Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are one of the largest health problems in the United States, as well as throughout the world. There are fifteen million newly diagnosed cases each year in the United States alone, and approximately 25% are acquired by teenagers . According to national statistics one out of four Americans will contract a STD by the age of twenty-four, and at least another quarter of the population will become infected at some point in their lifetime. Approximately sixty-five million Americans have an incurable STD (not including HIV), yet the United States has the highest rate of curable diseases in the developed world. It is estimated that approximately 8.4 billion dollars are spent towards the treatment of STDs each year. There are many different types of STDs: Chlamydia, gonorrhea, syphilis, herpes, genital warts, hepatitis B, and human immunodeficiency virus (HIV) which leads to acquired immunodeficiency syndrome (AIDS) are some of the better known diseases. The following paragraphs will elaborate on and differentiate between the above mentioned diseases.

Chlamydia
Chlamydia is caused by bacteria known as Chlamydia trachomatis. This is the most common bacterial STD. This bacterium has been found to infect the eyes, causing conjunctivitis, particularly in newborns that contract it from their mother, the throat, usually in people who perform fellatio on an infected male, and both genital and rectal areas of the body after sexual intercourse or anal sex with an infected partner.

In men this disease can lead to problems such as inflammation of the urethra, urethritis of the epididymis, epididymitis of the prostate, prostatitis, and proctitis, Chlamydia can also lead to Reiter’s syndrome, which is continuous urethritis, arthritis, conjunctivitis, and skin rashes even after the treatment of the disease.

In women it can cause pelvic inflammatory disease (PID) affecting fertility, urethritis, inflammation of the cervix, cervicitis of the Bartholin’s gland, bartholinitis of the fallopian tubes, salpingitis of the liver, and perihepatitis, also known as Fitz-Hugh Curtis syndrome, as well as causing reactive arthritis. (www.nlm.nih.gov)

Most people, fifty percent of males and seventy five percent of females, do not experience any symptoms. Symptoms for men include discharge from the penis, burning with urination, an itchy or irritated urethra, and redness at the tip of the penis. Symptoms for women include genital discharge, burning with urination, pelvic pain, and/or bleeding between periods or after intercourse.

No test for Chlamydia is one hundred percent accurate. Culturing for the bacteria is the oldest method of detection, which now is preferred to detect the disease in the throat or rectum. Testing for proteins and genetic material associated with Chlamydia has also been developed. The most accurate (ninety percent) is the polymerase chain reaction (PCR) or the ligase chain reaction (LCR) which test directly for the genetic material of Chlamydia through either swabs or urine.

Once detected, antibiotics are used to treat the disease. Although there may be long term affects Chlamydia itself is completely curable. Popular medicines include doxycycline, offlozcin, erythromycin, and azithromycin. Medicines must be taken for their full course. Follow up testing is also important to make sure that the disease has been effectively treated or that one has not been re-infected. Condoms are usually very successful at preventing the contraction of Chlamydia. (Marr, 1998)

Gonorrhea
Gonorrhea is also caused by bacteria known as Neisseria gonorrhoeae. Close to one million people are infected each year in the United States. Unfortunately, women are much more susceptible to contract the disease if sexually active with an infected partner. Men have a twenty to thirty percent chance of contraction when sexually involved with an infected partner, while women have a sixty to eighty percent chance. (www.nlm.nih.gov).

Gonorrhea has many of the same effects as Chlamydia, including urethritis, epididymitis, and prostatitis in men, while causing urethritis, cervicitis, salpingitis, perihepatitis, and PID in women. Other similarities include infections of the throat, eyes and the rectum. Gonorrhea can also lead to joint infections, infections of the brain and spinal cord lining (meningitis), infections of the heart valves (endocarditis), and skin sores. People infected with Gonorrhea also become more susceptible to contracting other sexually transmitted diseases. Most people do experience symptoms of gonorrhea, however about ten percent of men and twenty to forty percent of women do not. Symptoms can include all of those associated with Chlamydia as well as vaginal swelling in women, and frequent urination in men.

Culturing is the most prevalent method in testing for gonorrhea. The bacteria can also be identified under a microscope. LCRs and PCRs may also be used. All methods involve swabbing of possible infected areas. Antibiotics are used to treat this disease. Depending on the severity of the infections different methods of administration can be used. A single injection of ceftriaxone, or oral medications such as ofloxacin, cefixime, and ciprofloxacin are all used in treating gonorrhea. Condoms again are the best method of prevention. Follow up testing is also important. (Marr, 1998)

Syphilis
Syphilis is a bacterial infection caused by the bacterium Treponema pallidum. Fifty thousand new cases of syphilis occur in the United States annually. One out of one thousand children are born with syphilis contracted from the mother. Syphilis can be contracted by contact of any mucus membranes. There are three stages of symptoms. The first stage occurs after about three weeks and consists of a painless open sore, known as a chancre, at the site of primary infection and painless swelling of the lymph nodes. The second stage may consist of all or some of the following, a red painless rash over the entire body, swelling of the lymph nodes, fever, sore throat, joint pain, headaches, hair loss, and wart like lesions in the genital area. The tertiary or late stage of syphilis includes the destruction of the body systems and organs, including the brain which is known as neurosyphilis; It is this stage which is life threatening.

There are two ways to detect syphilis. The bacteria can be found under a microscope after swabbing an infected area, or a blood test to check for an immune system reaction to the disease. Often there are false positives in blood tests, so multiple tests are necessary. Penicillin is the most common form of treatment for syphilis, and it must be injected in order to become fully successful. Early stages may be cured with one injection, the later may involve more over several weeks. Neurosyphilis requires intravenous penicillin for up to two weeks. Those who are allergic to penicillin may be treated with doxycycline or tetracycline. Again follow up testing is used to measure the success of treatment. (Marr, 1998)

Herpes
Herpes is a viral infection. The virus is known as herpes simplex virus or simply “HSV”. There are two types: HSV-1 and HSV-2. HSV-1 usually causes cold sores around the mouth. HSV-2 generally causes open sores in the genital area. However, both viruses can cause sores on any mucus membrane including the anal area, eyes and broken skin, which means that genital herpes can be caused by either virus. Seventy million Americans have oral herpes, less than one third show symptoms. About forty five million Americans have genital herpes caused by the type two virus, with about half a million new cases being reported annually in the United States.
Herpes can be especially dangerous because there are often no symptoms present. Infected individuals will often engage in sexual activities and unknowingly spread the disease on to their partners. Forty percent of those with genital herpes are symptom free after initial infection; those who do develop symptoms do so within two to twenty days. Twenty percent will remain symptom free their entire lifetime. Seventy percent of those with oral herpes will never notice symptoms. Herpes can also lead to meningitis, and encephalitis, or inflation of brain tissues. An outbreak is the term for the visible and painful sores which occur. Some experience a prodrome, or itching or tingling, prior to an outbreak. It is also possible for the virus to come to the surface without an outbreak, which is referred to as asymptomatic or subclinical shedding of the virus. Even without symptoms this shedding must occur in those infected. Men are more likely to show symptoms than women. The first outbreak is usually the most severe. The longer this first outbreak of type two lasts the more outbreaks can be expected in a year. Those with type one usually have one outbreak a year. Generally, outbreaks last ten to fourteen days, but can last up to six weeks.
Herpes can be detected by culturing, or skin/blood tests including PCRs. The Tzanck skin test checks an infected piece of skin under a microscope for characteristics of herpes. It cannot distinguish type one from type two. This test has a fifty percent false negative, and therefore must be combined with additional testing when results are negative. Western blot assays and immunodot assays can be used to distinguish type one from type two although neither can say where in the body the infection lies.
Though there is no cure for herpes, there are however medicines which help to treat and prevent outbreaks. Suppressants include acyclovir, valacyclovir, and famiciclovir. All these are also used in treating outbreaks, as well as penciclovir cream for cold sores. (Marr, 1998)

HPV
Genital warts are caused by the virus known as human papillomavirus (HPV). This is possibly the most common STD in the United States, with an estimated forty to seventy percent of sexually active people having HPV. There are over seventy types of HPV with some strains being responsible for several types of warts. Each strain tends to affect a specific area of the body. There are about twelve that affect the genital area, strains six and eleven tend to cause visible genital warts, while strains sixteen and eighteen can lead to cervical or skin cancer.

Symptoms of genital warts do not always occur, yet once they do it is usually about ninety days after infection; although they sometimes take years to appear. Some will never experience symptoms in their lifetime. Though genital warts are painless they often produce itchy and fleshy bumps which can occur anywhere from the lower abdomen to the upper thighs. Urethral warts most likely will not have symptoms, but they include urethral bleeding or discharge, and/or a change in urine flow. Symptoms may clear up on their own, about twenty percent of the time, or after treatment but there is always the chance of re-occurrence. (www.cdc.gov)
Genital warts can be detected visually. There is no blood test for warts as of today, although PCR can detect the virus but is not known to be definitive. A colposcopy can detect warts that are not easily visible. A colposcope is a machine used to magnify viewing of the cervix, where internal warts may reside. Since there is no cure for HPV, treatment is only used in order to stop visible symptoms. It does not prevent the spread of the disease. Cryotheropy is the act of using liquid nitrogen to freeze and kill the skin tissue of the wart. This can be used on external and cervical warts, though not on vaginal warts due to the fragile nature of the tissue. Since several treatments may be necessary the process can be painful, and redness or blistering will likely occur.

Topical treatments include podophyllin or trichloracetic acid (TCA). These solutions are applied directly to warts not located on mucosal skin, as this can cause detrimental side affects if absorbed through mucosal skin, and can be combined with other treatments. Repeated use may also be necessary. Another less intense and less painful topical treatment is imiquimod. It is a cream applied to warts several times a week, for up to sixteen weeks. It has been shown to stimulate the body’s own natural immune ability.

Surgery uses a scalpel to cut off warts after local anesthesia. Electro surgery uses an electrified blade or wire to perform this same task. Laser surgery requires general anesthesia and uses a laser on affected tissue to remove it. Today several vaccines are also being tested which may prevent the contraction of this disease as well as help to prevent symptoms in those infected. (Marr, 1998)

Hepatitis B
Hepatitis B is caused by a virus. This infection causes damage to and inflammation of the liver. Three hundred thousand new cases occur in the United States annually. Of those infected, about five thousand die of it annually. Ten percent of people in the United States blood test show evidence of this disease. Most of those infected show few or no symptoms of hepatitis B, only about one third of those infected do. Older people and those in poor health are more likely to show symptoms, which include nausea, yellowing of the skin, or jaundice, headaches, a rash which may itch, diarrhea, and/or a change of color in excrements. These usually occur within four months of initial infection, and symptoms last one to two months. This can escalate to fulminant hepatitis, which is severe liver damage, possibly causing death. In one percent of cases it progresses to liver failure, of which seventy five percent die. Problems with the skin, kidneys, and blood cells may also result.

Ninety five percent of people will recover and develop immunity to the infection. The other five percent becomes carriers. There are two types of carriers, one third having chronic active hepatitis, and two thirds having chronic persistent hepatitis. The former is more severe and more contagious. Those who develop this can also develop cirrhosis, or scarring of the liver, as well as liver cancer. Those with the latter usually have very mild or no symptoms at all. Even carriers may eventually become free of this disease.

There is a specific blood test for hepatitis B, which can test for either immune responses to the virus or for the virus itself. This test can distinguish between those vaccinated, those who have recovered, and those whom are carriers. The stage of this infection can be determined through a liver biopsy. Though treatment is not always necessary it is recommended as the best course of action along with adequate rest. For those who develop chronic hepatitis, alpha-interferon and steroids administered intravenously help to counter the infection. Oral medicines such as lamivudine and famciclovir are currently being tested. After liver failure a transplant is necessary, even then it may still become re-infected. This disease can be prevented with a vaccine. (Marr, 1998)

HIV/AIDS
HIV and AIDS are caused by a virus. Over thirty million people, globally, have this virus. Sixteen thousand new cases occur daily. One million infected are within the United States. There are no definitive symptoms for HIV, although some, thirty to seventy percent do develop flu like symptoms two to six weeks after infection. Another possible symptom is the swelling of the lymph nodes. Tell-tale symptoms only become prevalent once the disease manifests into AIDS, which takes on average ten years.

This virus attacks CD4 cells, which are a part of the immune system. Healthy people have about five hundred CD4 cells. Those with AIDS are defined by having less than two hundred. The less CD4 cells the more susceptible one is to infection. At different counts different infections can occur. Between two hundred and five hundred, one is more susceptible to diseases such as pneumonia, tuberculosis, shingles, yeast infections, cervical cancer, anemia, Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and others. Between one and two hundred, one is more susceptible to AIDS dementia, and wasting syndrome, or inability to maintain a healthy body weight. Between fifty and one hundred, one can develop cytomegalovirus retinitis, also known as inflammation of the retina, toxoplasmosis, and/or criptococcosis. Less then fifty often results in Mycobacterium avium complex infection, cryptosporidiosis, progressive multifocal leukencephalopathy, and/or primary central nervous system lymphoma. It is these secondary infections and the body’s inability to detect and fight them which eventually lead to death.

Blood tests and cultures can detect the presence of the virus. Blood tests are the most accurate, which detect the viral proteins, genetic material, or antibodies associated with HIV. Cultures are usually not used except in research settings.

There is no cure for HIV or AIDS, thus treatment consists of delaying the progress of this disease. The CD4 count must be carefully monitored and each stage of damage requires different treatments. The two classes of medicines aimed at treating HIV both help stop the virus from replicating, but in different ways. Ziovudine, didanosine, zalcitabine, stavudine, and lamivudine are known as antiretroviral and make up one group. Saquinivir, indinavir, and retonivir make up the other and are known as protease inhibitors. Combinations of these drugs are considered the best treatment. The secondary infections must also be treated as they occur. New medications and further research continue to expand treatments. (Marr, 1998)

It is apparent that sexually transmitted diseases are a major problem in our society. They pose a threat to any sexual relationship including marriage. Since many have no symptoms partners often infect each other and may not know it. In a marriage the sudden occurrence of symptoms or the detection of an STD can cause suspicion of an affair leading to great stress on the relationship. The financial expenses associated with treatment can also stress a relationship. Both partners getting tested for STDs before and after entering any sexual relationship should be of utmost importance. Early detection is very important in minimizing the damage to one’s health. Education on the ways of contracting STD’s, as well as on how to practice safer sex is important to prevention.

Works Cited

Marr, Lisa. (1998). Sexually Transmitted Diseases: A Physician Tells You What You Need to Know. Baltimore, MA: The John Hopkins University Press.

National Institute of Health, National Library of Medicine
Gonorrhea
Retrieved October 25, 2008, from
http://www.nlm.nih.gov/medlineplus/gonorrhea.html

National Institute of Health, National Library of Medicine
Chlamydia
Retrieved October 26, 2008, from
http://www.nlm.nih.gov/medlineplus/chlamydiainfections.html

Genital HPV Infection – CDC Fact Sheet
Retrieved November 3, 2008, from
http://www.cdc.gov/STD/HPV/STDFact-HPV.htm

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