Sexually Transmitted Diseases

Reviewed By:   Chandra Chataut, MD

 

Sexually transmitted infections (STIs) are the infections caused by a sexual contact with an infected person. Some of these infections can also spread from mother to infant or unborn babies. The microorganisms enter the body via the skin and mucosal linings of the genitals (urethra, cervix, vagina, rectum) and oral cavity. The causative organisms are bacteria, spirochete, chlamydia, virus, protozoa, fungi and parasites. Infections does not always cause symptoms, but when symptoms are present it is termed as sexually transmitted disease (STD). If not treated they can lead to complications like pelvic inflammatory disease, infertility, tubal or ectopic pregnancy, urethral stricture (narrowing) and  cervical cancer.

 

STDs and Causative Organisms

 

Disease Type of Organism
Gonorrhea, Chancroid, Bacterial Baginosis Bacteria
Syphilis Spirochete
Nongonococcal Urethritis, Epididymitis, Cervicitis, Pelvic Inflammatory Disease,

Lymphogranuloma Venereum

Chlamydia
Herpes Genitalis, Hepatitis B, Cytomegalovirus, HIV/AIDS, Condylomata Acuminate, Molluscum Contagiosum Virus
Trichomoniasis Protozoa
Candidiasis Fungi
Pediculosis pubis (Pubic lice), Scabies Parasite

 

Risk Factors

  • STDs are transmitted from one person to another with heterosexual or homosexual intercourse or intimate contact with the genitals, mouth or rectum.
  • Those who have unsafe (without the use of condoms) sexual activity with multiple partners or with prostitutes are at higher risk.
  • Certain STIs — such as gonorrhea, chlamydia, HIV and syphilis — can be passed from an infected mother to her child during pregnancy or delivery. STIs in infants can be serious and may be fatal. All pregnant women should be screened for these infections and treated.
    • Men who have sex with men are at a higher risk.
    • Injection drug user are at higher risk of hepatitis, HIV infection.
  • STDs that cause genital ulcer increase the risk of HIV.
  • History of prior STDs increases the risk.

 

Symptoms

Sexually transmitted infection does not always show symptoms.

Some of the symptoms and organism/disease conditions include the following:

  • Genital ulcer: Usually painful Herpes, Chancroid (painful ulcer). Usually painless- Lymphogranuloma venereum (LGV), Granuloma inguinale (Donovanosis), Primary syphilis (chancre)
  • Penile discharge/painful urination: Gonorrhea, Chlamydia
  • Vaginal discharge: Bacterial vaginosis, Trichomoniasis, Gonorrhea, chlamydia
  • Testicular pain and swelling
  • Warty  lesion: Genital warts (Human papilloma virus)
  • Lower abdomen pain in women- Pelvic inflammatory disease
  • Skin rash: Secondary syphilis
  • Enlarged lymph nodes: Syphilis, HIV, other condition causing genital ulcer
  • Sore throat (Pharyngitis)- due to gonorrhea acquired during oral sex
  • Intense itching- Scabies
  • Lice in pubic area
  • Rectal bleeding in men who have sex with men- HIV,Chlamydia
  • In newborn- conjunctivitis due to gonococcus contracted from untreated mother

 

Diagnosis

History, physical exam and lab tests as necessary for diagnosing the problem.

Because of perceived stigma and possible threat to emotional relationships, patients may not be comfortable for seeking medical advise or will be reluctant to disclose full and reliable history. In many cases, patients may not have common symptoms of the disease.  It is always important to give correct information to your health care provider for easier diagnosis. 

Blood test, tests of body fluid and imaging tests may be necessary. Patients diagnosed with one STD should be screened for other common STIs as well.

 

Treatment Options

It is very important to consult your physician for treatment. Self treatment is not advisable.

Chlamydia and Gonorrhea: Chlamydia, Gonorrhea  and pelvic inflammatory disease are bacterial STDs/STIs, and are treated with antibiotics. Antibiotic course should be completed even if the symptom goes away. Sexual partner should also be treated. If chlamydia and gonorrhea are not treated properly, they can cause permanent damage to reproductive organs and result in infertility.

Syphilis: Penicillin is the drug of choice. Treatment regimen depends upon stage of syphilis.

Bacterial vaginosis: Bacterial vaginosis can be treated with antibiotics, typically metronidazole.

Genital herpes: Genital herpes can be treated with antiviral drugs such as Acyclovir, Valacyclovir. Although this medication can limit the length and severity of outbreaks, it does not cure the infection completely. If a pregnant woman has an herpes outbreak during labor,  cesarean section is done  to reduce the risk of  transmission of herpes  to the unborn child. 

Genital warts: Cryotherapy (freezing), cauterization (burning), laser surgery are treatment options.  There is some chance of transmission of disease even after symptoms related to warts are no longer visible/evident.

Hepatitis B: The goal of the treatment is to prevent further liver damage. Antiviral medicines are used to treat hepatitis B. Liver transplant done for  end stage liver disease

Trichomoniasis: Trichomoniasis can be treated with a single dose of an antibiotic, usually either metronidazole or tinidazole, taken by mouth.

Scabies: Permethrin are the drug of choice for treating scabies.

Candidiasis: It is treated with antifungal drug like fluconazole.

HIV: treatment with antiretroviral therapy (ART)

 

 

When to seek a Medical Care?

  • You are sexually active and had sexual intercourse with an infected person.
  • You have signs and symptoms of an STI like sores on the genitals or in the oral or rectal area, painful or burning urination, foul smelling discharge from the penis and vagina, unusual vaginal bleeding, pain during sexual intercourse, swollen lymph nodes, particularly in the groin region, lower abdominal pain, fever, rash over the trunk, hands or feet.
  • Pregnant woman should be screened for STI like HIV, syphilis, Hepatitis B. C, gonorrhea, chlamydia.
  • Men who have sex with men.

 

Prevention: Here are some common methods to prevent STIs:

  • Mutually monogamous relationship between uninfected partner
  • Limit number of sexual partners
  • Condoms: when used correctly male condoms reduce risk of  STD, but it is not 100% safe. Female condoms can also reduce STD transmission
  • Vaccination against hepatitis A, B, Human papilloma virus (HPV)
  • Pre exposure and post exposure prophylaxis for HIV
  • Timely treatment of infected person prevents spread of infection
  • Abstinence from sex till cure (when it can be done)
  • Concomitant  partner therapy
  • Women with genital wart should get more frequent Pap test (to screen for cervical cancer)

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