Sexually transmitted infections - a summary of chapter 18 of Understanding human sexuality by Hyde and DeLamater

Sexology
Chapter 18
Sexually transmitted infections

Bacterial infections can be cured by antibiotics.
Viral infections cannot be cured, but they can be treated to reduce symptoms.

Chlamydia

Chlamydia trachomatis: a bacterium that is spread by sexual contact and infects the genital organ of both males and females.

Symptoms

• Men
  Thin, clear discharge
  Mild pain on urination
• Females
  Frequently asymptomatic

Treatment

Chlamydia is quite curable.
Treated with axithromycin or doxycycline.

Poorly treated or undiagnosed cases may lead to a number of complications

• Urethral damage
• Epididymitis
• Reither’s syndrome
• Procititis in men who have had anal intercourse
• Women
  Pelvic inflammatory disease: an infection and inflammation of the pelvic organs.

Prevention

Until a vaccine is available, the most effective tools for prevention is screening.
On individual level, the best way of prevention is the consistent use of a condom.

HPV

HPV: human papillomavirus, the virus that causes cervical cancer.

Genital warts: a sexually transmitted infection causing warts on the genitals.
Typically appear 3 to 8 months after intercourse with an infected person.
The majority of people infected with HPV are asymptomatic.

Oral sex can transmit HPV.

Diagnosis

A DNA test can be run on a sample of cells from the cervix to detect the types that are linked to genital cancers.
For warts, diagnosis can be made by inspecting the warts.
But warts are not always produced or visible.

Treatment

Several treatments for genital warts are available.
Chemicals can be applied directly to the warts. Typically this have to be repeated several times, and the warts then fall off.
With cryotherapy the warts are frozen off.
Drugs can be applied.

Many cases of HPV infection go away on their own, but others persist for long periods.

Vaccine

A vaccination against cervical cancer.

Genital herpes

Genital herpes: a sexually transmitted infection, the symptoms of which are small, painful bumps or blisters on the genitals.

The great majority is asymptomatic and do not know they are infected.
These persons transmit the disease unknowingly.

Symptoms

Small, painful bumps or blisters on the genitals.
Typically appear within 2 or 3 weeks of infection.
Fever, painful urination, and headaches may occur.
The blisters heal on their own in about 3 weeks in the fist episode of infection.
But the virus continues to live in the body and remains dormant for the rest of the person’s life.
The symptoms may recur unpredictably.

People with herpes are most infectious when they are having an active outbreak.
But people are infectious even when there is not outbreak or if they have never been symptomatic.
There is no completely safe period.

Treatment

There is no known drug that kills the virus.
There is no cure.

Long-term consequences

Either men or women with recurrent herpes may develop complications such as meningitis or narrowing of the urethra due scarring, leading to difficulties with urination.
Such complications do not affect the majority of those with herpes.

Having herpes increases one’s risk of becoming infected with HIV.

There is the risk of transfering of the virus from the mother to infant in childbirth, which in some cases leads to serious illness or death in the baby.

Psychological aspects: coping with herpes

The range of psychological responses is enormous.

HIV infection and AIDS

AIDS (acquired immune deficiency syndrome): a sexually transmitted disease that destroys the body’s natural immunity to infection so that the person is susceptible to and may die form a disease such as certain pneumonias or cancers.
HIV: human immune deficiency virus; the virus that causes AIDS.

Transmission

HIV is transmitted by exchange of body fluids: semen, blood, and possibly secretions of the cervix and vagina.

HIV is spread in four ways

• Sexual intercourse
• Contaminated blood
• Contaminated hypodermic needles
• From an infected woman to her baby during pregnancy or childbirth

Condoms are 80 to 95 percent effective in protecting against HIV transmission during heterosexual intercourse if sued consistently.

The virus

HIV is one of a group retroviruses.
Retroviruses: reproduce only in living cells of the host species.
They invade a host cell, and each time the host cell divides, copies of the virus are produced along with more host cells, each containing the genetic code of the virus.

HIV invades a specific group of white blood cells called CD4+ T-lymphocyters.
These cells are critical to the body’s immune response in fighting off infections.
When HIV reproduces, it destroys the infected cell.
Eventually the HIV-positive person’s number of CD4+ T-lymphocyters is so reduced that infections cannot be fought off.

The disease

• Stage 0
  Initial infection and development of antibodies to the virus over the next 2 to 8 weeks.
  Confirmed by a positive test for antibodies.
  Lasts as long as the person keeps feeling well and the T cell count stays around 1000 cells per µL of blood.
• Stage 1
  The T cell count drops but is still over 500.
  The person may still have no outward symptoms.
  In this stage, the person may develop symptoms that are not immediately life threatening.
  • Swollen lymph nodes
  • Night sweats
  • Fever
  • Diarrhea
  • Persistent yeast infections in the throat or vagina
  • Shingles
  • Fatigue
  • Abnormal cells in the cervix
• Stage 2
  The T cell count falls to between 200 and 499
• Stage 3
  Aids
  The T cell count falls below 200
  People in this stage are vulnerable to opportunistic infections that can be life-threatening

Diagnosis

The blood test that detects the presence of antibodies is the ELISA.
A very sensitive test.
Or Western blot test.

Both tests detect only the presence of HIV antibodies.
They do not predict whether the person will develop symptoms or will progress the the AIDS classification.

Treatment

There is not yet any cure for AIDS.
Treatments are available to control the disease.

AZT: a drug used to treat HIV-infected persons.
Can stop the virus from multiplying.

Protease inhibitors attack the viral enzyme protease, which is necessary for HIV to make copeis of itself and multiply.

Psychological considerations in AIDS

Psychological issues for those infected with HIV and for AIDS patients can be profound.

Recent progress in AIDS research

Vaccine

The problem with this is that HIV has many forms, and mutates rapidly and recombines, creating more forms.
The virus doesn’t hold long enough for a vaccine to take effective aim at it.

Two strategies

• Developing a vaccine that stimulates the body to from resistance to HIV
• A vaccine that acts at the cellular level by stimulating the production of specialized T cells that are toxic to HIV
• Developing a vaccine that combines both

Treatment as prevention

ART treat treatment for the infected person prevented transmission to the sexual partner.

Preexposure prophylaxis

Preexposure prophylaxis: the use of antiretroviral drugs to prevent infection in people who are HIV negative and are in a high-risk category.

Research on non-progressors

Non-progressors have HIV for a long time, but no symptoms.

Killer T cells and chemokines

Certain lymphocytes (CD8+ T cells) battle against HIV in the body.
They do so by secreting chemokines.
Chemokines can bind to the coreceptor CCR5, blocking HIV from entering cells.

Genetic resistance

A mutation of the gene CCR5 creates strong resistance to HIV infection.
People with two copies of the mutation are resistant to infection.
People with one copy may become infected but show much slower disease progression.

Microbicides

Microbicides: substances that kill microbes such as HIV.

Behavioural prevention

Increase condom use, communication with the partner, and other behaviours that help to prevent infection.

Gonorrhea

Gonorrhea: a sexually transmitted infection that usually causes symptoms of a puslike discharge and painful, burning urination in males, but is frequently asymptomatic in females.

Symptoms

Males
Inflammation of the urethra

White blood cells rush to the area and attempt to destroy the bacteria, but the bacteria soon win the battle.
In most cases, symptoms appear 2 to 5 days after infection, although they may appear as early as the first day or as late as 2 weeks after infection.

• Initially a thin, clear mucous discharge seeps out of the meatus
• Within a day or so it becomes thick and creamy and may be white, yellowish, or yellow-green.
  The area around the meatus may become swollen.
• About half of infected men experience a painful burning sensation when urinating

When not treated, the urethritis spreads to the urethra, causing inflammations in the prostate, seminal vesicles, urinary bladder, and epididymis.
Pain on urination becomes worse and is felt in the whole penis.
Then these early symptoms may disappear as the disease spreads to the other organs.
It may spread to the testicles and the resulting scar tissue may cause sterility.

The gonorrheal infection in women invades the cervix.
Pus is discharged, but the amount may be so slight that it is not noticed.
Although the cervix is the primary site of infection, the inflammation may spread to the urethra, causing pain on urination.

If the infection is not treated, the Bartholin glands may become infected, and it may spread to the anus and rectum.

In women who go untreated, the gonococcus moves up into the uterus.
From there it infects the fallopian tubes.
The tissues become swollen and inflamed.
The major symptom is pelvic pain and, in some cases, irregular or painful menstruation.
If not treated, scar tissue may form, blocking the tubes and leaving the woman infertile.

Infection in the eyes and resulting blindness is can be if the baby is infected during birth.

Diagnosis

A urine test is available for men and women.
Swabs can be taken as well.
A pelvic exam.

Treatment

A large dose of penicillin or tetracycline.

Syphilis

Syphilis: a sexually transmitted infection that causes a chancre to appear in the primary stage.
Its effects are quite serious if left untreated.
It can damage the nervous system and even cause death.

Syphilis infection makes one more vulnerable to HIV and vice versa.

Symptoms

The major early symptom of syphilis is the chancre.
Chancre: a painless, ulcerlike lesion with a hard, raised edge, that is a symptom of syphilis.
Appears about 3 weeks after intercourse.
The chancre appears at the point where the bacteria enters the body.
You may get infected from touching the chancre from another person.

The progress of the disease is divided into four stages

• Primary-stage syphilis
  The first few weeks of a syphilis infection during which the chancre is present
  If left untreated, the chancre goes away within 1 to 5 weeks after it appears.
  The disease is not gone, it has only gone underground
• Secondary-stage syphilis
  Occurs several months after infection.
  The chancre has disappeared an a generalized body rash appears. It does not itch or hurt.
  Hair loss may occur.
  Without treatment, this goes away in a few weeks. This does only mean it has entered a more dangerous state.
• Latent syphilis
  May last for years.
  Symptoms disappear although the person is still infected.
  Treponema pallidum is busily burrowing into the tissues of the body, especially the blood vessels, central nervous system, and bones.
  It is no longer infectious, except that a pregnant woman can still past it on the the fetus
• Late syphilis
  The disease does damage to major organs of the body.
  Occurs 10 to 40 years after the initial infection.
  Can lead to death.

Cogenital syphilis: a syphilis infection in a newborn baby resulting from transmission from an infected mother.
May cause early death of the fetus or severe illness at or shortly after birth.

Diagnosis

The physician exam should include inspection not only of the genitals but also of the entire body surface.
If a chancre is present, some of its fluid is taken and placed on a slide for inspection.

The most common test for syphilis are blood tests based on antibody reactions.

Treatment

Penicillin

Hepatitis B

A disease of the liver.
One symptom is an enlarged lever that is somewhat tender.
Can vary greatly in severity.

Hepatitis B: a liver disease that can be transmitted sexually or by needle sharing.

Treatments are available.
And a vaccine.

Trichomoniasis

Trichomoniasis: a form of vaginitis causing a frothy white or yellow discharge with an unpleasant odour.
Can also survive form toilet seats.

If left untreated, can cause pelvic inflammatory disease and problems with birth.
Also increases susceptibility to HIV infection.

Pubic lice

Pubic lice: tiny lice that attach themselves to the base of pubic hairs and cause itching.

Can also be caught from toilet seats.

Preventing STIs

• Limit yourself to a monogamous relationship with an uninfected person
• Latex condom
• Simple health precaustions
  Washing the genitals before intercourse
  Inspecting your partner’s genitals
• Test for STIs

Other genital infections

Vaginitis: an irritation or inflammation of the vaginal, usually causing a discharge.

Candida

Candidia: a form of vaginitis causing a thick, white discharge.
Intercourse can aggravate it.

Prostatitis

Prostatistis: an infection or inflammation of the prostate gland.