Sexually Transmitted Disease

exually transmitted disease (STD) constitutes a staggering public health problem in the U.S. According to the government's Centers for Disease Control, nearly 12 million new cases are diagnosed annually. Young people aged 15 to 29 have the highest rates of infection. By the age of 21, almost one American in five requires treatment for a disease acquired through sexual contact. Among teenagers who are sexually active, the infection rate is a whopping one in four.

Sexually transmitted diseases are more than just a nuisance. Some of these diseases may be fatal, particularly to women and their unborn babies. Other STDs cause pelvic inflammatory disease, tubal pregnancy, sterility, certain types of cancer, or blindness. Babies whose mothers are infected with STDs may suffer from birth defects or mental retardation.

Although the rates of disease and disability from sexually acquired illnesses are highest among the poor, the impact of STDs on health care spending touches all income levels. Indeed, STDs cost Americans more than $3.5 billion a year. Almost 75 percent of this amount goes to treat pelvic inflammatory disease and its consequences, which include tubal pregnancy and female infertility.

During the 1970s, the government monitored just five sexually transmitted diseases--syphilis, gonorrhea, chlamydial infection/nongonococcal urethritis, pelvic inflammatory disease, and genital herpes/warts.

In the 1980s, however, the mounting AIDS epidemic triggered an explosion of research into and monitoring of diseases that were transmitted sexually. The painstaking study of AIDS taught scientists a great deal about other STDs; and today the federal government recognizes some 50 types of sexually transmitted infection.

Thanks to public awareness campaigns, many people now know how to protect themselves from the AIDS virus by avoiding injection drug use and by faithfully using "safer sex" techniques. Fortunately, this same approach also protects them from the many other disease agents transmitted through sexual contact or some other transfer of bodily fluids.

Basic Facts About Sexually
Transmitted Diseases

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Here are a few basic facts everyone should know for his or her own protection:

• STDs are easily spread through any person-to-person transfer of bodily fluids such as semen, vaginal secretions, or blood.
• When someone has a sexually transmitted disease, anyone who has sex with that person stands a good chance of becoming infected. Thus, having sex with multiple partners carries a greater risk of disease than staying faithful to a spouse or long-term partner. Even a monogamous relationship isn't necessarily risk-free, however, since one partner could be carrying an infection picked up during a prior sexual encounter.
• Many sexually transmitted diseases are highly contagious. For example, if a man has gonorrhea, a woman who has sex with him just once stands an 80 to 90 percent chance of getting infected. If the man has gonorrhea plus chlamydia, as frequently happens, the woman could be infected with both diseases at the same time.
• Vaginal intercourse is the classic route of STD infection. However, other important routes include anal sex (among men or man-to-woman), oral sex, sexual abuse of children, and mother-to-baby infection during childbirth.
• Sexually transmitted diseases weaken the immune system, so a person infected with one STD has a greater risk of acquiring other infections. Unfortunately, recovering from an STD does not make a person immune. Anyone who has had a particular STD is still at risk of getting it again.
• Men are more likely to show clear symptoms of STDs. Symptoms in women may not be as obvious, and the problem could be misdiagnosed.
• Many women infected with certain types of STDs have no early symptoms at all and may unknowingly infect sexual partner(s).
• In the past, gay men have tended to have an above-average rate of infection with STDs. This is largely attributed to promiscuity and may have declined in response to the AIDS epidemic. Additionally, some men are secretly bisexual. If a man picks up an STD from a homosexual encounter, he may then pass the infection on to unsuspecting heterosexual partners.
• Lesbians have a lower-than-average risk for STDs, since most sexually acquired diseases are not easily spread from woman to woman.

Preventive Measures

It is important to distinguish between birth control and prevention of STDs. While birth control pills and IUDs help prevent pregnancy, neither measure offers any worthwhile protection against disease.

Practicing "safer sex" is the most reliable way for sexually active people to protect themselves against STDs. Using a latex condom with a contraceptive foam or jelly is an excellent option. The chemical in the foam or jelly kills some infectious microorganisms along with the sperm. (Warning: People who reach for a tube of contraceptive jelly during sex should make sure they do not accidentally grab a tube of simple lubricating jelly, which has no sperm- or germ-killing ingredients.) It's also wise to think about a partner's sexual history, and avoid intimate contact with people at high risk of infection, such as those with multiple sexual partners.

People who even suspect they might have acquired a sexually transmitted disease should stop having sex until they consult a doctor and find out for sure. If test results show an infection, it is essential to notify all sexual partners so they can be tested, too. It is vitally important to follow the treatment exactly as prescribed and to abstain from sexual contact until receiving a clean bill of health.

How Sexually Transmitted Disease
Is NOT Spread

In most cases, people do NOT pick up sexually transmitted diseases from doorknobs, toilet seats, or towels. That's because the microorganisms that cause STDs thrive in a warm, moist environment such as the mucous membranes of the genitals or the mouth. Many of these organisms die soon after being exposed to dry air. (The virulent hepatitis B virus is a notable exception.)

Common Sexually Transmitted Diseases

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As we've seen, the government currently monitors about 50 sexually transmitted diseases. Here is a brief overview of some common STDs (excluding AIDS).

Gonorrhea

Gonorrhea is an infection caused by the Gonococcus bacterium. In men, it is marked by a thick, white discharge from the penis and a burning pain when urinating.

In women, gonorrhea may infect the cervix. There may be mild pain and a discharge. If the urethra is infected, there may be a burning sensation during urination. However, women's symptoms are most often mild or simply unnoticeable. Even so, it is important to treat the infection because gonorrhea can lead to pelvic inflammatory disease (see below).

When gonorrhea is transmitted during anal or oral sex, painful infection of the rectum or throat may occur in both men and women.

Chlamydia

Infection by the Chlamydia trachomatis bacterium is the leading cause of nongonococcal urethritis in men. This condition consists of pain or burning during urination, a thin discharge from the penis, and staining on underwear. Chlamydial infection may also inflame the sperm-collecting tubules in the scrotum and eventually cause sterility. A man infected with Chlamydia may be infected simultaneously with Ureaplasma urealyticum, which also causes urethritis.

In women, a chlamydial infection may cause a thin vaginal discharge, pain during urination, or pain in the lower abdomen about 10 to 20 days after exposure. However, women often do not notice any early symptoms. Chlamydia may also lead to pelvic inflammatory disease.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an infection of the uterus, fallopian tubes, or ovaries and usually results from either gonorrhea or chlamydial infection.

The disease typically develops in two stages. First the infection attacks the cervix (the lower part of the uterus). It then spreads to the uterus, fallopian tubes, and ovaries. Sometimes PID starts directly within the uterus when germs gain entry following childbirth, abortion, or the insertion of an intrauterine contraceptive device (IUD). This, however, is rare.

Since PID causes scar tissue to form, there is up to a 25 percent risk of infertility. PID is also the single most common cause of tubal pregnancy, in which a fertilized egg begins to grow while still in the fallopian tube, instead of the uterus. If the tube bursts, the woman could die.

Genital Warts

Genital warts (condyloma) are caused by the human papillomavirus (HPV) and look much like other warts. They usually occur near the tip of the penis in men. In women, the warts appear on the vulva, in the vagina, on the cervix of the uterus, or near the anus.

Genital warts are flat, hard, and painless when they first appear. If allowed to grow, however, they develop a "cauliflower" appearance and hurt when pressed. Genital warts tend to get bigger during pregnancy. In rare instances, very large warts may interfere with childbirth, making a Caesarean section necessary.

CERVICAL CANCER: A DEADLY STD

Normal cervix: Like skin, the surface of the cervix is constantly being replaced with new cells from below. Generated by division of the basal cells, these new cells rise as older ones are shed from the surface.

Cervical dysplasia: Triggered by an HPV infection, the cervical basal cells may go into overdrive, producing an excessive number of new -- but malformed -- replacement cells. These cells are not cancerous, but signal the danger of cancer to come.

Invasive cancer of the cervix: As the condition progresses, truly malignant cells develop and migrate downward into underlying tissues. Unchecked, the disease can be fatal.

There are several types of HPV. Some types can cause precancerous cell changes in the tissues of a woman's vulva, anus, cervix, or vagina. An invasive cervical cancer can be fatal, which is why women with genital warts should have a Pap test at least once a year.

Vaginitis

Vaginitis, or inflammation of the vagina, is an extremely common gynecological problem. Some types of vaginitis occur because of irritation from tampons, tight clothing, or frequent douching. Other types develop as a side effect of birth control pills or treatment with antibiotics, which may encourage fungal infections.

Two types of vaginitis, however, can be transmitted sexually: Bacterial vaginosis is caused by an overgrowth of several bacteria; trichomoniasis is caused by a one-celled organism called a protozoon. Although these infections do not carry dire consequences, they do cause burning, itching, discharge, and odor, and should certainly be treated.

In either case, it is important for both sexual partners to be treated at the same time. Men may harbor these organisms without showing any symptoms. Unless both partners are cured, the couple could keep passing the problem back and forth.

Genital Herpes

Infection by the Herpes simplex virus causes red bumps. These bumps change to watery blisters and then rupture, leaving little hollow spots that may ooze or bleed. The first attack is often accompanied by high fever and swollen lymph nodes in the groin.

In men, genital herpes sores may develop on the penis, scrotum, buttocks, anus, or thighs. The sores can also develop inside the urethra (urinary passage), remaining invisible but possibly causing a thin discharge and painful urination.

Women develop herpes sores on the outer genital area, buttocks, or thighs, or in the vagina or cervix. The sores may cause vaginal discharge, pain during urination, inflammation of the vulva, and aching or pain in the entire genital region.

Herpes sores usually scab over and heal within a week to 10 days, even without treatment. However, because the virus continues to live inside the body, a man or woman can pass on the infection even when the sores have disappeared. Outbreaks of sores may recur periodically. A tingling sensation in the genitals often announces the development of a new outbreak.

Pregnant women infected with herpes are at risk for miscarriage or premature delivery. A woman may pass herpes on to her baby during childbirth. This happens rarely, but can cause blindness, brain damage, and infant death.

Syphilis

The spirochete bacterium Treponema pallidum causes syphilis. The infection develops in distinct stages:

The first symptom is often a painless but highly infectious sore called a chancre. The sore develops from nine to 90 days after exposure and is sometimes accompanied by swollen lymph glands in the groin. Chancres may occur on the genitals or on the mouth, lips, breast, anus, or even the fingertips. The chancre often goes unnoticed in women because it develops inside the vagina. Some infected people never do get a chancre sore. Although a chancre disappears within one to five weeks, the syphilis bacteria remain in the body.

Stage two starts a week to six months later and involves a rash, mouth sores, and/or flu symptoms (headache, mild fever, aching joints). By this time, the bacteria have multiplied and spread, and the disease can be transmitted just by kissing.

Stage three, the latent stage, begins approximately a year after initial infection and lasts 10 to 20 years. There are no noticeable signs of the disease during this period, and after several years the disease is no longer contagious. However, the syphilis bacteria may be silently invading the heart, brain, or other organs.

Stage four is the late stage. Depending on which organs have been attacked, the accumulated damage may cause heart disease, blindness, mental illness, or crippling.

If syphilis is not treated during pregnancy, the mother-to-be may pass the disease on to her baby, and the infant could be born dead, deformed, or diseased.

Before syphilis was curable, it was the most dreaded of the sexually transmitted diseases. The advent of penicillin in the 1940s brought a large and gratifying drop in the syphilis rate. The case load plummeted from 575,600 in 1943 to fewer than 68,000 cases in 1985. Unfortunately, rampant prostitution among crack cocaine users has now driven the syphilis rate back up to its highest level since the early 1950s.

Hepatitis B

Like AIDS, hepatitis B is caused by a virus and can be transmitted via sexual contact, bodily secretions, or blood. But unlike the virus that causes AIDS, hepatitis B is a hardy virus and can remain infectious for quite a while, even in dried blood, saliva, or other secretions.

Hepatitis B begins with flu-like symptoms that disappear as jaundice, the second stage, sets in. The person infected with hepatitis B is thin, weak, lethargic, and irritable and has an enlarged, painful liver. The resulting liver damage is often permanent, and one-fourth of those with hepatitis B eventually die of liver failure.

People who know about hepatitis B fear the virus because it is so easy to catch--especially when compared to AIDS. A hepatitis B vaccine is available, and medical personnel must be inoculated. Unfortunately, the very people most likely to get hepatitis B--intravenous drug users, prostitutes, and sexual partners of infected individuals--generally don't bother to get vaccinated or simply don't know the vaccine exists. That's why the incidence of this serious disease has been rising since 1982.

Treating Sexually Transmitted Diseases

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Once again, the best way to handle sexually transmitted disease is to prevent its spread by faithfully following safety precautions, including "safer sex" techniques.

If an STD does develop, it may be treated with medications, surgical procedures, or possibly both.

For a given STD, it is important to take the right medication exactly as prescribed. For example, even though gonorrhea and chlamydial infections often occur together, they require different medications. Never try to treat a sexually transmitted disease without a doctor's supervision. Using the wrong medication could do more harm than good.

By far the most common group of medications used to treat sexually transmitted diseases are the antibiotics that are available in ever-increasing variety. Sometimes a disease-causing organism "learns" to outwit a given antibiotic, at which point a different one is required. To cope with this ongoing problem, pharmaceutical companies are constantly striving to develop new antibiotics.

Metronidazole, a different type of antimicrobial medication, is used to combat STDs caused by anaerobic (non-oxygen-dependent) bacteria or protozoa.

Various caustic creams, ointments, and solutions are used to shrink genital warts. Dry ice can be used to freeze and remove them. Laser surgery is also employed.

Although not a cure, acyclovir helps prevent or reduce the severity of genital herpes sores. To remove growths on or in the vagina, cervix, or uterus, electrosurgical excision is an option.

 

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