Sexually transmitted infections (STI) or sexually transmitted diseases (STD) or Venereal diseases (VD) are a group of diseases that are passed from one person to another through sexual contact (vaginal, anal or oral sex). This is a major public health problem everywhere in the world due to the high incidences recorded every day. WHO estimates that more than 1 million new cases of STDs are acquired each day worldwide and people aged 15 – 24 make up about half of all the new cases.
The genital areas are generally warm and moist which provide the ideal condition for growth of yeasts, bacteria and viruses. Micro organisms that exist on the skin or mucus membranes of the male and female genital organs can be sexually transmitted including microbes in the semen, vaginal fluids and blood. These microbes are spread more easily through unprotected sex.
Some STDs can also be transmitted through other media apart from sexual intercourse. Infected unsterilized sharp needles, blood transfusion, mother to child transmission at birth or breastfeeding are other possible means of acquiring STDs. An infection like meningitis can be transmitted through sexual contact but it is not classified as an STD.
PATHOGENS THAT CAUSE SEXUALLY TRANSMITTED DISEASES
• Neisseria Gonorrhoea : Gonorrhoea
• Gardnerella vaginalis : urethritis, vaginitis
• Hemophilis ducreyi : chanchroid
• Chlamydia granulomatis : donovaniasis
• Traponema paľlidum : syphilis
• Chlamydia trachomatis : non gonococcal urethritis, lymphogranuloma venerum
• Mycoplasma hominis : non gonococcal urethritis
• Ureaplasma urealyticum : non gonococcal urethritis
• Herpes simplex virus : herpes genitalis
• Human papilloma virus : condylomata accuminatis
• Pox virus : molluscum contagiosum
• Hepatitis B virus : Hepatitis
• Human immunodeficiency virus : AIDS
• Trachomonas vaginalis : vaginitis
• Pthirus pubis : pthiriasis (pedicularis pubis)
• Sarcoptes scabie : scabies
CLINICAL PRESENTATION OF STDs
Most STDs do not present with any symptoms and when they do, the signs and symptoms are so mild that they may go unnoticed. In women, signs and symptoms may appear anytime from 2-3 days to several months and even up to years after the sexual act with the infected partner. They include
• Increased discharge from the vagina that looks or smells different. There is change in amount, colour or smell of the discharge.
• Pain or burning sensation during urination.
• Vulvo-vaginal pruritus or discomfort.
• Lower abdominal pain.
• Rashes around the genital like genital warts, sores or blisters that may or may not be painful.
• Menstrual irregularities.
• Post coital bleeding.
• Swelling on one or both sides of groin (inguinal buboes).
• Rash on the entire body, or palms or soles alone.
• Pink eye (conjunctivitis).
DIAGNOSTIC APPROACH TO STDs
In addition to the history taking and physical examination of the patient, diagnostic tests of the specimen collected from the patient are the key to diagnosing STDs accurately. The specimen must be appropriately collected and transported to optimize chances of isolating the causative organisms. It is the responsibility of the clinician to collect the specimen which should be performed with care. Specimen may be collected from patient’s vagina, cervix, urethra, anus, urine or blood for diagnostic test of STD.
Diagnostic tests for STDs however, are more widely used in high income countries and are especially useful for diagnosis of asymptomatic infections. In low and middle income countries, these diagnostic tests are largely unavailable, expensive and geographically inaccessible to most patients who may need to wait for very long periods or even return another day to receive results of their tests. This impedes diagnostic and treatment follow ups for many patients. The only inexpensive rapid diagnostic tests currently available for STDs are for syphilis and HIV which can be done within 10 to 20 minutes.
MANAGEMENT OF STDs
A wholistic approach is the key to the effective management of STDs. This will have to include
1. Patient screening and diagnosis.
2. Risk status assessment for the patient (whether patient’s partner is symptomatic, patient is 1 sexual partner, or new sexual partner in last 3 months).
3. Appropriate timing for examination of patient, including lab investigations.
4. Effective antimicrobial curative therapy for patients and their sexual partners before onset of complications such as PID and epididymitis.
5. Risk reduction through education and counselling, promotion and provision of condoms.
Because the ideal aetiological diagnostic methods for most STDs are expensive and require sophisticated lab equipments and well trained personnel, and therefore not accessible to many patients in developing countries, an alternative approach to treating STDs is required. This alternative approach is the “syndromic approach” which allows health workers in resource poor countries to improve the diagnostic and treatment process of STDs. The advantage of this approach is that it allows for diagnosis and treatment in one visit and requires minimum training, simple, inexpensive, rapid and can be implemented on large scale and in nearly all health settings.
Syndromic approach involves observing certain syndromes from patient’s who visit the clinic and appropriate management commenced. The syndromes are
1. Vaginal discharge
2. Urethral charge
3. Genital ulcers and
4. Abdominal pains
STEPS FOR PREVENTING STDs
• Keep to one sexual partner.
• Avoid sexual intercourse with someone you know just briefly.
• Always use condoms if you must have casual sex.
• Recognise symptoms of STDs in your body.
• Get early treatment and take all medications as instructed even if symptoms disappear.
• Do not have sex while on treatment.
• Encourage sexual partner or partners to report for treatment.
• Return for follow up visits.
• Get vaccinated against Hepatitis B and Human papilloma virus (HPV) which are currently available.
www.who.int : “Sexually transmitted infections facts”
www.medicalnewstoday.com : “Sexually transmitted diseases “