STDs/STI (Sexually Trasnmitted Infection) are very common.Each year millions of new cases are diagnosed.A STI could be due to a virus,bacteria,fungus or a parasite which people get through sexual contact be it vaginal,oral or anal.STIs may cause minimal symptoms or no symptoms at all,so it is possible to have an infection without knowing it.If one is at high risk of getting an STI,getting STI tests done is important.Most STIs are treatable and some are completely curable. STIs are preventable by proper sex education.
Viral STIs
1) Genital Warts
Human Papillomavirus (HPV) is the most common STI.There are many types of HPV. Some types can causes genital warts and cancer.You can get infection after sexually contact with someone who has the virus.It can also spread by close skin to skin contact.Sexually active people can get infection from someone with no symptoms. Symptoms of infection can develop years after sex with someone who has infection making it hard to know when infection first happened. In most cases HPV goes away on its own within 2 years, but in some cases it can cause genital warts and cancers.Certain types of HPV can cause cancer of cervix,vagina,vulva,penis or anus.It can aslo cause cancer of back of throat (oropharyngeal cancer). Cancer can take many years to develop after a person gets HPV.There is no way to know who will develop health problem due to HPV, generally people with weak immune system are more susceptible.
There is no test to find a person's HPV status.There are tests to screen for HPV cervical cancer.Most people don't have symptoms and they never know they have infection till they develop genital warts.Women may know when they get abnormal Pap smear test during cervical cancer screening.Others might only find out when they have developed cancer. Genital warts affect all genders, most common in teenagers and young adults.They appear as small growths around genitals,rectum,grion area,lips,mouth and throat.They are not painful,occasionally bleed,itch or cause discomfort.Risk increases by having unprotected sex and having multiple partners.HPV6 and HPV 11 cause genital warts. Warts might appear within few weeks of exposure or might take months to years.It is possible to have infection and not get genital warts.You might have warts inside your vagina or anus with no symptoms and spread the virus unknowingly.
Warts are diagnosed by examination.Internal warts are difficult to examine.Pelvic examination,Pap smear and biopsy may be needed.Anal examination and use of anoscope to look inside for warts.
Genital warts may go away if immune system is able to fight the infection or else they may get larger and multiply and spread.Removing genital warts reduces the spread though it is not the cure.Genital warts can come back even after treatment.Genital warts don't turn into cancer.Pregnant women with genital warts may need to deliver via C section.There are several ways of treating genital warts and you may need more than one method to get rid of them.Commonly used methods are
- Cryotherapy liquid nitrogen is sued to freez and destroy the warts.
- Topical medications applied once a week for several weeks on warts.
- Surgery Liquid nitrogen is sprayed to freeze and destroy the warts.warts may be to removed surgically if they are large or those which don't respond to other treatments.
HPV vaccination is recommended at age 9 to 26 years if not already vaccinated.This vaccine prevents most HPV types that cause cancers as well as prevents most HPV types that cause genital warts.
Get routine testing.Tell your sexual partner if you have HPV so that they can get tested.
Limit your number of sexual partners.
2) Genital Herpes
Genital herpes is common STI caused by herpes simplex virus (HSV).There are two types of HSV namely HSV-1 and HAV-2.HSV-2 is the most common cause of genital herpes and HSV-1 causes cold sores or fever blisters.A person having HSV-1 of mouth can pass it to genitals of a sexual partner during oral sex.Some people may have no symptoms or mild symptoms.Others may have pain,itching,blisters, sores,ulcers around genitals,anus or mouth.First out break may have flu like symptoms like fever,headache,bodyache or swollen lymph nodes.Infection can also spread by touching the area to finger causing herpetic whitlow or to eye.After first epidose, symptoms can recur called recurrent outbreaks.They are less severe than first episode and don't last as long.Neither HSV1 nor HSV 2 survive at room temperature so virus is unlikely to spread through surfaces like faucet handles or towels,toilet seats,however it may spread by kissing or sharing a drinking glass. A baby can get HSV during delivery.Less often virus is passed during pregnancy or by close contact after delivery.Newborns with HSV can develop infection of nervous system or internal organs.If you are pregnant and have genital herpes,tell your doctor.
There is no cure for genital herpes. Doctor will prescribe anti viral medications like acyclovir to limit the number of outbreaks.
3) Molluscum contagiosum (MC)
It is a fairly common infection caused by poxvirus.It spreads from person to person and contact with objects like towels, swiming pools contaminated with virus.Adults with healthy immune system can get MC on genitals,lower abdomen or inner thighs from sexual activity with an infected partner.It is most common in children over face,trunk,arms and can affect adults with weak immune system. It causes painless round,skin colored,firm bumps over skin.Bumps and skin around them can sometimes get inflamed.If scratched they can get infected. MC usually gets better witgout treatment in 6 months to 2 years.Once they are gone person is no more infectious to others.It is possible to get reinfected. If lesions are spreading our doctor will discuss the treatment options like curattage , cryoptherapy and some topical medications.
Wash hands,avoid touching the bumps,don't share personal items and avoid sexual contact till bumps are treated and gone.
4) Cytomegalovirus (CMV)
CMV is a common virus.Once infected body retains the virus for life.Most people may not know they have the virus as it rarely causes health issues.CMV spreads from person to person through body fluids,such as blood,saliva,urine,semen and breast milk.If pregnant lady gets active CMV, virus can pass to baby.Also people with organ transplant it can be fatal due to weakened immune system.It can cause symptoms like fever,aching muscles,skin rash,sore throat and others serious symptoms. A CMV blood test will detect the infection.There is no cure, but there are medications to treat it.
5 ) Human immunodeficiency virus
HIV is a virus that affects cells which help body fight infectionmaking person more prone to other infections and diseases. It spreads by contact with body fluids of a person with HIV, most commonly by having unprotected sex or through sharing injection drug needles.From these fuilds virus enters the blood stream through mucous membrane found in vagina,rectum,mouth or tip of penis, through open cuts or directly by needle of syringe.Anal sex is more riskier than vaginal sex. Transmission to baby during pregnancy,birth or breast feeding has been reduced by HIV medicines. HIV can aslo spread by receiving blood transfusion,blood products or organ/tissue transplants that are contaminated by virus
If left untreated. HIV will lead to AIDS.This infection is for life and bo cure exists.However, effective treatments are available with antiretroviral therapy (ART). These medications reduce the amount of HIV in the blood ( called viral load) to very low levels that a standard lab can't detect it.People who take medicine as prescribed and with undetectable viral load live longer, healthy lives and will not transmit HIV to their HIV negative partners through sex.There are also medications used to prevent getting HIV infection from sex or injection drug use especially in high risk people ( Pre exposure prophylaxis PrEP) and also HIV medications taken within 72 hours of possible exposure to virus ( Post exposure prophylaxis PEP).AIDS is the late stage of HIV infection resulting from badly damaged immune system by the virus.Without medication people with AIDS survive about 3 years.Once fatal infection develop life expectancy can drop to one year without medications.HIV medicines will still help at this stage but people who start early benefit the most, making HIV testing very important.
6) Viral hepatitis
It is caused by various viral strains such as hepatitis A virus (HAV),hepatitis B virus (HAB) and hepatitis C virus (HAC).HAV causes short term liver infection which can be serious.It can be transmitted during sexual,activity and also through oral-anal contact.May cause symptoms like abdominal pain,nausea,vomiting and others.Usually infection gets better on its own unless infection is severe. HBV can cause immediate illness and life long infection leading to cirrhosis and liver failure.Spreads through sexual contact and also through contact with body fluids,shared contaminated needles used for injecting drugs and through tattooing and piercing.Pregnant women can transmit infection to their infants during delivery.Vaccinations and use of hepatitis B immunoglobulin at birth can prevent this transmission.People with chronic HBV infection need to take precautions not to transmit the virus to their sexual partners and sexual partners should receive vaccination if not already immune.Vaccination can prevent HAV and HBV.HCV causes serious infection of liver.Most people may not be initially aware they have infection as they do not develop symptoms.It is also transmitted through sharing needles and exposure to infected blood.Less commonly spread is sexual or from mother to baby during pregnancy and delivery.It can be treated. Newer medications seem to be effective.
Bacterial Sexually transmitted Infection (STIs)
1) Chlamydia
Caused by Chlanydia trachomatis.Can be transmitted by sexual contact with infected partner.It can be asymptomatic or cause fever,unusual discharge from penis or vagina.If left untreated can cause pelvic inflammatory diseases (PID) and infertility.It can be transmitted to fetus during pregnancy or delivery.It is treated with antibiotics.
2) Gonorrhea
Caused by Neisseria gonorrhoeae. Most common symptom is discharge form vagina or penis and painful or difficult urination. It can also cause PID and infertility like chlamydia. It can also infect mouth, throat, eyes, rectum and spread to blood and joints causing life threatening illness. Can be transmitted to fetus during pregnancy. Can be treated with antibiotics. Chlamydia and gonnorrhea often occur together, people with one infection are treated for both. Treatment should be provided promptly to avoid complications.
3) Syphilis
Caused by treponema pallidum.Spreads by sexual contact or through direct contact with syphilis sores.It can spread from infected mother to hwer fetus.The first sign (primary syphilis) of syphilis is a painless genital sore occuring most commonly over penis or in and around vagina.This is called chancre, which usually resolves on its own but the infections stays in body and without treatment progresses to secondary stage.Chancre also makes person more prone to get HIV infection and also increases the chances virus is passed to sexual partner. Secondary syphilis starts with development of skin rash,usually not itchy,may appear as red to brown spots over palms of hands and bottom of feet.Sometimes rash mimicks rash of other diseases.In warm, moist areas like mouth,underarms and grions large grey-white growths called condyloma lata may develop.Patients may have fever,sore throat,patchy hair loss,weight loss,headache and other symptoms.These symptoms may go away without treatment but disease progression continues to latent/hidden stage. In this stage there are no visible signs/symptoms of syphilis.Early latent syphilis is if infection occurs within past 12 months and when infection is more than 12 months it is called late latent syphilis and it can last for years.It can be of unknown duration if there is no evidence to confirm initial infection.Teritary syphilis is rare and develops in some untreated patients.It can manifest after 10-30 years after a person gets the infection.It can affect multiple organs and be fatal.Symptoms depend on the organ affected such as brain,nerves,eyes,heart and others.
Syphilis can be detected by blood test.Diagnosis of syphilis can be confirmed by non treponemal test (VDRL or RPR) and a treponemal test (TP-PA).Majority of patients with positive treponemal test will have it positive for the rest of their lives, regardless of treatment or disease activity.
Treatment of syphilis is with Penicillin G.Person exposed through sexual contact with a person diagnosed with syphilis should get evaluated clinically and serologically.
4) Bacterial Vaginosis
It occurs when the problematic bacteria which are usually present in small number, increase significantly and replace the normal vaginal bacteria. Most likely if a women douches frequently or has new or multiple sexual partners. It causes thin, milky discharge with fishy odor. Treatment is with antibiotics like metronidazole or clindamycin.
Parasitic Infections
Trichomonias
Caused by single cell parasite Trichomonas vaginalis.Common in young,sexually active women.Can be transmitted by physical contact between the genital areas.Can cause painful burning urination in men and women, as well as vaginal discharge,genital soreness and itching in women. Treated with single dose of an antibiotic.Sexual partner should be treated to prevent reinfection
Pubic lice and scabies
Caused by carb louse, presents with severe itching. Daignosed by observing the adult lice or nits in the areas that bear coarse hair. Scabies us caused by itch mite sarcoptic scabies. It cause very itchy popular or vesicular rash and linear burrows seen in finger webs and genital area. Pyrethin applied as creams or lotions are used for treating both conditions.
Oral-anal and oral-genital sexual practices predispose male homosexuals to infections with enteric pathogens, most common being amebiasis and giardiasis.
