STIs

Sexually transmitted diseases (STDs) are diseases that are mainly passed from one person to another during sexual contact.

The term sexually transmitted infection (STI) is increasingly being used instead of STD, because some sexually transmitted infections, such as chlamydia, do not cause any pain or unpleasant symptoms such as blisters. Many people may never know that they have been infected unless they are tested in a clinic.     

1. Chlamydia is caused by the bacterium chlamydia trachomatis. This bacteria can infect the cervix in women and the urethra and rectum in both men and women. Occasionally chlamydia can also affect other parts of the body, including the throat and eyes.     

         
Chlamydia symptoms usually appear between 1 and 3 weeks after exposure but may not emerge until much later. Chlamydia is known as the ‘silent’ disease as in many people it produces no symptoms. It is estimated that 70-75% of women infected with chlamydia are asymptomatic (have no symptoms) and a significant proportion of men also have no symptoms. Those who do have symptoms of chlamydia may experience:

Women

• An increase in vaginal discharge caused by an inflamed cervix;

• the need to urinate more frequently, or pain whilst passing urine;

• pain during sexual intercourse or bleeding after sex;

• lower abdominal pains;

• irregular menstrual bleeding.

Men

• A white/cloudy and watery discharge from the penis that may stain underwear;

• a burning sensation and/or pain when passing urine;

• pain and swelling in the testicles.         

Treatment:
The treatment of chlamydia is simple and effective once the infection has been diagnosed. It consists of a short course of antibiotic tablets, which if taken correctly, can be more than 95 percent effective.

• HSV-1 is acquired orally, causing cold sores.

• HSV-2 is acquired during sexual contact and affects the genital area.

2. Genital herpes is caused by infection with herpes simplex virus (HSV). There are two types of HSV, HSV-1 and HSV-2, both of which belong to a wider group called Herpesviridae. Another well-known virus in this group is varicella zoster virus, which causes chicken-pox and shingles.
In general:

Once the initial outbreak of herpes is over, the virus hides away in the nerve fibres adjacent to the infection site, where it remains dormant, causing no symptoms. It is possible for the dormant virus to be 'reactivated' in some people, in which case it travels back down the nerve to the skin surface.


Symptom: If symptoms do occur, they will usually appear 2 to 7 days after exposure and last 2 to 4 weeks. Both men and women may have one or more symptoms, including:

• Itching or tingling sensations in the genital or anal 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.

Treatment:   There is no cure for the herpes simplex 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 to reduce the severity of an outbreak. The antiviral tablets work by preventing the herpes simplex virus from multiplying.
Recurrences of genital herpes vary from person to person in frequency. Some will never experience an outbreak again, whilst others may have milder recurrences more than 6 times a year. Because these recurrent infections are milder, they often do not require treatment.

3.   Genital warts, caused by some types of HPV (human papillomavirus), can appear on the skin anywhere in the genital area as white or flesh-coloured, smooth, small bumps, or larger, fleshy, cauliflower-like lumps . There are more than 100 different subtypes of HPV, and around 30 of them specifically affect the genitals. Other HPV subtypes cause warts to grow on different parts of the body, such as the hands.
Not everyone infected with HPV will develop genital warts. Some people will be infected with a strain that does not produce warts, or they will remain asymptomatic (i.e. no warts will appear), even though the virus is present in the skin or mucous membranes around the genital area, or on the cervix in women. Those who do go on to develop genital warts will usually notice them 1 to 3 months after initial infection.

Symptom: If symptoms do appear then the infected person may notice pinkish/white small lumps or larger cauliflower-shaped lumps on the genital area. Genital warts can appear on or around the penis, the scrotum, the thighs or the anus. In women genital warts can develop around the vulva or inside the vagina and on the cervix. If a woman has warts on her cervix, this may cause slight bleeding or, very rarely, an unusual coloured vaginal discharge. Warts may occur singly or in groups. The warts may itch, but they are usually painless. Sometimes genital warts can be difficult to spot. In severe cases, it is possible for genital warts to spread from the genitals to the area around the anus, even if anal intercourse has not occurred.

Treatment:   There is no treatment that can completely eliminate genital warts once a person has been infected. Often outbreaks of genital warts will become less frequent over time, until the body naturally clears the virus and the warts disappear of their own accord. However, in some people the infection may linger.
A doctor can give patients various treatments to clear genital warts, but they may reappear even after treatment. Genital warts are caused by a virus, not a bacterium, so antibiotics will not get rid of them.

4. Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrheoae. Gonorrhea affects both men and women and can infect the cervix, urethra, rectum, anus and throat. Gonorrhea is one of the most common sexually transmitted diseases and the global gonorrhea statistics show that an estimated 62 million cases of gonorrhea occur each year, affecting more women than men. Gonorrhea is easily curable but if left untreated it can cause serious health problems such as pelvic inflammatory disease (PID), which can lead to abdominal pain and ectopic pregnancy in women. Untreated, gonorrhea can also lead to infertility, meningitis (bacterial infection of the membranes covering the brain and spinal cord) and septicaemia (commonly referred to as blood poisoning)

Symptom: Symptoms of gonorrhea infection may appear 1 to 14 days after exposure, although it is possible to be infected with gonorrhea and have no symptoms. Men are far more likely to notice symptoms as they are more apparent. It is estimated that nearly half of the women who become infected with gonorrhea experience no symptoms, or have non-specific symptoms such as a bladder infection.
Gonorrhea symptoms can include:

Women

• A change in vaginal discharge; it may appear in abundance, change to a yellow or greenish colour, and develop a strong smell.

• A burning sensation or pain whilst passing urine.

• Irritation and/or discharge from the anus.

Men

• A white or yellow discharge from the penis.

• A burning sensation or pain whilst passing urine.

• Irritation and/or discharge from the anus.         

Treatment: The patient will be given an antibiotic in tablet, liquid or injection form.

5. HIV stands for: Human Immunodeficiency Virus

HIV is a virus. Viruses such as HIV cannot grow or reproduce on their own, they need to infect the cells of a living organism in order to replicate (make new copies of themselves). The human immune system usually finds and kills viruses fairly quickly, but HIV attacks the immune system itself - the very thing that would normally get rid of a virus.

Often people who are infected with HIV don't have any symptoms at all. It is important to remember that a person who has HIV can pass on the virus immediately after becoming infected, even if they feel healthy. It's not possible to tell just by looking if someone has been infected with HIV.

With around 2.7 million people becoming infected with HIV in 2010, there are now an estimated 34 million people around the world who are living with HIV, including millions who have developed AIDS.
The condition that is referred to as AIDS is caused by HIV damaging the immune system cells until the immune system can no longer fight off other infections that it would usually be able to prevent.

Symptom: Some people experience a flu-like illness, develop a rash, or get swollen glands for a brief period soon after they become infected with HIV. However, these are also common symptoms of other less serious illnesses, and do not necessarily mean that a person has HIV. The only way to know for certain if someone is infected with HIV is for them to be tested.     

Treatment: Antiretroviral drugs keep the levels of HIV in the body at a low level, so that the immune system is able to recover and work effectively. Antiretroviral drugs enable many HIV positive people to live long and healthy lives.

Starting antiretroviral treatment for HIV infection involves commitment - drugs have to be taken every day, and for the rest of a person's life. Adhering to HIV treatment is important, particularly because not doing so increases the risk of drug resistance. Side effects to the HIV drugs can make adherence difficult, and are sometimes very severe. There are ways of reducing the impact of these side effects, but sometimes it is necessary to change to an alternative HIV treatment regime.     

6. 'Hepatitis' refers to viral infections that cause inflammation of the liver. Hepatitis A, B and C are the most common types. Each have different causes and symptoms.

a. Hepatitis A is the most common of the seven known types of viral hepatitis. Infection with the hepatitis A virus leads to inflammation of the liver, but complications are rarely serious.
 It is possible to experience mild or no symptoms whatsoever, but even if this is the case the person’s faeces will still be infectious to others. Many people who become infected with HAV will have symptoms that include:

• A short, mild, flu-like illness;

• nausea, vomiting and diarrhoea;

• loss of appetite;

• weight loss;

• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);

• itchy skin;

• abdominal pain.

Patients should get plenty of rest and eat a nutritious diet. They should also ensure they do not spread HAV by washing their hands after using the toilet and before preparing food. Patients with more severe symptoms may be monitored in hospital for a short period.
There is no specific treatment for HAV and most people fight off the virus naturally, returning to full health within a couple of months. The doctor will advise avoiding alcohol and fatty foods as these can be hard for the liver to process and may exacerbate the inflammation.

b.  Hepatitis B is similar to hepatitis A in its symptoms, but is more likely to cause chronic long-term illness and permanent damage to the liver if not treated.

  Many people who become infected with HBV experience mild symptoms or no symptoms at all, but they may still carry the infectious virus and pass it on to others. When symptoms do appear they are similar to those of hepatitis A and may include:

• A short, mild, flu-like illness;

• nausea, vomiting and diarrhoea;

• loss of appetite;

• weight loss;

• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);

• itchy skin.

Antiviral medication is given as treatment to those with chronic symptoms to help prevent further liver damage. These medications may be injected or given in pill form. Examples are Interferon Alpha, Lamivudine and Baraclude. Treatment usually lasts 6 months, during which time the patient will be carefully monitored.
Regardless of whether the infection is producing symptoms or not, the patient will be advised to avoid alcohol, get plenty of rest and maintain a healthy diet.

c. Hepatitis C, like other forms of hepatitis, causes inflammation of the liver. The hepatitis C virus is transferred primarily through blood, and is more persistent than hepatitis A or B.
 Symptoms may include:

• A short, mild, flu-like illness;

• nausea and vomiting;

• diarrhoea;

• loss of appetite;

• weight loss;

• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces);

• itchy skin.

Treatment combines the antiviral drugs interferon and ribavirin. Although treatment has improved in recent years, the success rates vary depending on which genotype the patient has and how long they have had hepatitis C. In 2011, the FDA approved a new drug called Victrelis (for the treatment of the genotype 1 strain of hepatitis C). When taken alongside existing drugs, Victrelis cured more than 60 percent of patients in clinical trials compared to between 20-40 percent of patients when existing drugs were taken alone.Unlike other drugs for hepatitis C, Victrelis is a protease inhibitor, similar to those used to treat HIV. Adherence to this drug is essential to prevent drug resistance.          

7. Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidium. The infection is usually sexually transmitted, in which case it is called venereal syphilis. It may also be passed from an infected mother to her unborn child, in which case it is known as congenital syphilis.  
The symptoms of syphilis are the same in men and women. They can be mild and difficult to recognise or distinguish from other STDs. Symptoms may take up to 3 months to appear after initial infection. Syphilis is a slowly progressing disease that has several stages. The primary and secondary stages of syphilis are very infectious.

Primary stage of syphilis
One or more painless ulcers (know as chancres) appear at the place where the syphilis bacteria entered the body. On average, this will be 21 days after sexual contact with an infected person. Chancres may be difficult to notice and are highly infectious. The usual locations for chancres are:

• On the vulva (outside the vagina) or on the cervix (neck of the womb) in women.

• On the penis in men.

• Around the anus and mouth (both sexes).     

Treatment:  Treatment for syphilis usually consists of a two-week course of intramuscular penicillin injections or, in some cases, antibiotic tablets or capsules. If the patient has had syphilis for less than a year then fewer doses will be needed. If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, then the doctor should be informed so that alternative medication can be prescribed. It is important that the full course of treatment is completed. If treatment is interrupted then it may be necessary to start again from the beginning.
         
 If a patient is allergic to any antibiotics, or if there is a possibility they may be pregnant, it is important that the doctor is informed as this may affect which antibiotics are prescribed. Treatment must not be interrupted once a course of antibiotics has been started, otherwise it may be necessary to start again from the beginning.