Book Review

Sexually Transmitted Diseases: Epidemiology, pathology, diagnosis, and treatment

N Engl J Med 1998; 338:1235-1236April 23, 1998

Article

Sexually Transmitted Diseases: Epidemiology, pathology, diagnosis, and treatment
Edited by Kenneth A. Borchardt and Michael A. Noble. 349 pp., illustrated. Boca Raton, Fla., CRC Press, 1997. $74.95. ISBN: 0-8493-9476-7

Sexually transmitted diseases remain a major public health issue in our country. A recent report from the Institute of Medicine highlighted the impact of continuing high rates of both viral and bacterial sexually transmitted diseases and their complications with respect to morbidity, mortality, and cost. In contrast, other developed countries, such as Canada and Sweden, have virtually eliminated bacterial sexually transmitted diseases (gonorrhea, chlamydia, and syphilis) and in so doing have seen rates of pelvic inflammatory disease plummet as well. The control of these diseases has important implications that extend beyond decreasing morbidity attributable to the conditions themselves and their immediate complications. Sexually transmitted diseases, including vaginitis and vaginosis, have been associated with the acquisition and transmission of human immunodeficiency virus (HIV), and controlling these diseases may be one of the most effective methods for controlling HIV worldwide. In addition, bacterial vaginosis, a highly prevalent sexually associated infection, is an important, potentially remediable cause of preterm birth.

As the Institute of Medicine report notes, lack of education regarding the diagnosis and management of sexually transmitted diseases among physicians trained in the United States continues to be an important deterrent to controlling these infections. There are inadequate opportunities in medical schools and residency programs for clinical training in this area. If they do exist, they are often disjointed and sporadic and insufficient for primary care physicians to acquire competency. In addition, other aspects of prevention, such as screening and counseling, are almost always overlooked.

In view of the public health importance of sexually transmitted diseases and the need for improved training of health care professionals with respect to this topic, an additional reference book is most welcome. Sexually Transmitted Diseases discusses bacterial, viral, and protozoan causes as well as those due to ectoparasites. It does not address screening, counseling, and risk reduction, which are important components of the control of these diseases, nor does it provide detailed information on relevant laboratory procedures, as would a complete textbook on this topic. Instead, the book discusses the basic-science, epidemiologic, and clinical aspects of individual causes of sexually transmitted diseases.

The book is arranged according to the cause and thus discusses only in piecemeal fashion syndromes such as cervicitis, pelvic inflammatory disease, and nongonococcal urethritis. This approach leads to a lack of cohesiveness among the chapters and is not very user-friendly for the practitioner.

The quality of the chapters is variable. Some chapters, such as those on bacterial vaginosis, gonorrhea, chancroid, and the herpesviruses, are quite well written, provide extensive and helpful information on the topics, and stand alone as excellent resources. The chapter on the management of HIV infection is amazingly up to date, concise, and practical regarding the treatment and management of the infection itself. Complications of HIV are not covered. Other chapters are sketchy, wanting descriptions of the clinical findings and treatment options. Most, but not all, of the chapters are extensively referenced, and the photographs, although in black and white, are quite instructive.

Sexually Transmitted Diseases is probably a worthwhile addition to one's library on sexually transmitted diseases, but for those interested in the public health aspects of disease control or practicing clinicians who care for affected patients, it will not serve well as their sole reference.

Jane R. Schwebke, M.D.
University of Alabama at Birmingham, Birmingham, AL 35294