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Handsfield - FM:Handsfield-FM 3/28/11 4:53 PM Page I Handsfield - FM:Handsfield-FM 3/28/11 4:53 PM Page i Color Atlas & Synopsis of Sexually Transmitted Diseases Handsfield - FM:Handsfield-FM 3/28/11 4:53 PM Page ii Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide infor- mation that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the prepa- ration or publication of this work warrants that the information contained herein is in every re- spect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are en- couraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the con- traindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Handsfield - FM:Handsfield-FM 3/28/11 4:53 PM Page iii Color Atlas & Synopsis of Sexually Transmitted Diseases THIRD EDITION H. Hunter Handsfield, MD Clinical Professor of Medicine University of Washington Center for AIDS and STD Senior Research Leader Battelle Centers for Public Health Research and Evaluation Seattle, Washington New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Handsfield - FM:Handsfield-FM 4/27/11 4:40 PM Page iv Color Atlas & Synopsis of Sexually Transmitted Diseases, Third Edition Copyright © 2011, 2001, 1991 by The McGraw-Hill Companies, Inc. All rightsreserved. Printed in China. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be re- produced or distributed in any form or by any means, or stored in a data base or retrieval system, without prior written permission of the publisher. 1 2 3 4 5 6 7 8 9 10 CTP/CTP 14 13 12 11 ISBN 978-0-07-162437-4 MHID 0-07-162437-6 This book was set in Berkeley Book by Glyph International Ltd. The editors were James Shanahan and Christie Naglieri. The production supervisor was Sherri Souffrance. Project management was provided by Anupriya Tyagi, Glyph International. The designer was Mary McKeon; the cover design was by Pehrsson Design. China Translation & Printing, Ltd. was printer and binder. Library of Congress Cataloging-in-Publication Data Handsfield, H. Hunter. Color atlas and synopsis of sexually transmitted diseases / by H. Hunter Handsfield.—3rd ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-07-162437-4 (pbk.) ISBN-10: 0-07-162437-6 (pbk.) 1. Sexually transmitted diseases—Atlases. 2. Sexually transmitted diseases—Outlines, syllabi, etc. I. Title. [DNLM: 1. Sexually Transmitted Diseases—Atlases. WC 17] RC200.H36 2011 616.95′1—dc22 2010041685 INTERNATIONAL EDITION MHID: 0-07-176818-1; ISBN: 978-0-07-176818-4 McGraw-Hill books are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]. Handsfield - FM:Handsfield-FM 3/28/11 4:53 PM Page v For Evan, Nate, and Rowan Handsfield - FM:Handsfield-FM 3/28/11 4:54 PM Page vii Contents Contributors . viii Preface . ix List of Abbreviations. xi Section I Overview of Sexually Transmitted Diseases. 1 1 Clinical Approach to Patients with STDs or at Risk . 3 2 Global Epidemiology, Prevention and Management of Sexually Transmitted Diseases . 17 Section II Bacterial Sexually Transmitted Diseases . 31 3 Chlamydial Infections. 33 4 Gonorrhea . 45 5 Syphilis . 61 6 Chancroid. 89 7 Donovanosis . 99 Section III Viral Sexually Transmitted Diseases . 107 8 Genital Herpes. 109 9 Human Papillomavirus Infection and Genital Warts. 133 10 Molluscum Contagiosum . 149 11 Human Immunodeficiency Virus Infection . 157 12 Blood- Borne Viruses: Viral Hepatitis, Epstein- Barr Virus, Cytomegalovirus, and Others . 181 Section IV Cutaneous Infestations. 189 13 Pediculosis Pubis . 191 14 Scabies. 197 Section V Clinical Syndromes . 205 15 Nongonococcal Urethritis . 207 16 Epididymitis . 217 17 Reactive Arthritis . 225 18 Mucopurulent Cervicitis. 235 19 Vaginal Infections. 247 20 Pelvic Inflammatory Disease . 267 21 Proctitis, Colitis, and Enteritis . 279 22 Nonsexually Transmitted Genital Conditions. 289 Appendix Medical and Sexual History, Physical Examination, and Laboratory Evaluation of STD Patients . 313 Index . 323 vii Handsfield - FM:Handsfield-FM 3/28/11 4:54 PM Page viii Contributors Laura Sangaré, PhD, MPH Judd L. Walson, MD, MPH Senior Fellow Assistant Professor Department of Global Health Departments of Global Health, University of Washington Medicine (Infectious Disease), Seattle, Washington Pediatrics, and Epidemiology Chapter 2: Global Epidemiology, University of Washington Prevention and Management of Sexually Seattle, Washington Transmitted Diseases Chapter 2: Global Epidemiology, Prevention and Management of Sexually Transmitted Diseases Handsfield - FM:Handsfield-FM 3/28/11 4:54 PM Page ix Preface Sexually transmitted diseases (STDs) are among the most common afflictions in most societie. Awareness of STDs, including HIV infection and AIDS, is high among young people in all industrialized countries and among most health care providers, a welcome change over the two decades since the first edition of this book was published. However, the general awareness by clinicians and at-risk populations does not consistently translate into accurate knowledge or clinical practice. Many young people have serious mis- understandings about STDs, with both denial by some at obvious risk and inflated fear of contagion by others. Almost all clinicians now can list Chlamydia trachomatis and human papillomavirus as sexually transmitted pathogens, yet STD screening is undertaken far less frequently than recommended. The vac- cines against STDs are underutilized, treatment often is inconsistent with authoritative guidelines, and partners of infected persons often go untreated. This is understandable; most clinicians receive little train- ing in STD management, and even training in HIV/AIDS often is insufficient. Further, despite the high frequency of STDs, they are not so common that most providers see infected patients daily. Except in selected settings like reproductive health, student health, and STD clinics, most patients seemingly are not at high risk and STDs are diagnosed with modest frequency. Color Atlas and Synopsis of Sexually Transmitted Diseases is designed primarily for clinicians who find themselves caring for patients with STD or at risk, sometimes to their surprise, and need an easy-to-use aid to diagnosis, treatment, and prevention. At the same time, it contains sufficient detail to be useful for continuing education and review by highly experienced clinicians. The clinical and diagnostic pro- cedures described are within the capabilities of the basically trained clinician and most medical offices and laboratories in industrialized countries. The epidemiologic emphasis and treatment recommenda- tions are primarily those current in the United States, but for this edition every chapter has been modified to enhance its utility in developing countries and other resource-limited settings, and a new chapter re- views the global epidemiology of STDs. I have attempted to integrate the atlas components with the synopsis and to strike a balance between them, and users are encouraged not only to examine the pho- tographs but to read the text and case histories. Indeed, one clinical chapter has no photographs at all. This book also can serve as a visual aid in counseling patients and will be useful to many health educa- tors, clinic managers, and health administrators. Finally, our patients participate much more actively in their care than in the past, and the worldwide revolution in information technology has dramatically enhanced many persons’ access to technical information and their ability to assimilate it. With these trends in mind, this book also is designed in part for persons with STDs or at risk, many of whom will find it useful in understanding their own infections, assessing their risk, or judging the importance of symptoms that may require clinical assessment. The case histories are real, although some are composites of two or more patients. Most of the pho- tographs illustrate the patients described, but some were matched with other patients whose histories ix Handsfield - FM:Handsfield-FM 4/26/11 4:59 PM Page x x were better known. For several cases from past years, the tests performed or treatments given have been updated to conform with current recommendations. The text of all chapters has been extensively rewrit- ten to incorporate changes in epidemiology, diagnosis, and treatment since the previous edition, and the chapter on HIV infection has been greatly expanded. About a quarter of the photographs are new, and almost all the Suggested Reading citations
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