Sexually Transmitted Diseases
STDs are diseases that you can get after having sex with somebody who has the infection. They include:
- Human papillomavirus (HPV)
- Chlamydia
- Genital herpes
- HIV/AIDS
- Viral hepatitis
- Gonorrhea
- Syphilis
- Pelvic inflammatory disease (PID)
Many of the STDs have no symptoms, but they can be harmful to somebody’s health and can be passed to others. Some symptoms might include vaginal or penile discharge, pelvic pain and ulcers or irritations on or around the genitals. STDs affect both men and women, but in many cases the health problems they cause can be more severe for women. Some STDs cause fertility problems (difficulty getting pregnant) or might result in the baby becoming unwell if the infection happens during pregnancy.
The more common STDs, such as chlamydia and gonorrhea are curable by a course of antibiotics. Others like hepatitis B, HPV, HIV and herpes are treatable but not curable. In 2008 it is estimated that about 300,000,000 women have a Human Papillomavirus (HPV) and 530,000,000 have the genital herpes virus.
There is often stigma and shame associated with STDs, which makes it more difficult for the infected people to seek diagnosis and treatment and also to inform sexual partners.
Most of the time, people do not know that they are infected with an STD until they or a partner is tested or symptoms occur. Sometimes symptoms appear a long time after the infection. In the meantime, the disease can be passed to others. If some STDs are left untreated it may lead to infertility or even death.
HPV is the most common STD. It is so common that most men and women who are sexually active have it at some point. HPV is transmitted from oral, vaginal and anal sex. There are many different types of HPV and only a few cause health problems. Usually most people do not have any symptoms and never develop health problems associated with it. However, some specific strains of HPV cause genital warts while other specific strains can lead, in some people, to certain cancers developing (like cervical cancer in women or penile/anal cancer in men). In both sexes HPV can cause cancer in the throat. Anyone who is sexually active can have HPV, even if they had sex with only one person.
Recently, vaccines have been developed to protect men and women from HPV. The vaccines cover the strains of HPV that cause genital warts and cervical cancer. Currently in the UK, schoolchildren are offered the vaccination at age 12, in order to reduce the chance of them being infected by HPV and decrease their chance of getting cervical cancer. The vaccine does not work if it given after somebody has become sexually active, because HPV is so widespread. It is also of no benefit to someone who has been diagnosed with cervical cancer.
There is no treatment or cure for HPV. Genital warts can be treated by using topical creams (most common) or by freezing or heat to remove them. Once the warts have gone, a person still carries the HPV virus, and warts can reappear at any time, especially during times of low immunity. Genital warts can be harder to treat during pregnancy, but do not stop a woman from having a vaginal delivery as the baby is extremely unlikely to become infected.
The strains of HPV that can lead to cervical cancer do not need treatment with creams. Most people clear these strains of HPV by themselves. Because these strains of HPV do not cause any symptoms visible to the naked eye, it is very important that you attend for regular cervical smears, because early changes on the neck of the womb (cervix) which are pre-cancerous are picked up this way, and can be treated early (usually with heat treatment) before any cancer develops.
Chlamydia is a common STI that can sometimes cause permanent damage to a woman’s reproductive system, making her infertile (unable to become pregnant naturally). Chlamydia also can cause an ectopic pregnancy, which is a pregnancy that forms outside the womb and this can be dangerous because it can cause extremely heavy internal bleeding. Anyone can get chlamydia through unprotected vaginal, anal or oral sex. A pregnant woman can pass chlamydia to the baby when giving birth. This can cause eye infections or pneumonia (a severe chest infection) to the baby.
Most people with chlamydia have no symptoms or they appear many weeks after having getting the infection. Symptoms might include abnormal vaginal discharge for women or discharge from the penis and a burning sensation when passing urine in both sexes.
Chlamydia is easily treated with a course of antibiotics.
Genital Herpes
Genital herpes is common. In the USA, one in six people from 14 to 49 years old have herpes. Herpes can be transmitted by oral, vaginal or anal sex with somebody who has the infection. Herpes causes fluid-filled blisters or ulcers and can be transmitted by somebody who does not have a visible sore or might not know that they are infected. Herpes symptoms can occur in the genital areas protected by a condom, however blisters might occur in areas that are not covered, so a condom might not fully protect somebody from getting herpes. Many people with herpes have no symptoms or very mild ones. The blisters appear on or around the genitals, the rectum or the mouth. Recurrent outbreaks are common especially during the first year after the infection. Oral herpes causes cold sores, which can infect another person’s genitals during oral sex.
If a pregnant woman is exposed to or diagnosed with herpes, she has to talk to her doctor. Herpes infection can be transmitted to the baby which can lead to a very serious complication for the baby (neonatal herpes). If a pregnant woman has genital herpes diagnosed before pregnancy, it is very unlikely to lead to any infection in the baby, because the baby is protected by the mother’s immunity. If the mother has frequent outbreaks of herpes during pregnancy, anti-viral medication can be given to reduce the length and severity of the outbreaks. However, if genital herpes occurs for the first time within 6 weeks of giving birth, the mother will not have developed any protective immunity to pass on to the baby, in which case, delivery by caesarean section will be offered.
Treatment depends on whether it is your first episode of herpes (primary infection) or a recurrent outbreak. For a primary infection, you can take antiviral tablets which stops the virus multiplying but does not eliminate the virus from your body. For a recurrent outbreak, you may be given antiviral tables again (and if severe you may need to take these daily long term), and your doctor will tell you ways to ease the symptoms, such as keeping the infected area clean, using an ice-pack, avoid wearing tight clothes and drinking plenty of fluids. During an outbreak of herpes, it is important to not have oral/vaginal/anal sex, even if you are using a condom, because the risk of passing on herpes is higher. There is still a risk of passing on herpes if you have sex with a condom when you do not have an outbreak, and for this reason, it is important to tell a new sexual partner that you have previously had herpes.
HIV stands for the human immunodeficiency virus. The virus attacks a type of white blood cell called CD4 T cells resulting in a weakening of the immune system so you are unable to fight infections and disease. It is carried through bodily fluids, such as semen, anal or vaginal fluids, breast milk, and blood. It is transmitted through sexual intercourse without a condom, sharing needles for people who inject drugs and from an HIV positive mother to her child during pregnancy, childbirth or breast-feeding. The majority of people in the Western world get HIV through unprotected sexual intercourse. There is no cure but there are medications which allow a HIV positive person to lead a normal and active life.
AIDS (acquired immunodeficiency syndrome)(late stage HIV) is the final stages of HIV infection which causes death but with medication, the majority of HIV positive people will not get to this stage. HIV and AIDS are not the same thing and people who get HIV do not necessarily get AIDS. AIDS is unlikely to develop in people with HIV if treatment is early. The earlier that HIV is detected, the higher the chance that it can be successfully controlled with medication.
The symptoms for the primary infection of HIV are similar to flu:
- Sore throat
- High temperature
- Blotchy red rash
- Nausea
- Diarrhea
- Swollen glands
- Headache
- Tiredness
- General aches and pains
There may not be any further symptoms for several years. As HIV develops further symptoms include:
- Swollen lymph glands
- Night sweats
- Repeated mouth ulcers
- Repeated herpes or shingles infections
- Skin condition called seborrhoeic dermatitis, caused by a yeast.
- Diarrhea
- Skin rashes
- Tiredness
- Loss of weight
The only way to diagnose HIV is a blood test. Rapid testing, giving a result within 30 minutes, is offered in some family planning / sexual health clinics, but a blood test will still need to be sent to the laboratory to confirm it. If you are found to have HIV, your doctor may do a test to measure the levels of CD4 cells (white cells) and the amount of virus in your blood. These tests are usually repeated to determine how the disease is progressing.
HIV cannot be cured but can be treated using antiretroviral therapy (ART) and if this is started early, very few people go on to develop AIDS. ART slows down or almost stops the production of the virus. Most people take a combination of ART drugs to attack the virus from several different angles.
Links
- https://www.patient.co.uk/health/hiv-and-aids
- https://www.nhs.uk/Conditions/HIV/Pages/Introduction.aspx
- https://www.tht.org.uk/our-charity/Get-help-now/Service-finder
Hepatitis is a group of infections that affect the human liver. The most common types are A, B and C. Hepatitis A is more often transmitted by food that has been handled by an affected worker and is not considered an STI. Hepatitis B and C can be transmitted through sex; B more than C. Apart from sex, infection with hepatitis B and C could be the result of getting a tattoo or piercing, sharing drugs or needles, or a mother to child transmission during pregnancy. Both hepatitis B and C might become “chronic”, which means that the infection never cures and might worsen over time. Hepatitis affects the human liver, which is one of the most important organs of the body and can cause serious illness and death.
Over 300,000 people are infected with hepatitis B worldwide. One third of cases of hepatitis B happen after sex. 130 – 150,000 people globally have chronic hepatitis C infection and 315,000 to 500.000 people will die from hepatitis C related diseases.
There is an effective vaccine for hepatitis B; however, there is no effective vaccine for hepatitis C, although there is a lot of research in this area going on.
Most people with hepatitis B recover after a few months. Your doctor may refer you to a hepatologist (a liver specialist). If you go on to develop chronic hepatitis you may need to take medication to prevent liver damage.
Most cases of hepatitis C are not treated as patients do not have symptoms or think they have flu. If they do have symptoms, they can be treated with a medication called pegylated interferon. Chronic hepatitis C can be treated with combined therapy which involves taking pegylated interferon and an antiviral drug, ribavirin.
In pregnancy, hepatitis B and C infection can make the mother more likely to develop severe itching in pregnancy, called obstetric cholestasis. This condition can require delivery of the baby 2-3 weeks before the due date. Vaginal delivery is still possible, but you would need to discuss this with a doctor specializing in the care of pregnant women.
Gonorrhea can affect both men and women and is very common among young people from 15 to 24 years. Symptoms include burning when urinating and penile or vaginal discharge, though some men and women will have no symptoms. If a woman is pregnant and has gonorrhea, she can transmit the infection to the baby during childbirth, which can cause serious health problems. Treating gonorrhea as soon as possible is very important, especially during pregnancy. Untreated gonorrhea can cause pelvic inflammatory disease, which can lead to infertility and long-term pelvic pain. In men gonorrhea can cause chronic pain in the testicles. Sometimes it can lead to infertility. Untreated gonorrhea can sometimes be very serious and life-threatening, however can be cured with the right medication.
Gonorrhea is treated with a course of antibiotics. There are some strains of gonorrhea that are antibiotic resistant, so after being treated for gonorrhea, you will need to be re-tested to make sure that the infection has gone.
Syphilis is an STD that can lead to very serious complications, if untreated. Syphilis causes painless sores or seemingly harmless bumps that cause mild symptoms or no symptoms at all. The sores can appear on the vagina, penis, mouth or around the anus. Syphilis also can be transmitted from a mother to her unborn baby.
If a woman is pregnant, having syphilis can lead to a baby with a low birth weight and also increase the chances of having a premature or a stillborn baby (a baby born dead). During pregnancy, women should be tested and receive immediate treatment if the result is positive.
Serious complications of syphilis (if left untreated) include paralysis (inability to move parts of the body), blindness and dementia. In the late stage of syphilis the disease can damage the internal organs, resulting to death.
Primary and secondary syphilis can be successfully treated with a single dose of penicillin.
It is recommended that couples use a condom for all sex acts from start to finish. You should be tested regularly (once a year) for STDs. You can arrange this through your GP or a local family planning or sexual health clinic. When starting a new relationship, it is sensible for both you and your partner to get checked for STDs before you start having sex.
The way to prevent STDs is
- safer sex practices (use condoms)
- limiting the number of sexual partners
- being in a monogamous relationship
- vaccinations for some infections (such hepatitis B or certain types of HPV)
Mutual monogamy (you have sexual contact with each other only) protects against STDs only if you are both STD free.
Links