Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are a major health problem in the world. These diseases, including human immunodeficiency virus (HIV) infection, represent some of the most complex ones in modern medicine.

STDs exhibit a higher incidence and prevalence, an alarming rate of antimicrobial resistance, a higher rate of serious complications and interaction with HIV infection in developing countries.

Failure to diagnose and treat traditional infections, such as gonorrhea, chlamydia, and syphilis infections which can have deleterious effects during pregnancy and on the newborn, is also common in these countries.

Other complications especially in women, such as pelvic inflammatory disease, ectopic pregnancy, infertility, and cervical cancer, are large health and social problems.

In most developing countries, the incidence and prevalence of STDs maybe 20 times higher than those in developed countries.

Point-prevalence studies are employed most widely in the developing world. Such information is useful but limited since it is not totally representative of the whole population as it is obtained mostly from high-risk groups of individuals and/or patients.

The developing world is a heterogeneous community, but it has at least one common feature, that the STDs in this community are expected to occur among those between 20 and 40 years of age, in contrast to the population of developed countries.

The consequence of this is not only a higher absolute incidence of STDs in the developing countries but also a potentially worsening situation in the future.

More than 30 different bacteria, viruses, and parasites are known to be transmitted through sexual contact. Eight of these pathogens are linked to the greatest incidence of sexually transmitted disease.

4 of these 8 infections are currently curable: syphilis, gonorrhea, chlamydia, and trichomoniasis.

The other 4 are viral infections that are incurable: hepatitis B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV). Symptoms or diseases due to incurable viral infections can be reduced or modified through treatment.

STIs are spread predominantly by sexual contact, including vaginal, anal, and oral sex. Some STIs can also be spread through non-sexual means such as via blood or blood products.

Many STIs—including syphilis, hepatitis B, HIV, chlamydia, gonorrhea, herpes, and HPV can also be transmitted from mother to child during pregnancy and childbirth.

A person can have an STI without having obvious symptoms of the disease. Common symptoms of STIs include vaginal discharge, urethral discharge or burning in men, genital ulcers, and abdominal pain.

STIs can have serious consequences beyond the immediate impact of the infection itself.

STIs like herpes and syphilis can increase the risk of HIV acquisition three-fold or more.

Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low-birth-weight and prematurity, sepsis, pneumonia, neonatal conjunctivitis, and congenital deformities.

Approximately 1 million pregnant women were estimated to have active syphilis in 2016, resulting in over 350 000 adverse birth outcomes of which 200 000 occurred as stillbirth or neonatal death.

HPV infection causes 570 000 cases of cervical cancer and over 300000 cervical cancer deaths each year.

STIs such as gonorrhea and chlamydia are major causes of pelvic inflammatory disease (PID) and infertility in women.

Counselling and behavioural interventions offer primary prevention against STIs (including HIV), as well as against unintended pregnancies. These include:

Comprehensive sexuality education, STI and HIV pre- and post-test counselling;

safer sex/risk-reduction counselling, condom promotion;

STI interventions targeted to key populations, such as sex workers, men who have sex with men and people who inject drugs; and STI prevention education and counselling tailored to the needs of adolescents.

In addition, counselling can improve people’s ability to recognize the symptoms of STIs and increase the likelihood they will seek care or encourage a sexual partner to do so. Unfortunately, lack of public awareness, lack of training of health workers, and long-standing, widespread stigma around STIs remain barriers to greater and more effective use of these interventions.

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)

AIDS is caused by the human immunodeficiency virus (HIV), which is spread through unprotected sexual intercourse with an infected person or through using a contaminated needle to inject drugs. 

It can also be spread through intravenous drug use and much less commonly, blood, blood products, needles, or other sharp instruments contaminated with infected body fluids or blood.

Upon entering the circulation, the HIV microorganisms abduct a type of white blood cell known as T-helper lymphocytes (also known as CD4 cells, T cells or helper-Ts). In a person with a healthy immune system, T-cells band together to help defend the body against diseases. But the hijacked T-cells are forced to mass-produce copies of HIV. Left untreated, helper T cells mass produce large numbers of HIV, this further depletes the number of normal helper-Ts in the blood stream, rendering the individual vulnerable to AIDS defining illness.

CHLAMYDIA
Chlamydia, the most prevalent bacterial STI in the United States, is the result of the Chlamydia trachomatis bacterium, which can infect the urethra (bladder opening) and cervix (uterus opening). It is common in youngsters aged fifteen to nineteen. The disease is easily treated, but like other sexually transmitted infections, chlamydia tends to be silent and therefore go undiagnosed until it becomes more serious than in its early stages. Three in four women and one in two men have no symptoms. In 40 percent of cases, by the time a girl seeks medical attention, the disease has progressed to pelvic inflammatory disease (PID, described below), a major cause of female infertility and pelvic pain

GONORRHEA
Chlamydia infection is sometimes confused with gonorrhea, another bacterial infection transmitted through vaginal and anal intercourse, and oral sex. Not only do they share many of the same symptoms, the two diseases can occur together.

Gonorrhea usually begins in the urethra (bladder opening) or the cervix. However, the rapidly proliferating Neisseria gonorrhoea bacterium can migrate to the uterus and the fallopian tubes, giving rise to pelvic inflammatory disease (PID). The infection, like chlamydia, may also involve the rectum.

HPV
HPV is passed from one person to another during unprotected sex and cause benign genital warts (condylomata acuminata). Other human papillomaviruses are responsible for four in five cases of cervical cancer, in addition to several other genital malignancies.

HPV is another, often silent, STI. According to the National Institute of AIDS and Infectious Diseases, almost half the women harboring the virus exhibit no symptoms at all. Genital warts typically appear in clusters inside and outside the vagina, the cervix and/or the anus. Male venereal warts, which are far less common, form on the penis, the scrotum, and/or around the anus. The pinkish or flesh-colored growths often vanish on their own.