The Skinny on STDs

Sexually transmitted diseases (STDs) are extremely prevalent worldwide and can affect all sexually active people. Because STDs can often be transmitted unknowingly by asymptomatic partners, I felt it would be important to at least discuss STDs with the Beijing community.

What are STDs and why should we be concerned about them?

STDs rank among the most common infectious diseases, and more than 20 have been identified. They are referred to as “sexually transmitted” because they can be spread via any sexual activity involving sex organs, the mouth, or anus. They can also be spread, though less frequently, through blood, body fluids, and organ tissues.

Who can be affected?

Simple answer: anyone. People can pass STDs to sexual partners even if they themselves don’t exhibit any symptoms. Many STDs can also be vertically transmitted from mother to baby before, during, or immediately after birth.

How would a person know if s/he is infected?

A person who is infected may experience a variety of symptoms, or s/he may be completely asymptomatic. Symptomatic patients are likely to see a healthcare provider for diagnosis and treatment, and in many cases (not all), these patients will be cured. Some STDs may be chronic and lifelong. In these cases although the symptoms can be controlled, the infection cannot be completely eradicated.

Those with an asymptomatic infection can unfortunately go on to unknowingly infect their partners. Additionally, untreated asymptomatic infections can, over time, lead to other complications, such as upper genital tract infections, infertility, cervical cancer, and increased risk of transmission and acquisition of HIV. Because the mode of transmission is the same for many STDs, a person can often simultaneously acquire more than one type of infection – e.g., approximately 50% of people who are infected with gonorrhea also are infected with Chlamydia from the same sexual encounter.

What are some of the most common STDs?

Types of STD infections can be grouped by type of pathogen:

Bacterial pathogens/infections include:

•     Syphilis (Treponema pallidum)
•     Gonorrhea (Neisseria gonorrhea)
•     Chlamydia (Chlamydia trachomatis)
•     Chancroid (Haemophilus ducreyi)
•     Lymphogranuloma venereum (Chlamydia trachomatis)
•     Granuloma inguinale (Calymmatobacterium granulomatis)

Viral pathogens/infections include:

•     Genital herpes (Herpes simplex virus types 1 and 2)
•     Genital warts (Human papillomavirus – HPV)
•     Hepatitis B and D (approximately 30% of cases of hepatitis B worldwide are due to sexual transmission) and, less commonly types A, C (very rare for type C)
•     Molluscum contagiosum (Poxvirus)
•     HIV (Human immunodeficiency virus)

Fungal pathogens/infections include: Yeast infections (Candida species)

Protozoal pathogens include: Trichomoniasis (Trichomonas vaginalis)

Parasitic infections:

•     Pubic lice (a.k.a. “crabs”) (Pediculosis pubis)
•     Scabies (Sarcoptes scabiei)

(These infections can be transmitted through sexual contact or contact with skin or infested clothing or bedding.)

Can I be treated for STDs?

For most STDs, there are treatments – a course of antibiotics for bacterial and protozoal infections, antifungals for fungal infections, and anti-parasitics for parasitic infections. Some viral infections are self-limited, which means that the immune system produces antibodies to “cure” the infection by clearing the virus from the blood.

For some viral infections, such as genital, anal, and oral herpes, treatment with antiviral agents may lessen the symptoms and duration of an acute outbreak, but will not cure infection. In fact, a person who is infected may continue to spread the virus to sexual partners even when they are completely asymptomatic.

How would I know if I have an infection? What are some symptoms of common STDs?

There are too many STDs to mention all of them, so I’ll only deal with the most common infections here.

Syphilis is a systemic disease caused by Treponema pallidum. It has three stages of infection – primary, secondary, and tertiary. Primary infection often is mild and goes undetected. Secondary infection may manifest as a diffuse rash that involves the palms of the hands and soles of the feet, and may be accompanied by fever, headaches, joint pains, and enlargement of lymph glands. Tertiary infection can occur many years after primary infection and can involve the heart and central nervous system.

A simple blood test can detect presence of infection, but not the stage.

Gonorrhea, transmitted through vaginal, oral, or anal sexual contact, may cause various infections. Infection most typically manifests as painful urination and/or vaginal or penile discharge. However, it may also be asymptomatic in individuals who then can, unknowingly, transmit the infection to sexual partners. Women who have one or more risk factors are advised to have annual screenings. These risk factors include:

•     sexually active woman
•     unprotected sexual encounters
•     multiple partners or a partner who has had multiple contacts
•     sexual contact with a partner with a documented STD
•     history of previous STDs
•     high-risk activity/occupational risks, or drug use
•     pregnancy

Chlamydia is transmitted similarly to, and often simultaneously with, gonorrhea. It is asymptomatic in about 80% of women and 50% of men. Typical symptoms consist of vaginal or penile discharges, and pain or burning sensations during urination.

Annual screening is advised for sexually active women less than 25 years of age and sexually active women 25 years or older who have one or more of the following risk factors:

•     sexual encounter with a new partner in the past 2 months
•     multiple partners
•     unprotected encounters (no condom use)
•     history of previous STDs

Screening should also be considered for sexually active men in settings with a known high prevalence of infection, and all sexually active men who engage in sexual activity with other men.

Trichomoniasis is a protozoal infection. Typical symptoms in women include a copious, frothy foul-smelling yellowish or greenish vaginal discharge, vaginal itching, and painful urination. In men, symptoms may include urethral discharge, painful urination, and scrotal swelling. However, the majority of men are asymptomatic. Screening for T. vaginalis is advised for women with a history of STDs or who have recently had new or multiple partners.

Genital Warts are caused by subtypes of Human papillomavirus (HPV), which can also cause warts on other parts of the body. They appear small and fleshy in the genital and anal areas, and they sometimes occur in cauliflower-like clusters. Generally, they are painless, but they can sometimes cause itching, a burning sensation and/or pain. Several months can pass between time of infection and when warts appear. Thus, you can have the infection and unknowingly transmit it to sexual partners.

HIV/AIDS is caused by Human immunodeficiency virus. Although often referred to as two distinct entities, AIDS is simply a more advanced stage of HIV infection. Someone with AIDS – acquired immune deficiency syndrome – has a more advanced stage of HIV infection.

HIV is transmitted through blood, semen and preseminal fluid, vaginal fluid, and breast milk. Transmission can occur through vaginal, anal or oral sex, blood transfusion of contaminated blood, contaminated needles, and fluids exchanged between mother and baby during pregnancy, childbirth, or breastfeeding.

People who are infected with HIV may be asymptomatic. When manifested, symptoms of HIV infection may include fever, rash, pharyngitis, enlargement of the lymph glands, or a flu-like illness.

If there is a risk that exposure occurred, initial testing should be done, followed by subsequent testing at standard intervals. Furthermore, as a rule, ANYONE BEING SCREENED FOR STDs SHOULD ALSO BE TESTED FOR HIV. The virus can “hide” in lymph tissue, and a person may remain asymptomatic and unaware of their HIV positive status for many years. Again, here is another situation where people can unknowingly infect their partner(s).

How can I protect myself/avoid STD infections?

The only foolproof, reliable method is ABSTINENCE from oral, vaginal, and anal sex. Otherwise, being in a monogamous relationship with an uninfected partner is the next best thing.

Barrier methods of contraception can provide protection against STDs. Male Condoms: Latex condoms, used correctly, are highly effective in preventing STD transmission. Condom failure is usually the result of inconsistent or improper use rather than breakage. USE OF NATURAL MEMBRANE CONDOMS FOR PREVENTION OF STDs IS NOT ADVISED. It is also important to note that only water-based lubricants should be used with latex condoms as the oil-based varieties can weaken the latex. Finally, condoms lubricated with nonoxynol-9 spermicides are not recommended because they are actually shown to increase the risk for HIV transmission.

Female Condoms have been proven to be effective barriers to viruses (including HIV) and semen in a limited number of clinical trials. It is a good option if a male condom cannot be used.

Cervical Diaphragms used with a spermicide do offer some protection against gonorrhea, Chlamydia, and trichomoniasis, but not against herpes viruses, HPV, and HIV. Furthermore, diaphragms and nonoxynol-9 spermicide use have been associated with increased risk of urinary tract infections in women.

Bottom Line

Protect yourself. Consider protective vaccines if appropriate. Have yourself tested at regular intervals as advised by your physician, and more frequently if you engage in high risk activities, have multiple partners, a new partner, or a high-risk encounter. Be proactive in protecting yourself, and expect the same of your partner.