Sexually Transmitted Infections

What are sexually transmitted diseases (STDs)?

Sexually transmitted diseases (STDs) are diseases that are mainly passed from one person to another during sex. There are at least 25 different sexually transmitted diseases with a range of different symptoms. These diseases may be spread through vaginal, anal and oral sex.

Most sexually transmitted diseases will only affect you if you have sexual contact with someone who has an STD. However there are some infections, for example scabies, which are referred to as STDs because they are most commonly transmitted sexually, but which can also be passed on in other ways.

What are sexually transmitted infections (STIs)?

Sexually transmitted infection (STI) is another name for sexually transmitted disease (STD). The name STI is often preferred because there are a few STDs, such as chlamydia, that can infect a person without causing any actual disease (i.e. unpleasant symptoms). Someone without symptoms may not think of themselves as having a disease, but they may still have an infection that needs treating.

How can you tell if you have a sexually transmitted disease?

You may become aware that you have an STD because of symptoms, or it may be that a sexual partner tells you they have an STD which they might have passed on to you. Some sexually transmitted diseases can be transmitted by an infected person even if they don't have any symptoms. Certain STDs can also be transmitted from a pregnant woman to her unborn child.

If you think you might have been exposed to an STD then you should go to see a doctor. Many sexually transmitted diseases can be easily cured, but if left untreated, they may cause unpleasant symptoms and could lead to long-term damage such as infertility. It is important that anyone diagnosed with an STD informs everyone they have had sex with within the past year (or everyone following the partner they believe may have infected them).

What are common STD symptoms?

STD symptoms vary, but the most common are soreness, unusual lumps or sores, itching, pain when urinating, and/or an unusual discharge from the genitals.

Which are the most common sexually transmitted diseases?

Below are some of the most common STDs and other genital diseases.

 

Chlamydia

Chlamydia is one of the most commonly reported bacterial sexually transmitted diseases. It is caused by the chlamydia trachomatis bacterium. It infects the urethra, rectum and eyes in both sexes, and the cervix in women. If left untreated, long-term infection can lead to fertility problems in women. Chlamydia is transmitted through genital contact and/or sexual intercourse with someone already infected. Symptoms of chlamydia usually show between 1 and 3 weeks after exposure but may not emerge until much later. 

Women

• An increase in vaginal discharge caused by an inflamed cervix;
• the need to urinate more frequently, or pain whilst passing urine;
• pain during sexual intercourse or bleeding after sex;
• lower abdominal pains;
• irregular menstrual bleeding.

Men

• A white/cloudy and watery discharge from the penis that may stain underwear;
• a burning sensation and/or pain when passing urine;
• pain and swelling in the testicles.
• Men are more likely to notice chlamydia symptoms than women, though they too may be asymptomatic.

In both men and women a chlamydia infection in the rectum will rarely cause symptoms.

Crabs or Pubic Lice

Crabs or pubic lice are small crab-shaped parasites that burrow into the skin to feed on blood. They live on coarse body hair, predominantly pubic hair, but can also be found in armpit hair, facial hair and even on eyelashes. The lice are yellow-grey in colour and use their crab-like claws to grip hair strands. They can sometimes be spotted moving on the skin.

Crabs are easily passed on during sex, but can also be passed on through sharing clothes, towels or bedding with someone who has them. Crabs cannot be transmitted via toilet seats or swimming pools.

Symptoms of crabs are usually noticed around 5 days to 7 weeks after infection and include:

• itchy skin;
• inflammation of the affected area;
• sometimes visible lice and eggs;
• spots of blood as lice feed from blood vessels in the skin.

Although there is no effective way to prevent becoming infected during sex, a person who has crabs can reduce the risk to others by washing bedding, towels and clothes on a hot wash to kill off the parasites.

Treatment for public lice is easy, consisting of special shampoos, lotions and creams that kill the lice and their eggs. It is not necessary to shave pubic hair as this is unlikely to remove all lice.

Genital warts

Genital warts are caused by some sub-types of human papilloma virus (HPV). They can appear on the skin anywhere in the genital area as small whitish or flesh-coloured bumps, or larger, fleshy, cauliflower-like lumps. They are unlikely to cause pain but may itch and can be difficult to spot. Often there are no other symptoms of genital warts, but if a woman has a wart on her cervix she may experience slight bleeding or unusual coloured vaginal discharge. 

Gonorrhea

Gonorrhea (once known as the clap) is a sexually transmitted infection that can infect the urethra, cervix, rectum, anus and throat. Symptoms of gonorrhea usually appear between 1 and 14 days after exposure, but it is possible to have no symptoms. Men are more likely to notice symptoms than women. Symptoms can include:

• a burning sensation when urinating;
• a white/yellow discharge from the penis;
• a change in vaginal discharge;
• irritation or discharge from the anus (if the rectum is infected).

Hepatitis

Hepatitis refers to viral infections that cause inflammation of the liver. Several different types of hepatitis virus exist (labelled A to G), with hepatitis A, B and C being the most common. Hepatitis can occur following excessive and prolonged consumption of alcohol or the use of certain medicines and drugs, but it is most commonly caused by a virus. Hepatitis B is the main Hepatitis transmitted sexually.

Signs and symptoms of hepatitis B

Many people who become infected with HBV experience mild symptoms or no symptoms at all, but they may still carry the infectious virus and pass it on to others. When symptoms do appear they are similar to those of hepatitis A and may include:

• A short, mild, flu-like illness;
• nausea, vomiting and diarrhoea;
• loss of appetite;
• weight loss;
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
• itchy skin.

If symptoms become severe then a person with hepatitis B may be admitted to hospital.

Most adults infected with the hepatitis B virus fully recover and develop life-long immunity. Between 2% and 10% of individuals infected as adults will become chronic carriers, which means they will be infectious to others and can develop chronic liver damage. Infected children, especially newborn babies, are much more likely to become chronic carriers.

Signs and symptoms of hepatitis C

Many people do not have symptoms when they become infected with hepatitis C. Symptoms may emerge later, taking anywhere between 15 and 150 days to develop. Occasionally a person will not develop any symptoms and their immune system will successfully clear the virus without their knowledge. An infected person without symptoms can still act as a carrier and pass the virus on to others.

Symptoms may include:

• A short, mild, flu-like illness
• nausea and vomiting;
• diarrhoea;
• loss of appetite;
• weight loss;
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);
• itchy skin.

About 20% of individuals who become infected with HCV will clear the virus from their body within 6 months, though this does not mean they are immune from future infection with HCV.The other 80% of people will develop chronic hepatitis C infection, during which the virus may cause mild symptoms or no symptoms at all. These people will however carry the hepatitis C virus for the rest of their lives and will remain infectious to others.

If symptoms become severe then a person with hepatitis C may be admitted to hospital for monitoring and treatment.

Herpes

Herpes is caused by two strains of the herpes simplex virus, type 1 (HSV-1) and type 2 (HSV-2). HSV-2 is more common and usually manifests itself in the genital and anal area, whereas HSV-1 is more likely to affect the mouth and lips in the form of cold sores. On a global scale, HSV-2 is a very common STD. Symptoms of herpes usually appear 2 to 7 days after first exposure to the virus and last 2 to 4 weeks. Both men and women may have multiple symptoms, including:

• itching or tingling sensations in the genital or anal area;
• small fluid-filled blisters that burst leaving small painful sores;
• pain when passing urine over the open sores (especially in women);
• headaches;
• backache;
• flu-like symptoms, including swollen glands or fever.

Once the first outbreak of blisters has gone, the herpes virus hides away in nerve fibres near the infection site, where it remains dormant, causing no symptoms. Symptoms may come back later (particularly during times of stress and illness) but usually in less severe and shorter episodes. 

 

HIV and genital herpes

Those with suppressed immune systems are likely to have more frequent and severe recurring episodes of genital herpes. They may also have more asymptomatic outbreaks (where the virus travels up the nerve to the surface of the skin but causes no blisters) during which time the virus can be passed on.

A genital herpes infection increases the risk of becoming infected with HIV by up to three times in both men and women.³ This is due to the breaks in the skin caused by HSV, that facilitate entry of HIV.

Syphilis

Syphilis is a bacterial infection caused by Treponema pallidium, which used to be known as the pox. It is usually sexually transmitted, but can also be passed from an infected woman to her unborn child. Syphilis progresses through several stages, of which the primary and secondary stages are very infectious. Syphilis symptoms can be difficult to recognise and may take 3 months to appear after sexual contact with an infected person. They include:

• one or more painless ulcers on the penis, vagina, vulva, cervix, anus or mouth;
• small lumps in the groin due to swollen glands;
• a non-itchy rash;
• fever or flu-like symptoms.

Left untreated the infection progresses to a latent stage. This may be followed by tertiary syphilis, which can seriously affect organs such as the heart, and can sometimes lead to death.

Trichomoniasis

Trichomoniasis (also known as Trich) is caused by the single-celled organism trichomonas vaginalis, which is transmitted through sex. It can infect the vagina and the male and female urethra. Often this STD presents no symptoms, though women are more likely to have symptoms than men. If symptoms do appear, they can include:

• discharge in both men and women (sometimes copious and unpleasant smelling in women);
• discomfort or pain whilst having sex;
• pain when urinating and inflammation of the urethra.

Women may also experience an inflammation of the vulva and they may develop cystitis (an infection of the urinary system).

Transmission is usually through vaginal, anal or oral sex with an infected person. The most effective prevention method is to practise safer sex by using condoms.

Treatment for both men and women is a drug called metronidazole which can be taken orally or applied as a gel. It is important for any sexual partners to also be treated as trichomoniasis can be carried and spread without symptoms. If a woman is pregnant then she should seek medical advice before pursuing treatment.

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)

HIV is a virus. Viruses such as HIV cannot grow or reproduce on their own, they need to infect the cells of a living organism in order to replicate (make new copies of themselves). The human immune system usually finds and kills viruses fairly quickly, but HIV attacks the immune system itself - the very thing that would normally get rid of a virus.

With around 2.6 million people becoming infected with HIV in 2009, there are now an estimated 33.3 million people around the world who are living with HIV, including millions who have developed AIDS.

What is the connection between HIV and AIDS?

HIV causes AIDS by damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent.

It takes around ten years on average for someone with HIV to develop AIDS. However, this average is based on the person with HIV having a reasonable diet, and someone who is malnourished may well progress from HIV to AIDS more rapidly.

How is HIV treated?

Antiretroviral drugs keep the levels of HIV in the body at a low level, so that the immune system is able to recover and work effectively. Antiretroviral drugs enable many HIV positive people to live long and healthy lives.

Starting antiretroviral treatment for HIV infection involves commitment - drugs have to be taken every day, and for the rest of a person's life. Adhering to HIV treatment is important, particularly because not doing so increases the risk of drug resistance. Side effects to the HIV drugs can make adherence difficult, and are sometimes very severe. There are ways of reducing the impact of these side effects, but sometimes it is necessary to change to an alternative HIV treatment regime. Access to antiretroviral treatment is limited in some parts of the world due to a lack of funding.

How is HIV passed on?

HIV is found in the blood and the sexual fluids of an infected person, and in the breast milk of an infected woman. HIV transmission occurs when a sufficient quantity of these fluids get into someone else's bloodstream.

There are various ways a person can become infected with HIV:

1. Unprotected sexual intercourse with an infected person: Sexual intercourse without a condom carries the risk of HIV infection.
2. Contact with an infected person's blood: If sufficient blood from somebody who has HIV enters someone else's body, then HIV can be passed on in the blood.
3. Use of infected blood products: Many people in the past have been infected with HIV by the use of blood transfusions and blood products which were contaminated with the virus. In much of the world this is no longer a significant risk, as blood donations are routinely tested for HIV.
4. Injecting drugs: HIV can be passed on when injecting equipment that has been used by an infected person is then used by someone else. In many parts of the world, often because it is illegal to possess them, injecting equipment or works are shared.
5. From mother to child: HIV can be transmitted from an infected woman to her baby during pregnancy, delivery and breastfeeding.

Certain groups of people, such as injecting drug users, sex workers, prisoners, and men who have sex with men have been particularly affected by HIV. However, HIV can infect anybody, and everyone needs to know how they can and can't become infected with HIV.

Does HIV have symptoms?

Some people experience a flu-like illness, develop a rash, or get swollen glands for a brief period soon after they become infected with HIV. However, these are also common symptoms of other less serious illnesses, and do not necessarily mean that a person has HIV.

Often people who are infected with HIV don't have any symptoms at all. It is important to remember that a person who has HIV can pass on the virus immediately after becoming infected, even if they feel healthy. It's not possible to tell just by looking if someone has been infected with HIV.

The only way to know for certain if someone is infected with HIV is for them to be tested.

Testing for HIV

It is important for a person to get an HIV test if they think they may have been at risk of HIV infection.

There are various types of HIV test, but the most commonly used - the antibody or ELISA test - detects HIV antibodies in a person's blood. It is necessary to wait at least 3 months after the last possible exposure before having an HIV antibody test, to be certain of an accurate result.

The prospect of receiving a positive test result (meaning that a person is infected with HIV) may be daunting, but learning that you are HIV positive is the first step to getting support and staying healthy. HIV testing is also very important for stopping the spread of HIV, as somebody who is aware of their HIV status can take steps to ensure they do not pass on the virus.

How can HIV be prevented?

Despite considerable investment and research, there is currently no vaccine for HIV, and microbicides (designed to prevent HIV being passed on during sex) are still undergoing trials. However, there are other ways that people can protect themselves from HIV infection, which are the basis of HIV prevention efforts around the world.

Education about HIV and how it is spread is an essential part of HIV prevention. HIV education needs to be culturally appropriate and can take place in various settings, for example lessons at school, media campaigns, or peer education.

Preventing sexual transmission of HIV

If a person has sexual intercourse with someone who has HIV they can become infected. ‘Safer sex’ refers to things that a person can do to minimise their risk of HIV infection during sexual intercourse; most importantly, using condoms consistently and correctly.

A person can be certain that they are protected against HIV infection by choosing not to have sex at all, or by only doing things that do not involve any blood or sexual fluid from one person getting into another person's body. This kind of sexual activity is the only thing that can be considered ‘safe sex’.

Preventing transmission of HIV through blood

A person can protect him or herself against HIV infection by ensuring that HIV infected blood does not enter their body.

Injecting drug users who share injecting equipment or works are at risk of HIV infection. Needle exchange programmes can help to prevent HIV transmission among drug users by providing clean needles and disposing of used ones.

Health care workers can be exposed to HIV infected blood while at work. The most effective way to limit their risk of HIV infection is to use universal precautions with every patient, for example washing hands and wearing protective barriers (gloves, aprons, goggles). In the event that a healthcare worker is exposed to potentially HIV infected blood at work, PEP (post exposure prophylaxis) is recommended as an HIV prevention measure.

Preventing mother to child transmission of HIV

Mother-to-child transmission of HIV can be prevented by using antiretroviral drugs, which reduce the chances of a child becoming infected with HIV from around 25% to less than 2%. Once a child is born, safer infant feeding practices can also greatly reduce the risk of HIV being passed on from mother to child.

For these precautions to be taken, an HIV positive mother must firstly be aware of her status. This is why HIV testing in pregnancy is a crucial prevention measure.

Source: http://www.avert.org/stds.htm