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Sexually transmitted diseases (STDs) are diseases that are passed from one person to another through sexual intercourse. They are sometimes called "venereal diseases". Some STDs can cause very serious complications and even death. Often, a person may have more than one STD at a time. It is very important to be aware of how STDs are caught as well as the signs of STDs.
Sexually transmitted diseases are widespread throughout the world, and they are on the increase almost everywhere. Many factors account for the growing number of people who have STDs. Many more people live in or travel to large cities these days, separated from their families. This gives them more opportunities, or more temptation, to have sexual relations with someone other than their husband or wife. Also, many people become sexually active before marriage.
In addition, many of the germs that cause STDs are easily transmitted from person to person. It is possible to catch the disease even after only one act of sexual intercourse with an infected person. Some STDs can no longer be treated successfully with the medicines that were used in the past, because the germs that cause the disease are now resistant to the medicines. For these reasons, STDs are becoming more common in many areas. Anyone can get an STD - not just prostitutes or people with "loose morals".
Many different types of germs can cause STDs. The most common STDs are gonorrhoea, chlamydia, syphilis, chancroid, genital herpes, genital warts, trichomonas, and AIDS. The next few pages will focus on those STDs that have important and significant health implications.
STDs are a problem not only because they cause pain and illness, but also because they can cause long-term complications in a woman and her child, as well as in a man. Some STDs can be passed from mother to baby either during pregnancy or during delivery. This can cause serious illness in the baby.
Most men can tell when they have an STD because there are usually clear signs. Women, however, often have an STD without knowing it, because there are often no signs that they have the disease. Sometimes only an experienced and trained person can find signs of an STD in a woman. This is especially true during pregnancy, when many STD symptoms (for example, an increase in the amount of fluid produced by the vagina) are mistaken for side-effects of pregnancy itself. Sometimes it is necessary to examine samples of a woman's blood or vaginal discharge to find out if she has an STD, and which type of STD she has.
Counselling and treating women and men with STDs requires sensitivity and understanding. People are often embarrassed or ashamed of having an STD. They may not want to talk about their symptoms or how they got the disease. It helps if the health workers who are treating them are patient and non-judgmental. They should not be blamed for getting the disease. It is also very important for health workers to encourage both men and women to tell their sexual partners that they also need to go for treatment. Otherwise, the person can be reinfected if he or she has sexual relations with the infected person again.
If a woman needs to have a vaginal examination to diagnose an STD, it may help her feel more comfortable if the tests and procedures being used are explained to her. If she has to be referred to another health facility or hospital for laboratory tests and treatment, the importance of this treatment should be clearly explained.
If a treatment is not effective for some reason, referral may be necessary so that another drug can be prescribed.
GONORRHOEA
Gonorrhoea is the most common STD. In men, the disease usually causes a burning sensation when passing urine and a thick discharge from the penis. These symptoms begin within a week of being infected (see Figure 18.1). Some women have the same symptoms - pain with urination and discharge from the vagina -but about 80% of women have no symptoms at all. Therefore, it is very important for a man to tell his wife or sexual partner that he has the disease, since she is likely to have it as well but may not know it. Even if there are no symptoms, the disease can be transmitted. It is possible to catch gonorrhoea from just one act of sexual intercourse with an infected person.
Gonorrhoea can be a serious disease. It can usually be treated with penicillin, but not always. If penicillin is not effective, other drugs that can be used are cefixime, ceftriaxone, ciprofloxacin (which should not be given to pregnant women), and spectinomycin. If the symptoms do not go away within a week of treatment, the patient needs to go back to the clinic and get another type of antibiotic. All the tablets prescribed by the doctor must be taken to make sure the disease is completely gone.
If a pregnant woman has gonorrhoea that is not treated, there is a chance that her baby will catch the infection in the eyes. This can lead to blindness. If a woman has gonorrhoea repeatedly or does not seek treatment, she may develop pelvic inflammatory disease (PID), an infection of the reproductive organs. PID is a very serious disease. Its signs are constant lower abdominal pain, painful menstruation and menstrual disorders, fever, and bad-smelling vaginal discharge (see Figure 18.2). Sometimes the symptoms of PID go away without treatment, but this does not mean that the disease has been cured. There can still be serious complications. If a woman with PID does not get treatment, the fallopian tubes can become blocked from scarring, and she can become infertile. Some 15-20% of women who develop PID become infertile (see Chapter 19).
Figure 18.1: Signs of an STD in
Men
The most common STDs are gonorrhoea and chlamydia; signs of these diseases in men include a burning sensation while urinating, and a thick discharge from the penis. They can be treated in most health clinics, and in special STD clinics.
Figure 18.2: Signs of Pelvic
Inflammatory Disease (PID)
If an STD such as gonorrhoea or chlamydia is not treated, it can lead to PID. The signs of PID are constant pain in the lower abdomen, painful menstruation, fever, and bad-smelling discharge from the vagina. A woman with these signs should seek treatment immediately.
CHLAMYDIA
Chlamydia is an infection of the tissues lining the urethra and the opening of the womb. It is becoming common in Africa. In some countries, as many as one in five women attending antenatal clinics have the infection without even being aware of it. The signs of chlamydia are similar to those of gonorrhoea, except they are usually milder. Up to 75% of people with chlamydia have no symptoms at all. The disease can be treated with tetracycline or doxycycline, although these should not be given to pregnant women. Alternative treatments are erythromycin or sulfisoxazole.
If not treated correctly, chlamydia can lead to the same complications as gonorrhoea, such as PID and infertility. It can also cause infertility in men. If a pregnant woman has chlamydia and is not treated, her baby is likely to weigh less than normal because the disease affects the growth in the womb. The baby can also catch the infection during delivery. If untreated, this may cause an eye infection or, in severe cases, pneumonia in the newbom.
SYPHILIS
Syphilis has been around for thousands of years. At one time it appeared to be on the decline as a result of the widespread use of penicillin. Recent studies indicate, however, that the disease is becoming more common. Syphilis is a very serious disease for women, especially pregnant women, because it can be passed on to the baby during pregnancy or labour, with tragic consequences. One-third of the babies born to women with untreated syphilis are born dead. Another third are born with syphilis. Children born with syphilis are often deaf, blind, or mentally retarded; many of them die very young.
Like other STDs, syphilis is transmitted during sexual intercourse with an infected person. The first signs of syphilis usually show up about 25 days after infection, but are easy to overlook. They consist of a small and painless sore in the genital area or vagina, which heals by itself in 3-4 weeks. There may be swellings in the genital area which are not painful. The second stage of syphilis is marked by fever, headaches, and pain in the bones and muscles, usually 6-8 weeks after infection. A rash, which causes no itching, appears on the body, particularly on the soles of the feet and palms of the hands. Warts may appear in the genital area.
The third and last stage of syphilis may not appear for many years; in some cases, as long as 15 or 20 years. By this time the disease has attacked almost the entire body: the heart and major blood vessels, the bones, and the nervous system, including the brain. Late syphilis causes insanity and eventually death from damage to one of these organs. This late stage of the disease is rarely seen any- more because syphilis can be effectively treated at any stage with injections of penicillin.
CHANCROID (GENITAL SORES)
This disease causes shallow, painful sores or ulcers around the genital area and inside the vagina. The sores are accompanied by painful swelling in the genital area. Without treatment, the sores take 2-3 months to heal. Women often have the disease without developing any symptoms, but they can still transmit the disease if they have sexual intercourse. Chancroid does not affect newborns. Like syphilis, it can be treated with penicillin. Chancroid is a serious cause for concern because a woman with chancroid has a high risk of getting the virus that causes AIDS if she has sexual relations with someone who has that virus.
GENITAL HERPES
Herpes is a disease that causes painful, swollen blisters or sores on the penis in a man, and in the vagina of a woman. It can also cause sores in the anus. These sores are usually tender or itchy. The disease is caused by a virus. Unfortunately, herpes cannot be cured. After the first outbreak has healed, the sores can come back. The disease can be transmitted when the sores are actually present, or just before the sores come back. It is possible to tell when the sores are coming because there is a feeling of burning or itching at the place where the sore will come. Sex should be avoided or a condom should be used from the time the itching is felt until the sore has completely disappeared and the skin is whole again. Herpes is not a serious disease in itself, although it can be uncomfortable; but the open sores can make a person much more likely to catch other STDs, including AIDS. A pregnant woman who has an active outbreak of herpes at the time of delivery should have a Caesarean section. The baby can catch the disease by coming into contact with the sores.
GENITAL WARTS
Genital warts are fleshy growths in the genital area caused by a virus. They are not painful. They are easily transmitted from person to person by sexual contact. The warts can be removed, but they are likely to grow again. Treatment usually involves applying an acid preparation repeatedly to the warts. There are many types of viruses that can cause genital warts. Some of these viruses have been linked to an increased risk of getting cancer of the cervix. A woman who has genital warts should have a Pap smear every year to check for cervical cancer.
TRICHOMONAS
Trichomonas is an infection caused by germs or bacteria. The signs are increased fluid from the vagina, and fluid that looks frothy. Itching and pain with urination may also be signs of a trichomonas infection. The disease is diagnosed by looking at fluid from the vagina under a microscope. It may cause low birth weight babies, or premature labour. Trichomonas is easily treated with metronidazole.
CANDIDIASIS
Candidiasis is actually not a sexually transmitted disease, although its symptoms - increased fluid from the vagina and itching - may be confused with other, more serious infections. Candidiasis, otherwise known as a "yeast infection", occurs when some of the bacteria or germs that are normally found in the vagina grow out of control. It can be diagnosed by examining a sample of fluid from the vagina under a microscope. It is treated with medicated suppositories or creams placed in the vagina. Wearing loose clothing or cotton underwear and not douching will help prevent yeast infections. Candidiasis is common during pregnancy, but it will not hurt the baby. If a woman has Candidiasis repeatedly, or if the case is very severe, it may be a sign that she is infected with HIV.
BACTERIAL VAGINOSIS
Like candidiasis, bacterial vaginosis (BV) is not considered a sexually transmitted disease. The signs of BV are an increase in the fluids from the vagina, vaginal fluids that have a bad smell, and sometimes itching. As with candidiasis, the disease is diagnosed by looking at the vaginal fluids under a microscope. It is treated with metronidazole. If a pregnant woman has BV it should be treated since it may cause premature rupture of membranes. However, the disease poses no direct threat to the baby.
AIDS is a very serious STD, a deadly disease for which there is no cure. The disease is the result of infection with the virus known as the human immunodeficiency virus, or HIV. Everyone infected by HIV will eventually develop the disease AIDS.
The virus kills by attacking and destroying certain white cells in the blood that defend the body against diseases. Once a person is infected, the virus can remain in the body for many years without any sign that something is wrong. This phase can last for as little as a few months, or as long as ten years. During this phase an infected person appears healthy and may not even know he or she has the virus, but the disease can be transmitted to others.
Once AIDS actually develops, the infected person begins to get sick often because the body is less able to fight off diseases. In Africa, the most common symptoms are fever, diarrhoea that will not go away, severe weight loss, persistent cough, tiredness, loss of appetite, and skin diseases. The most common diseases developed by people with AIDS are tuberculosis, cancer, meningitis, pneumonia, and - for women - gynaecological infections.
HOW IS HIV TRANSMITTED?
HIV infection is spreading very quickly in sub-Saharan Africa. Scientists believe that already about eight million people are infected, and more than 600,000 have developed the disease. HIV is not transmitted in any of the following ways: by sitting on toilet seats, sharing drinking cups or utensils, touching or other casual physical contact with an infected person (such as hugging or shaking hands), or mosquito bites. The virus can be transmitted in three ways:
SEXUAL TRANSMISSION: The virus is usually passed from one infected person to another through sexual intercourse. About 80-85% of the people in Africa who have HIV were infected through sexual transmission. This happens because the virus is present in the semen or vaginal fluids of an infected person. Sometimes the virus is caught during only one act of sexual intercourse with an infected person. Other times a person has sex many times with an infected person and still does not get the virus. To help protect themselves against the virus, people should:
· Use latex (rubber) condoms every time they have intercourse.· Avoid sexual intercourse if they or their sexual partners have a sexually transmitted disease. If one person has an STD and one person also has HIV, the chances of transmitting HIV are very high.
· Avoid having sexual relations with different people. In fact, the best way to avoid getting AIDS is to stay with one person who does not have the HIV virus and who does not have sexual relations with other people.
· Avoid causing scrapes, cuts, or scratches in the genital area when having sexual intercourse. Women who have been circumcised may be at increased risk for catching the virus, since sexual intercourse is more likely to cause bleeding and cuts. Anal sex should also be avoided since this causes sores that can easily be infected by the HIV virus.
TRANSMISSION THROUGH BLOOD OR BLOOD
PRODUCTS: Since the virus is present in the blood of an infected person, it is possible to catch it if some infected blood gets inside the body. This can happen through blood transfusions with infected blood, or through injections with a needle that has not been sterilised. Women sometimes need blood transfusions during pregnancy and childbirth if they have severe bleeding or a serious case of anaemia. This means they are especially likely to get HIV through transfusions with infected blood. It has also been suggested that some rituals, such as female genital mutilation, male circumcision, and scarification (tribal markings), could transmit the virus by sharing blood on instruments. The best way to avoid transmission through blood is for health workers to:
· Make sure that needles and surgical instruments are always sterilised.· For blood transfusions, use only blood that has been tested.
· Wear surgical gloves during delivery, when there is the risk of being exposed to large amounts of blood.
In addition, communities should be encouraged to avoid rituals that involve cutting the skin, or to make sure that the instruments are sterilised.
MOTHER TO INFANT: If a pregnant woman is infected with the HIV virus, her infant will also get the virus in about 25% of the cases. HIV-infected infants usually become seriously ill by the age of six months. Most die before they are two years old. It is not known for sure whether transmission from mother to child takes place before, during, or after childbirth. HIV can be present in the milk of an infected mother, and there have been a few cases where the virus was transmitted to a baby through breast milk. However, because breastfeeding has so many benefits for the baby (see Chapter 15), it is recommended that women continue breastfeeding even if they are infected with HIV.
HOW TO TELL IF A PERSON HAS BEEN INFECTED BY HIV
The only way to tell whether someone has been infected by HIV is to have a blood test to see whether the antibodies to HIV are in the blood. Otherwise infection can only be confirmed when the disease AIDS has developed.
The blood test for HIV antibodies is fairly widely available now. Most hospitals and blood banks can do it. Some cities have clinics or counselling centres that can perform the blood test (see Figure 18.3). It is important to get diagnosed early so that the infected person can take steps not to infect other people.
Figure 18.3: Testing and
Counselling for HIV/AIDS
Many cities now have clinics or centres where a person's blood can be tested for signs of HIV, the virus that causes AIDS. Couples may want to be tested before marrying, or before having a child. The test should always be accompanied by counselling from a trained person.
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Box 18.1: Key Facts About AIDS AIDS is an STD which is 100% fatal; there is no cure. AIDS weakens the body's immune system, making it susceptible to other diseases which lead to death. | |
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HOW AIDS IS TRANSMITTED: SEXUALLY: During sexual intercourse |
WAYS TO AVOID IT: · Don't have intercourse with more than one person · Don't have intercourse that causes cuts or scrapes in the genital area · Avoid having intercourse with people who already have HIV or other STDs · Always use a condom |
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THROUGH BLOOD: By contact with HIV-infected blood, such as from a needle, a blood transfusion, or a cut |
· Only use sterile needles · Use surgical gloves · Test blood used for transfusions, and use only non-infected blood · Avoid genital mutilation and rituals that cause bleeding |
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FROM MOTHER TO INFANT: A pregnant woman who has HIV can pass it along to her infant |
· A woman who is HIV positive should not get pregnant |
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Signs of HIV/AIDS: The only way to tell if someone has HIV is through a blood test. Even people who appear healthy can have the virus, and can infect others. | |
IS IT POSSIBLE TO PREVENT OR CURE AIDS?
Right now, there is no cure for AIDS. Nor is it likely that there will be any vaccine in the near future. If a person is already infected, certain medicines may delay the onset of symptoms. These medicines are very expensive, however, and are only available in Europe and the United States.
The best way to avoid getting infected with HIV is not to have sexual relationships at all, or to have relations only with someone who is not infected and is faithful. The next best option is to use a condom, but condoms are not 100% effective. A condom can prevent sexual transmission of the HIV virus only if it is used correctly so that no semen spills, and if the condom does not break. Even if they have been stored properly, about one out of every 100 condoms breaks. Another way to reduce the chance that a condom will break is to make sure that the vagina of the woman is wet or lubricated. Creams or oils can be used (except for petroleum jelly, which can damage the condom).
Many women find it very difficult to start a discussion about AIDS with their husbands, and to suggest that they use condoms. It might appear that they think their husbands are not being faithful, or it might make their husbands suspect them. One way to begin talking is to raise the possibility of infection from an injection or blood transfusion. This way, AIDS can be brought up without talking about sexual relations right away. AIDS can be a life or death issue. Everyone owes it to themselves, their children, and their families to do something if they think there is a chance they have been infected, or might become infected.
The popular saying "prevention is better than cure" is very true in the case of sexually transmitted diseases. In the first place, anyone can have an STD. Since the signs are often difficult to see, it is hard to tell who has an STD. Therefore, having sexual intercourse with a number of people should be avoided, since this increases the chance that one of them might have an STD. People who continue to have sexual relations with several partners should at least use condoms. Condoms, particularly if used together with spermicides, offer protection against catching STDs, although this protection is not 100% guaranteed.
In women, the signs of STDs are often not obvious, so diagnosis is more difficult. Those who believe they might have an infection should go to a health facility. Any unusual amount of vaginal discharge, pain during urination, or sudden lower abdominal pain should be investigated. Ulcers, sores, or warts around the genital area also require a visit to a health facility. All women should get a blood test early in pregnancy to check for syphilis so that treatment can be given soon to protect the baby.
Health centres or clinics, especially in rural areas, do not always have the laboratory facilities to test for STDs. Various organisations have developed charts that say what kind of treatment can be given, depending on the symptoms the person has and his or her sexual history (for example, a woman whose husband has a discharge from his penis is almost certain to have gonorrhoea or chlamydia). If the Ministry of Health has accepted this system, these charts should be available. Health workers need to be trained in how to use them.
AIDS and genital herpes are the only STDs which cannot be cured. All other STDs can be treated, as long as the medicines are available. That is why it is important to go to a health facility immediately after getting an STD. Some of the medicines can be quite expensive, but often only a single dose is needed. People should not take medicines without going to a clinic first, since taking medicine without proper directions can cause problems. Herbs or other treatments may also be available from traditional healers. These may not do any harm, but little is known about them. Therefore, people should be advised to use medicines from regular clinics.
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Summary: Sexually Transmitted Diseases The following are the most common signs that someone has an STD. But often, people can have an STD without showing any signs or symptoms that they are ill. | |
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SIGNS IN WOMEN: |
SIGNS IN MEN: |
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Sores or bumps inside the vagina, or around the entrance |
Sores on or around the penis or anus |
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to the vagina or anus |
Discharge (fluid) from the penis |
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Pain during urination |
Pain during urination |
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Discharge from the vagina that is: bad-smelling All STDs except genital herpes and AIDS can be treated, as long as they are identified early enough. If an STD is not treated it can lead to pelvic inflammatory disease, which can make a woman infertile. The signs of PID are: Pain or tenderness in the lower abdomen High fever Pain during menstruation (the period), or pain and bleeding during sexual intercourse Bad-smelling discharge from the vagina | |
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