Module 4 – STIs

Sexually transmitted infections (STIs) are a major global cause of acute illness, infertility, long term disability and death, with severe medical and psychological consequences for millions of men, women, and children. The World Health Organization (WHO) states that “in developing countries, STIs and their complications are amongst the top five disease categories for which adults seek health care”.  Except for HIV and a few others, many STIs can be treated and cured relatively easily and cheaply if diagnosed early. To fight these epidemics college authorities must act to expand access to testing and treatment facilities; educate students about safer sex and risk reduction, avoidance and to counter the prejudice surrounding STI infections and treatment on campus.

Topic objectives

• To recognize STIs and their symptoms.
• To understand STI transmission and prevention
• To explore the STI risks among young people in Zimbabwe and the effects of STIs on the socio-economic life as well as physical wellbeing of young people.
• To understand the importance of seeking STI treatment early and from a health care worker.

DEFINITION OF TERMS

The terms below may appear in this module and in other modules presented before. Please always refer to this section if you meet a new word or a word that you are not sure of its meaning.

Ectopic Pregnancy A pregnancy in which the fertilized egg implants outside the uterus. Women with a history of sexually transmitted diseases (STDs), such as gonorrhea or chlamydia or pelvic inflammatory disease have a high risk of ectopic pregnancy.

Drug Resistance is the reduction in effectiveness of a medication in treating a disease or condition. Gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it.

Ophthalmic Neonatorum An eye infection that occurs within the first 30 days of life. It is caught during birth by contact with the mother’s birth canal that is infected with a sexually transmitted disease.

Infertility The inability to conceive after 12 months or longer of regular unprotected sexual intercourse. Most cases of tubal factor infertility are attributable to untreated sexually transmitted diseases that ascend along the reproductive tract and can cause tubal inflammation, damage, and scarring.

Morbidity The rate of disease in a population.

Asymptomatic When a person with a disease or other medical condition experiences no symptoms or evidence of illness or abnormality. Many STIs have no signs or symptoms (asymptomatic)

Antibiotics a medicine (such as penicillin or its derivatives) that inhibits the growth of or destroys microorganisms.

Chemotherapeutic Agents are used to inhibit the uncontrolled growth and proliferation of cancer cells directly or indirectly.

KEY POINTS ON STIs

• STIs are not only a cause of acute morbidity in adults but may also result in complications such as: Infertility in men and women, Ectopic pregnancy in women, Cervical cancer, Premature delivery of babies, Ophthalmic neonatorum.
• STIs are infections that you can contract through sexual intercourse and/contact with an individual who is infected. These infections are usually passed by having vaginal intercourse, but they can also be passed through oral sex, or skin-to-skin contact.
• STIs can be caused by viruses, fungal or bacteria. STIs caused by viruses include but are not limited to hepatitis B, genital herpes, and HIV. STIs caused by bacteria include but are not limited to chlamydia, gonorrhea, and syphilis.
• Most STIs that are caused by fungi and bacteria are curable by appropriate antibiotics and chemotherapeutic agents. Despite this STIs have remained a major challenge, particularly in developing countries.
• HIV is another sexually transmitted pathogen (a pathogen is a disease-causing organism)
• Globally young people (ages 15-24) account for 53 % of all new STIs, although they represent just 25% of the sexually experienced population.
• Many STIs can be treated and cured, however early treatment is necessary to avoid complications and permanent damage.
• Symptoms and signs may not be noticed, particularly in women until complications appear.
• Most STIs can be diagnosed by a doctor through the examination of the secretions from your vagina, penis, or through a blood test.

Primary Prevention of STIs

The primary prevention of STIs aims to prevent the acquisition of infection. This can be done by abstaining from sex all together or adopting safer sexual behaviors like correct and consistent use of condoms for penetrative sexual acts.

Secondary Prevention

If you suspect you have an STI you must get treatment immediately. It is critical that you be examined by a healthcare professional and adhere to all prescribed treatments.  It is critical that you get your sexual partner to be treated as well even if they may not present any symptoms.

It is important to seek care for STIs from the public sector and certified private sector practitioners. It is discouraged to seek care from uncertified traditional healers and uncertified pharmacists.

DIFFERENT TYPES OF SEXUALLY TRANSMITTED INFECTIONS

HIV is the commonly known infection in most discussions about sex and sexuality. In this section we are going to discuss many more sexually transmitted infections which are not always in the spotlight but with the most experienced signs and symptoms when one is said to have contracted an STI.

The predominant mode of transmission of HIV and other STIs is sexual. The detection and treatment of individuals with STIs is an important part of an HIV control strategy. If the incidence of STIs is high in a country, then there is the possibility of high rates of sexual transmission of HIV. Measures for preventing sexual transmission of HIV and STIs are mostly the same.

Clinical services for STIs are important entry points to contact individuals with high risk of contracting HIV. Other STIs, when present, facilitate the transmission of HIV, making early diagnosis and effective treatment of STIs an important strategy for the prevention of HIV transmission.

1. Chlamydia

Causative agent – It is caused by a bacterium called Chlamydia trachomatis bacterium.

Areas affected – urethra (bladder opening) and cervix (uterus opening).

Symptoms

Women – A minor increase in vaginal discharge caused by an inflamed cervix. Cystitis (an inflammation of the lining of the bladder). The need to urinate more frequently, or pain whilst passing urine. Pain during sexual intercourse or bleeding after sex. Mild lower abdominal pains. Irregular menstrual bleeding. A painful swelling and irritation in the eyes (if they become infected). Three in four women and one in two men have no symptoms.

Men – Men are more likely to notice symptoms early than women, though they too may be asymptomatic. A white/cloudy and watery discharge from the penis that may stain underwear. A burning sensation and/or pain when passing urine. A painful swelling and irritation in the eyes (if they become infected).

If Untreated – it can progress to pelvic inflammatory disease (PID, described below), a major cause of female infertility and pelvic pain.

Treatment – a full course of antibiotics

2. Gonorrhea

Causative agent – Bacteria

Areas affected – urethra (bladder opening) and cervix (uterus opening), throat.

Symptoms – About 1 in 10 infected men and 5 in 10 infected women will not experience any obvious symptoms, which means the condition can go untreated for some time.

Women – an unusual vaginal discharge, which may be thin or watery and green or yellow in color, pain or a burning sensation when passing urine, pain, or tenderness in the lower abdominal area – this is less common, bleeding between periods, heavier periods, and bleeding after sex – this is less common.

Men are more likely to notice symptoms than women. A burning sensation when urinating. A white/yellow discharge from the penis.

Gonorrhea in babies – Gonorrhea can be passed from a mother to her baby during childbirth. Newborn babies normally show symptoms in their eyes during the first 2 weeks. The eyes become red and swollen, and have a thick, pus-like discharge.

If Untreated – can migrate to the uterus and the fallopian tubes, giving rise to pelvic inflammatory disease (PID).

Treatment – antibiotics

3. Pelvic Inflammatory Disease (PID)

Causative agent – Several different microorganisms can cause pelvic inflammatory disease of the upper female reproductive tract. The two most common culprits are Chlamydia trachomatis and Neisseria gonorrhoeae, which account for four in five cases.

Areas affected – Lower abdomen in women.

Symptoms – PID from chlamydia infection typically produces mild symptoms or none, but if untreated it can inflame and scar the ovaries and the fallopian tubes. PID from gonorrhea, on the other hand, can produce the worst lower-abdominal pain a woman has ever had.

If Untreated – Because PID affects the fallopian tubes, where conception takes place, if the scarring is severe enough, the male sperm may be prevented from reaching the female egg causing sterility.

Treatment – antibiotics

4. Genital Warts and Human Papillomavirus (HPV)

Causative agent – Scientists have identified more than one hundred types of the human Papilloma      virus.

Areas affected – Genital warts affect the genitals. HPV is often silent, STI. Almost half the women harboring the virus exhibit no symptoms at all.

Symptoms

Women – Genital warts typically appear in clusters inside and outside the vagina, and the cervix.

Male – venereal warts, which are far less common, form on the penis, and the scrotum. The pinkish or flesh-colored growths often vanish on their own.

If Untreated – HPV is responsible for four in five cases of cervical cancer, in addition to several other genital malignancies.

Treatment – Most cases can be managed with topical treatment of the warts, though the lesions tend to return. Large warts may have to be removed using one of several surgical procedures: cryosurgery (freezing), electrocautery (burning) or laser surgery.

5. Genital Herpes (HSV-1, HSV-2)

Causative agent – two types of herpes HSV1 and HSV2.

Areas affected – HSV1 affects mouth gums and throats, HSV2 affects vagina, penis, and thighs.

Symptoms –Both men and women may have multiple symptoms that include itching or tingling sensations in the genital 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.

If Untreated – both HSV1 and HSV2 cannot be treated because the virus permanently inhabits sensory nerves at the base of the spinal cord, genital herpes is a chronic, lifelong condition. Most of the time, HSV lies dormant but often comes due to stress, illness, and old age.

Treatment – There is no cure for the herpes virus and treatment is not essential, as an outbreak of genital herpes will usually clear up by itself. A doctor may however prescribe a course of antiviral tablets that reduce the severity of an outbreak. The antiviral tablets work by preventing the herpes virus from multiplying. These tablets are only effective when taken within 72 hours of the onset of symptoms and will cease to have any effect once the patient stops taking them.

6. Syphilis

Causative agent – bacterium Treponema pallidum

Areas affected – The first evidence of syphilis is a hard, round open sore known as a chancre (pronounced “shan-ker”) in the genital area.

Symptoms

• Stage 1 or primary stage is the chancre,
• Stage 2 or secondary stage presents a rash on the palms of hands and soles of feet and
• Stage 3 or tertiary stage infection spreads to other body organs.

If Untreated Can be fatal as it slips into the bloodstream, which sends it to organs outside the reproductive tract.

Treatment

• A two-week course of intramuscular penicillin injections
• In some cases, antibiotic tablets, or capsules.
• If the patient has had syphilis for less than a year, then fewer doses will be needed.

1. Syphilis in pregnancy

• a pregnant woman with primary or secondary syphilis will almost certainly transmit the bacterium to her fetus.
• Infection early in fetal life leads to death and abortion.
• infection later in pregnancy leads to a variety of problems including anemia, bleeding, swollen glands, and infection of the various organs, such as the lungs, spleen, and brain.