HEALTH : The rise of sexually-transmitted infections

Human immunodeficiency virus (HIV), the microorganism that causes Acquired Immune Deficiency Syndrome (AIDS), is deadly. This must be the reason why other sexually transmitted infections (STIs) are relegated to the background.

Unfortunately, these “neglected” STIs are on the rise. According to the Geneva-based World Health Organization (WHO), the annual incidence of curable STDs is 333 million cases, of which 111 million occur in people under 25 years of age, particularly those living in the cities.

“More than 1 million people acquire a sexually transmitted infection every day,” the United Nations health agency said, adding that these STIs and their complications rank in the top ten causes of healthy days lost in the urban areas of the developing world.

“The burden of curable STIs is far greater than the discomfort and pain caused by initial infection,” the WHO says. “They cause many serious complications, especially for women. These include spread of infection of the pelvis (pelvic inflammatory disease) which in turn is a major cause of infertility in many parts of the world.”

Rising STI cases also significantly increase the risk of HIV transmission. “The presence of an STI dramatically enhances the efficiency of HIV transmission, increasing the likelihood of infection of exposure to HIV as much as 10-fold,” reports the United States Agency for International Development.

STIs are infections that are passed from person to person through sexual contact. “Because sexual activity includes intimate contact, it provides an easy opportunity for organisms to spread from one person to another,” notes The Merck Manual of Medical Information. “A variety of infectious organisms can be spread by sexual contact.”

Although they are called sexually transmitted, some STIs may be spread via skin-to-skin sexual contact. “The organisms causing STIs can also be spread through non-sexual means such as blood products and tissue transfer,” the WHO says. Many STIs can also be transmitted from mother to child during pregnancy and childbirth.

In the past, there were only two known STIs. Today, medical science has identified some 60 different STIs. The most common ones are the following:

Syphilis

Syphilis was once a major public health threat, commonly causing serious long-term health problems such as arthritis, brain damage, and blindness. It defied effective treatment until the late 1940s, when the antibiotic penicillin was first developed.

How serious was syphilis in the past? Let’s take a closer look at history. Christopher Columbus (better known as the explorer of America) became infected with syphilis and later died of it. Napoleon Bonaparte, too, suffered from syphilis and probably died due to consumption of arsenic which was used for treatment for syphilis during that time.

The same thing happened to Franz Schubert, a romantic Austrian composer and one of the most gifted musicians of the 19th century. He had battled syphilis since 1822 and the cause of his death was consumption of mercury.

A highly contagious disease, syphilis is spread primarily by sexual activity, including oral and anal sex. “Occasionally, the disease can be passed to another person through prolonged kissing or close bodily contact,” WebMd.com explains. “Although this disease is spread from sores, the vast majority of those sores go unrecognized. The infected person is often unaware of the disease and unknowingly passes it on to his or her sexual partner.”

In the United States, 75% of the syphilis cases were among men who have sex with men. As it is sexually transmitted, the bacterium that causes it (called Treponema pallidum) is not spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

According to WebMd.com, syphilis infection occurs in three distinct stages:

Early stage: People with primary syphilis will develop one or more sores. The sores are usually small painless ulcers. They occur on the genitals or in or around the mouth somewhere between 10-90 days (average three weeks) after exposure. Even without treatment they heal without a scar within six weeks.

Secondary stage: This may last one to three months and begins within six weeks to six months after exposure. People with secondary syphilis experience a rosy rash typically on the palms of the hands and soles of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. They may also experience moist warts in the groin, white patches on the inside of the mouth, swollen lymph glands, fever, and weight loss. Like primary syphilis, secondary syphilis will resolve without treatment.

Tertiary stage: If the infection isn’t treated, it may then progress to a stage characterized by severe problems with the heart, brain, and nerves that can result in paralysis, blindness, dementia, deafness, impotence, and even death if it’s not treated.

“Syphilis in pregnancy leads to approximately 305,000 fetal and neonatal deaths every year and leaves 215,000 infants at increased risk of dying from prematurity, low-birth-weight or congenital disease,” notes the UN health agency.

Gonorrhea

J.E.B. Stuart, Joseph Goebbles and Frederick the Great had one thing in common. They were infected with Neisseria gonorrheaoe, the bacterium that causes gonorrhea. It grows in warm, moist areas of the body. This can include the tube that carries urine out of the body (urethra). In women, the bacterium may be found in the reproductive tract (which includes the fallopian tubes, uterus, and cervix). It can also grow in the eyes.

Any type of sex can spread gonorrhea. You can get it through contact with the mouth, vagina, penis, or anus. It occurs among people who have sex with multiple partners, especially in those who do not practice safe sex. Oral sex with an infected partner can produce a gonorrheal infection of the throat.

“Symptoms may occur within two to five days after exposure,” wrote Dale Kiefer in an article published by Healthline.com. “However, men may not develop noticeable symptoms for several weeks, and some may never develop symptoms.”

A person with gonorrhea who doesn’t have symptoms is still contagious. A person is more likely to spread the infection to other partners when symptoms remain “silent” like this. If a pregnant woman has gonorrhea, she can pass it on her baby during delivery. This can cause blindness in the child.

In men, the first noticeable symptom is often a burning or painful sensation during urination. Other symptoms may include: greater frequency or urgency of urination; a pus-like discharge from the penis (white, yellow, or greenish); swelling or redness at the opening of the penis; swelling or pain in the testicles; and a persistent sore throat.

In women, symptoms may be more difficult to identify. Gonorrhea infection is often mistaken for common vaginal yeast or bacterial infections. Symptoms include: discharge from the vagina; pain or burning sensation while urinating; the need to urinate more frequently; sore throat; pain upon engaging in sexual intercourse; sharp pain in the lower abdomen; and fever.

“Untreated infection with gonorrhea may also result in the infection spreading to the bloodstream,” points out Kiefer. “In this case, rash, fever, or pain in the joints may eventually develop.”

Chlamydia

Doctors miss this bacterial infection because people don’t realize they’re infected. Unless it is picked up in a routine doctor’s visit, a person wouldn’t know he or she had it. “Most people who have chlamydia are symptom-free,” says Dr. Bernard Fabre-Teste, an advisor with the sexually transmitted infection unit of regional WHO office in Manila. In 80-90% of women, and in 70-80% of men, there are no symptoms.

Initially, symptoms consist of discharge or itching that is so mild most people don’t see a doctor. Over time women can experience lower abdominal or back pain, pain during intercourse, bleeding between periods and nausea or fever. For men, discharge from the penis, pain or burning during urination, or pain and swelling of the testicles.

“Chlamydia infection is easily confused with gonorrhea because the symptoms of both diseases are similar,” note Dr. David Perlin and Ann Cohen, authors of The Complete Idiot’s Guide to Dangerous Diseases and Epidemics. “Direct culture from the vagina or penis, or from urine, is used to detect the disease. Once diagnosed with chlamydia infection, a person can be effectively treated with antibiotics.”

But “untreated chlamydia can lead to some negative consequences,” Understanding Your Health warns. “Initially, your body’s immune system might contain the infection to a sub-clinical level, where you temporarily exhibit no ill effects. However, in men, the pathogens can invade and damage the deeper reproductive structures. Sterility can result. The pathogens can spread further and produce joint problems (arthritis) and heart complications (damaged heart valves, blood vessels and heart muscle tissue).”

In women, the bacterial agents enter the body through the urethra or the cervical area. If not properly treated, chlamydia can cause pelvic inflammatory disease, scarring of the fallopian tubes, ectopic pregnancy and, in some cases, infertility, also a problem for men. Among children born from mothers who have chlamydia, complications include pneumonia and eye infection.

According to the US Centers for Disease Control and Prevention, you can get chlamydia by having vaginal, anal, or oral sex with someone who has chlamydia. If your sex partner is male you can still get chlamydia even if he does not ejaculate. If you’ve had chlamydia and were treated in the past, you can still get infected again if you have unprotected sex with someone who has chlamydia.

No room for complacency

“The worldwide incidence of STIs is already high and constantly rising,” deplores the WHO. “The ever greater mobility of populations and weakening of traditional customs are increasing the prevalence of people having sexual relations with multiple partners.”

If that’s not bad news, here is more bad news. “Resistance of STIs — in particular gonorrhea — to antibiotics has increased rapidly in recent years and has reduced treatment options,” the WHO points out.

“The emergence of decreased susceptibility of gonorrhea to the ‘last line’ treatment option (oral and injectable cephalosporins) together with antimicrobial resistance already shown to penicillins, sulphonamides, tetracyclines, quinolones and macrolides make gonorrhea a multidrug-resistant organism. Antimicrobial resistance for other STIs, though less common, also exists, making prevention and prompt treatment critical,” it adds.

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