Sexually transmitted diseases

Sexually transmitted disease (STD) is a term used to describe more than 20 different infections that are transmitted through exchange of semen, blood, andother body fluids; or by direct contact with the affected body areas of people with STDs. Sexually transmitted diseases are also called venereal diseases.

Once called venereal diseases, STDs are some of the most commonly reported infections and the incidence has been rising over the past 20 years, despite improved methods of diagnosis and treatment. The Centers for Disease Control and Prevention has reported that 85% of the most prevalent infectious diseasesin the United States are sexually transmitted. The rate of STDs in this country is 50-100 times higher than that of any other industrialized nation; in fact, one in four sexually active Americans will be affected by an STD at somepoint. About 13 million new infections occur in the United States each year,and almost 65% of all STD infections affect people under the age of 25.

Throughout the 1970s and 1980s, people could expect to be cured of any STD they might contract, but by the mid-1980s doctors began to realize that new sexually-transmitted infections such as herpes, hepatitis B and AIDS were incurable. STDs are a particular problem for women, who have more severe and frequent health problems as a result of STDs. For example, STDs can spread to the uterus and fallopian tubes, causing pelvic inflammatory disease (PID). Some STDs, such as human papillomavirus infection (HPV), are associated with cervical cancer. Further, STDs can be passed from a mother to her baby before or during birth.

STDs can have very painful long-term consequences as well as immediate healthproblems. They can cause:

  • Birth defects
  • Blindness
  • Bone deformities
  • Brain damage
  • Cancer
  • Heart disease
  • Infertility and other abnormalities of the reproductive system
  • Mental retardation
  • Death.

Some of the most common and potentially serious STDs in the United States include:

  • Chlamydia
  • gonorrhea
  • genital warts
  • Syphilis
  • Human immunodeficiency virus (HIV) and AIDS
  • Hepatitis B

Chlamydia

Chlamydia is one of the most common STDs in the United States, infecting morethan 4.5 million people each year. This serious but easily-cured disease isthree times more common than gonorrhea and six times more common than genitalherpes. It's caused by Chlamydia trachomatis, a germ that is classified as abacterium even though it's similar to a virus. The disease is transmitted during sex with an infected partner (or a baby can become infected as it passesthrough the infected birth canal). Some studies suggest a person becomes infected between one to two weeks after exposure, and remains infectious until acomplete course of antibiotics has been taken. Those at highest risk are women under age 24, women taking birth control pills, women who have had more than one sexual partner or who have other STDs (especially gonorrhea).

Symptoms include a yellowish-black discharge or bleeding and pain, burning ora frequent urge to urinate. Infected people without symptoms can still infect a partner during sex.

The disease is treated with seven days of antibiotics or a one-gram single dose of azithromycin (penicillin isn't effective against Chlamydia. All sexualpartners should be treated even if there are no symptoms. Untreated chlamydiainfections may lead to infections of the fallopian tubes or uterine lining (endometritis), pelvic inflammatory disease, or higher risk of premature birthand low-birth-weight infants. Condoms don't provide complete protection; theonly sure way to prevent chlamydia is by not having sex.

Gonorrhea

Gonorrhea is one of the most commonly-reported STDs -- a million cases reported each year, mostly among young peole under age 24 (some experts think the number is twice as high). The infection is caused by the bacterium Neisseria gonorrhoea, which thrives in warm, moist places and is transmitted during sex.Women who have unprotected sex with an infected man have an 80% to 90% chance of becoming infected.

About half of all infected people will notice symptoms including green-yellowdischarge, vaginal swelling or bleeding between periods (in women), itchingand burning or pain during urination. Severe infections may affect the entirebody, causing nausea and vomiting, fever, and rapid heartbeat. About 40% ofwomen develop pelvic inflammatory disease, scarring the Fallopian tubes and leading to infertility. Untreated pregnant women may have smaller babies or premature birth; babies born to infected mothers may have gonorrhea conjunctivitis during delivery (untreated infants can be blinded).

A doctor can diagnose the infection with a tissue culture of cells from the cervix and surrounding areas; results are usually available within 48 hours. While gonorrhea is becoming resistant to some antibiotics, newer drugs have been developed which will cure the infection.

Genital warts

Genital warts are an extremely common sexually transmitted disease, caused byinfection with the human papillomavirus (HPV). The virus infects almost 2 million Americans each year, mostly among women between the ages of 15 and 24.High-risk candidates are those who have more than one sex partner and who don't use condoms. The virus is transmitted during unprotected sex with an infected partner; visible warts signal a highly infectious stage, but the virus remains after the warts disappear. The warts may range from pink to gray and are either raised or flat, cause itching, burning or bleeding around the genital area. Warts may appear anywhere on the genitals or anus, and occasionally they may crop up on the cervix. Occasionally, warts may grow larger and blockthe entrance to the vagina, anus, urethra, or (after oral sex) the throat.

At least two strains of the warts have been associated with higher risk of cervical cancer, especially among women with persistent warts and many sex partners, but the association between the type of cancer and the virus is not well understood. While there are eight different types of HPV associated with genital warts, only two (types 16 and 18) have been associated with cervical cancer. The different types of warts can only be distinguished in a research lab. Most women with genital warts are not at higher risk for developing cervical cancer.

A doctor can diagnose the warts from their appearance; a Pap smear will identify warts on the cervix, or those deep inside the vagina. No treatment will remove all traces of the virus, but a doctor will try to remove or shrink thewarts themselves with a topical solution, freezing, or burning them off witha laser. Unfortunately, genital warts often reappear after treatment. As a last resort, a doctor may turn to surgical removal if the warts are very largeor cause problems (but even then, 20% of the time they grow back).

Anyone with genital warts (or who has been diagnosed in the past) should always use a condom, since there is no other way to prevent the disease. At present there is no vaccine for the virus. All women with anogenital warts need aPap test every 6 to 12 months to detect early signs of cervical cancer.

Genital herpes

Genital herpes is a very common sexually transmitted disease, primarily infecting young, single, and mostly-middle class women and men. The medical community has always considered genital herpes to be more of an annoyance than a life-threatening infection. The virus for genital virus invades the body duringsex, where it remains for a lifetime, usually reactivating several times a year with painful sores in the genital area. It's estimated that there are more than 700,000 new cases each year, and that the disease is responsible for more than 500,000 doctor visits each year.

Herpes simplex type II (HSV-II) causes most of the genital herpes cases; (herpes simplex virus type I causes cold sores, usually above the waist). HSV-IIcan infect any skin or mucous membrane, and while it's usually spread by contact with the genital secretions of a person with an open sore, it's possiblefor someone without lesions to infect a partner. Genital herpes also can be acquired by infants as they pass through the birth canal of an infected mother; the resulting "neonatal herpes" can cause serious damage to the child's brain and other organs. Even with treatment, more than 20% of the affected infants will die, and many survivors will be seriously impaired. Because of this,thousands of women in the U.S. with active herpes near the time of delivery undergo a Cesarean section.

About 60% of people with herpes never have any symptoms; of those who do, thefirst infection is usually the most severe. After the sores fade away, the virus remains in the body, reactivating and triggering lesions on the genitals, anus, upper thighs, or buttocks. The sores usually recur within six monthsof the first attack. The reactivation is often signalled by a "prodrome" -- tingling or stinging in the area where the virus first entered the body. Scientists at one time thought there might be a link between herpes and cervical cancer, but new studies show that there is probably no correlation.

Antiviral drugs can reduce the number and severity of attacks, but won't curethe infection. Taking the drug at the very first sign of the prodrome may shorten the healing time from five days to one. People with more than six episodes a year may take antiviral drugs daily to prevent recurrence for up to three years. At least two companies are in the final stages of testing for a vaccine to prevent the infection, but so far none has been approved.

Hepatitis B

Hepatitis B is the most common preventable STD in the United States, caused by an extremely infectious virus 100 times more contagious than the virus thatcauses AIDS. While experts believe there are 300,000 new cases a year, onlyabout 15,000 are reported. About 1.25 million Americans are carriers and areinfectious for all their lives, and almost 6,000 Americans each year die fromacute hepatitis B or the complications of infection. Tragically, while it can be prevented by a vaccine, only about 5% of those who account for most of the infections (teens aged 15 to 19) ever get vaccinated.

The virus is carried in the blood and saliva, semen and other body fluids, and is transmitted much as the AIDS virus -- not by casual contact. The virus must get into a person's blood to cause infection, either by sex, blood transfusions, dirty needles, or by sharing toothbrushes, razors or utensils. It's also possible to pass the infection on to a baby during the final three monthsof pregnancy, during delivery or nursing. The virus is very stable and can survive for some time on dry surfaces for days. Still, more than half of all cases are linked to sex with an infected person.

Symptoms may appear six months after exposure, if at all, and include fatigue, joint and muscle aches, mild stomach pain, poor appetite hives or rash, andmild diarrhea. About half of those infected may develop jaundice. About 25%of carriers develop chronic symptoms and are at greatest risk of developing cirrhosis. The virus can be found in blood and body fluids several weeks before symptoms appear and several months afterward. People who are chronic carriers are always infectious, although they don't appear to be sick. Those who recover are immune for life.

Hepatitis B is diagnosed by blood tests; other tests can differentiate this virus from other types of hepatitis. Chronic active hepatitis B is treated with alpha-interferons, but the treatment itself causes many flu-like side effects. There is no treatment for acute hepatitis B beyond bed rest and a high carbohydrate, low-fat diet. After recovery, blood tests will reveal if the patient remains infectious; these people are at higher risk for developing complications. About 10% of these chronic carriers become uninfectious each year.

While hepatitis B is completely preventable with the vaccine, thousands continue to come down with the disease each year. Anyone at risk for the disease (including all medical and nursing personnel) should have the vaccine. As of November 1991, the vaccine was recommended for all infants. Unlike some immunizations, there is no apparent risk of serious side effects from the hepatitisB vaccine. Those who haven't been vaccinated but who are exposed can receiveimmune globulin HBIG for 90% protection, if they get the treatment with a week of exposure and begin the vaccine series at the same time.

Carriers should follow standard hygienic procedures to make sure close contacts aren't contaminated, and not share razors, toothbrushes, or any other object that may become contaminated with blood. In addition, household members (especially sexual partners) should be immunized with hep B vaccine. Carriers should tell health care workers and dentists.

Syphilis

This once-fatal infection has tormented people around the world for centuries, first recorded as a major epidemic after Columbus returned from his trip toAmerica. Today the incidence of syphilis is 60 times higher among African Americans than among Caucasians, and four times higher in Hispanics than in Anglos. Today, penicillin can cure the disease if it's caught in time, and the rate of infection is currently dropping in the United Stats after a recent epidemic from 1986 to 1990. However, thousands of Americans still contract the infection each year.

It's caused by the Treponema pallidum bacteria, which enters the body via broken skin or mucous membranes during sex, by kissing, or by other body contactwith an open sore. The rate of infection during a single contact with an infected person is about 30%. The initial sore may be easily overlooked so thatthe infection is not detected until a rash appears during the second stage ofthe disease. Syphilis can be diagnosed from a culture of the sore, or from ablood test.

Penicillin cures the infection 98% of the time if diagnosed early, but if it's not treated, the infection can spread to the central nervous system leadingto irreversible nerve damage.

HIV and AIDS

Infection with human immunodeficiency virus (HIV) leads to the condition called acquired immune deficiency syndrome (AIDS). Since its discovery in 1984, AIDS has reached epidemic proportions throughout the world, infecting about 13million people. Although the disease was originally found primarily among homosexual men, it's now transmitted mostly through heterosexual activities.

This change has led to a dramatic increase in HIV infection among women, whotoday make up almost 13% of the AIDS cases. In the United States, AIDS is thefourth leading cause of death in black women of reproductive age in New Yorkand New Jersey. Absent an effective vaccine, the best way to stop the spreadof HIV is by avoiding sex with infected individuals and by practicing "safesex." Using a rubber condom during sex is the next best protection; they should always be used for oral, anal and vaginal sex in any relationship or if there is a chance that either partner is infected. Only water-based lubricantsshould be used with latex condoms, because oil-based lubricants (such as petroleum jelly) weaken natural rubber. Those allergic to latex can use any of several polyurethane condoms, which are comparable to latex as a barrier to both sperm and HIV virus.

In the United States, blood and blood products have been tested since 1985 for HIV, and are considered safe. In addition, the FDA inspects the more than 3,000 donor centers where blood and components are collected. The risk of HIVtransmission has dropped from 1 in 2500 units of blood in 1985 to 1 in 440,000 to 640,000 units by the end of 1995.

HIV infects body fluids, such as blood, semen, saliva, vaginal secretions, amniotic fluid, breast milk and urine. It can be transmitted by coming in contact with body secretions during sex, being exposed to blood or blood productsvia blood transfusion. While at present there is no cure for AIDS, intensiveresearch has produced new medication combinations that can prolong life. Three groups of medicines currently treat AIDS: antiviral drugs, prophylactic medicines to protect against certain infections, and other drugs to fight infections and cancer.

An enormous number of new antiretroviral drugs for treating HIV infections have been introduced, including new nucleoside agents, HIV protease inhibitors,and non-nucleoside reverse transcriptase inhibitors. In addition, tests to evaluate how much virus is circulating in a patient's blood make it possible to monitor the effectiveness of these drugs.

This combination of new agents for HIV infection, together with new ways to monitor the effectiveness of therapy, has significantly improved the prognosisfor today's HIV-infected women. Combination therapy, the use of more than one antiretroviral drug at a time, is often used. By combining drugs, the likelihood that a woman will become resistant is much lower.

Characteristics of STDs

STDs affect certain groups of people more severely than others. Women, youngpeople, and members of minority groups are particularly affected. Women in any age bracket are more likely than men to develop medical complications related to STDs.

The symptoms of STDs vary somewhat according to the cause, the sex of the patient, and the body systems affected. The symptoms of some STDs are easy to identify; others produce infections that may either go unnoticed for some timeor are easy to confuse with other diseases. Syphilis in particular can be confused with disorders ranging from infectious mononucleosis to allergic reactions to prescription medications. In addition, the incubation period of STDs varies. Some produce symptoms close enough to the time of sexual contact-- often less than 48 hours later-- for the patient to recognize the connection between the behavior and the symptoms. Others have a longer incubation period, so that the patient may not recognize the early symptoms as those of a sexually transmitted infection.

Some symptoms of STDs affect the genitals and reproductive organs:

  • A woman who has an STD may bleed when she is not menstruating or have an abnormal vaginal discharge. Vaginal burning, itching, and odor are common, and she may experience pain in her pelvic area or while having sex.
  • A discharge from the tip of the penis may be a sign that a man has an STD. Males may also have painful or burning sensations when they urinate.
  • There may beswelling of the lymph nodes near the groin area.
  • Both men and womenmay develop skin rashes, sores, bumps, or blisters near the mouth or genitals. Homosexual men frequently develop these symptoms in the area around the anus.

Other symptoms of STDs are systemic, which means that they affect the body asa whole. These symptoms may include:

  • Fever, chills, and similar flu-like symptoms
  • Skin rashes over large parts of the body
  • Arthritis-like pains or aching in the joints
  • Throat swelling and redness that lasts for three weeks or longer.

Diagnosis

The diagnostic process begins with a thorough physical examination and a detailed medical history that documents the patient's sexual history and assessesthe risk of infection. The doctor may suggest that a patient diagnosed withone STD be tested for others, since it's possible to have more than one STD at a time and one infection may hide the symptoms of another, or create a climate that fosters its growth. It is particularly important that persons who are HIV-positive be tested for syphilis.

The law in most parts of the United States requires public health officials to trace and contact the partners of persons with STDs. Minors, however, can get treatment without their parents' permission. Public health departments inmost states can provide information about STD clinic locations; Planned Parenthood facilities provide testing and counseling. These agencies can also helpwith or assume the responsibility of notifying sexual partners who must be tested and may require treatment.

Treatment

Although self-care can relieve some of the pain of genital herpes or genitalwarts that has recurred after being diagnosed and treated by a physician, other STD symptoms require immediate medical attention. Antibiotics are prescribed to treat gonorrhea, chlamydia, syphilis, and other STDs caused by bacteria. Although prompt diagnosis and early treatment almost always cures these STDs, new infections can develop if exposure continues or is renewed.

When diagnosed and treated early, almost all STDs can be treated effectively.Some organisms, such as certain strains of gonorrhea, have become resistantto the medications used to treat them and now require newer types of antibiotics. Untreated syphilis in particular can lead to long-term complications anddisability. Viral STDs such as genital herpes and warts can't be cured but must be treated on a long-term basis to relieve symptoms and prevent life-threatening complications. The most serious STD for which no cure now exists is acquired immunodeficiency syndrome (AIDS), a fatal viral infection of the immune system, although recent multiple-drug combinations has been improving thelong-term outlook for AIDS patients.

Prevention

Vaccines for the prevention of hepatitis B are currently recommended for gayand bisexual men, users of illegal drugs, and others at risk of contracting these diseases. Vaccines to prevent other STDs are being tested and may be available within several years.

The risk of becoming infected with an STD can be reduced or eliminated by decisions about personal behavior. Abstinence from sexual relations or a monogamous relationship with a partner who is not having sex outside it are legitimate options. It is also wise to avoid sexual contact with partners who are known to be infected with an STD, whose health status is unknown, who abuse drugs, or who are involved in prostitution.

Men or women who have sex with an infected partner should make sure a new condom is used every time they have genital, oral, or anal contact. Used correctly and consistently, male condoms provide good protection against HIV and other STDs. Female condoms (lubricated sheaths inserted into the vagina) have been shown to be effective in preventing HIV and other viral STDs. Researchersbelieve female condoms will substantially reduce the risk of developing otherSTDs; however, studies testing that theory have not yet been completed.

Spermicides and diaphragms can prevent transmission of some STDs, but they don't protect women from contracting HIV. Birth-control pills, patches, or injections do not prevent STDs; neither do surgical sterilization or hysterectomy.

Urinating and washing the genital area with soap and water immediately afterhaving sex may eliminate some germs before they cause infection. Douching, however, can spread infection deeper into the womb. It may increase a woman's risk of developing pelvic inflammatory disease (PID).

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