Sexually transmitted infections A50-A64

Group of infectious diseases (note: in German the English terms STD -sexually transmitted diseases- or STI -sexually transmitted infections- are increasingly used), formerly called venereal diseases (Venerea), which are mainly but not exclusively transmitted through sexual intercourse.

The group of STIs is now relatively broadly defined. It includes infections caused by:

viruses, bacteria, fungi, protozoa and parasitic arthropods. This definition therefore also includes diseases such as scabies, in which sexual transmission does not play a primary role.

The term STI (sexually transmitted infections) has replaced the term STD (sexually transmitted diseases) as infections often go unnoticed. STI is based on a multitude of pathogens.

Among the pathogens of the "classical venereal diseases" are:

• Troponema pallidum (syphilis)
• Neisseria gnonorrhoeae (Gonorrhoeae)
• Haemophilus ducreyi (ulcer molle)
• Chlamydia trachomatis (lymphogranuloma venereum)
• Klebsiella trachomatis (Granuloma inguinale; Donovanosis)

The clinical significance of these infections had decreased significantly in the near past due to the widespread use of antibiotics, but has experienced a significant renaissance in recent years (especially in the wake of HIV infection). In addition to the "classic venereal diseases", the following pathogens are of greater clinical relevance for STI:

• HIV virus (HIV infection and AIDS)
• HTLV-1 (human T-cell leukemia virus)
• Hepatitis B virus (hepatitis B)
• Hepatitis A virus (hepatitis A)
• Hepatitis C virus (hepatitis C)
• Adenoviruses (non-gonorrhoeic non-chlamydia urethritis)
• HSV type I and type II (herpes simplex genitalis)
• Human herpes virus type 8 (angiotumours of the skin)
• Epstein-Barr virus infections (mononucleosis, ulcus vulvae acutum, oral hair leukoplakia, etc.)
• Cytomegalovirus (mononuleosis-like exanthema)
• Chlamydia trichomatis (infections with Chlamydia; urethritis, prostatitis, epidydimitis, cervicitis, etc.)
• Trochomonas vaginalis (infections with trichomonads; vaginal trichomoniasis)
• Giardia lamblia (lambliasis mainly in MSM)
• Phthirus pubis (fungal infection)
• Scabies mite (scabies)
• HPV (infections with human papilloma viruses; condylomata acuminta, laryngeal papillomas, bowenoid papulosis, carcinomas of the vulva, vagina, cervix)
• Infections with mycoplasma genitalium
• Candida spp (Balanitis, Vulvovagintis)

Other rare pathogens from STI are:

• Shigella spp. (shigellosis in MSM = acronym for men having sex with men)
• Camphylobacter spp. (enteritis and proctocolitis in MSM)
• Staphylococcus spp (dysuria syndrome, non-gonorrhoeic non-chlamydia urethritis -NGNCU; chancreatic pyoderma)
• Haemophilus influenza (non-gonorrhoeic non-chlamydia urethritis)
• Enterococcus catarrhalis (non-gonorrhoeic non-chlamydia urethritis)
• Morexella catarrhalis (non-gonorrhoeic non-chlamydia urethritis)
• Neisseria meningitis (non-gonorrhoeic non-chlamydia urethritis)
• Zika virus (febrile exanthema, sexual transmission rather rare)
• Ebola virus (haemorrhagic fever)

A post-exposure prophylaxis with doxycycline was able to reduce the occurrence of STI in a study of men who had sex with men without using a comdom (Molina et al. 2018).

• Obligation to notify: The Federal Epidemic Law (BGB I. S. 1012 of 18.7.1971), which regulates the compulsory notification of certain infectious diseases, has been replaced by the Infection Protection Law since 1.1.2001. Among other things, this law regulates the obligation to report infectious diseases. The attending physician, any other person professionally engaged in nursing care, the midwife, the head of the family and the coroner are obliged to report suspected cases, illness or death of certain diseases (see below obligation to report) to the public health department (lower health authority) immediately or within 24 hours at the latest.

  Only acute hepatitis B must be reported by name. HIV and syphilis infections must be reported anonymously to the Robert Koch Institute Berlin.

1. Molina JM et al (2018) Post-exposure prophylaxis with doxycycline to prevent sexually transmitted infections in men who have sex with men: an open-label randomised substudy of the ANRS IPERGAY trial. Lancet Infect Dis 18:308-317.