Sexually Transmitted Diseases (STDs)

Some 56 million Americans have an STD other than AIDS and many more are infected each year. The causative bacterial, viral, or parasitic agents are spread primarily by sexual contact, but may also be spread by the use of infected needles. Some STDs are chronic infections, but many can be cured. Quick diagnosis and treatment are often the keys to cure.

The only 100% prevention is abstinence. Maintaining faithful monogamous relations with one’s spouse is effective, provided both partners are free of STDs. Safe sex (use of a condom) with a monogamous partner is the next best protection against STDs. Always remember that prevention is better than therapy.

Bacterial:

Gonorrhea
Gonorrhea (“clap”), a common disease worldwide, is caused by the bacteria Neisseria gonorrhoeae. There are over 650,000 new cases in the U.S. each year. 82% of cases of gonorrhea occur in teenagers and young adults, and females are twice as likely to become infected after one act of intercourse with an infected male as males are after one act of intercourse with an infected female.

Symptoms occur within a few days of exposure and include urethral or vaginal discharge and frequent and painful urination. Bacterial culture confirms diagnosis. Gonorrhea requires antibiotic to resolve, so see your doctor for appropriate diagnosis and treatment. Penicillin used to be the drug of choice but many strains have become resistant. Sexual partners should be treated and intercourse avoided until the infection is cured. Untreated gonorrhea can damage the heart or cause a form of arthritis.

Chlamydia
Chlamydia is caused by the bacteria Chlamydia trachomatis. Infection with chlamydia is often concurrent with gonorrheal infections. Chlamydia is the most frequently reported and fastest spreading STD in the United States. More than 3 million men and women in the U.S. are diagnosed each year.

Males typically experience painful and frequent urination and a urethral discharge 7-21 days after exposure. Females often do not have any symptoms and the infection is discovered in conjunction with a gonorrheal infection. Chlamydia requires antibiotics to resolve. A physician should be consulted for appropriate diagnosis and treatment. Sexual partners should be treated and intercourse avoided until the infection is cured.

Pelvic inflammatory disease
Pelvic inflammatory disease is a complication of gonorrhea or chlamydia. It is an infection that generally involves the uterus, fallopian tubes, or pelvic area. Symptoms vary but usually include abdominal pain and tenderness, fever and vaginal discharge.

This is a very serious infection and requires antibiotics to treat and may also require hospitalization. A doctor should be consulted for appropriate diagnosis and treatment. If untreated or inadequately treated, it may result in infertility and/or sterility.

Syphilis

There are more than 70,000 new cases of syphilis each year in the U.S. caused by the spirochete bacteria Treponema pallidum. The risk of infection with syphilis after a single exposure is ~50%. Syphilis has four clinical stages — primary, secondary, tertiary and congenital (passed from mother to baby). The primary stage occurs between 10 and 90 days after infection and causes an ulcer at the site of infection. The primary stage is highly infectious. Secondary syphilis occurs about 6 weeks after the primary stage and causes a rash all over the body, fever headache, loss of appetite and joint pain. The tertiary form of syphilis has many different forms and may present without any external signs or symptoms. If untreated, the third stage, can affect the heart, brain or other vital organs.

Syphilis is usually diagnosed by a blood test, The disease can cause many problems in all areas of the body including the heart, brain, skin, bone, upper respiratory tract and liver. Syphilis requires antibiotics to resolve. Consult a doctor for appropriate diagnosis and treatment.

Bacterial vaginosis
This is a vaginal bacterial infection caused by several bacteria that are normally harmless. Signs and symptoms include malodorous vaginal discharge, but you may or may not be symptomatic. This infection requires antibiotics to treat. Consult a doctor for appropriate diagnosis and treatment.

Protozoal:

Trichomoniasis
Trichomoniasis is a readily curable infection caused by the protozoa Trichomonas vaginalis. Common signs and symptoms include a mild to severe malodorous vaginal discharge, intense itching and painful urination; males may not have any symptoms.

Trichomoniasis requires antibiotic therapy, so see your doctor for appropriate diagnosis and treatment. The drug of choice is metronidazole (Flagyl®). It is very effective but may produce several side effects. Both partners should be treated.

Viral:

Genital Herpes
Genital Herpes Information

Human Papilloma Virus (HPV)

Some 5.5 million new cases of HPV infection are reported each year in the U.S.. Twenty million Americans, men and women alike, are infected with this virus. HPV is a double stranded DNA virus that is the causative agent of genital warts. There are more than 65 types of the virus. Infection with specific types of HPV can lead to neoplastic changes in genital epithelia. The lesions are usually papules or plaques that may be hard to see. In women, the infection may be intravaginal or cervical. If the cervix becomes affected, cervical cancer can result. Because of the contagious and possibly neoplastic nature of the infection, treatment is necessary.

Destructive treatment includes removal of the warts by the use of lasers, freezing or burning. Some medications may be applied by a physician (podophyllin, trichloracetic acid) or the patient with proper training (podofilox, imiquimod), but there are some side effects. These include pain, burning, inflammation, skin erosion, scarring, erythema and the medications should not be used during pregnancy. There is no cure and the warts may recur at any time. Patients with genital warts are also at risk for other STDs.

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)
HIV is the virus that causes AIDS. Some 900,000 Americans are estimated to be infected with HIV with 45,000 being added each year. The most common risk factor for this disease is homosexual relations (male-to-male). In addition, the virus can be spread by heterosexual relations or by blood transfusions, although these are less common. Thus HIV infections are preventable.

HIV is a virus that affects the human immune system, specifically T-helper cells that have a CD4+ marker on their surface. These T-helper cells normally function to protect against infection.

When HIV enters one of these cells, it is protected by a capsule. This capsule breaks open and a single strand of RNA is released along with an enzyme called reverse transcriptase. Reverse transcriptase than converts the single strand of RNA into a double strand of DNA. This DNA is then incorporated into the normal cellular DNA. The rest of the immune system does not respond because the virus is inside the cell. The HIV virus has taken over the cellular machinery and forcing the immune system to make millions of copies of the HIV virus. Infected persons frequently succumb to opportunistic infections.

Clinically, HIV presents with flu-like symptoms, and then the symptoms go into dormancy but the virus continues to replicate. As the amount of HIV virus in the body increases, the immune system is further impaired and opportunistic infections become more common. Some of the most common infections include thrush (fungal infection), Kaposi’s Sarcoma (cancer), pneumonia, recurrent herpes infections, and in later stages severe bacterial, protozoal or fungal blood stream infections.

There are many medications available to help slow the progression of HIV, however no cure is currently known. If you have questions and also for appropriate diagnosis and treatment, talk to a doctor.