Medicine for Africa - Medical Information Service

EXUALLY TRANSMITTED DISEASES

Definition:
 
Sexually transmitted diseases - STDs - are, as the name says, a family of diseases which are, most of the time, transmitted during sexual contacts between two people. 'Sexual contact' does not only imply sexual intercourse, it also includes any close bodily contact, that is oral as well as anal contact and intercourse, and often just a kiss. The offending agents are either a bacterium or a virus. The most important bacterial diseases include Gonorrhea (caused by the bacterium Neisseria gonorrhea), Chlamydia (caused by the bacterium Chlamydia trachomatis) and the recently reemerging Syphilis (caused by the spirochaete Treponema pallidum). The most prevalent viral diseases are the genital Herpes (caused by Herpes Simplex Virus Type 2, HSV-2, but also, less often, by HSV Type-1 which most commonly causes fever blisters or cold sores, usually on the lips), genital wart infections caused by certain subtypes of the Human Papilloma Virus, HPV and the AIDS causing Human Immunodeficiency Virus, HIV. Certain types of HPV as well as HIV have the potential to cause cancers not only in the genital region but also in many other organs. The Hepatitis causing Hepatitis B Virus is a virus that causes more deaths per year than HIV; it can also be transmitted through intimate sexual contacts and is therefore another potential risk factor which has to be considered. Other infections include the fungal organism Candida albicans which is often associated with the rather frequently occurring Trichomonas vaginalis, both of which can cause acute, purulent (pus containing) infections of the cervix (cervicitis) and of the vagina (vaginitis). Pregnant women can infect their baby either while still bearing it in the womb (uterus) or during delivery. Infection with the syphilis causing agent can lead to severe mental and physical deformations in the unborn child, even to its death. The Human Immunodeficiency Virus (HIV) can also be transmitted to the unborn child, with often severe if not deadly consequences; it can also be transmitted through the mother's milk during breast-feeding of the baby. Hepatitis B and Herpes Simplex Virus as well as Gonorrhea and Chlamydia can be transmitted from mother to baby during delivery, when the baby passes through the birth canal.
 

Symptoms:
 
Depending on the offending organism, there may appear to be no initial symptoms as the symptoms can be so mild that they are often not noticed; or they can be characteristic of the disease and bothersome to the extent that they may cause pain as well as pain and discomfort during intercourse (=dyspareunia). For a specific description of symptoms, please refer to the description of the particular disease.
 

Diagnosis:
 
Diagnosis of sexually transmitted diseases can be established either by examining the discharge under the microscope (Gonorrhea, Trichomonas vaginalis), by examining it under a special microscope (Syphilis), by culture (Gonorrhea, Chlamydia, Herpes genitalis, Trichomonas vaginalis, Candida albicans), by blood tests (Syphilis, Human Immunodeficiency virus, Hepatitis B virus), by biopsy (Human Papillomavirus) or by special DNA tests (Human Immunodeficiency virus, Human Papillomavirus, Hepatitis B virus).

Recently, so-called Rapid Diagnostic Tests have also become available for a number of sexually transmitted diseases. These tests are rapid immunochromatographic assays, performed on uncut cards, with dipsticks, or on strips or cassettes, and therefore also called 'dry tests'. Tests are available for chlamydia, gonorrhea, HIV, syphilis, as well as hepatatis B and hepatitis C, and additional tests are constantly being developed. Usually only one or two drops of whole blood or plasma are required, or alternatively a urine sample for some tests. Dry tests are easy to perform and provide results within less than one minute. Because of their easy handling and reading of the results, they can be performed by nursing staff and even less well trained medical personnel. This makes these tests ideally suited for less developed countries where physicians and well trained medical personnel are often a rarity.
 

Therapy:
 
Antibiotic treatment either by injection or orally (by mouth) is available for Gonorrhea, Chlamydia, Syphilis and Trichomonas vaginalis. There is a vaccine for Hepatitis B that is effective if administered before the infection occurs. Two vaccines for Human Papillomavirus are available since 2006 and 2007, respectively, which are said to provide some protective shield for women against some cancer- and wart-causing HPV types for a certain period of time; however, these vaccines are only approved for women, men can still be HPV carriers and transmit the virus to their female sexual partners, even without being aware of their own infection. Treatment regimes against the Human Immunodeficiency Virus - HIV - have shown impressive results over the last few years - are, however, not absolutely effective as yet. Recently available chemotherapeutic drugs for the treatment of the Herpes genitalis virus include acyclovir, valacyclovir and famciclovir - all of which show some relieving effects and a certain decrease of outbreaks, but none of them has shown to have a curative effect.
 

Prevention:
 
Prevention of all sexually transmitted diseases lies primarily in avoiding and eliminating sexual contact with an infected person. Since one cannot always be assured of the sexual hygiene of a partner, prevention is best achieved, with a relatively high degree of success, by using a latex condom. Non-latex condoms are not as certain to prevent contact with the infected person's organisms, since some organisms can penetrate non-latex materials and infect the partner. In addition to the condoms used by men, there are now also condoms for women who can take the initiative if the man does not. A condom should never be used more than once, because contamination with or leaking of semen occurs frequently upon repeated usage of any kind of condom. If a person knows that he/she is infected by one of these diseases, he/she should take responsibility and abstain from sexual contacts with anybody during the time of contagion.

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DISCLAIMER: The above article is only intended to provide general information regarding this topic. It is not intended and does NOT replace the need to consult a medical or other professional person, if you have or believe to have this disease/disorder. While the article was researched, written and reviewed by medical professionals, and Medicine for Africa, its staff and publisher made every effort to assure accuracy and correctness, it does not claim to be complete, correct or to reflect the very latest stand of medical/scientific knowledge in the disease’s/syndrome’s pathology, diagnostic and/or therapeutic development. Medicine for Africa, its founder, management, staff, writers, reviewers or publishers may NOT be made responsible or legally bound to any information provided above, and cannot be held liable to any conclusions or decisions the reader may draw after reading this article. The reader is explicitly advised to consult a licensed physician and to present his/her specific situation before making any health related decisions.