Sexually Transmitted Diseases – Something you need to know!!!
E M Shimitha
Sexually Transmitted Infections (STIs) are the infections that are transmitted from an infected person to healthy person through sexual contact. The causative organisms can be bacteria, virus or even parasites. Sexually transmitted infections are 8 in number. That are syphilis, gonorrhoea, chlamydia, trichomoniasis, hepatitis B, genital herps, HIV and human papillomavirus. In which syphilis, gonorrhoea, chlamydia, trichomoniasis are curable and hepatitis B, genital herps, HIV and human papillomavirus are incurable. STIs are spread predominantly by sexual contact, including vaginal, anal and oral sex. Some STIs can also be transmitted from mother-to-child during pregnancy, childbirth and breastfeeding. A person can have an STI without showing symptoms of disease. Common symptoms of STIs include vaginal discharge, urethral discharge or burning in men, genital ulcers and abdominal pain. Sexually Transmitted Infections (STIs) are the infections that are transmitted from an infected person to healthy person through sexual contact. The causative organisms can be bacteria, virus or even parasites. Sexually transmitted infections are 8 in number. That are syphilis, gonorrhoea, chlamydia, trichomoniasis, hepatitis B, genital herps, HIV and human papillomavirus. In which syphilis, gonorrhoea, chlamydia, trichomoniasis are curable and hepatitis B, genital herps, HIV and human papillomavirus are incurable. STIs are spread predominantly by sexual contact, including vaginal, anal and oral sex. Some STIs can also be transmitted from mother-to-child during pregnancy, childbirth and breastfeeding. A person can have an STI without showing symptoms of 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, gonorrhoea and syphilis can increase the risk of HIV acquisition.
- 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 cervical cancer. Cervical cancer is the fourth most common cancer among women globally, with an estimated 570 000 new cases in 2018 and over 311 000 cervical cancer deaths each year (2).
- Hepatitis B resulted in an estimated 820 000 deaths in 2019, mostly from cirrhosis and hepatocellular carcinoma (primary liver cancer).
- STIs such as gonorrhoea and chlamydia are major causes of pelvic inflammatory disease (PID) and infertility in women.
When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Condoms also protect against unintended pregnancy in mutually consented sexual relationships. Although highly effective, condoms do not offer protection for STIs that cause extra-genital ulcers (i.e., syphilis or genital herpes). When possible, condoms should be used in all vaginal and anal sex.
Safe and highly effective vaccines are available for 2 viral STIs: hepatitis B and HPV. These vaccines have represented major advances in STI prevention. By the end of 2020, the HPV vaccine was introduced as part of routine immunization programmes in 111 countries, most of them high- and middle-income. HPV vaccination could prevent the deaths of millions of women over the next decade in low- and middle-income countries, where most cases of cervical cancer occur, if high (>80%) vaccination coverage of young women (ages 11–15) can be achieved.
Research to develop vaccines against herpes and HIV is advanced, with several vaccine candidates in early clinical development. There is mounting evidence suggesting that the vaccine to prevent meningitis (MemB) has cross-protection against gonorrhoea. More research into vaccines for chlamydia, gonorrhoea, syphilis and trichomoniasis are needed.
Diagnosis of STIs
Accurate diagnostic tests for STIs are widely used in high-income countries. These are especially useful for the diagnosis of asymptomatic infections. However, diagnostic tests are largely unavailable in low- and middle-income countries. Where testing is available, it is often expensive and geographically inaccessible, and patients often need to wait a long time (or need to return) to receive results. As a result, follow-up can be impeded and care or treatment can be incomplete.
The only inexpensive, rapid tests currently available for STIs are for syphilis, hepatitis B and HIV. The rapid syphilis test is already in use in some resource-limited settings. A rapid dual HIV/syphilis test is now available whereby a person can be tested for HIV and syphilis from a single finger-stick and using a single testing cartridge. These tests are accurate, can provide results in 15 to 20 minutes, and are easy to use with minimal training. Rapid syphilis tests have been shown to increase the number of pregnant women tested for syphilis. However, increased efforts are still needed in most low- and middle-income countries to ensure that all pregnant women receive a syphilis test at the first antenatal care visit.
Treatment of STIs
Effective treatment is currently available for several STIs.
- Three bacterial STIs (chlamydia, gonorrhoea and syphilis) and one parasitic STI (trichomoniasis) are generally curable with existing single-dose regimens of antibiotics.
- For herpes and HIV, the most effective medications available are antivirals that can modulate the course of the disease, though they cannot cure the disease.
- For hepatitis B, antiviral medications can help to fight the virus and slow damage to the liver.
What we can do?
Despite considerable efforts to identify simple interventions that can reduce risky sexual behaviour, behaviour change remains a complex challenge. Research has demonstrated the need to focus on carefully defined populations, consult extensively with the identified target populations, and involve them in design, implementation and evaluation. Education and counselling can improve people’s ability to recognize the symptoms of STIs and increase the likelihood that they will seek care and encourage a sexual partner to do so. Unfortunately, lack of public awareness, lack of training among health workers, and long-standing, widespread stigma around STIs remain barriers to greater and more effective use of these interventions.
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