Family doctor

Overview:

• Sexually transmitted diseases (STDs) are spread through sexual contact
• The range of diseases spread through sexual contact continues to increase
• Nearly six million people around the world were diagnosed with HIV in 1998
• 2.3 million people died of AIDS in 1998
• New treatments have prolonged the lives of AIDS sufferers.
• Genital warts, non-specific genital infection, and chlamydia are the most common STDs
• Most STDs can be prevented through safe sex
• Condoms may not fully protect against genital warts, HIV or syphilis
• Common symptoms of an STD are genital sores, vaginal discharge or urethral discharge
• Sexual partners should be traced to stop the disease from spreading
• Many STDs can be cured - early treatment and full assessment of your sexual health is vital if you have been at risk of an STD.

What are STDs?

Sexually transmitted diseases are among the most common infections worldwide and are transferred from one person to another through sexual contact.

STDs are likely to have been around for thousands of years but the most serious, AIDS, has only been recognised since 1984.

While other STDs are rarely fatal, infections can cause infertility, ectopic pregnancy, act as cofactor in cervical cancer and cause infant illness (e.g. chlamydia conjunctivitis in newborns).

The range of diseases spread by sexual activity continues to increase. Sexually transmitted hepatitis A and B are becoming more common. Hepatitis C may also be spread sexually, although the risk of this is lower.

The increase in STDs worldwide can be partly explained by people starting sexual activity at a younger age and having more sexual partners. The use of the oral contraceptive pill and IUCDs has also reduced the rate of condom use.

STDs are spread through sexual contact and this involves sexual intercourse (both vaginal and anal), kissing, oral sex and the use of sex toys like vibrators.

What are the symptoms of a STD?

The most common symptoms of an STD are vaginal discharge, genital ulcers, urethral discharge and pain while urinating. Other symptoms include rash, burning urine, jaundice, arthralgia (aching joints), and rectal discharge.

Abdominal or scrotal pain, urinary retention may indicate complications from a sexual disease.

Common STDs

Genital warts, also known as the human papilloma virus (HPV), is the most common STD with rates of up to 50 percent in sexually active women. It usually causes benign skin lesions, can cause discomfort and psychological distress. HPV infection can cause itching or genital pain, and some types (type 16) also been strongly linked to cervical cancer. However, many women are not aware they have it. Current treatments involve removing visible warts and treating pre-cancerous changes.

Chlamydia is another common infection. It is asymptomatic (causes no symptoms) in approximately 50 percent of women and 30 percent of men. Up to a third of inadequately treated or undiagnosed women may go on to develop pelvic inflammatory disease, one fifth will become infertile. This disease does not usually occur in isolation and often other STDs are present. Drugs in the tetracycline class are often used to treat the infection. Single dose azythromycin is also effective and may be useful where compliance is a problem. The highest risk group for chlamydia infection are those with new partners aged 15 to 25, and routine screening of this age group has recently been recommended.

Gonorrhoea is frequently found in conjunction with chlamydia, 25 to 40 percent of women infected with gonorrhoea will also have chlamydia. Gonorrhoea is a bacterial infection and one of the oldest STDs. It cannot live outside the body for more than a few minutes. In the past the infection was cured by penicillin but now new strains of the disease have become resistant to penicillin and other antibiotics.

Syphilis is one of the oldest recognised STDs and has been around for centuries. It is highly contagious in the first one to five weeks, and if the ulcer is on the outside of the vagina or on the scrotum of the male, condoms may not prevent infection. Syphilis ulcers can also develop in the mouth, and kissing can spread the disease. The infection can disappear without treatment in the first stage in women, but if not, it is still contagious for four to six weeks. Without treatment syphilis can be fatal. A penicillin injection is the recommended treatment.

Genital herpes is increasing worldwide. Fifty percent of those attending an STD clinic have the herpes simplex virus. However, 80 percent of those have no symptoms and may not even realise they have the infection. It is this group that is most likely to spread the virus (asymptomatic shedders).

Nearly six million people worldwide were diagnosed with HIV in 1998, and 2.3 million died of AIDS. Rates of infection vary widely from country to country, with the highest number in the United States. There were 641,000 AIDS cases in the US in 1998, and 15,000 in the UK. Australia had 8,744 and New Zealand 641.

The rates are very high in many parts of Africa (e.g. Zimbabwe/South Africa), India, and many parts of Asia (Thailand). Accurate statistics are not available from many countries. Travellers should take extreme care and be aware that the risk may be higher than thought in the country they are visiting.

There have been huge advances in the treatment of HIV and AIDS in recent years, creating new hope for people living with the disease. Triple therapy, consisting of a protease inhibitor plus two necleoside analogue reverse transcriptase inhibitors, has been shown to slow the progression of HIV.

The main challenge remains the prevention of spread particularly in some countries. An effective vaccine is some time away - partly due to the fact that the HIV virus can rapidly mutate.

Hepatitis A, B and C are liver diseases that can be spread through sexual activity. Hepatitis A can be transmitted from person to person in food and drink or swimming in water contaminated by sewerage. Hepatitis B is spread through contact with blood and semen. Homosexual men are at high risk from both hep A and B. The risk of sexual transmission for hepatitis C appears to be small (but has been documented).

Non specific urethritis, also known as NSU, is urethritis that is not caused by either gonorrhoea or chlamydia. The cause of NSU is not known (the bacteria are difficult to culture), however antibiotic treatment is effective in most cases.

What can be done to help?

Most STDs can be cured. However, gonorrhoea has now become resistant to many older antibiotics. Some cases are treated with the use of fluoroquinolones but recent cases from the UK and other countries have shown resistant to this drug as well.

The partners of sexually transmitted infections must be traced and treated after diagnosis to help stop the disease from spreading. It is important that partners are treated at the same time to prevent the infection being passed back and forth.

Many people, especially women, often don't notice any body changes despite contracting an STD. People who think they may have been in contact with an infected person should see a doctor.

How can STDs be prevented?

STDs are prevented through safe sex but the safest method is abstinence. Sex within a monogamous relationship in which no partner has a sexual disease is also considered safe.

Condoms carry the best protection from STDs during sexual intercourse. They are good for protecting against diseases like herpes and gonorrhoea, but may not guard against genital warts, syphilis or AIDS. It is important to realise that they do not totally remove the risk of getting a STD although they substantially reduce it.