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A large variety of infectious agents are transmitted by sexual contact (Table 54-1). These sexually transmitted diseases are considered separately because they present special problems relating to transmission and prevention.

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Table 54–1. Major Sexually Transmitted Diseases.
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The sexual revolution that started in the 1960s has been associated with an increase in the incidence of sexually transmitted diseases, many of which now represent major public health problems. New sexually transmitted diseases—including infection with human immunodeficiency virus (HIV) (types 1 and 2)—have also emerged.

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The diseases traditionally regarded as sexually transmitted infections are gonorrhea, nongonococcal urethritis, syphilis, herpes genitalis, chancroid, lymphogranuloma venereum, and granuloma inguinale. More recently, HIV, hepatitis B, and human papillomavirus infection have been included in this category. In this chapter, only the traditional sexually transmitted diseases are discussed. Infection with HIV, which causes acquire immunodeficiency syndrome (AIDS), is discussed in Chapter 7: Deficiencies of the Host Response, hepatitis B in Chapter 42: The Liver: I. Structure & Function; Infections, and human papillomavirus infection in Chapters 51 and 53. The recognition of human papillomavirus as a sexually transmitted disease has expanded this concept to include cancer of the cervix and anal canal.

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Gonorrhea is one of the most common sexually transmitted diseases, with a reported incidence of over 300 per 100,000 population in the United States. This represents a decline from the peak incidence year in 1975. It is estimated that approximately l% of the population (ie, 2 to 3 million persons) in the United States have had gonorrhea. Because large numbers of cases may go unreported, 1% is almost certainly an underestimate.

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Gonorrhea has a high prevalence in teenagers in large cities, in nonwhites, in drug abusers, and among lower socioeconomic groups. The incidence in homosexual males declined in the 1980s.

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Pathology

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Gonorrhea is caused by the gram-negative diplococcus, Neisseria gonorrhoeae. The organism infects chiefly the urethra in ...

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