SEXUALLY TRANSMITTED DISEASE OVERVIEW

CAUSE, TREATMENT,AND AVOIDANCE

Finding you are infected with a sexually transmitted disease is a life-changing event. Most STDs require antibiotics or an antiviral for a genital herpes outbreak. Submitting yourself to such an exam may seem degrading but is very important. Serious complications of pelvic inflammatory disease can require hospitalization and intravenous antibiotics with the longterm outcome of possible sterility in women, rapid evaluation and treatment is important. For both men and women, stopping the spread of disease to others is essential.

Anyone diagnosed with a sexually transmitted disease should be tested for HIV.

Family doctors, urgent care centers, state health departments, community and VD clinics and Planned Parenthood clinics are all good choices for evaluation and treatment. Some of them provide free testing and treatment. Both partners should be tested and often both require treatment.

Remember, condom use can reduce your risk for getting an STD.

The most common cause of a vaginal discharge or fishy malodor is BV, resulting from numerous bacteria having replaced the Lactobacillus normally found in the vagina. The cause is unknown but it is seen more often in women who have multiple sex partners, don’t use condoms and douche (wash out the vagina). It is also seen commonly in women who have HIV. Treatment: Oral metronidazole or antibiotic intravaginal gel or cream. Male partners are not treated.

Chlamydia – Most reported infectious disease in the U.S.

Chlamydia trachomatis bacteria cause this inflammatory disease affecting men and women. Symptoms may not occur for several weeks after exposure. But, as the disease progresses in women, it spreads from the vagina into the cervix and uterus, extending into the fallopian tubes causing pelvic inflammatory disease (PID). Yellowish vaginal discharge and pain with intercourse are common symptoms.

Infertility occurs when the tubes scar and close the narrow passage for eggs and sperm. If an egg travels into the tube and is fertilized, but the fertilized egg is unable to migrate into the uterus, it grows within the tube resulting in a tubal pregnancy. The enlarging fetus causes pain, rupture of the tube, and sometimes death of the mother due to hemorrhage. Treatment is usually surgical removal of the tube and the nonviable fetus.

Men may have no symptoms, but can still spread the disease. Later, they may develop urethritis (burning discomfort with urination) and a discharge from the penis. Some men develop epididymitis (painful inflammation in a testicle). Proctitis (inflammation of the rectum) also occurs causing pain, discharge and bleeding.

The infection can spread to the eyes resulting in conjunctivitis due to touching with contaminated fingers. Some people develop arthritis. Newborns may develop eye infection with Chlamydia by passing through an infected birth canal.

Treatment: Antibiotics. No sexual activity for one week after completing treatment to avoid spread to a partner. Retest following treatment to assure a cure. Antibiotics do not reverse tube scarring.

Another Chlamydia STD is lymphogranuloma venereum (LGV). It is common in Africa, but has spread to Europe and the U.S. LGV begins with a painless genital ulcer (an open sore), then days to weeks later, lymph nodes in the groin enlarge and become painful. It is most common with men who have sex with men (MSM) but is also seen in women. Antibiotic treatment. Sometimes surgery is needed to drain the lymph nodes.

Gonorrhea (GC) – The second most reported infectious disease in the U.S.

Neisseria gonorrhoeae bacteria are easily passed by sexual contact and spread to others. More than 800,000 new cases are diagnosed each year in the U.S.

Discomfort with urination and a thick yellow discharge from the penis are the symptoms that usually bring men to see a physician for treatment. In women, the infection may cause no symptoms until complications with infection migrating into the tubes and abdomen occurs – PID. This infection can cause tubal scarring and lead to infertility and tubal pregnancies.

Gonorrhea may infect the throat from oral sex. This problem is more difficult to treat. Serious blinding eye infections can occur in both adults and newborn infants. Sexually abused children are also found to have GC.

Treatment: The diagnosis is made by cultures and treated with antibiotics. Cure is possible, but resistant organisms have developed making common treatments less effective. Additional medications, sometimes with dual therapy are needed. Sex partners should be referred for evaluation and possible treatment.

Unfortunately, GC infection can be carried throughout the body in the blood (Disseminated Gonococcal Infection). When this happens skin lesions pop up and joints become painful. Sometimes meningitis, infection inside the heart, and around the liver occur. Hospitalization and treatment by an infectious disease expert is needed.

Genital Herpes

Two herpes simplex viruses spread by genital infection: Type 1 (HSV-1) and Type 2 (HSV-2). Transmission may occur from an infected partner who has no visible sores and is unaware he or she is infected. The disease is very common. More than three-quarters of a million people get new herpes infections each year.

Both types cause painful blisters and ulcers. Although the skin lesions are usually on the genitals, the viruses can spread and infect buttocks, groin, hands and eyes. Blindness and even encephalitis (brain inflammation) and meningitis (inflammation of brain lining) can occur. In pregnant women who have genital lesions at the time of delivery, C-section delivery of the infant is done to prevent potentially fatal HSV transmission to the child.

Condom use does not always prevent spread of HSV because lesions may be outside the areas covered by condoms. Genital herpes infection is incurable and periodic flares of the disease occur over a lifetime. Antiviral medications can shorten outbreaks. Daily antiviral medication can reduce the possible transmission to sex partners. To avoid HSV infection, abstain from sexual contact or be in a longterm relationship with one partner who has been tested and is uninfected.

Genital Warts (Caused by HPV – Human Papilloma Virus)

Genital warts are caused by numerous HP Viruses. HPV types 16 and 18 are associated with high-grade squamous intraepithelial cancerous lesions of the cervix, vagina, penis, anal and oropharyngeal (mouth and throat) cancers.

Most of the HPVs do not stimulate cancerous changes in the tissue, however they cause growths along the vaginal opening, inside the vagina, on the cervix, beneath the foreskin of the penis, on the scrotum and around the anus. Some infections resolve without treatment, others persist despite multiple interventions. The warts may be small and flat, but may resemble cauliflower flowerets and dangle from stems. Warts may be painful or itchy. These lesions are highly contagious.

Treatment: Many different treatments are used and many physician visits are necessary. Surgical removal, cryotherapy (freezing), topical acid treatments and laser therapy may be necessary. Cure is unlikely.

Always use condoms to prevent this disease. Partners of infected people should be warned and evaluated by a physician. Women who have had HPV require long term monitoring for cervical cancer.

HPV immunization recently became available and it prevents infection. It is the only immunization against a cancer. HPV infections of the cervix and throat are known to be associated with cancer.  To be effective it must be given before becoming sexually active.

Syphilis

Treponema pallidum is a bacterium that causes a serious disease beginning in Primary Syphilis with painless infectious ulcers, often on lips or genitals.  This is the highly contagious time. The next stage, Secondary Syphilis, produces a rash, more lesions inside the mouth and on genitals, and swelling of lymph nodes. In the final stage, Tertiary Syphilis causes heart and neurologic symptoms including meningitis, stroke, altered mental function, hearing and eye problems. Eventually, numbness and loss of balance make life miserable. Babies born to infected women have congenital syphilis with distorted features and mental deficiency.

A microscopic evaluation of material from the ulcers may show tiny snake-like bacteria in the Primary stage. These spirochetes cannot be cultured, but in later stages blood serum testing is helpful. The Venereal Disease Research Laboratory test (VDRL) or the Rapid plasma Reagin (RPR) will likely be positive. Newer tests use specialized processes. Interpretation of the tests and treatment are difficult and best done by experts. Sometimes spinal fluid must be tested.

Treatment: Early treatment with penicillin intravenous can be curative. In later stages, treatment is longer. A specific form of penicillin, Penicillin G, must be used because it crosses the blood-brain barrier where others do not penetrate the brain and should not be used. Syphilitic pregnant women can be treated with Penicillin G. It is important to follow guidelines for contacting and possibly treating sex partners. Anyone with syphilis should be tested for all STDs and HIV.

Hepatitis Overview

Many forms of hepatitis (liver inflammation) are not contagious and are unrelated to viral infection. Chronic alcohol excess and auto-immune hepatitis are two forms that are not contagious.

Infectious hepatitis is often spread by consuming food or water with fecal contamination due to inadequate hand washing and food preparation.

Hepatitis symptoms are similar for all forms of the disease. Initial symptoms may be so mild they are unrecognized as liver inflammation. When the condition worsens, the following symptoms are common: loss of appetite, exhaustion, abdominal pain, nausea, dark urine, yellow skin/eyes (jaundice).

Hepatitis A (HAV)

HAV is usually a mild, self-limited form of the disease. Infection results from fecal-oral contamination. This means inadequate health practices allow transmission of the virus from feces (stool) into water or food. Once the virus enters the body it takes between 15-50 days for symptoms to occur. If transmitted sexually it is likely through the fecal-oral route and poor health practices. Sometimes international travelers become ill with this via a food or contaminated water outbreak. There is no chronic phase and no specific treatment. The body produces antibodies that persist for life and protect against re-infection. In travelers and high risk people such as those with chronic liver disease and men who have sex with men, vaccination is possible.

Hepatitis B (HBV)

HBV can be self-limited or chronic. After exposure, it takes from 6 weeks to 6 months for symptoms to occur. One-percent of HBV new infections cause liver failure and death. Infected infants have about a 90% chance of chronic hepatitis, this decreases with age. Only 2%-6% of adults who become infected as adults develop chronic liver disease. Chronic HBV increases risk for liver failure and liver cancer – 15%-25%. Risk factors in teens and adults include unprotected sex, history of other STDs and injection-drug use.

HBV is diagnosed with serologic blood testing. Only limited treatment is available. Prevention can be accomplished by immunization, and the use of post-exposure injection of Hepatitis B immune globulin (HBIG) if exposure is known. Infants are now immunized against HBV as are those in risk professions such as physicians, nurses, MSMs, and travelers.

Hepatitis C (HCV)

HCV is a contagious disease spread via blood contact and sometimes by sexual contact. Many people who have HCV infection have no symptoms, but after a short-term illness the infection in the liver becomes chronic. Over years, chronic infection in the liver causes damage and then failure. In years past, this occurred after blood transfusions transmitted the yet unknown virus. Risk practices include unprotected sex, contact with any potential blood source including dental work, acupuncture and tattoos.  Antiviral treatment can be effective.

Zika Virus

Zika virus is a disease spread by mosquitoes, but is also spread by sexual intercourse with infected people. Both infected men and women can spread the virus to a sex partner. Infected pregnant women can transmit the infection to their fetus with dire effects. Infants are often born with severe birth defects and brain damage. Prevention is key. There is no treatment or vaccine at this time.

Human Immunodeficiency Virus (HIV)

HIV is a sexually transmitted disease that begins as an acute viral syndrome caused by a small retrovirus. The disease transitions to a chronic stage, and after months-to-years, ends with Acquired Immunodeficiency Syndrome (AIDS).

The virus infects T-lymphocyte blood cells (CD-4 cells) and destroys them. Depleting CD-4 cells leaves the infected person immune suppressed. Without treatment, the disease is fatal. With early antiretroviral treatment, it becomes a chronic disease and infected people live a near-normal lifespan. Early diagnosis is essential for adequate treatment and to decrease the risk of transmission to others.

The disease can be spread through dirty needles, intravenous drug use, exposure to infected blood and by sexual contact.

Testing: Blood serum screened for an antigen/antibody combination or an antibody immunoassay (IA) is performed. The tests are highly specific and sensitive, capable of detecting HIV-1 and its subtypes. Most can also detect HIV-2. There is a thirty-minute test that gives a preliminary diagnosis, but may be negative in a recently infected person. Supplemental tests must be done. All people who seek STD testing should be screened for HIV.

Treatment: Antiretroviral therapy. Best treated by physicians experienced in HIV/AIDs care.

Pubic Lice (Pediculosis Pubis)

Usually transmitted by sexual contact, but can be transmitted from infected beds or clothing. Itching, nits (eggs attached to hair) and little moving critters will freak you out. OTC topical treatment is available. Shaving hair makes treatment easier. Decontaminating all clothing, bedding, couches, blankets and fumigating the home may be necessary to rid the area of lice. More than one treatment may be needed. If contracted from a sexual partner, consider full STD and HIV evaluation.

Scabies (Sarcoptes scabiei insect infestation)

Scabies causes severe itching and is often acquired via sexual contact in adults. Scabies in children is typically related to sleeping in the same areas or sharing clothing with infected people. The mites must be killed through topical application of OTC medications (ex. Permethrin). All clothing and bedding should be washed in hot water and dried in a dryer. More than one treatment may be necessary. Some medications are toxic to children, so discuss treatments with health department, healthcare giver or pharmacist.