Barbosa, et al. “Prevention of sexually transmitted diseases among visually impaired people: educational text validation.” Revista latino-americana de enfermagem 24 (2016).
          • Magalhães, Bárbara Machado, et al. “Donovanosis in a child victim of sexual abuse: response to doxycycline treatment.” Anais brasileiros de dermatologia 93.4 (2018): 592-594.
          • Ahmed, Nadia, et al. “Donovanosis causing lymphadenitis, mastoiditis, and meningitis in a child.” The Lancet9987 (2015): 2644.
          • O’Farrell, Nigel, and Harald Moi. � European guideline on donovanosis.” International journal of STD & AIDS 27.8 (2016): 605-607.
          • De Carvalho Bezerra, Sarita Martins, Marcio Martins Lobo Jardim, and Juliana Uchiyama. “Donovanosis.” Diagnostics to Pathogenomics of Sexually Transmitted Infections (2018): 167-179.
          • Passos, Mauro Romero Leal. “Donovanosis.” Atlas of Sexually Transmitted Diseases. Springer, Cham, 2018. 161-172.
          • Belda, Walter. “Sexually transmitted diseases.” Dermatology in Public Health Environments. Springer, Cham, 2018. 139-156.
          • Symptoms
            • Chow, Eric PF, et al. “Ongoing decline in genital warts among young heterosexuals 7 years after the Australian human papillomavirus (HPV) vaccination programme.” Sex Transm Infect 91.3 (2015): 214-219.
            • Suligoi, Barbara, et al. “Prevalence and incidence of external genital warts in a sample of Italian general female population.” BMC infectious diseases 17.1 (2017): 126.
            • Bartels, Anne, Michael Crandall, and Leah Spring. “Recalcitrant genital papules: this patient was initially told he had genital warts, but the appearance of the lesions, and the presence of a rash on his trunk and extremities, suggested another diagnosis.” Journal of Family Practice 66.7 (2017): 457-461.
            • Schöfer, Helmut, et al. “Sinecatechins and imiquimod as proactive sequential therapy of external genital and perianal warts in adults.” International journal of STD & AIDS 28.14 (2017): 1433-1443.
            • Edwards, Sarah K. “Genital rash (including warts and infestations).” Medicine 46.6 (2018): 325-330.
            • Aung, Ei T., et al. “Detection of human papillomavirus in urine among heterosexual men in relation to location of genital warts and circumcision status.” Sex Transm Infect 94.3 (2018): 222-225.
            • Boda, Daniel, et al. “HPV strain distribution in patients with genital warts in a female population sample.” Oncology letters 12.3 (2016): 1779-1782.
            • Hu, Zhili, et al. “Dynamics of HPV viral loads reflect the treatment effect of photodynamic therapy in genital warts.” Photodiagnosis and photodynamic therapy 21 (2018): 86-90.
            • Thomas, Réjean, et al. “P3. 189 Recurrence of human papillomavirus external genital wart infection among high-risk adults in montrÉal, quÉbec.” (2017): A163-A163.
            • Zhu, Cansheng, et al. “Prevalence and distribution of HPV types in genital warts in Xi’an, China: a prospective study.” BMJ open 9.5 (2019): e023897.
            • Park, Ina U., Camille Introcaso, and Eileen F. Dunne. “Human papillomavirus and genital warts: a review of the evidence for the 2015 centers for disease control and prevention sexually transmitted diseases treatment guidelines.” Clinical Infectious Diseases 61.suppl_8 (2015): S849-S855.
            • Yuan, Jianwei, et al. “Genital warts treatment: beyond imiquimod.” Human vaccines & immunotherapeutics 14.7 (2018): 1815-1819.
            • Abu-Naser, Samy S., and Mones M. Al-Hanjori. “An expert system for men genital problems diagnosis and treatment.” (2016).
            • Firooz, A., et al. “The efficacy and safety of other cryotherapy compounds for the treatment of genital warts: a randomized controlled trial.” Journal of Dermatological Treatment 30.2 (2019): 176-178.
            • Das, Suchibrata, et al. “Auto-wart inoculation: An easy and effective treatment of multiple, recalcitrant and genital warts.” Journal of Pakistan Association of Dermatology 26.3 (2017): 229-234.
            • Park, Ina U., Camille Introcaso, and Eileen F. Dunne. “Human papillomavirus and genital warts: a review of the evidence for the 2015 centers for disease control and prevention sexually transmitted diseases treatment guidelines.” Clinical Infectious Diseases 61.suppl_8 (2015): S849-S855.
            • Centers for Disease Control and Prevention. “Epidemiology and prevention of vaccine-preventable diseases.” Washington DC Public Health Foundation 2 (2015): 20-2.
            • Stanley, Margaret. “Preventing cervical cancer and genital warts–How much protection is enough for HPV vaccines?.” Journal of Infection 72 (2016): S23-S28.
            • Sharma, M., S. Sy, and J. J. Kim. “The value of male human papillomavirus vaccination in preventing cervical cancer and genital warts in a low‐resource setting.” BJOG: An International Journal of Obstetrics & Gynaecology 123.6 (2016): 917-926.
            • Steben, Marc. “A Very Common Intimate Concern:“Will My Genital Warts Ever Stop Recurring?”.” (2018): 682-684.
            • Chow, Eric Pui Fung, et al. “Ratio of anogenital warts between different anatomical sites in homosexual and heterosexual individuals in Australia, 2002–2013: implications for susceptibility of different anatomical sites to genital warts.” Epidemiology & Infection 143.7 (2015): 1495-1499.
            • Mohammed, Hamish, et al. “Increase in sexually transmitted infections among men who have sex with men, England, 2014.” Emerging infectious diseases 22.1 (2016): 88.
            • Ma, Liang, et al. “Distribution of human papillomavirus genotypes (2014–2016) in women with genital warts at a sexually transmitted disease clinic in Beijing, China.” Future Virology 13.2 (2018): 111-117.
            • Schöfer, Helmut, et al. “Sinecatechins and imiquimod as proactive sequential therapy of external genital and perianal warts in adults.” International journal of STD & AIDS 28.14 (2017): 1433-1443.
            • Grennan, Dara. “Genital Warts.” Jama 321.5 (2019): 520-520.
            • Symptoms
              • Shover, Chelsea L., et al. “Accuracy of Presumptive Gonorrhea Treatment for Gay, Bisexual, and Other Men Who Have Sex with Men: Results from a Large Sexual Health Clinic in Los Angeles, California.” LGBT health2 (2018): 139-144.
              • Orr, Tamra B. Gonorrhea. The Rosen Publishing Group, Inc, 2015.
              • Bonyah, E., et al. “Modelling the effects of heavy alcohol consumption on the transmission dynamics of gonorrhea with optimal control.” Mathematical biosciences 309 (2019): 1-11.
              • Moyosore, Adebisi Temitayo. “Adolescent Sexual Development and Sexually Transmittted Infections.” International STD Research & Reviews (2016): 1-11.
              • Elawad, N. A. M. “Situation of Sexually Transmitted Infections (STIs) in Sudan.” Adv Reprod Sci Reprod Health In-fertil: ARRHI-102. DOI 10 (2018).
              • Reekie, Joanne, et al. “Risk of pelvic inflammatory disease in relation to chlamydia and gonorrhea testing, repeat testing, and positivity: a population-based cohort study.” Clinical Infectious Diseases 66.3 (2018): 437-443.
              • Wang, Li Yan, et al. “Human Immunodeficiency Virus, Chlamydia, and Gonorrhea Testing in New York Medicaid–Enrolled Adolescents.” Sexually transmitted diseases 45.1 (2018): 14-18.
              • Pittman, Ellen, et al. “Patient Acceptability and Feasibility of Self-Collecting Genital Samples for Chlamydia and Gonorrhea Testing in a Community Setting Using Privacy Shelters.” Journal of Adolescent Health 58.2 (2016): S107-S108.
              • Hoots, Brooke E., et al. “Self-reported chlamydia and gonorrhea testing and diagnosis among men who have sex with men—20 US cities, 2011 and 2014.” Sexually transmitted diseases 45.7 (2018): 469-475.
              • McRee, Annie‐Laurie, Allahna Esber, and Paul L. Reiter. “Acceptability of Home‐Based Chlamydia And Gonorrhea Testing Among a National Sample Of Sexual Minority Young Adults.” Perspectives on sexual and reproductive health 47.1 (2015): 3-10.
              • Kerani, Roxanne P., et al. “Gonorrhea treatment practices in the STD Surveillance Network, 2010–2012.” Sexually transmitted diseases 42.1 (2015): 6-12.
              • Weston, Emily J., et al. “Adherence to CDC recommendations for the treatment of uncomplicated gonorrhea—STD Surveillance Network, United States, 2016.” Morbidity and Mortality Weekly Report 67.16 (2018): 473.
              • Hook III, Edward W., et al. “Efficacy and Safety of Single-Dose Oral Delafloxacin Compared With Intramuscular Ceftriaxone for Uncomplicated Gonorrhea Treatment: An Open-Label, Noninferiority, Phase 3, Multicenter, Randomized Study.” Sexually transmitted diseases 46.5 (2019): 279-286.
              • Long, Jill E., Michael R. Wierzbicki, and Edward W. Hook III. “Impact of eligibility criteria on participant enrollment for a randomized clinical trial of gonorrhea treatment.” Sexually transmitted diseases 44.6 (2017): 362.
              • Singh, Ameeta E., et al. “Gonorrhea treatment failures with oral and injectable expanded spectrum cephalosporin monotherapy vs dual therapy at 4 Canadian sexually transmitted infection clinics, 2010–2013.” Sexually transmitted diseases 42.6 (2015): 331-336.
              • Handsfield, H. Hunter. “Gonorrhea Prevention in the United States: Where Do We Go From Here?.” (2016): 731-732.
              • Kirkcaldy, Robert D., et al. “Considering the Potential Application of Whole Genome Sequencing to Gonorrhea Prevention and Control.” Sexually transmitted diseases 45.6 (2018): e29-e32.
              • Bowen, Virginia B., et al. “Gonorrhea.” Current Epidemiology Reports 4.1 (2017): 1-10.
              • Spicknall, Ian H., et al. “Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex With Men.” Sexually transmitted diseases 46.5 (2019): 321-328.
              • Spicknall, Ian H., et al. “Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex With Men.” Sexually transmitted diseases 46.5 (2019): 321-328.
              • Fairley, Christopher K., et al. “Frequent transmission of gonorrhea in men who have sex with men.” Emerging infectious diseases 23.1 (2017): 102.
              • Spicknall, Ian H., et al. “Assessing Uncertainty in an Anatomical Site-Specific Gonorrhea Transmission Model of Men Who Have Sex With Men.” Sexually transmitted diseases 46.5 (2019): 321-328.
              • Tuite, Ashleigh R., et al. “Impact of rapid susceptibility testing and antibiotic selection strategy on the emergence and spread of antibiotic resistance in gonorrhea.” The Journal of infectious diseases 216.9 (2017): 1141-1149.
              • Bonyah, E., et al. “Modelling the effects of heavy alcohol consumption on the transmission dynamics of gonorrhea with optimal control.” Mathematical biosciences 309 (2019): 1-11.
              • Ndeffo-Mbah, Martial L., et al. “Dynamic models of infectious disease transmission in prisons and the general population.” Epidemiologic reviews 40.1 (2018): 40-57.
              • Symptoms
                • Vestergaard, Hanne Thang, et al. “Transfusion transmission of hepatitis A virus with fecal shedding in a previously hepatitis A vaccinated recipient.” Journal of infection and chemotherapy 24.9 (2018): 766-768.
                • Parsa Nahad, Mehdi, et al. “Seroprevalence of Hepatitis E Virus Infection among Patients with Acute Hepatitis Symptoms in Ahvaz, Iran.” International Journal of Medical Laboratory 5.1 (2018): 11-18.
                • Brietzke, Aline P., et al. “Neuroplastic effects of transcranial direct current stimulation on painful symptoms reduction in chronic hepatitis C: a phase II randomized, double blind, sham controlled trial.” Frontiers in neuroscience 9 (2016): 498.
                • Evon, Donna M., et al. “Patient-reported symptoms during and after direct acting antiviral therapies for chronic hepatitis C: The PROP UP Study.” Journal of hepatology (2019).
                • Kirstein, Martha M., Arndt Vogel, and Michael P. Manns. “Autoimmune Hepatitis.” Evidence‐based Gastroenterology and Hepatology 4e (2019): 592-601.
                • Easterbrook, Philippa, et al. “HIV and hepatitis testing: global progress, challenges, and future directions.” AIDS Rev 18.1 (2016): 3-14.
                • Bottero, Julie, et al. � French guidelines for hepatitis B and C screening: a combined targeted and mass testing strategy of chronic viruses namely HBV, HCV and HIV.” Liver International 36.10 (2016): 1442-1449.
                • Coffie, Patrick A., et al. “Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa.” BMC infectious diseases 17.1 (2017): 706.
                • AASLD/IDSA HCV Guidance Panel, et al. “Hepatitis C guidance: AASLD‐IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus.” Hepatology 62.3 (2015): 932-954.
                • Mezzo, Jennifer L., et al. “The Hepatitis Testing and Linkage-to-Care Data Review Process: An Approach to Ensuring the Quality of Program Data.” Public Health Reports 131.2_suppl (2016): 44-48.
                • Terrault, Norah A., et al. “A ASLD guidelines for treatment of chronic hepatitis B.” Hepatology 63.1 (2016): 261-283.
                • European Association for The Study of The Liver. “EASL recommendations on treatment of hepatitis C 2018.” Journal of hepatology 69.2 (2018): 461-511.
                • Terrault, Norah A., et al. “Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance.” Hepatology 67.4 (2018): 1560-1599.
                • Charlton, Michael, et al. “Sofosbuvir and ribavirin for treatment of compensated recurrent hepatitis C virus infection after liver transplantation.” Gastroenterology 148.1 (2015): 108-117.
                • World Health Organization. Guidelines for the Prevention Care and Treatment of Persons with Chronic Hepatitis B Infection: Mar-15. World Health Organization, 2015.
                • Centers for Disease Control and Prevention. “HIV and viral hepatitis.” South Carolina State Documents Depository (2017).
                • Zhang, Qian, et al. “Epidemiology of hepatitis B and hepatitis C infections and benefits of programs for hepatitis prevention in northeastern China: a cross-sectional study.” Clinical Infectious Diseases 62.3 (2015): 305-312.
                • Tavitian, Suzanne, et al. “Ribavirin for chronic hepatitis prevention among patients with hematologic malignancies.” Emerging infectious diseases 21.8 (2015): 1466.
                • Dahiya, Parveen, et al. ““Hepatitis”–Prevention and management in dental practice.” Journal of education and health promotion 4 (2015).
                • He, Tianhua, et al. “Prevention of hepatitis C by screening and treatment in US prisons.” Annals of internal medicine 164.2 (2016): 84-92.
                • Pan, Calvin Q., et al. “Tenofovir to prevent hepatitis B transmission in mothers with high viral load.” New England Journal of Medicine 374.24 (2016): 2324-2334.
                • Doceul, Virginie, et al. “Zoonotic hepatitis E virus: Classification, animal reservoirs and transmission routes.” Viruses 8.10 (2016): 270.
                • Jourdain, Gonzague, et al. “Tenofovir versus placebo to prevent perinatal transmission of hepatitis B.” New England Journal of Medicine 378.10 (2018): 911-923.
                • Hofmeister, Megan G., Monique A. Foster, and Eyasu H. Teshale. “Epidemiology and transmission of hepatitis A virus and hepatitis E virus infections in the United States.” Cold Spring Harbor perspectives in medicine 9.4 (2019): a033431.
                • Dionne-Odom, Jodie, et al. “# 38: Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission.” American journal of obstetrics and gynecology 214.1 (2016): 6-14.
                • Symptoms
                  • Armangue, Thaís, et al. “Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis.” The Lancet Neurology 17.9 (2018): 760-772.
                  • Groves, Mary Jo. “Genital herpes: a review.” Am Fam Physician 93.11 (2016): 928-934.
                  • Jonker, Iris, et al. “The association between herpes virus infections and functional somatic symptoms in a general population of adolescents. The TRAILS study.” PloS one 12.10 (2017): e0185608.
                  • Verhoeven, Dirk HJ, et al. “Reactivation of human herpes virus-6 after pediatric stem cell transplantation: risk factors, onset, clinical symptoms and association with severity of acute graft-versus-host disease.” The Pediatric infectious disease journal 34.10 (2015): 1118-1127.
                  • Croll, Benjamin J., et al. “MRI diagnosis of herpes simplex encephalitis in an elderly man with nonspecific symptoms.” Radiology case reports 12.1 (2017): 159-160.
                  • Tan, S. K., and B. A. Pinsky. “Molecular Testing for Herpes Viruses.” Diagnostic Molecular Pathology. Academic Press, 2017. 89-101.
                  • Piret, Jocelyne, Nathalie Goyette, and Guy Boivin. “Novel method based on real-time cell analysis for drug susceptibility testing of herpes simplex virus and human cytomegalovirus.” Journal of clinical microbiology 54.8 (2016): 2120-2127.
                  • Hauser, Ronald G., et al. “Reply to Galen,“Screening cerebrospinal fluid prior to herpes simplex virus pcr testing might miss cases of herpes simplex encephalitis”.” Journal of clinical microbiology 55.10 (2017): 3144.
                  • Hauser, Ronald G., et al. “Cost-effectiveness study of criteria for screening cerebrospinal fluid to determine the need for herpes simplex virus PCR testing.” Journal of clinical microbiology 55.5 (2017): 1566-1575.
                  • Bohn-Wippert, Kathrin, et al. “Resistance testing of clinical herpes simplex virus type 2 isolates collected over 4 decades.” International Journal of Medical Microbiology 305.7 (2015): 644-651.
                  • Wilhelmus, Kirk R. “Antiviral treatment and other therapeutic interventions for herpes simplex virus epithelial keratitis.” Cochrane Database of Systematic Reviews 1 (2015).
                  • James, Scott H., and David W. Kimberlin. “Neonatal herpes simplex virus infection: epidemiology and treatment.” Clinics in perinatology 42.1 (2015): 47-59.
                  • Jeon, Young Hoon. “Herpes zoster and postherpetic neuralgia: practical consideration for prevention and treatment.” The Korean journal of pain 28.3 (2015): 177.
                  • Eppink ST, Kumar S, Miele K, Chesson H. Lifetime medical costs of genital herpes in the United States: Estimates from insurance claims. Sex Transm Dis. (2021).
                  • Breier, Alan, et al. “Herpes simplex virus 1 infection and valacyclovir treatment in schizophrenia: Results from the VISTA study.” Schizophrenia research (2018).
                  • Varanasi, Siva Karthik, et al. “Azacytidine treatment inhibits the progression of herpes stromal keratitis by enhancing regulatory T cell function.” Journal of virology 91.7 (2017): e02367-16.
                  • Abdool Karim, Salim S., et al. “Tenofovir gel for the prevention of herpes simplex virus type 2 infection.” New England Journal of Medicine 373.6 (2015): 530-539.
                  • Jeon, Young Hoon. “Herpes zoster and postherpetic neuralgia: practical consideration for prevention and treatment.” The Korean journal of pain 28.3 (2015): 177.
                  • Marrazzo, Jeanne M., et al. “Tenofovir Gel for Prevention of Herpes Simplex Virus Type 2 Acquisition: Findings From the VOICE Trial.” The Journal of infectious diseases (2019).
                  • Chi, Ching‐Chi, et al. “Interventions for prevention of herpes simplex labialis (cold sores on the lips).” Cochrane Database of Systematic Reviews 8 (2015).
                  • Colombel, Jean-Frédéric. “Herpes zoster in patients receiving JAK inhibitors for ulcerative colitis: mechanism, epidemiology, management, and prevention.” Inflammatory bowel diseases 24.10 (2018): 2173-2182.
                  • Oevermann, Lena, et al. “Transmission of chromosomally integrated human herpes virus-6A via haploidentical stem cell transplantation poses a risk for virus reactivation and associated complications.” Bone marrow transplantation (2019): 1.
                  • Tronstein E, Johnston C, Huang ML, Selke S, Magaret A, Warren T, Corey L, Wald A. Genital shedding of herpes simplex virus among symptomatic and asymptomatic persons with HSV-2 infection. JAMA. (2011).
                  • Pandey, Utsav, et al. “Inferred father-to-son transmission of herpes simplex virus results in near-perfect preservation of viral genome identity and in vivo phenotypes.” Scientific reports 7.1 (2017): 13666.
                  • Ceña-Diez, Rafael, et al. “Prevention of vaginal and rectal herpes simplex virus type 2 transmission in mice: Mechanism of antiviral action.” International journal of nanomedicine 11 (2016): 2147.
                  • Ramchandani M, Selke S, Magaret A, Barnum G, Huang MW, Corey L, Wald A. Prospective cohort study showing persistent HSV-2 shedding in women with genital herpes 2 years after acquisition. Sex Transm Infect. (.2018).
                  • Omori, Ryosuke, and Laith J. Abu-Raddad. “Sexual network drivers of HIV and herpes simplex virus type 2 transmission.” AIDS (London, England) 31.12 (2017): 1721.
                  • Aebi-Popp, Karoline, et al. “High prevalence of herpes simplex virus (HSV)-type 2 co-infection among HIV-positive women in Ukraine, but no increased HIV mother-to-child transmission risk.” BMC pregnancy and childbirth 16.1 (2016): 94.
                  • Symptoms
                    • Earnshaw, Valerie A., et al. “HIV stigma and physical health symptoms: Do social support, adaptive coping, and/or identity centrality act as resilience resources?.” AIDS and Behavior 19.1 (2015): 41-49.
                    • Lyon, Maureen E., et al. “Advance care planning and HIV symptoms in adolescence.” Pediatrics 142.5 (2018): e20173869.
                    • Garey, Lorra, et al. “Anxiety, depression, and HIV symptoms among persons living with HIV/AIDS: the role of hazardous drinking.” AIDS care 27.1 (2015): 80-85.
                    • Webel, Allison R., et al. “A cross-sectional relationship between social capital, self-compassion, and perceived HIV symptoms.” Journal of pain and symptom management 50.1 (2015): 59-68.
                    • Braksmajer, Amy, et al. “Effects of Discrimination on HIV-Related Symptoms in Heterosexual Men of Color.” American journal of men’s health 12.6 (2018): 1855-1863.
                    • World Health Organization. Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services. World Health Organization, 2016.
                    • Arya, Monisha, et al. “The Promise of Patient-Centered Text Messages for Encouraging HIV Testing in an Underserved Population.” The Journal of the Association of Nurses in AIDS Care: JANAC 29.1 (2018): 101-106.
                    • Greensides, Dawn R., et al. “Alternative HIV testing methods among populations at high risk for HIV infection.” Public health reports (2016).
                    • Granich, Reuben M., et al. “Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model.” The Lancet 373.9657 (2009): 48-57.
                    • Kalichman, Seth C., and Leickness C. Simbayi. “HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa.” Sexually transmitted infections 79.6 (2003): 442-447.
                    • Cihlar, Tomas, and Marshall Fordyce. “Current status and prospects of HIV treatment.” Current opinion in virology 18 (2016): 50-56.
                    • Gonzalez, Jeffrey S., et al. “Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis.” Journal of acquired immune deficiency syndromes (1999) 58.2 (2011).
                    • Callaghan, Mike, Nathan Ford, and Helen Schneider. “A systematic review of task-shifting for HIV treatment and care in Africa.” Human resources for health 8.1 (2010): 8.
                    • Benjamin, Laura A., et al. “HIV, antiretroviral treatment, hypertension, and stroke in Malawian adults: a case-control study.” Neurology 86.4 (2016): 324-333.
                    • Levi, Jacob, et al. “Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades.” BMJ global health 1.2 (2016): e000010.
                    • Cohen, Myron S., et al. “Antiretroviral therapy for the prevention of HIV-1 transmission.” New England Journal of Medicine 375.9 (2016): 830-839.
                    • World Health Organization. Policy brief: Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. No. WHO/HIV/2017.05. World Health Organization, 2017.
                    • Baeten, Jared M., et al. “Use of a vaginal ring containing dapivirine for HIV-1 prevention in women.” New England Journal of Medicine 375.22 (2016): 2121-2132.
                    • Fowler, Mary G., et al. “Benefits and risks of antiretroviral therapy for perinatal HIV prevention.” New England Journal of Medicine 375.18 (2016): 1726-1737.
                    • World Health Organization. “Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations–2016 update.” (2016).
                    • Rodger, Alison J., et al. “Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy.” Jama 316.2 (2016): 171-181.
                    • Landefeld, C. C., et al. “Prevention of Mother-to-Child Transmission of HIV in Yaounde: Barrier to Care.” AIDS care 30.1 (2018): 116-120.
                    • Zafer, Maryam, et al. “Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis.” Fertility and sterility 105.3 (2016): 645-655.
                    • Cohen, Myron S., et al. “Antiretroviral therapy for the prevention of HIV-1 transmission.” New England Journal of Medicine 375.9 (2016): 830-839.
                    • Poon, Art FY, et al. “Near real-time monitoring of HIV transmission hotspots from routine HIV genotyping: an implementation case study.” The lancet HIV 3.5 (2016): e231-e238.
                    • Symptoms
                      • Carpén, Timo, et al. “Presenting symptoms and clinical findings in HPV-positive and HPV-negative oropharyngeal cancer patients.” Acta oto-laryngologica 138.5 (2018): 513-518.
                      • Suzuki, Sadao, and Akihiro Hosono. “No association between HPV vaccine and reported post-vaccination symptoms in Japanese young women: results of the Nagoya study.” Papillomavirus Research 5 (2018): 96-103.
                      • Nadarzynski, Tom, et al. “Perceptions of HPV and attitudes towards HPV vaccination amongst men who have sex with men: A qualitative analysis.” British journal of health psychology 22.2 (2017): 345-361.
                      • Martínez-Lavín, Manuel, Laura-Aline Martínez-Martínez, and Paola Reyes-Loyola. “HPV vaccination syndrome. A questionnaire-based study.” Clinical rheumatology 34.11 (2015): 1981-1983.
                      • León-Maldonado, Leith, et al. “Perceptions and experiences of human papillomavirus (HPV) infection and testing among low-income Mexican women.” PloS one 11.5 (2016): e0153367.
                      • Koliopoulos, George, et al. “Cytology versus HPV testing for cervical cancer screening in the general population.” Cochrane Database of Systematic Reviews 8 (2017).
                      • Ogilvie, Gina Suzanne, et al. “Effect of screening with primary cervical HPV testing vs cytology testing on high-grade cervical intraepithelial neoplasia at 48 months: the HPV FOCAL randomized clinical trial.” Jama 320.1 (2018): 43-52.
                      • Goodman, Annekathryn. “HPV testing as a screen for cervical cancer.” BMJ: British Medical Journal 350 (2015): h2372.
                      • Kuhn, Louise, and Lynette Denny. “The time is now to implement HPV testing for primary screening in low resource settings.” Preventive medicine 98 (2017): 42-44.
                      • Bishop, Justin A., et al. “HPV-related squamous cell carcinoma of the head and neck: an update on testing in routine pathology practice.” Seminars in diagnostic pathology. Vol. 32. No. 5. WB Saunders, 2015.
                      • Quake, Stephen R., and Jianbin Wang. “Compositions and methods for cell targeted hpv treatment.” U.S. Patent Application No. 15/166,936.
                      • Mirghani, H., et al. “Treatment de‐escalation in HPV‐positive oropharyngeal carcinoma: ongoing trials, critical issues and perspectives.” International journal of cancer 136.7 (2015): 1494-1503.
                      • Wang, Marilene B., et al. “HPV-positive oropharyngeal carcinoma: a systematic review of treatment and prognosis.” Otolaryngology–Head and Neck Surgery 153.5 (2015): 758-769.
                      • Stich, Maximilian, et al. 𔄝-aza-2′-deoxycytidine (DAC) treatment downregulates the HPV E6 and E7 oncogene expression and blocks neoplastic growth of HPV-associated cancer cells.” Oncotarget 8.32 (2017): 52104.
                      • Hildesheim, Allan, et al. “Impact of human papillomavirus (HPV) 16 and 18 vaccination on prevalent infections and rates of cervical lesions after excisional treatment.” American journal of obstetrics and gynecology 215.2 (2016): 212-e1.
                      • Grandahl, Maria, et al. “School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study.” BMJ open 6.1 (2016): e009875.
                      • Stanley, Margaret, and Mario Poljak. “Prospects for the new HPV Prevention and Control Board.” Papillomavirus Research 3 (2017): 97.
                      • Bosch, F. Xavier, et al. “HPV-FASTER: broadening the scope for prevention of HPV-related cancer.” Nature reviews Clinical oncology 13.2 (2016): 119.
                      • Dilley, Sarah E., et al. “Abstract C92: A diagnostic review of barriers to and opportunities for improving HPV vaccination in Alabama.” (2018): C92-C92.
                      • Gervais, Frédéric, et al. “Systematic review of cost-effectiveness analyses for combinations of prevention strategies against human papillomavirus (HPV) infection: a general trend.” BMC public health 17.1 (2017): 283.
                      • Kero, Katja, and Jaana Rautava. “HPV infections in heterosexual couples: mechanisms and covariates of virus transmission.” Acta cytologica 63.2 (2019): 143-147.
                      • Giuliano, Anna R., et al. “EUROGIN 2014 roadmap: Differences in HPV infection natural history, transmission, and HPV-related cancer incidence by gender and anatomic site of infection.” International journal of cancer. Journal international du cancer 136.12 (2015): 2752.
                      • Guenat, David, et al. “Exosomes and other extracellular vesicles in HPV transmission and carcinogenesis.” Viruses 9.8 (2017): 211.
                      • Zouridis, Andreas, et al. “Intrauterine HPV transmission: a systematic review of the literature.” Archives of gynecology and obstetrics 298.1 (2018): 35-44.
                      • Louvanto, Karolina, et al. “Breast milk is a potential vehicle for human papillomavirus transmission to oral mucosa of the spouse.” The Pediatric infectious disease journal 36.7 (2017): 627-630.
                      • Symptoms
                        • Ireland, Georgina, et al. “Human T-lymphotropic viruses (HTLV) in England and Wales, 2004 to 2013: testing and diagnoses.” Eurosurveillance 22.21 (2017).
                        • Orge, Glória O., et al. “Psychiatric disorders in HTLV-1-infected individuals with bladder symptoms.” PloS one 10.5 (2015): e0128103.
                        • Neijenhuis, Myrte K., et al. “Impact of liver volume on polycystic liver disease-related symptoms and quality of life.” United European gastroenterology journal 6.1 (2018): 81-88.
                        • da Silva Dias, George Alberto, et al. “Correlation between clinical symptoms and peripheral immune response in HAM/TSP.” Microbial pathogenesis 92 (2016): 72-75.
                        • Terada, Yukiko, et al. “Treatment of rheumatoid arthritis with biologics may exacerbate HTLV-1-associated conditions: A case report.” Medicine 96.6 (2017).
                        • Miller, Liane. “Profile of the MP Diagnostics HTLV Blot 2.4 test: a supplemental assay for the confirmation and differentiation of antibodies to HTLV-1 and HTLV-2.” Expert review of molecular diagnostics 16.2 (2016): 135-145.
                        • Styles, Clare E., et al. “Reconsideration of blood donation testing strategy for human T‐cell lymphotropic virus in Australia.” Vox sanguinis 112.8 (2017): 723-732.
                        • Hohn, Oliver, et al. “No significant HTLV seroprevalence in German people who inject drugs.” PloS one 12.8 (2017): e0183496.
                        • Gotuzzo, Eduardo, et al. “A-107 A general description of the HTLV-1 Cohort at the Institute of Tropical Medicine Alexander von Humboldt (1989–2015).” JAIDS Journal of Acquired Immune Deficiency Syndromes 81 (2019): 34.
                        • O’brien, Sheila F., et al. “Human T‐cell lymphotropic virus: A simulation model to estimate residual risk with universal leucoreduction and testing strategies in Canada.” Vox sanguinis 113.8 (2018): 750-759.
                        • Yamanaka, S., et al. “Adult T-cell leukemia-lymphoma complicated by Takotsubo cardiomyopathy and HTLV-1-associated myelopathy after treatment with the anti-CCR4 antibody mogamulizumab.” [Rinsho ketsueki] The Japanese journal of clinical hematology 58.4 (2017): 309-314.
                        • Futsch, Nicolas, Renaud Mahieux, and Hélène Dutartre. “HTLV-1, the other pathogenic yet neglected human retrovirus: from transmission to therapeutic treatment.” Viruses 10.1 (2017): 1.
                        • Iliceto, Alessandro, and Bridget Bagert. “Successful Treatment of HTLV-1 Associated Myelopathy with Chronic Immunosuppression (P2. 310).” (2017): P2-310.
                        • Lebrette, Marie-Gisèle, and Corinne Amiel. “Current issues about VIH and HTLV-1 infection and their treatment.” Médecine de la Reproduction 20.2 (2018): 95-103.
                        • Saito, Mineki, et al. “The CC chemokine ligand (CCL) 1, upregulated by the viral transactivator Tax, can be downregulated by minocycline: possible implications for long-term treatment of HTLV-1-associated myelopathy/tropical spastic paraparesis.” Virology journal 14.1 (2017): 234.
                        • Miura, Kiyonori, and Hideaki Masuzaki. “Prevention of Human T-Cell Leukemia Virus Type 1 (HTLV-1) Mother-to-Child Transmission.” Adult T-cell Leukemia/Lymphoma. Springer, Tokyo, 2017. 157-169.
                        • Gruber, Karl. “Australia tackles HTLV-1.” The Lancet Infectious Diseases 18.10 (2018): 1073-1074.
                        • Bangham, Charles. “Abstract SY23-03: How does HTLV-1 cause leukemia.” (2017): SY23-03.
                        • Matsuoka, M., et al. “Reducing the global burden of HTLV-1 infection: An agenda for research and action.” (2017).
                        • Gallo, Robert C., Luc Willems, and Hideki Hasegawa. “Screening transplant donors for HTLV-1 and-2.” Blood 128.26 (2016): 3029-3031.
                        • Percher, Florent, et al. “Mother-to-child transmission of HTLV-1 epidemiological aspects, mechanisms and determinants of mother-to-child transmission.” Viruses 8.2 (2016): 40.
                        • Gross, Christine, and Andrea Thoma-Kress. “Molecular mechanisms of HTLV-1 cell-to-cell transmission.” Viruses 8.3 (2016): 74.
                        • Ribeiro, Ivonizete Pires, et al. “HTLV‐1 and‐2 in a first‐time blood donor population in Northeastern Brazil: Prevalence, molecular characterization, and evidence of intrafamilial transmission.” Journal of Medical Virology 90.10 (2018): 1651-1657.
                        • Prendergast, Andrew J., et al. “Transmission of CMV, HTLV-1, and HIV through breastmilk.” The Lancet Child & Adolescent Health 3.4 (2019): 264-273.
                        • Futsch, Nicolas, Renaud Mahieux, and Hélène Dutartre. “HTLV-1, the other pathogenic yet neglected human retrovirus: from transmission to therapeutic treatment.” Viruses 10.1 (2017): 1.
                        • Symptoms
                          • Kiani, Hamed, et al. “Prevalence, risk factors and symptoms associated to intestinal parasite infections among patients with gastrointestinal disorders in Nahavand, Western Iran.” Revista do Instituto de Medicina Tropical de São Paulo 58 (2016).
                          • Krogsgaard, Laura Rindom, et al. “The prevalence of intestinal parasites is not greater among individuals with irritable bowel syndrome: a population-based case-control study.” Clinical Gastroenterology and Hepatology 13.3 (2015): 507-513.
                          • Omrani, V. Fallah, et al. “Prevalence of intestinal parasite infections and associated clinical symptoms among patients with end-stage renal disease undergoing hemodialysis.” Infection 43.5 (2015): 537-544.
                          • Ramírez, Juan David, et al. “Blastocystis subtyping and its association with intestinal parasites in children from different geographical regions of Colombia.” PloS one 12.2 (2017): e0172586.
                          • Babaei, Zahra, et al. “Adaptive immune response in symptomatic and asymptomatic enteric protozoal infection: evidence for a determining role of parasite genetic heterogeneity in host immunity to human giardiasis.” Microbes and infection 18.11 (2016): 687-695.
                          • Lifson, Alan R., et al. “Prevalence of tuberculosis, hepatitis B virus, and intestinal parasitic infections among refugees to Minnesota.” Public health reports (2016).
                          • McKenna, Megan L., et al. “Human intestinal parasite burden and poor sanitation in rural Alabama.” The American journal of tropical medicine and hygiene 97.5 (2017): 1623-1628.
                          • Balarak, Davoud, et al. “Prevalence of intestinal parasitic infection among food handlers in northwest Iran.” Journal of parasitology research 2016 (2016).
                          • Meurs, Lynn, et al. “Diagnosing polyparasitism in a high-prevalence setting in Beira, Mozambique: detection of intestinal parasites in fecal samples by microscopy and real-time PCR.” PLoS neglected tropical diseases 11.1 (2017): e0005310.
                          • Llewellyn, Stacey, et al. “Application of a multiplex quantitative PCR to assess prevalence and intensity of intestinal parasite infections in a controlled clinical trial.” PLoS neglected tropical diseases 10.1 (2016): e0004380.
                          • Speich, Benjamin, et al. “Effect of sanitation and water treatment on intestinal protozoa infection: a systematic review and meta-analysis.” The Lancet Infectious Diseases 16.1 (2016): 87-99.
                          • Pillai, Raja R., et al. “Lysine requirements of moderately undernourished school-aged Indian children are reduced by treatment for intestinal parasites as measured by the indicator amino acid oxidation technique.” The Journal of nutrition 145.5 (2015): 954-959.
                          • Maskery, Brian, et al. “Economic analysis of the impact of overseas and domestic treatment and screening options for intestinal helminth infection among US-bound refugees from Asia.” PLoS neglected tropical diseases 10.8 (2016): e0004910.
                          • Lei, Weiwei, et al. “Activation of intestinal tuft cell-expressed Sucnr1 triggers type 2 immunity in the mouse small intestine.” Proceedings of the National Academy of Sciences 115.21 (2018): 5552-5557.
                          • Mahmud, Mahmud Abdulkader, et al. “Efficacy of handwashing with soap and nail clipping on intestinal parasitic infections in school-aged children: a factorial cluster randomized controlled trial.” PLoS medicine 12.6 (2015): e1001837.
                          • Rivero, Maria Romina, et al. “Prevention of intestinal parasites in a tri‐border area of Latin America: Children perceptions and an integral health education strategy.” Zoonoses and public health 64.8 (2017): 673-683.
                          • Rajeswari, B., B. Sinniah, and Hasnah Hussein. “Socio-economic factors associated with intestinal parasites among children living in Gombak, Malaysia.” Asia Pacific Journal of Public Health (2016).
                          • Brewer, Matthew T., and John H. Greve. “Internal parasites: helminths.” Diseases of swine (2019): 1028-1040.
                          • Patwardhan, Vrushali, Dinesh Kumar, and Sarman Singh. “Parasitic Infections in Pediatric Population of India: Epidemiology, Diagnosis, and Strategies for Prevention.” Journal of Pediatric Infectious Diseases 12.04 (2017): 228-237.
                          • Sharif, Mehdi, et al. “Prevalence of intestinal parasites among food handlers of Sari, Northern Iran.” Revista do Instituto de Medicina Tropical de São Paulo 57.2 (2015): 139-144.
                          • Sahimin, Norhidayu, et al. “Migrant workers in Malaysia: current implications of sociodemographic and environmental characteristics in the transmission of intestinal parasitic infections.” PLoS neglected tropical diseases 10.11 (2016): e0005110.
                          • Ramírez, Juan David, et al. “Blastocystis subtyping and its association with intestinal parasites in children from different geographical regions of Colombia.” PloS one 12.2 (2017): e0172586.
                          • Diakou, Anastasia, et al. “Intestinal parasites and vector-borne pathogens in stray and free-roaming cats living in continental and insular Greece.” PLoS neglected tropical diseases 11.1 (2017): e0005335.
                          • Sharif, Mehdi, et al. “Prevalence of intestinal parasites among food handlers of Sari, Northern Iran.” Revista do Instituto de Medicina Tropical de São Paulo 57.2 (2015): 139-144.
                          • Meurs, Lynn, et al. “Diagnosing polyparasitism in a high-prevalence setting in Beira, Mozambique: detection of intestinal parasites in fecal samples by microscopy and real-time PCR.” PLoS neglected tropical diseases 11.1 (2017): e0005310.
                          • Symptoms
                            • Charest, Louise, Judith Fafard, and Zoë R. Greenwald. “Asymptomatic urethral lymphogranuloma venereum: a case report.” International journal of STD & AIDS 29.8 (2018): 828-830.
                            • Diaz, Asuncion, Marta Ruiz-Algueró, and Victoria Hernando. “Lymphogranuloma venereum in Spain, 2005–2015: A literature review.” Medicina Clínica (English Edition) (2018).
                            • O’Byrne, Patrick, et al. “Approach to lymphogranuloma venereum.” Canadian Family Physician 62.7 (2016): 554-558.
                            • Belda, Walter. “Sexually transmitted diseases.” Dermatology in Public Health Environments. Springer, Cham, 2018. 139-156.
                            • Sullivan, Brian, et al. “Lymphogranuloma venereum (LGV) proctocolitis mimicking rectal lymphoma.” Radiology case reports 13.6 (2018): 1119-1122.
                            • Maxwell, Alexandra Z., Penelope R. Cliff, and John A. White. “O12 LGV testing: are we identifying all cases in a timely manner?.” Sex Transm Infect 93.Suppl 1 (2017): A4-A5.
                            • Were, John, et al. “P219 Responding to the LGV epidemic: are the right patients being tested for LGV?.” (2016): A93-A93.
                            • Maxwell, Alexandra, Penelope Cliff, and John White. “O12 LGV testing.” Sexually Transmitted Infections 93.Suppl_1 (2017).
                            • Griffiths, Tristan, and Nneka Nwokolo. “O002 Rates of asymptomatic lymphogranuloma venereum (LGV) in men who have sex with men (MSM).” (2016): A1-A1.
                            • Herrmann, Björn, et al. “P3. 27 Lymphogranuloma venereum in sweden 2004–2016: increased rates among hiv-negative men who have sex with men and changed genotypes.” (2017): A103-A103.
                            • Simons, Rebecca, et al. “Observed treatment responses to short-course doxycycline therapy for rectal lymphogranuloma venereum in men who have sex with men.” Sexually transmitted diseases 45.6 (2018): 406-408.
                            • Stoner, Bradley P., and Stephanie E. Cohen. “Lymphogranuloma venereum 2015: clinical presentation, diagnosis, and treatment.” Clinical Infectious Diseases 61.suppl_8 (2015): S865-S873.
                            • Fauzi, Mohd, Sameena Ahmad, and Cara Saxon. “P135 A review of local test of cure (TOC) practice following treatment for rectal chlamydia and lymphogranuloma venereum.” Sex Transm Infect 93.Suppl 1 (2017): A61-A61.
                            • Leeyaphan, Charussri, et al. “Treatment outcomes for rectal lymphogranuloma venereum in men who have sex with men using doxycycline, azithromycin, or both: a review of clinical cases.” Sexually transmitted diseases 44.4 (2017): 245-248.
                            • Donachie, Alastair, et al. “Lymphogranuloma venereum (LGV) in men who have sex with men (MSM): a re-emerging problem, Malta, 2018.” Eurosurveillance 23.43 (2018).
                            • Reyes-Urueña, J. M., et al. “Lymphogranuloma venereum in Barcelona, 2007–2012: the role of seroadaptation in men who have sex with men.” Epidemiology & Infection 143.1 (2015): 184-188.
                            • Caumes, Eric. “Letter to the editor: Prevention of bacterial sexually transmitted infections (STI) in France: why not recommend using condoms and safer sex?.” Eurosurveillance 24.12 (2019): 1900171.
                            • Donachie, Alastair, et al. “Lymphogranuloma venereum (LGV) in men who have sex with men (MSM): a re-emerging problem, Malta, 2018.” Eurosurveillance 23.43 (2018).
                            • Brook, Gary, et al. � European guideline for the screening, prevention and initial management of hepatitis B and C infections in sexual health settings.” International journal of STD & AIDS 29.10 (2018): 949-967.
                            • Mungati, M., et al. “P09. 23 High prevalence of hiv infection among patients with sti syndromes in zimbabwe: implications for prevention.” (2015): A156-A157.
                            • de Vries, Henry John C. “The Enigma of Lymphogranuloma Venereum Spread in Men Who Have Sex With Men: Does Ano-Oral Transmission Plays a Role?.” (2016): 420-422.
                            • Boutin, C. A., et al. “LGV in Quebec.” CCDR 44 (2018): 2.
                            • Templeton, David J., et al. “Enhanced surveillance of a lymphogranuloma venereum outbreak in Sydney 2010–2012.” Australian and New Zealand journal of public health 40.4 (2016): 368-370.
                            • de Vries, Henry JC. “Lymphoganuloma venereum in the Western world, 15 years after its re-emergence: new perspectives and research priorities.” Current opinion in infectious diseases 32.1 (2019): 43-50.
                            • Touati, Arabella, et al. “Did L Strains Responsible for Lymphogranuloma Venereum Proctitis Spread Among People With Genital Chlamydia trachomatis Infection in France in 2013?.” Sexually transmitted diseases 43.6 (2016): 374-376.
                            • Symptoms
                              • Kawada, Tomoyuki. “Molluscum contagiosum and associations with atopic eczema in children: a retrospective longitudinal study in primary care.” (2019).
                              • Loh, Tiffany Y., et al. “Molluscum Contagiosum of the Nipple-Areola Complex.” Nipple-Areolar Complex Reconstruction. Springer, Cham, 2018. 145-151.
                              • Fonocho, Ernest, Richard Murray, and Nail Aydin. “Disseminated coccidioidomycosis with molluscum-like lesions, diffuse lymphadenopathy, and splenomegaly in an immunocompetent patient.” International medical case reports journal 10 (2017): 251.
                              • Chikazawa, Sakiko, et al. “Widespread Molluscum Contagiosum with Atopic Dermatitis-like Skin Manifestations.” Acta dermato-venereologica 97.2 (2017): 291-292.
                              • DiBiagio, Jennifer R., Tia Pyle, and Justin J. Green. “Reviewing the use of imiquimod for molluscum contagiosum.” Dermatology online journal 24.6 (2018).
                              • Kaufman, William S., Christine S. Ahn, and William W. Huang. “Molluscum contagiosum in immunocompromised patients: AIDS presenting as molluscum contagiosum in a patient with psoriasis on biologic therapy.” Cutis 101.2 (2018): 136-140.
                              • Trčko, Katarina, et al. “Clinical, histopathological, and virological evaluation of 203 patients with a clinical diagnosis of molluscum contagiosum.” Open forum infectious diseases. Vol. 5. No. 11. US: Oxford University Press, 2018.
                              • Sorte, Hanne S., et al. “A potential founder variant in CARMIL2/RLTPR in three Norwegian families with warts, molluscum contagiosum, and T‐cell dysfunction.” Molecular genetics & genomic medicine 4.6 (2016): 604-616.
                              • Mendez-Rios, Jorge D., et al. “Molluscum contagiosum virus transcriptome in abortively infected cultured cells and a human skin lesion.” Journal of virology 90.9 (2016): 4469-4480.
                              • Uzuncakmak, Tugba K., et al. “Isolated giant molluscum contagiosum mimicking epidermoid cyst.” Dermatology practical & conceptual 6.3 (2016): 71.
                              • Guzman, Anthony K., et al. “Safety and efficacy of topical cantharidin for the treatment of pediatric molluscum contagiosum: a prospective, randomized, double‐blind, placebo‐controlled pilot trial.” International journal of dermatology 57.8 (2018): 1001-1006.
                              • Vakharia, Paras P., et al. “Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: a systematic review.” American journal of clinical dermatology 19.6 (2018): 791-803.
                              • Harel, Avikam, et al. “To Treat Molluscum Contagiosum or Not—Curettage: An Effective, Well‐Accepted Treatment Modality.” Pediatric dermatology 33.6 (2016): 640-645.
                              • Giner-Soriano, Maria, et al. “Randomized placebo-controlled clinical trial on efficacy and safety of topical 10% Potassium hydroxide for molluscum contagiosum treatment in children.” Journal of Dermatological Treatment (2019): 1-7.
                              • Haque, Malika, and Daniel L. Coury. “Treatment of molluscum contagiosum with an East Indian sandalwood oil product.” Journal of Dermatological Treatment 29.5 (2018): 531-533.
                              • Hodges, Ashley L., and Aimee C. Holland. “Prevention and Treatment of Injuries and Infections Related to Pubic Hair Removal.” Nursing for women’s health 21.4 (2017): 313-317.
                              • Allen, H. B., R. M. Allawh, and S. Ballal. “Virally-Induced, Intracellular Biofilms Novel Findings in Molluscum Contagiosum.” Clin Microbiol 6.302 (2017): 2.
                              • Scott, Christopher M., Ronald R. Lubritz, and Gloria F. Graham. “Prevention and management of complications.” Dermatological Cryosurgery and Cryotherapy. Springer, London, 2016. 235-240.
                              • Damevska, Katerina, and Arben Emurlai. “molluscum Contagiosum in a Patient with Atopic Dermatitis.” New England Journal of Medicine 377.21 (2017): e30.
                              • Hall, Anthony. “Molluscum Contagiosum.” Atlas of Male Genital Dermatology. Springer, Cham, 2019. 91-92.
                              • Neri, Iria, et al. “Congenital molluscum contagiosum.” Paediatrics & child health 22.5 (2017): 241.
                              • Zhuang, Kaiwen, et al. “Atypical infantile genital Molluscum contagiosum.” Anais brasileiros de dermatologia 90.3 (2015): 403-405.
                              • Nunns, David, and Rosalind Simpson. “Molluscum Contagiosum.” Vulvar Disease. Springer, Cham, 2019. 105-106.
                              • Bhengra, Masuma P., et al. “HAART–The best treatment modality for widespread and disfigured giant molluscum contagiosum.” Journal of Pakistan Association of Dermatology 25.4 (2016): 314-318.
                              • Ruby, Kristen N., Ann E. Perry, and Konstantinos Linos. “Expanding the Morphologic Heterogeneity of Stromal Changes in Molluscum Contagiosum Infection.” The American Journal of Dermatopathology 40.12 (2018): 941-943.
                              • Symptoms
                                • Endriz, John, Peggy P. Ho, and Lawrence Steinman. “Time correlation between mononucleosis and initial symptoms of MS.” Neurology-Neuroimmunology Neuroinflammation 4.3 (2017): e308.
                                • Sforza, Emilia, David Hupin, and Frederic Roche. “Mononucleosis: a possible cause of idiopathic hypersomnia.” Frontiers in neurology 9 (2018).
                                • Katz, Ben Z., et al. “A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis.” The Journal of pediatrics (2019).
                                • Katz, Ben Z., et al. “A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis.” The Journal of pediatrics (2019).
                                • Heo, Dae‐Hyuk, et al. “Splenic infarction associated with acute infectious mononucleosis due to Epstein–Barr virus infection.” Journal of medical virology 89.2 (2017): 332-336.
                                • Womack, Jason, and Marissa Jimenez. “Common questions about infectious mononucleosis.” American family physician 91.6 (2015).
                                • Bhaskaran, Praveena Nediyara, et al. “Multiple Pulmonary Nodules in an Immunocompetent Adolescent with Infectious Mononucleosis.” Indian pediatrics 55.2 (2018): 161-162.
                                • Huang, Yu, et al. “The early diagnostic value of EBV-DNA load in plasma and PBMC for children′ s primary infectious mononucleosis.” Chinese Journal of Laboratory Medicine 40.6 (2017): 443-446.
                                • Ónodi-Nagy, Katinka, et al. “Amoxicillin rash in patients with infectious mononucleosis: evidence of true drug sensitization.” Allergy, Asthma & Clinical Immunology 11.1 (2015): 1.
                                • Carroll, Christine, Simon Sarkisian, and Daniel Brillhart. “An Unusual Presentation of Murine Typhus and Mononucleosis.” Military medicine 183.11-12 (2018): e756-e757.
                                • Sullivan, John L. “Clinical manifestations and treatment of Epstein-Barr virus infection.” Доступно по URL http://www. uptodate. com/contents/clinical-manifestations-and-treatment-of-epstein-barr-virus-infection (2016).
                                • Chen, Jun, et al. “Analysis on curative effect of the combined therapy of ReDuNing injection and acyclovir on children with infectious mononucleosis.” The Journal of Practical Medicine 33.18 (2017): 3103-3107.
                                • Lyu, H. T., et al. “Clinical effect of pidotimod oral liquid as adjuvant therapy for infectious mononucleosis.” Zhongguo dang dai er ke za zhi= Chinese journal of contemporary pediatrics 20.7 (2018): 563-566.
                                • Naviglio, Samuele, et al. “Splenic infarction in acute infectious mononucleosis.” The Journal of emergency medicine 50.1 (2016): e11-e13.
                                • Cui, Qianghua, et al. “Influence of Epstein-Barr virus infection on T cell subset in children with infectious mononucleosis.” Chongqing Medicine 46.25 (2017): 3491-3493.
                                • Ghosh, Jagabandhu, Dipankar Gupta, and Nibedita Chattopadhyay. “Routine or Selective Immunization against Infectious Mononucleosis: Which One Is Necessary?.” Journal of Pediatric Infectious Diseases 12.02 (2017): 136-137.
                                • Johannsen, Eric C., and Kenneth M. Kaye. “Epstein-Barr virus (infectious mononucleosis, Epstein-Barr virus–associated malignant diseases, and other diseases).” Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. Content Repository Only!, 2015. 1754-1771.
                                • Jia, Y. U., and Lihong Ren. “Research progress of infectious mononucleosis.” Chinese Journal of Postgraduates of Medicine 39.5 (2016): 475-478.
                                • Mule, Prashant. “Heterophile Antibody Positive Infectious Mononucleosis by Epstein Barr Virus (EBV)-A Short Review.” Acta Scientific Microbiology 1 (2018): 44-49.
                                • Katz, Ben Z., et al. “A Validated Scale for Assessing the Severity of Acute Infectious Mononucleosis.” The Journal of pediatrics (2019).
                                • Mule, Prashant. “Heterophile Antibody Positive Infectious Mononucleosis by Epstein Barr Virus (EBV)-A Short Review.” Acta Scientific Microbiology 1 (2018): 44-49.
                                • Lampejo, Temi, et al. “Epstein-Barr virus and cytomegalovirus mononucleosis: important causes of febrile illness in returned travellers.” Travel medicine and infectious disease 19 (2017): 28-32.
                                • Bing, H. U., and Gang Liu. “Study progress of listeria mononucleosis in children.” Journal of Applied Clinical Pediatrics 31.10 (2016): 729-732.
                                • Grose, Charles, and Donald C. Johanson. “Transmission of Cytomegalovirus, Epstein–Barr Virus, and Herpes Simplex Virus Infections: From the Lucy Australopithecus Epoch to Modern-Day Netherlands.” The Journal of pediatrics 170 (2016): 9-10.
                                • Kessenich, Cathy R., and Megan Flanagan. “Diagnosis of infectious mononucleosis.” The Nurse Practitioner 40.8 (2015): 13-16.
                                • Symptoms
                                  • Lis, Rebecca, Ali Rowhani-Rahbar, and Lisa E. Manhart. “Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis.” Clinical Infectious Diseases 61.3 (2015): 418-426.
                                  • Horner, Patrick J., and David H. Martin. “Mycoplasma genitalium infection in men.” The Journal of infectious diseases 216.suppl_2 (2017): S396-S405.
                                  • Slifirski, Josephine B., et al. “Mycoplasma genitalium infection in adults reporting sexual contact with infected partners, Australia, 2008–2016.” Emerging infectious diseases 23.11 (2017): 1826.
                                  • Ona, Samsiya, Rose L. Molina, and Khady Diouf. “Mycoplasma genitalium: an overlooked sexually transmitted pathogen in women?.” Infectious diseases in obstetrics and gynecology 2016 (2016).
                                  • Ison, Catherine A., et al. “Highlighting the clinical need for diagnosing Mycoplasma genitalium infection.” International journal of STD & AIDS 29.7 (2018): 680-686.
                                  • Björnelius, Eva, Charlotta Magnusson, and Jørgen Skov Jensen. “Mycoplasma genitalium macrolide resistance in Stockholm, Sweden.” Sex Transm Infect 93.3 (2017): 167-168.
                                  • Unemo, Magnus, and Jorgen S. Jensen. “Antimicrobial-resistant sexually transmitted infections: gonorrhoea and Mycoplasma genitalium.” Nature Reviews Urology 14.3 (2017): 139.
                                  • Jensen, Jørgen Skov, and Catriona Bradshaw. “Management of Mycoplasma genitalium infections–can we hit a moving target?.” BMC infectious diseases 15.1 (2015): 343.
                                  • Romano, Sarah S., et al. “Long Duration of Asymptomatic Mycoplasma genitalium Infection After Syndromic Treatment for Nongonococcal Urethritis.” Clinical Infectious Diseases (2018).
                                  • Getman, Damon, et al. “Mycoplasma genitalium prevalence, coinfection, and macrolide antibiotic resistance frequency in a multicenter clinical study cohort in the United States.” Journal of clinical microbiology 54.9 (2016): 2278-2283.
                                  • Bradshaw, Catriona S., Jorgen S. Jensen, and Ken B. Waites. “New horizons in Mycoplasma genitalium treatment.” The Journal of infectious diseases 216.suppl_2 (2017): S412-S419.
                                  • Read, Tim RH, et al. “Outcomes of resistance-guided sequential treatment of Mycoplasma genitalium infections: a prospective evaluation.” Clinical Infectious Diseases 68.4 (2018): 554-560.
                                  • Gesink, Dionne, et al. “Mycoplasma genitalium in Toronto, Ont: estimates of prevalence and macrolide resistance.” Canadian Family Physician 62.2 (2016): e96-e101.
                                  • Gaydos, Charlotte A. “Mycoplasma genitalium: accurate diagnosis is necessary for adequate treatment.” The Journal of infectious diseases 216.suppl_2 (2017): S406-S411.
                                  • Guschin, Alexander, et al. “Treatment efficacy, treatment failures and selection of macrolide resistance in patients with high load of Mycoplasma genitalium during treatment of male urethritis with josamycin.” BMC infectious diseases 15.1 (2015): 40.
                                  • Golden, Matthew R., Kimberly A. Workowski, and Gail Bolan. “Developing a public health response to Mycoplasma genitalium.” The Journal of infectious diseases 216.suppl_2 (2017): S420-S426.
                                  • Balkus, J. E., et al. 𔄛: Detection of macrolide resistance-mediating mutations among women with mycoplasma genitalium infection in the preventing vaginal infections trial.” American Journal of Obstetrics & Gynecology 215.6 (2016): S828.
                                  • Workowski, Kimberly A. “Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines.” Clinical Infectious Diseases 61.suppl_8 (2015): S759-S762.
                                  • Read, Tim RH, et al. “Use of pristinamycin for macrolide-resistant Mycoplasma genitalium infection.” Emerging infectious diseases 24.2 (2018): 328.
                                  • Dirks, J. A. M. C., et al. “P3. 100 High mycoplasma genitalium prevalence in chlamydia trachomatis positive patients.” (2017): A130-A130.
                                  • Unemo, Magnus, and Jorgen S. Jensen. “Antimicrobial-resistant sexually transmitted infections: gonorrhoea and Mycoplasma genitalium.” Nature Reviews Urology 14.3 (2017): 139.
                                  • Jensen, Jørgen Skov, et al. � European guideline on Mycoplasma genitalium infections.” Journal of the European Academy of Dermatology and Venereology 30.10 (2016): 1650-1656.
                                  • Lillis, Rebecca A., David H. Martin, and M. Jacques Nsuami. “Mycoplasma genitalium Infections in Women Attending a Sexually Transmitted Disease Clinic in New Orleans.” Clinical Infectious Diseases (2018).
                                  • Pereyre, Sabine, et al. “Mycoplasma genitalium and Trichomonas vaginalis in France: a point prevalence study in people screened for sexually transmitted diseases.” Clinical Microbiology and Infection 23.2 (2017): 122-e1.
                                  • Edouard, Sophie, et al. “Mycoplasma genitalium, an agent of reemerging sexually transmitted infections.” Apmis 125.10 (2017): 916-920.
                                  • Symptoms
                                    • Frølund, Maria, et al. “Urethritis-associated pathogens in urine from men with non-gonococcal urethritis: a case-control study.” Acta dermato-venereologica 96.5 (2016): 689-695.
                                    • Read, Tim RH, et al. “Symptoms, Sites, and Significance of Mycoplasma genitalium in Men Who Have Sex with Men.” Emerging infectious diseases 25.4 (2019): 719-727.
                                    • Ng, Andrea, and Jonathan DC Ross. “Trichomonas vaginalis infection: How significant is it in men presenting with recurrent or persistent symptoms of urethritis?.” International journal of STD & AIDS 27.1 (2016): 63-65.
                                    • Jordan, Stephen J., et al. “Defining the Urethritis Syndrome in Men Using Patient Reported Symptoms.” Sexually transmitted diseases 45.7 (2018): e40-e42.
                                    • Horie, Kengo, et al. “‘Haemophilus quentini’in the urethra of men complaining of urethritis symptoms.” Journal of Infection and Chemotherapy 24.1 (2018): 71-74.
                                    • Horner, P., et al. “Should we be testing for urogenital Mycoplasma hominis.” (2018).
                                    • Abbott, Collette E., et al. “A case of rectal ureaplasma infection and implications for testing in young men who have sex with men: the P18 cohort study.” LGBT health 4.2 (2017): 161-163.
                                    • Trembizki, Ella, et al. “Opportunities and pitfalls of molecular testing for detecting sexually transmitted pathogens.” Pathology 47.3 (2015): 219-226.
                                    • Davies, Nicola. “Mycoplasma genitalium: the need for testing and emerging diagnostic options.” MLO Med Lab Obs 47.12 (2015): 8.
                                    • Zhang, Zhanguo, et al. “NGU: Development of a two‐bed circulating fluidized bed reactor system for nonoxidative aromatization of methane over Mo/HZSM‐5 catalyst.” Environmental Progress & Sustainable Energy 35.2 (2016): 325-333.
                                    • Bachmann, Laura H., et al. “Advances in the understanding and treatment of male urethritis.” Clinical Infectious Diseases 61.suppl_8 (2015): S763-S769.
                                    • Couldwell, Deborah L., and David A. Lewis. “Mycoplasma genitalium infection: current treatment options, therapeutic failure, and resistance-associated mutations.” Infection and drug resistance 8 (2015): 147.
                                    • Romano, Sarah S., et al. “Long Duration of Asymptomatic Mycoplasma genitalium Infection After Syndromic Treatment for Nongonococcal Urethritis.” Clinical Infectious Diseases (2018).
                                    • Kissinger, Patricia, et al. “Azithromycin treatment failure for Chlamydia trachomatis among heterosexual men with nongonococcal urethritis.” Sexually transmitted diseases 43.10 (2016): 599.
                                    • Tabrizi, Sepehr N. “Mycoplasma genitalium: update on diagnosis, treatment and resistance.” Pathology 47 (2015): S50.
                                    • Workowski, Kimberly A. “Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines.” Clinical Infectious Diseases 61.suppl_8 (2015): S759-S762.
                                    • Hogben, Matthew, et al. “Partner services in STD prevention programs: a review.” Sexually transmitted diseases 43.0 0 1 (2016): S53.
                                    • Ong, Jason J., et al. “Should female partners of men with non-gonococcal urethritis, negative for Chlamydia trachomatis and Mycoplasma genitalium, be informed and treated? Clinical outcomes from a partner study of heterosexual men with NGU.” Sexually transmitted diseases 44.2 (2017): 126-130.
                                    • Territo, Heather, and John V. Ashurst. “Nongonococcal Urethritis (NGU).” StatPearls [Internet]. StatPearls Publishing, 2018.
                                    • Ekiel, Alicja, et al. “Prevalence of Urogenital Mycoplasmas Among Men with NGU in Upper Silesia, Poland. Preliminary Study.” Polish journal of microbiology 65.1 (2016): 93-95.
                                    • Saxena, Ajit, Reetika Dawar, and Upasana Bora. “Haemophilus parainfluenzae urethritis through orogenital transmission.” Indian journal of sexually transmitted diseases and AIDS 39.2 (2018): 127.
                                    • Ong, Jason J., et al. “Should female partners of men with non-gonococcal urethritis, negative for Chlamydia trachomatis and Mycoplasma genitalium, be informed and treated? Clinical outcomes from a partner study of heterosexual men with NGU.” Sexually transmitted diseases 44.2 (2017): 126-130.
                                    • Workowski, Kimberly A. “Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines.” Clinical Infectious Diseases 61.suppl_8 (2015): S759-S762.
                                    • Hogben, Matthew, et al. “Partner services in STD prevention programs: a review.” Sexually transmitted diseases 43.0 0 1 (2016): S53.
                                    • Read, Tim RH, et al. “Symptoms, Sites, and Significance of Mycoplasma genitalium in Men Who Have Sex with Men.” Emerging infectious diseases 25.4 (2019): 719-727.
                                    • Symptoms
                                      • Esser, M. M., R. Nortje, and P. Potter. “Meeting the needs of primary immunodeficiency patients in South Africa-some findings from the South African registry: PID article.” Current Allergy & Clinical Immunology 29.1 (2016): 56-61.
                                      • Nortje, R., M. M. Esser, and P. Potter. “Meeting the needs of primary immunodeficiency patients in South Africa-some findings from the South African registry: PID article.” Current Allergy & Clinical Immunology 29.1 (2016): 56-61.
                                      • Matsuyama, Reiko, Akira Tsuchiya, and Osamu Nishii. “Predictive factors for emergent surgical intervention in patients with ovarian endometrioma hospitalized for pelvic inflammatory disease: A retrospective observational study.” Journal of Obstetrics and Gynaecology Research 44.2 (2018): 286-291.
                                      • Martínez-Moreno, Francisco, Gilberto Figueiredo, and E. Lorenzo. “In-the-field PID related experiences.” Solar Energy Materials and Solar Cells 174 (2018): 485-493.
                                      • Latimer, Rosie L., et al. “Clinical Features and Therapeutic Response in Women Meeting Criteria for Presumptive Treatment for Pelvic Inflammatory Disease Associated With Mycoplasma genitalium.” Sexually transmitted diseases 46.2 (2019): 73-79.
                                      • Hacke, Peter, and Steve Johnston. “All About PID-Testing and Avoidance in the Field.” Photovoltaics International 33.NREL/JA-5J00-66799 (2016).
                                      • Sakurai, Keiichiro, et al. “Accelerated Outdoor PID Testing of CIGS Modules and Comparison with Indoor PID Tests.” 2018 IEEE 7th World Conference on Photovoltaic Energy Conversion (WCPEC)(A Joint Conference of 45th IEEE PVSC, 28th PVSEC & 34th EU PVSEC). IEEE, 2018.
                                      • Gou, Xianfang, et al. “PID testing method suitable for process control of solar cells mass production.” International Journal of Photoenergy 2015 (2015).
                                      • Berghold, J., et al. “PID: from material properties to outdoor performance and quality control counter measures.” Reliability of Photovoltaic Cells, Modules, Components, and Systems VIII. Vol. 9563. International Society for Optics and Photonics, 2015.
                                      • Koentopp, Max B., Marcel Kröber, and Christian Taubitz. “Toward a PID test standard: understanding and modeling of laboratory tests and field progression.” IEEE Journal of Photovoltaics 6.1 (2016): 252-257.
                                      • Dean, Gillian, et al. “O031 Pelvic Inflammatory Disease (PID), Mycoplasma genitalium and macrolide resistance in England.” (2016): A12-A12.
                                      • Dean, Gillian, et al. “O006 Is a short course of azithromycin effective in the treatment of mild to moderate Pelvic Inflammatory Disease (PID)?.” (2016): A3-A3.
                                      • Latimer, Rosie L., et al. “Clinical Features and Therapeutic Response in Women Meeting Criteria for Presumptive Treatment for Pelvic Inflammatory Disease Associated With Mycoplasma genitalium.” Sexually transmitted diseases 46.2 (2019): 73-79.
                                      • Solomon, Michelle, et al. “Pelvic Inflammatory Disease in a Pediatric Emergency Department: Epidemiology and Treatment.” Pediatric emergency care (2017).
                                      • Buchanan, Cara, et al. 󈬈. Parental Notification following Diagnosis of PID in Urban Adolescent Young Adults.” Journal of Adolescent Health 56.2 (2015): S13.
                                      • Das, Breanne B., Jocelyn Ronda, and Maria Trent. “Pelvic inflammatory disease: improving awareness, prevention, and treatment.” Infection and drug resistance 9 (2016): 191.
                                      • Esser, M. M., R. Nortje, and P. Potter. “Meeting the needs of primary immunodeficiency patients in South Africa-some findings from the South African registry: PID article.” Current Allergy & Clinical Immunology 29.1 (2016): 56-61.
                                      • Nortje, R., M. M. Esser, and P. Potter. “Meeting the needs of primary immunodeficiency patients in South Africa-some findings from the South African registry: PID article.” Current Allergy & Clinical Immunology 29.1 (2016): 56-61.
                                      • Oh, Jaewon, et al. “Application of flexible glass to prevent PID in PV modules.” 2015 IEEE 42nd Photovoltaic Specialist Conference (PVSC). IEEE, 2015.
                                      • Low, N., et al. “P08. 21 Sex and pelvic inflammatory disease: what’s the relationship? case-control study.” (2015): A140-A140.
                                      • Brunham, Robert C., Sami L. Gottlieb, and Jorma Paavonen. “Pelvic inflammatory disease.” New England Journal of Medicine 372.21 (2015): 2039-2048.
                                      • Butz, Arlene M., et al. “Care-seeking behavior after notification among young women with recurrent sexually transmitted infections after pelvic inflammatory disease.” Clinical pediatrics 55.12 (2016): 1107-1112.
                                      • Ross, Jonathan, et al. � European guideline for the management of pelvic inflammatory disease.” International journal of STD & AIDS 29.2 (2018): 108-114.
                                      • Haggerty, Catherine L., et al. “Identification of novel microbes associated with pelvic inflammatory disease and infertility.” Sex Transm Infect 92.6 (2016): 441-446.
                                      • Chen, Justin Z., et al. “Gonococcal and Chlamydial Cases of Pelvic Inflammatory Disease at 2 Canadian Sexually Transmitted Infection Clinics, 2004 to 2014: A Retrospective Cross-sectional Review.” (2018): 280-282.
                                      • Symptoms
                                        • Osterberg, E. Charles, et al. “Correlation between pubic hair grooming and STIs: results from a nationally representative probability sample.” Sex Transm Infect 93.3 (2017): 162-166.
                                        • Gloster, Hugh Morris, Lauren E. Gebauer, and Rachel L. Mistur. “Lice.” Absolute Dermatology Review. Springer, Cham, 2016. 293-294.
                                        • Durden, Lance A. “Lice (Phthiraptera).” Medical and veterinary entomology. Academic Press, 2019. 79-106.
                                        • Sonthalia, Sidharth, Sangeeta Varma, and Abhijeet K. Jha. “Dermoscopy of pubic louse.” Indian dermatology online journal 10.1 (2019): 90.
                                        • Bragg, Bradley N., and Leslie V. Simon. “Pediculosis Humanis (Lice, Capitis, Pubis).” StatPearls [Internet]. StatPearls Publishing, 2018.
                                        • Mana, Nassima, et al. “Human head lice and pubic lice reveal the presence of several Acinetobacter species in Algiers, Algeria.” Comparative immunology, microbiology and infectious diseases 53 (2017): 33-39.
                                        • Sonthalia, Sidharth, Sangeeta Varma, and Abhijeet K. Jha. “Dermoscopy of pubic louse.” Indian dermatology online journal 10.1 (2019): 90.
                                        • Standard, I. P. C. “SCABIES AND HUMAN LICE POLICY.” (2018).
                                        • Australia, Healthdirect. “Screening tests for STIs.” (2019).
                                        • Ly, Tran Duc Anh, et al. “The presence of Acinetobacter baumannii DNA on the skin of homeless people and its relationship with body lice infestation. Preliminary results.” Frontiers in cellular and infection microbiology 9 (2019): 86.
                                        • Gunning, Karen, Bernadette Kiraly, and Karly Pippitt. “Lice and Scabies: Treatment Update.” American Family Physician 99.10 (2019).
                                        • Monsel, Gentiane, and Olivier Chosidow. 󈬈 Scabies, lice, and myiasis.” Clinical Infectious Disease (2015): 162.
                                        • Shakya, M., A. K. Jayraw, and M. Singh. “Pubic lice infestation in man from Mhow, Madhya Pradesh.” Journal of parasitic diseases 42.3 (2018): 402-404.
                                        • Spring, Nicholas, and Garry T. Gwozdz. “Topical Avermectin Formulations and Methods For Elimination and Prophylaxis of Susceptible and Treatment Resistant Strains of Head Lice.” U.S. Patent Application No. 15/968,364.
                                        • Hodges, Ashley L., and Aimee C. Holland. “Prevention and Treatment of Injuries and Infections Related to Pubic Hair Removal.” Nursing for women’s health 21.4 (2017): 313-317.
                                        • Durden, Lance A. “Lice (Phthiraptera).” Medical and veterinary entomology. Academic Press, 2019. 79-106.
                                        • Gunning, Karen, Bernadette Kiraly, and Karly Pippitt. “Lice and Scabies: Treatment Update.” American Family Physician 99.10 (2019).
                                        • Hodges, Ashley L., and Aimee C. Holland. “Prevention and Treatment of Injuries and Infections Related to Pubic Hair Removal.” Nursing for women’s health 21.4 (2017): 313-317.
                                        • Moshki, Mahdi, Fereshteh Zamani-Alavijeh, and Mehdi Mojadam. “Efficacy of peer education for adopting preventive behaviors against head lice infestation in female elementary school students: a randomised controlled trial.” PloS one 12.1 (2017): e0169361.
                                        • Osterberg, E. Charles, et al. “Correlation between pubic hair grooming and STIs: results from a nationally representative probability sample.” Sex Transm Infect 93.3 (2017): 162-166.
                                        • Osterberg, Charles, et al. “Association between pubic hair grooming and sexually transmitted infections: Results from a nationally representative probability sample.” The Journal of Urology 195.4 (2016).
                                        • Monsel, Gentiane, and Olivier Chosidow. 󈬈 Scabies, lice, and myiasis.” Clinical Infectious Disease (2015): 162.
                                        • Hodges, Ashley L., and Aimee C. Holland. “Prevention and Treatment of Injuries and Infections Related to Pubic Hair Removal.” Nursing for women’s health 21.4 (2017): 313-317.
                                        • Kin, Cindy, and Mark Lane Welton. “Sexually Transmitted Infections.” The ASCRS Textbook of Colon and Rectal Surgery. Springer, Cham, 2016. 325-342.
                                        • Mehlhorn, Heinz. “Mouthparts of Bloodsuckers and Their Ability to Transmit Agents of Diseases.” Mosquito-borne Diseases. Springer, Cham, 2018. 131-158.
                                        • Symptoms
                                          • Engelman, Daniel, and Andrew C. Steer. “Diagnosis, treatment, and control of scabies: can we do better?.” The Lancet Infectious Diseases 18.8 (2018): 822-823.
                                          • Salavastru, C. M., et al. “European guideline for the management of scabies.” Journal of the European Academy of Dermatology and Venereology 31.8 (2017): 1248-1253.
                                          • Park, Jebyung, et al. “Identifying the time to cure for patients with classic scabies after infection control intervention in acute care hospital settings.” American journal of infection control 47.5 (2019): 588-590.
                                          • Hewitt, K. A., A. Nalabanda, and J. A. Cassell. “Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England.” Epidemiology & Infection 143.7 (2015): 1542-1551.
                                          • Cohen, Philip R. “Scabies masquerading as bullous pemphigoid: scabies surrepticius.” Clinical, cosmetic and investigational dermatology 10 (2017): 317.
                                          • Arlian, Larry G., Hermann Feldmeier, and Marjorie S. Morgan. “The potential for a blood test for scabies.” PLoS neglected tropical diseases 9.10 (2015): e0004188.
                                          • Thompson, M. J., et al. “Systematic review of the diagnosis of scabies in therapeutic trials.” Clinical and experimental dermatology 42.5 (2017): 481-487.
                                          • Abdel-Latif, Azmy A., et al. “Comparing the diagnostic properties of skin scraping, adhesive tape, and dermoscopy in diagnosing scabies.” Acta dermatovenerologica Alpina, Pannonica, et Adriatica 27.2 (2018): 75-78.
                                          • Walton, Shelley F., and Bart J. Currie. “Scabies.” Neglected Tropical Diseases-Oceania. Springer, Cham, 2016. 249-272.
                                          • Hahm, J. E., C. W. Kim, and S. S. Kim. “Nested PCR for diagnosing scabies infestation.” British Journal of Dermatology 179.4 (2018): e173-e173.
                                          • Engelman, Daniel, and Andrew C. Steer. “Diagnosis, treatment, and control of scabies: can we do better?.” The Lancet Infectious Diseases 18.8 (2018): 822-823.
                                          • Sanders, Kristen M., et al. “Non-Histaminergic Itch Mediators Elevated in the Skin of a Porcine Model of Scabies and of Human Scabies Patients.” Journal of Investigative Dermatology 139.4 (2019): 971-973.
                                          • Aussy, A., et al. “Risk factors for treatment failure in scabies: a cohort study.” British Journal of Dermatology (2018).
                                          • Mounsey, Kate E., et al. “Prospects for moxidectin as a new oral treatment for human scabies.” PLoS neglected tropical diseases 10.3 (2016): e0004389.
                                          • Ahmad, Hesham M., Eman S. Abdel‐Azim, and Rasha T. Abdel‐Aziz. “Clinical efficacy and safety of topical versus oral ivermectin in treatment of uncomplicated scabies.” Dermatologic therapy 29.1 (2016): 58-63.
                                          • May, Philippa J., et al. “Treatment, prevention and public health management of impetigo, scabies, crusted scabies and fungal skin infections in endemic populations: a systematic review.” Tropical Medicine & International Health 24.3 (2019): 280-293.
                                          • May, Philippa, et al. “Protocol for the systematic review of the prevention, treatment and public health management of impetigo, scabies and fungal skin infections in resource-limited settings.” Systematic reviews 5.1 (2016): 162.
                                          • Wang, Peihong, et al. “Investigation, prevention and control of a healthcare-associated infection outbreak due to Norwegian scabies.” Chinese Journal of Infection Control 16.8 (2017): 749-751.
                                          • Makkar, S. S. “Prevention and management of scabies in pets vis-a-vis human health.” Allgemeine Homöopathische Zeitung 262.02 (2017): FF03-02.
                                          • Mara, Duncan. “Scabies control: the forgotten role of personal hygiene.” The Lancet Infectious Diseases 18.10 (2018): 1068.
                                          • van der Linden, Naomi, et al. “A systematic review of scabies transmission models and data to evaluate the cost-effectiveness of scabies interventions.” PLoS neglected tropical diseases 13.3 (2019): e0007182.
                                          • Rihatmadja, Rahadi, et al. “Why are they hard to treat? A preliminary survey to predict important factors causing persistent scabies among students of religion-affiliated boarding schools in Indonesia.” Dermatology Reports (2019).
                                          • Kinyanjui, Timothy, et al. “Scabies in residential care homes: Modelling, inference and interventions for well-connected population sub-units.” PLoS computational biology 14.3 (2018): e1006046.
                                          • Park, Jebyung, et al. “Identifying the time to cure for patients with classic scabies after infection control intervention in acute care hospital settings.” American journal of infection control 47.5 (2019): 588-590.
                                          • Engelman, Daniel, and Andrew Steer. “Control strategies for scabies.” Tropical medicine and infectious disease 3.3 (2018): 98.
                                          • STI/STD Stigma
                                            • Thomas JA, Ditchman N, Beedle RB. The impact of knowledge, self-efficacy, and stigma on STI testing intention among college students. J Am Coll Health. (2020).
                                            • Hood JE, Friedman AL. Unveiling the hidden epidemic: a review of stigma associated with sexually transmissible infections. Sex Health. (2011).
                                            • Wombacher K, Dai M, Matig JJ, Harrington NG. Using the integrative model of behavioral prediction to understand college students’ STI testing beliefs, intentions, and behaviors. J Am Coll Health. (2018).
                                            • Lee ASD, Cody SL. The Stigma of Sexually Transmitted Infections. Nurs Clin North Am. (2020).
                                            • Hutchinson P, Dhairyawan R. Shame, stigma, HIV: philosophical reflections. Med Humanit. (2017).
                                            • Tan RKJ, Kaur N, Kumar PA, Tay E, Leong A, Chen MI, Wong CS. Clinics as spaces of costly disclosure: HIV/STI testing and anticipated stigma among gay, bisexual and queer men. Cult Health Sex. (2020).
                                            • Shepherd L, Harwood H. The role of STI-related attitudes on screening attendance in young adults. Psychol Health Med. (2017).
                                            • Newton DC, McCabe MP. Sexually Transmitted Infections: Impact on Individuals and Their Relationships. Journal of Health Psychology. (2008).
                                            • Charlton BM, Hatzenbuehler ML, Jun HJ, Sarda V, Gordon AR, Raifman JRG, Austin SB. Structural stigma and sexual orientation-related reproductive health disparities in a longitudinal cohort study of female adolescents. J Adolesc. (2019).
                                            • Symptoms
                                              • Chow, E. P. F., et al. “Duration of syphilis symptoms at presentations in men who have sex with men in Australia: are current public health campaigns effective?.” Epidemiology & Infection 144.1 (2016): 113-122.
                                              • Patel, Nupur U., et al. “Early congenital syphilis: recognising symptoms of an increasingly prevalent disease.” Journal of cutaneous medicine and surgery 22.1 (2018): 97-99.
                                              • Yao, Xiao, et al. “Novel predictors of neurosyphilis among HIV-negative syphilis patients with neurological symptoms: an observational study.” BMC Infectious Diseases 17 (2017).
                                              • Nyatsanza, Farai, and Craig Tipple. “Syphilis: presentations in general medicine.” Clinical Medicine 16.2 (2016): 184-188.
                                              • Gevorgyan, Ofelya, et al. “A nodular-ulcerative form of secondary syphilis in AIDS.” Baylor University Medical Center Proceedings. Vol. 30. No. 1. Taylor & Francis, 2017.
                                              • Chow, Eric PF, et al. “Increased syphilis testing of men who have sex with men: greater detection of asymptomatic early syphilis and relative reduction in secondary syphilis.” Clinical Infectious Diseases 65.3 (2017): 389-395.
                                              • Swartzendruber, Andrea, et al. “Introduction of rapid syphilis testing in antenatal care: A systematic review of the impact on HIV and syphilis testing uptake and coverage.” International Journal of Gynecology & Obstetrics 130 (2015): S15-S21.
                                              • Adeyinka, Daniel A., et al. “Elimination of mother-to-child transmission of syphilis: Is it a reality in Nigeria by 2020?.” Scandinavian journal of public health 46.8 (2018): 794-797.
                                              • Tipple, Craig, and Graham P. Taylor. “Syphilis testing, typing, and treatment follow-up: a new era for an old disease.” Current opinion in infectious diseases 28.1 (2015): 53-60.
                                              • Hall, Brian J., et al. “Barriers and Facilitators of Rapid HIV and Syphilis Testing Uptake Among Filipino Transnational Migrants in China.” AIDS and behavior (2019): 1-10.
                                              • Stamm, L. V. “Syphilis: antibiotic treatment and resistance.” Epidemiology & Infection 143.8 (2015): 1567-1574.
                                              • Seña, Arlene C., et al. “Rate of decline in nontreponemal antibody titers and seroreversion after treatment of early syphilis.” Sexually transmitted diseases 44.1 (2017): 6.
                                              • Taylor, Melanie M., et al. “The amount of penicillin needed to prevent mother-to-child transmission of syphilis.” Bulletin of the World Health Organization 94.8 (2016): 559.
                                              • Antonio, Marilia B., et al. “Natural experiment of syphilis treatment with doxycycline or benzathine penicillin in HIV-infected patients.” Aids 33.1 (2019): 77-81.
                                              • Lawrence, David, et al. “Syphilis treatment in the presence of HIV: the debate goes on.” Current opinion in infectious diseases 28.1 (2015): 44-52.
                                              • Kidd, Sarah, et al. “Use of national syphilis surveillance data to develop a congenital syphilis prevention cascade and estimate the number of potential congenital syphilis cases averted.” Sexually transmitted diseases 45 (2018): S23-S28.
                                              • Chesson, Harrell W., and Kwame Owusu-Edusei Jr. “Relative Impact of Different Strategies for Allocating Federal Funds for Syphilis Prevention.” Sexually transmitted diseases 45 (2018): S72-S77.
                                              • Kroeger, Karen A., et al. “Pathways to congenital syphilis prevention: A rapid qualitative assessment of barriers, and the public health response, in Caddo Parish, Louisiana.” Sexually transmitted diseases 45.7 (2018): 442-446.
                                              • Plotzker, Rosalyn E., Ryan D. Murphy, and Juliet E. Stoltey. “Congenital Syphilis Prevention: Strategies, Evidence, and Future Directions.” Sexually transmitted diseases 45 (2018): S29-S37.
                                              • Wu, Xiaobing, et al. “Poor awareness of syphilis prevention and treatment knowledge among six different populations in south China.” BMC public health 16.1 (2016): 287.
                                              • Stahlman, Shauna, et al. “Acceptable interventions to reduce syphilis transmission among high-risk men who have sex with men in Los Angeles.” American journal of public health 105.3 (2015): e88-e94.
                                              • Stoltey, Juliet E., and Stephanie E. Cohen. “Syphilis transmission: a review of the current evidence.” Sexual health 12.2 (2015): 103-109.
                                              • Gumel, Abba, et al. “Mathematics of a sex‐structured model for syphilis transmission dynamics.” Mathematical Methods in the Applied Sciences 41.18 (2018): 8488-8513.
                                              • Taylor, Melanie M., et al. “The amount of penicillin needed to prevent mother-to-child transmission of syphilis.” Bulletin of the World Health Organization 94.8 (2016): 559.
                                              • Braccio, Serena, Mike Sharland, and Shamez N. Ladhani. “Prevention and treatment of mother-to-child transmission of syphilis.” Current opinion in infectious diseases 29.3 (2016): 268-274.
                                              • Symptoms
                                                • Doxtader, Erika E., and Tarik M. Elsheikh. “Diagnosis of trichomoniasis in men by urine cytology.” Cancer cytopathology 125.1 (2017): 55-59.
                                                • Ahady, Mohammad Taghi, et al. “Prevalence of Trichomoniasis among 18–48 year-old women in northwest of Iran.” Iranian journal of parasitology 11.4 (2016): 580.
                                                • Sobel, Jack D. “Approach to women with symptoms of vaginitis.” UpToDate. August 19 (2016).
                                                • Graves, Keonte J., et al. “Trichomonas vaginalis virus (TVV) among women with trichomoniasis and associations with demographics, clinical outcomes, and metronidazole resistance.” Clinical Infectious Diseases (2019).
                                                • Jamshidi, Ali. “Comparison of Three Methods of Clinical Diagnosis, Microscopic and PCR Techniques for Detection of Trichomoniasis in Women in the Yasuj City.” Science 5.1 (2016): 12-15.
                                                • Postenrieder, Nikki R., et al. “Rapid antigen testing for Trichomoniasis in an Emergency Department.” Pediatrics 137.6 (2016).
                                                • Muzny, Christina A., et al. “Incidence and predictors of reinfection with trichomoniasis based on nucleic acid amplification testing results in HIV-infected patients.” International journal of STD & AIDS (2018): 0956462418807115.
                                                • Natoli, Lisa, et al. 󈬁 Pointofcare testing for chlamydia, gonorrhoea and trichomoniasis.” A Practical Guide to Global Point-of-Care Testing (2016).
                                                • Liu, Eugene W., et al. “Survey of Obstetrician-gynecologists in the United States About Trichomoniasis, 2016.” Sexually transmitted diseases 46.1 (2019): 9.
                                                • Rosenberger, Kelly D., and Courtney Fisk. “A missed diagnosis of trichomoniasis.” The Nurse Practitioner 42.2 (2017): 1-4.
                                                • Kissinger, Patricia, et al. “Single-dose versus 7-day-dose metronidazole for the treatment of trichomoniasis in women: an open-label, randomised controlled trial.” The Lancet Infectious Diseases 18.11 (2018): 1251-1259.
                                                • Howe, Katharine, and Patricia Kissinger. “Single-dose compared to multi-dose metronidazole for the treatment of trichomoniasis in women: A meta-analysis.” Sexually transmitted diseases 44.1 (2017): 29.
                                                • Kissinger, Patricia. “Epidemiology and treatment of trichomoniasis.” Current infectious disease reports 17.6 (2015): 31.
                                                • Bouchemal, Kawthar, Christian Bories, and Philippe M. Loiseau. “Strategies for prevention and treatment of Trichomonas vaginalis infections.” Clinical microbiology reviews 30.3 (2017): 811-825.
                                                • de Brum Vieira, Patricia, Tiana Tasca, and W. Evan Secor. “Challenges and persistent questions in the treatment of Trichomoniasis.” Current topics in medicinal chemistry 17.11 (2017): 1249-1265.
                                                • Bouchemal, Kawthar, Christian Bories, and Philippe M. Loiseau. “Strategies for prevention and treatment of Trichomonas vaginalis infections.” Clinical microbiology reviews 30.3 (2017): 811-825.
                                                • Rönn, Minttu M., and Katherine ME Turner. “The dawn of novel STI prevention methods: modelling potential unintended effects of changes in cervical cancer screening guidelines on trichomoniasis.” (2018): 161-162.
                                                • Holmes, K. K., et al. “Sexually Transmitted Infections: Impact and Cost-Effectiveness of Prevention–Major Infectious Diseases.” (2017).
                                                • Howe, Katharine, and Patricia Kissinger. “Single-dose compared to multi-dose metronidazole for the treatment of trichomoniasis in women: A meta-analysis.” Sexually transmitted diseases 44.1 (2017): 29.
                                                • Khurana, Sumeeta, and Shreya Singh. “Human Trichomoniasis.” Infectious Diseases and Your Health. Springer, Singapore, 2018. 99-111.
                                                • de Brum Vieira, Patricia, Tiana Tasca, and W. Evan Secor. “Challenges and persistent questions in the treatment of Trichomoniasis.” Current topics in medicinal chemistry 17.11 (2017): 1249-1265.
                                                • Kissinger, Patricia. “Epidemiology and treatment of trichomoniasis.” Current infectious disease reports 17.6 (2015): 31.
                                                • Bruni, Mirian Pinheiro, et al. “Aptima Trichomonas vaginalis assay elucidates significant underdiagnosis of trichomoniasis among women in Brazil according to an observational study.” Sex Transm Infect 95.2 (2019): 129-132.
                                                • Meites, Elissa, et al. “A review of evidence-based care of symptomatic trichomoniasis and asymptomatic Trichomonas vaginalis infections.” Clinical infectious diseases 61.suppl_8 (2015): S837-S848.
                                                • Menezes, Camila Braz, Amanda Piccoli Frasson, and Tiana Tasca. “Trichomoniasis-are we giving the deserved attention to the most common non-viral sexually transmitted disease worldwide?.” Microbial cell 3.9 (2016): 404.
                                                • Symptoms
                                                  • Sobel, Jack D. “Approach to women with symptoms of vaginitis.” UpToDate. August 19 (2016).
                                                  • Paavonen, Jorma, and Robert C. Brunham. “Bacterial Vaginosis and Desquamative Inflammatory Vaginitis.” New England Journal of Medicine 379.23 (2018): 2246-2254.
                                                  • Mitchell, C., et al. “Vaginal bacteria and cytokines in women with idiopathic vaginitis.” American Journal of Obstetrics and Gynecology 219.6 (2018).
                                                  • Hillier, Sharon, et al. “Clinical practice and accuracy of vaginitis diagnosis in community based settings.” American Journal of Obstetrics and Gynecology 219.6 (2018).
                                                  • Nwankwo, Theophilus Ogochukwu, Uzochukwu Uzoma Aniebue, and Uchenna Anthony Umeh. “Syndromic diagnosis in evaluation of women with symptoms of vaginitis.” Current infectious disease reports 19.1 (2017): 3.
                                                  • Sanguinetti, Maurizio, et al. “In Vitro Activity of Fenticonazole against Candida and Bacterial Vaginitis Isolates Determined by Mono-or Dual-Species Testing Assays.” Antimicrobial agents and chemotherapy (2019): AAC-02693.
                                                  • Van Schalkwyk, Julie, et al. “Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis.” Journal of Obstetrics and Gynaecology Canada 37.3 (2015): 266-274.
                                                  • Johnston, Christine, et al. “O11. 1 Decline in genital shedding in the year after first clinical episode genital herpes simplex virus type 1.” (2017): A24-A25.
                                                  • Khan, Shahla. “A survey on Vulvovaginal Candidiasis or Vulvovaginitis-A Vaginal yeast infection by the fungus Candida albicans.” (2018).
                                                  • Vezzani, Cristina, et al. “Vulvovaginitis in Childhood.” Good Practice in Pediatric and Adolescent Gynecology. Springer, Cham, 2018. 1-17.
                                                  • Vieira-Baptista, Pedro, et al. “Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities.” European journal of clinical microbiology & infectious diseases 35.4 (2016): 657-664.
                                                  • Van Der Pol, Barbara, et al. “Molecular-based testing for sexually transmitted infections using samples previously collected for vaginitis diagnosis.” Clinical Infectious Diseases 68.3 (2018): 375-381.
                                                  • Hillier, Sharon, et al. “Clinical practice and accuracy of vaginitis diagnosis in community based settings.” American Journal of Obstetrics and Gynecology 219.6 (2018).
                                                  • Ackerman, Stacey J., et al. “Health care utilization and costs following amplified versus non-amplified molecular probe testing for symptomatic patients with suspected vulvovaginitis: a US commercial payer population.” ClinicoEconomics and Outcomes Research: CEOR 11 (2019): 179.
                                                  • Schwebke, Jane R., et al. “Diagnostic performance of a molecular test versus clinician assessment of vaginitis.” Journal of clinical microbiology 56.6 (2018): e00252-18.
                                                  • Danby, C., et al. 𔄟: Is more always better? comparing nucleic acid amplification testing to traditional methods in diagnosis of vaginal infections in gynecology and vulvovaginal referral offices.” American Journal of Obstetrics and Gynecology 213.6 (2015): 885-886.
                                                  • Paavonen, Jorma, and Robert C. Brunham. “Bacterial vaginosis and desquamative inflammatory vaginitis.” New England Journal of Medicine 379.23 (2018): 2246-2254.
                                                  • Vieira-Baptista, Pedro, et al. “Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities.” European journal of clinical microbiology & infectious diseases 35.4 (2016): 657-664.
                                                  • Gaydos, Charlotte A., et al. “Clinical validation of a test for the diagnosis of vaginitis.” Obstetrics and gynecology 130.1 (2017): 181.
                                                  • Van Schalkwyk, Julie, et al. “Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis.” Journal of Obstetrics and Gynaecology Canada 37.3 (2015): 266-274.
                                                  • Wallis, Luke, and Richard P. Usatine. “Vulvar pain in pregnancy: the patient was first diagnosed with candida vaginitis, but a second opinion and a closer look at the clinical picture gave way to a different diagnosis.” Journal of Family Practice 65.3 (2016): 201-204.
                                                  • Du, Qiuling, et al. “The antiviral activity of arbidol hydrochloride against herpes simplex virus type II (HSV2) in a mouse model of vaginitis.” International immunopharmacology 68 (2019): 58-67.
                                                  • Khan, Shahla. “A survey on Vulvovaginal Candidiasis or Vulvovaginitis-A Vaginal yeast infection by the fungus Candida albicans.” (2018).
                                                  • Santos, Carolina MA, et al. “Selection of Lactobacillus strains as potential probiotics for vaginitis treatment.” Microbiology 162.7 (2016): 1195-1207.
                                                  • Rioux, Jacques Emile, et al. 󈬁β-estradiol vaginal tablet versus conjugated equine estrogen vaginal cream to relieve menopausal atrophic vaginitis.” Menopause 25.11 (2018): 1208-1213.
                                                  • Zalewski, Jerzy, et al. “Calophyllum inophyllum in vaginitis treatment: Stimulated by electroporation with an in vitro approach.” Advances in clinical and experimental medicine: official organ Wroclaw Medical University (2018).
                                                  • Donders, Gilbert GG, Katerina Ruban, and Gert Bellen. “Selecting anti-microbial treatment of aerobic vaginitis.” Current infectious disease reports 17.5 (2015): 24.
                                                  • Van Schalkwyk, Julie, et al. “Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis.” Journal of Obstetrics and Gynaecology Canada 37.3 (2015): 266-274.
                                                  • Nyirjesy, Paul, and Jane R. Schwebke. “Secnidazole: next-generation antimicrobial agent for bacterial vaginosis treatment.” Future microbiology 13.5 (2018): 507-524.
                                                  • Bohbot, J. M., et al. “PRISM study: Comparison of a nystatin-neomycin-polymyxin B combination with miconazole for the empirical treatment of infectious vaginitis.” Medecine et maladies infectieuses (2019).
                                                  • Goje, Oluwatosin, and Jessian L. Munoz. “Vulvovaginitis: Find the cause to treat it.” Cleveland Clinic journal of medicine 84.3 (2017): 215-224.
                                                  • Shi, Hui-Juan, et al. “Efficacy and safety of combined high-dose interferon and red light therapy for the treatment of human papillomavirus and associated vaginitis and cervicitis: A prospective and randomized clinical study.” Medicine 97.37 (2018).
                                                  • Khan, Shahla. “A survey on Vulvovaginal Candidiasis or Vulvovaginitis-A Vaginal yeast infection by the fungus Candida albicans.” (2018).
                                                  • Sobel, Jack D., and Carol A. Kauffman. “Candida vulvovaginitis: Treatment.” Review Up to date May (2018).
                                                  • Wan Muda, Wan Mahfuzah, Li Ping Wong, and Sun Tee Tay. “Prevention practices of vaginitis among Malaysian women and its associated factors.” Journal of Obstetrics and Gynaecology 38.5 (2018): 708-715.
                                                  • Koledin, Slađana, et al. “Evaluation of incidence and prevention of vulvovaginitis in juvenile stage: Professional article.” Sestrinska reč 20.73 (2016): 4-6.
                                                  • Sobel, Jack D., and Carol A. Kauffman. “Candida vulvovaginitis: Treatment.” Review Up to date May (2018).
                                                  • Cianci, Antonio, et al. “Observational prospective study on Lactobacillus plantarum P 17630 in the prevention of vaginal infections, during and after systemic antibiotic therapy or in women with recurrent vaginal or genitourinary infections.” Journal of Obstetrics and Gynaecology 38.5 (2018): 693-696.
                                                  • Obiero, Jael, et al. “Nifuratel‐Nystatin combination for the treatment of mixed infections of bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis.” Cochrane Database of Systematic Reviews 4 (2018).
                                                  • Ratner, Adam J., and Saul Hymes. “Treatment and prevention of bacterial vaginosis and Gardnerella vaginalis infections.” U.S. Patent No. 9,198,957. 1 Dec. 2015.
                                                  • Heczko, Piotr B., et al. “Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial.” BMC women’s health 15.1 (2015): 115.
                                                  • Fang, Cheng, et al. “Effect of Pelvic Floor Muscle Rehabilitation in Preventing Recurrent Vulvovaginal Candidiasis and Recurrent Bacterial Vaginosis.” Journal of Gynecology and Obstetrics 6.4 (2018): 94-97.
                                                  • Donders, Gilbert GG, et al. “For publication Aerobic vaginitis: no longer a stranger.” (2017).
                                                  • Shen, Danting. “PREVENTION OF SERIOUS INFECTIONS DURING PREGNANCY.” (2017).
                                                  • Paavonen, Jorma, and Robert C. Brunham. “Bacterial vaginosis and desquamative inflammatory vaginitis.” New England Journal of Medicine 379.23 (2018): 2246-2254.
                                                  • Wallis, Luke, and Richard P. Usatine. “Vulvar pain in pregnancy: the patient was first diagnosed with candida vaginitis, but a second opinion and a closer look at the clinical picture gave way to a different diagnosis.” Journal of Family Practice 65.3 (2016): 201-204.
                                                  • Du, Qiuling, et al. “The antiviral activity of arbidol hydrochloride against herpes simplex virus type II (HSV2) in a mouse model of vaginitis.” International immunopharmacology 68 (2019): 58-67.
                                                  • Shi, Hui-Juan, et al. “Efficacy and safety of combined high-dose interferon and red light therapy for the treatment of human papillomavirus and associated vaginitis and cervicitis: A prospective and randomized clinical study.” Medicine 97.37 (2018).
                                                  • Grinceviciene, Svitrigaile, et al. “Sexual behaviour and extra‐genital colonisation in women treated for recurrent Candida vulvo‐vaginitis.” Mycoses 61.11 (2018): 857-860.
                                                  • Wang, Haixia, et al. “An epidemiological study on vaginitis in 6,150 women of reproductive age in Shanghai.” The new microbiologica 40.2 (2017): 113-8.
                                                  • Paavonen, Jorma, and Robert C. Brunham. “Bacterial Vaginosis and Desquamative Inflammatory Vaginitis.” New England Journal of Medicine 379.23 (2018): 2246-2254.
                                                  • Donders, Gilbert GG, et al. “Is multiple-site colonization with Candida spp. related to inadequate response to individualized fluconazole maintenance therapy in women with recurrent Candida vulvovaginitis?.” Diagnostic microbiology and infectious disease 92.3 (2018): 226-229.
                                                  • Mills, Benjie Brown. “Vaginitis: beyond the basics.” Obstetrics and Gynecology Clinics 44.2 (2017): 159-177.
                                                  • Wariso, K. T., et al. “Prevalence of Bacterial Vaginosis among Patients with Vulvovaginitis in a Tertiary Hospital in Port Harcourt, Rivers State, Nigeria.” Asian J. Med. and Health 7.4 (2017): 1-7.
                                                  • Van Der Pol, Barbara, et al. “Molecular-based testing for sexually transmitted infections using samples previously collected for vaginitis diagnosis.” Clinical Infectious Diseases 68.3 (2018): 375-381.
                                                  • Rulisa, Stephen, et al. “Nifuratel‐Nystatin combination for the treatment of mixed infections of bacterial vaginosis, vulvovaginal candidiasis, and trichomonal vaginitis.” The Cochrane Database of Systematic Reviews 2018.4 (2018).
                                                  • Vieira-Baptista, Pedro, and Jacob Bornstein. “Candidiasis, Bacterial Vaginosis, Trichomoniasis and Other Vaginal Conditions Affecting the Vulva.” Vulvar Disease. Springer, Cham, 2019. 167-205.
                                                  • Van Schalkwyk, Julie, et al. “Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis.” Journal of Obstetrics and Gynaecology Canada 37.3 (2015): 266-274.
                                                  • Brady, Paula C. “Vulvovaginitis and Vaginal Bleeding in Pediatric and Adolescent Patients.” Handbook of Consult and Inpatient Gynecology. Springer, Cham, 2016. 235-271.
                                                  • Nenoff, P., et al. “Non-viral sexually transmitted infections-epidemiology, clinical manifestations, diagnostics and therapy: part 2: Chlamydia and mycoplasma.” Der Hautarzt Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete 68.1 (2017): 50-58.
                                                  • Khan, Shahla. “A survey on Vulvovaginal Candidiasis or Vulvovaginitis-A Vaginal yeast infection by the fungus Candida albicans.” (2018).
                                                  • Isaac, N., et al. “Routine screening for Trichomonas vaginalis among human immunodeficiency virus-seropositive antenatal clients in Zaria: A necessity or option?.” Tropical Journal of Obstetrics and Gynaecology 33.3 (2016): 322.
                                                  • Wallis, Luke, and Richard P. Usatine. “Vulvar pain in pregnancy: the patient was first diagnosed with candida vaginitis, but a second opinion and a closer look at the clinical picture gave way to a different diagnosis.” Journal of Family Practice 65.3 (2016): 201-204.
                                                  • Symptoms
                                                    • Heymann, David L., et al. “Zika virus and microcephaly: why is this situation a PHEIC?.” The Lancet 387.10020 (2016): 719-721.
                                                    • Musso, Didier, et al. “Detection of Zika virus in saliva.” Journal of Clinical Virology 68 (2015): 53-55.
                                                    • Ginier, Mylène, et al. “Zika without symptoms in returning travellers: What are the implications?.” Travel medicine and infectious disease 14.1 (2016): 16-20.
                                                    • Gatherer, Derek, and Alain Kohl. “Zika virus: a previously slow pandemic spreads rapidly through the Americas.” Journal of General Virology 97.2 (2016): 269-273.
                                                    • Paixão, Enny S., et al. “History, epidemiology, and clinical manifestations of Zika: a systematic review.” American journal of public health 106.4 (2016): 606-612.
                                                    • Musso, Didier, et al. “Detection of Zika virus in saliva.” Journal of Clinical Virology 68 (2015): 53-55.
                                                    • McCarthy, Michael. “Zika virus was transmitted by sexual contact in Texas, health officials report.” (2016): i720.
                                                    • Cauchemez, Simon, et al. “Could clinical symptoms be a predictor of complications in Zika virus infection?–Authors’ reply.” The Lancet 388.10042 (2016): 338-339.
                                                    • Musso, Didier, and Duane J. Gubler. “Zika virus.” Clinical microbiology reviews 29.3 (2016): 487-524.
                                                    • Chimelli, Leila, et al. “The spectrum of neuropathological changes associated with congenital Zika virus infection.” Acta neuropathologica 133.6 (2017): 983-999.
                                                    • Jackman, Joshua A., et al. “Therapeutic treatment of Zika virus infection using a brain-penetrating antiviral peptide.” Nature Materials 17.11 (2018): 971.
                                                    • Saxena, Shailendra K., et al. “Zika virus outbreak: an overview of the experimental therapeutics and treatment.” Virusdisease 27.2 (2016): 111-115.
                                                    • Shiryaev, Sergey A., et al. “Repurposing of the anti-malaria drug chloroquine for Zika Virus treatment and prophylaxis.” Scientific reports 7.1 (2017): 15771.
                                                    • Shuaib, Waqas, et al. “Re-emergence of Zika virus: a review on pathogenesis, clinical manifestations, diagnosis, treatment, and prevention.” The American journal of medicine 129.8 (2016): 879-e7.
                                                    • Miller, Michele, et al. “What are people tweeting about Zika? An exploratory study concerning its symptoms, treatment, transmission, and prevention.” JMIR public health and surveillance 3.2 (2017): e38.
                                                    • Shuaib, Waqas, et al. “Re-emergence of Zika virus: a review on pathogenesis, clinical manifestations, diagnosis, treatment, and prevention.” The American journal of medicine 129.8 (2016): 879-e7.
                                                    • Gao, Daozhou, et al. “Prevention and control of Zika as a mosquito-borne and sexually transmitted disease: a mathematical modeling analysis.” Scientific reports 6 (2016): 28070.
                                                    • Miller, Michele, et al. “What are people tweeting about Zika? An exploratory study concerning its symptoms, treatment, transmission, and prevention.” JMIR public health and surveillance 3.2 (2017): e38.
                                                    • Oster, Alexandra M., et al. “Interim guidelines for prevention of sexual transmission of Zika virus—United States, 2016.” (2016).
                                                    • Sharma, Anshika, and Sunil K. Lal. “Zika virus: transmission, detection, control, and prevention.” Frontiers in microbiology 8 (2017): 110.
                                                    • Brooks, John T. “Prevention of Sexually Transmitted Zika, Zika Action Plan (ZAP) Post-Summit Teleconference.” (2016).
                                                    • Musso, Didier, et al. “Potential sexual transmission of Zika virus.” Emerging infectious diseases 21.2 (2015): 359.
                                                    • Chimelli, Leila, et al. “The spectrum of neuropathological changes associated with congenital Zika virus infection.” Acta neuropathologica 133.6 (2017): 983-999.
                                                    • McCarthy, Michael. “Zika virus was transmitted by sexual contact in Texas, health officials report.” (2016): i720.Musso, Didier, and Duane J. Gubler. “Zika virus.” Clinical microbiology reviews 29.3 (2016): 487-524.

                                                    About Jenelle Marie Pierce, Executive Director

                                                    Jenelle Marie Pierce (she/her/hers) is the Executive Director of The STI Project: Breaking the Stigma® and its child sites an Adjunct Professor the Spokesperson for Positive Singles and a Tri-Chair of the Communications Action Group at the National Coalition for Sexual Health (NCSH). As an STI+ Sexual Health Educator and content creator, Jenelle has been dismantling stigma by reclaiming STI narratives® through awareness, education, and acceptance since 2012. Current bylines can be found in O.School, SELF, HepatitisC.net, Kinkly, PornHub's Sexual Wellness Center, and Allure. For fun, Jenelle stays active as a group fitness instructor and also spends time camping, snow shoeing, hiking, skiing, kayaking, growing things, running through sprinklers, and building sand castles. Learn more about her here, or find her on social media: Instagram, YouTube, Twitter, Facebook, LinkedIn, Pinterest, or Tumblr.

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                                                    Watch the video: Sexually Transmitted Infections and their symptoms STIs. Biology. Bilingual Learning (September 2022).


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