What kind of sexually transmitted infections are there? - Chapter 18

It is important to know, how to prevent and treat sexually transmitted diseases (STD) or sexually transmitted infections (STI). Sexually transmitted infections are more common among youth, age fifteen to twenty-four and the infections human papillomavirus (HPV), trichomoniasis and chlamydia are the most common. Prevention efforts are not working as well as they should as this age group accounts for half of the STIs in the United States.

What is Chlamydia?

An example of a STI caused by a bacterium is Chlamydia, the chlamydia trachomatis is a bacterium that can be transmitted trough sexual contact. It can infect the genital organs of both men and women. Adolescent girls have a particularly high infection rate of chlamydia compared to Gonorrhea. This is important, because the symptoms can be similar, but the treatment for Gonorrhea does not work for Chlamydia. The symptoms are discomforting urination and it can be detected using a urine sample (or sample of cells in the vagina). The problem with Chlamydia is that about seventy-five percent of the women, and fifty percent of men do not have any symptoms, they are asymptomatic. Therefore, many people go untreated. This can cause urethral damage, infection of the epididymis and proctitis (in men that performed anal intercourse). The most extreme complication is pelvic inflammatory disease (PID) and infertility. Also, a baby born from a mother with Chlamydia can develop eye infections or pneumonia. Chlamydia can be treated with azithromycin or doxycycline. There is no vaccine available for Chlamydia yet, but it is being developed. The best prevention method is the consistent use of a condom.

What is HPV?

Human papillomavirus or HPV is a virus that increases the risk of specific cancers, such as cervical cancer. It also causes genital warts, there are warts appearing around the urethral opening, the scrotum or the shaft of the penis. For women the warts appear on the walls of the vagina or the cervix. Most people with HPV are asymptomatic. Not all infections with HPV cause cancer but it is the most important risk factor for developing cervical cancer. Oral sex can transmit HPV and people who get HPV trough oral sex have a higher risk for mouth and throat cancer. However, in most cases HPV infections go away within two years. A test of DNA cells from the cervix can detect HPV cells that can cause genital cancer. The diagnosis can also be made by studying warts, note that high-risk variants of HPV do not cause warts and warts can be out of sight, inside the vagina. Warts can be treated with chemicals or be frozen off. Drugs like Podofilox are used additionally. A vaccination is available for HPV, for both males and females to protect against most cases of cervical cancer and genital warts.

What is Genital Herpes?

Genital Herpes is caused by the herpes simplex virus (HSV) and is a disease in the genital organs. There are two types of the virus: HSV-1 and HSV-2. Both types can cause genital herpes and sores around the mouth. Many people with the virus are asymptomatic and can transmit the disease unknowingly. Symptoms consist of blisters and painful sores on the vagina lips or penis. They can also be found around the anus. HSV-2 infections are more severe, and the person can undergo seven to fourteen-day periods of sores. People are most infectious when the sores are present but can transmit the disease when there are no symptoms present.

There is no known drug to kill the virus, infected people can be treated with acyclovir to reduce symptoms. It does not cure the disease but reduces the rate of transmission to an uninfected person. The process of creating a vaccine for immunization is still ongoing. Long-term consequences are problems with urination and infection with HIV. The blisters that are open make the genitals more susceptible to get the virus. Another serious risk is the transmission from mother to child during childbirth. This can lead to illness or death in the baby. Besides medical, there are psychological consequences of herpes. The stigmatization of people with herpes is big and some people believe that infected people should abstain from sexual intercourse in general.

What is HIV and AIDS?

Acquired immune deficiency syndrome (AIDS) is caused by the human immune deficiency virus (HIV). HIV destroys the natural system of disease immunity of the body. The terms global epidemic and pandemic have been used for a reason: worldwide there are about seventy-five million people infected with HIV and it causes about one point six million deaths worldwide each year. HIV can be transmitted trough semen, blood and secretions of the vagina and cervix. There are four ways to transmit HIV:

1. Sexual intercourse, this can be both coitus or anal intercourse.
2. By contaminated blood, for example by receiving a blood donation.
3. By contaminated needles, people who use drugs or health care workers are at risk.
4. An infected woman can give it to her baby during childbirth.

The people that are mostly hit by the HIV infection are men who have sex with men, secondly heterosexual contact, injection drug use and other sources. Among women, the highest chance is heterosexual contact and contaminated needles. The greater the number of sexual partners, the bigger the chance of getting HIV. Condoms give around eighty to ninety-five percent of protection against getting infected with the HIV virus during intercourse.

HIV is a retrovirus, it reproduces in the living cells of the host species. Each time a cell divides, there are viruses produced because the cell contains the genetic code of the virus. The virus infects T-cells that are critical to the immune system. While reproducing the HIV virus destroys the T-cells. When someone does not have enough T-cells, an infection cannot be fought off anymore. There are several stages of HIV infection before it leads to the AIDS disease.

1. Stage 0 is the initial infection and development of antibodies to protect the body from the virus. In this stage someone can be tested positive for HIV-1 or HIV-2 antibodies. The T-cell count is normal, and people do not have any symptoms.
2. Stage 1 is when the count of T-cells drops to about five hundred. One thousand per μL of blood is a normal count. The immune system is declining, and people develop symptoms such as fever, night sweats, swollen lymph nodes or fatigue.
3. Stage 2 is when the T-cell amount drops to between two hundred and five hundred cells.
4. Stage 3 is called AIDS; the number of T-cells drops to below two hundred and people are vulnerable to all kinds of life-threatening infections. Opportunistic infections can only happen in people with severely compromised immune systems, such as people with AIDS. These infections include invasive cervical cancer and pneumocustis jirovecii, a rare type of pneumonia.

The disease can be diagnosed with the detection of antibodies. This can be used to screen blood prior to blood transfusions and determine which people are asymptomatic carriers to avoid further transmission of the HIV virus. The test is called ELISA and is very precise in the detection of antibodies. One drawback is that there are some false positives, so when a positive result is obtained another test should be performed. Also, the waiting period for the ELISA is long. There are new, faster methods for (home) testing of HIV available on the market that give the results in about twenty minutes.

There is no cure for AIDS available, but there is treatment to control the disease. One is AZT, azidothymidine that can stop the virus from multiplying. Another option is protease inhibitors that attack the viral enzyme so it cannot copy and multiply. Patients often take a drug cocktail consisting of a combination of the existing drugs. Besides the control of the virus, there is also medication to prevent or cure the opportunistic diseases.

What are the psychological considerations in AIDS?

People exhibit a few typical reactions when they are diagnosed with incurable diseases. It starts with denial, followed by anger and depression. Patients diagnosed with AIDS can have an even more severe response, because AIDS victims are highly stigmatized. They are often labelled as either gay or drug addicts. Psychological treatment can be helpful and can improve the effectiveness of medication.

What recent progress is made in research on AIDS?

There is not yet a cure available for AIDS and better treatments are sought. For example, researchers are trying to create a vaccine, but this turned out to be very complicated. The problem is the rapid mutation of the HIV virus, the virus changes before a vaccine can take effect. There are strategies to develop a vaccine to form resistance to the HIV virus to create T-cells that are toxic to the HIV virus. Another development is a vaccine so the virus cannot be transmitted trough breast milk or sexual activity. ART treatment is highly effective in preventing transmission. Preexposure prophylaxis (PrEP) is when antiretrovirals are given to a healthy person so they do not become infected. This is used for people in high-risk situations. There has also been research on nonprogressors, people with an unexceptional good immune system and killer T-cells and chemokines, these can avoid the HIV-virus to enter the cells. Genetic resistance refers to gene mutations to avoid the HIV virus to enter healthy cells. Lastly, behavioural prevention is about changing people’s behaviour to avoid infection.

What is Gonorrhea?

Gonorrhea is transmitted trough penis-in-vagina intercourse and invades the urethra. It produces inflammation of the urethra and a thin discharge seeps out, this is called purulent. It also causes pain with urination. If Gonorrhea is untreated it can cause prostatitis, epidymitis and cystitis. After that it can spread to the testes and cause impotence. There is also asymptomatic Gonorrhea, but the prevalence is low. Women can be unaware with the infection, unless they are told by their partner. When Gonorrhea is untreated in females, it can infect the fallopian tubes, and someone can get pelvic inflammatory disease. There is also non-genital infection possible in the mouth, eyes or throat.

What is Syphilis?

Syphilis is a bacterial infection and after the pandemic 1500s the prevalence is low. The effects when remain untreated are very severe though. It can damage the nervous system and can cause death. It makes people more susceptible to HIV and vice versa. The most common symptom is the chancre on the genitals, a lesion that resembles a crater. The bacteria can also infect the person trough any other cut or wound on the body. The progress of the disease is divided into four stages:

1. The primary-stage syphilis where the chancre goes away, but the infection is not cured.
2. The secondary-stage syphilis is characterized by a rash over the body, but it does not hurt or itch. There might also be a loss of hair. The symptoms are bad enough for someone to seek help. These symptoms disappear after a few weeks.
3. The latent syphilis stage does not have any symptoms, but the bacteria spreads trough the body. The person is no longer infectious, a woman can only pass it on to her child. Half of the people remain in this stage without further complications, others enter the next stage.
4. The late syphilis stage or cardiovascular late syphilis is when the major blood vessels and the heart is attacked. Also, the brain and spinal cord are attacked. This can lead to insanity and paralysis.

A child can get congenital syphilis, meaning it is present from birth. It can cause spontaneous abortion or severe illness after birth. Syphilis is difficult to diagnose from the symptoms, but it can be diagnosed using a blood sample. Treatment is penicillin.

What is Hepatitis B?

One symptom of hepatitis B is the enlargement of the liver. The symptoms range from asymptomatic to severe symptoms such as yellowish skin and vomiting. It can be transmitted via blood, semen, saliva and vaginal secretions. Some people develop a short-term illness but recover from that. Others develop long-term illness or serious liver disease. The HBV virus stays in the body forever. There are antiviral treatments and a vaccine available.

What is Trichomoniasis?

Trichomoniasis can be transferred no sexually trough toilet seats or other objects. It is an organism called trichomonas vaginalis. For women, the symptoms are vaginal discharge and an unpleasant small. For men, these are discharge from the penis. If untreated trichomoniasis can lead to pelvic inflammatory disease and problems with childbirth.

What are Pubic Lice?

Pubic lice are tiny lice that live in the pubic hairs. They feed on blood from their host and lay eggs. They can be transferred trough intercourse, but also towels and toilet seats. Medication to kill the lice are available and clothing should be washed roguishly.

How can STIs be prevented?

The most obvious way to prevent an STI is to abstain from sex or have a monogamous relationship with an uninfected person. Otherwise, the condom or diaphragm can be used. Also washing of the genitals and inspecting the genitalia of the partner are important to avoid lovemaking with someone with an STI.

What is Candida?

Candida or yeast infection is caused by fungus that is normally present in the vagina. Long-term birth control pills, menstruation and diabetes can increase the chances of candida getting out of hand. There is over the counter treatment available. It can be passed on to a child during birth and the child will develop thrush, yeast in the digestive system.

What is Prostatitis?

An inflammation of the prostate gland is called prostatitis. This is caused by the E coli bacteria. It can be caused by gonorrhea or chlamydia. Frequent urination, sexual dysfunction, pain around rectum and anus are symptoms. Antibiotics are the most common treatment option.