Sexually transmitted infections 101
Sexually transmitted infections (STI) are infections that spread primarily through sexual contact. Globally, 1 million sexually transmitted infections are acquired every day. A big proportion of these infections can be attributed to 8 pathogens, 4 of which are curable (chlamydia, syphilis, trichomoniasis, gonorrhea) and 4 are not (HIV, herpes, HPV, hepatitis B). We will discuss some of these infections.
Caused by Chlamydia trachomatis, chlamydia is an STI that is often asymptomatic. Symptoms that do appear include dysuria (pain during urinating), yellow mucopurulent discharge, dyspareunia (pain during sex), abnormal vaginal bleeding, etc. Aside from chlamydia, the bacteria can also cause other STIs, such as lymphogranuloma graneleum (where the bacteria travels and infects the lymph nodes).
Syphilis is an STI that is caused by the bacteria Treponema pallidum. This STI progresses into 4 stages if not treated, from primary, secondary, latent, and finally tertiary. In the primary stage, it will appear as a small sore, called a chancre, which is a well-defined, elevated, firm, red part of the skin. Then it will erode, creating an ulcerative crater. However, it will usually be painless. Found mostly on the head of the penis for males and vulva or cervix or females, will heal by itself, treated or not.
Without treatment, it would progress to secondary stage, which can manifest in various ways, such as skin eruptions, fever, headache, fatigue, etc. Then, entering the latent stage, it becomes asymptomatic, lasting years. Finally, in the tertiary stage, the infection progresses and can go to any organ, such as the brain and heart.
Another common STI, this one is caused by the protozoa Trichomonas vaginalis. Men are much more likely to be asymptomatic. For women, common manifestations include abnormal vaginal discharge (commonly frothy), vulvovaginal itchiness, dyspareunia (pain during sex), bleeding after sex, etc.
Caused by the bacteria Neisseria gonorrhoeae, this STI manifests around a week after contact. Symptoms around the genitourinary tract include dyspareunia (pain during sex), vaginal discharge, dysuria (pain during urinating), and bleeding between menstruation. If left untreated, it may progress to pelvic inflammatory disease (PID), which may cause lower pain in the abdomen.
The human papillomavirus is a virus that is often transmitted sexually. Consisting of various types, HPV can cause various infections. The most common are anogenital warts, where bumps, sometimes in the shape of a cauliflower, appear. However, certain types are significantly associated with cervical cancer, and thus are considered “high risk”.
The human immunodeficiency virus, or HIV, is a retrovirus that attacks the immune system, thus making the infected vulnerable to opportunistic infections (infections that would not be an issue/would not happen in an uninfected person). HIV also creates a reservoir in other organs.
One of the most well-known and heavily stigmatized infections in the world, HIV is spread through unprotected sex, non-sterile needles, contaminated blood transfusions, and breastfeeding. Having another STI increases your risk of getting HIV.
As HIV attacks the immune system, there is only a flu-like syndrome, such as fever and weakness, for a very short while. After that, there are no symptoms. However, after years of weakened immune system, the patient may not have a good enough immune system, entering the AIDS (acquired immunodeficiency syndrome) stage and the aforementioned opportunistic infections kick in, such as recurrent diarrhea, certain lung infections, etc.
As previously mentioned, STIs can be asymptomatic or, for example advanced stage syphilis, can affect other systems, and as such can be missed or mistaken for another illness. Even when clearly symptomatic of STI, such as vaginal discharge or abnormal bleeding, there still could be various possibilities for diagnosis. Because of this, it is important for those who are sexually active to, if possible, visit their healthcare providers and screen for STIs, and for those with symptoms to visit a healthcare provider. Diagnosis, at the end of the day, requires healthcare workers to do a complete examination, including tests such as examining the discharge if available.
Treatment will depend on the diagnosis and cause. Appropriate antibiotics are matched to their infections, such as azithromycin for gonorrhea and metronidazole for trichomoniasis. It is important to note, after antibiotics, sex should be delayed for a week. This is to ensure full treatment effect and not infect others who could reinfect you again.
For HPV, treatment does not cure the infection (killing the virus), but deals with the damage, such as cryotherapy to deal with the warts. However, when it comes to cervical cancer, the most important step is to diagnose it during its precancerous stage (normally with a Pap smear; other modalities like a visual inspection with acid is possible in resource constrained settings) and treat it then.
For HIV, current treatment controls the amount of virus (viral load), ideally to undetectable levels; not fully curing of the virus (due to the reservoir). A combination of several antiviruses, HIV treatment allows a person with HIV to live just as long as a person without HIV.
As these infections are transmitted sexually, the only way to 100% make sure not to get it is to not have partnered sex. This, however, doesn’t fully apply for infections like HIV, which can be transmitted via other means like unsterile needles.
Considering the unrealistic expectation of no sex, the most important step is to use condoms. The condom, a barrier method of contraceptive, not only prevents pregnancy, but also STIs, when used correctly. The main idea is that the condom stops contact. Thus, if the lesion is not covered, such as warts on the pubic area, infection is still possible.
For HPV, a vaccine usually for the “high risk” types are available. As for HIV, aside from condoms, prevention is possible for those living with HIV via treatment. If they take their medications and their viral load is undetectable, they cannot transmit it to others. This is the concept of “Undetectable = Untransmittable” or U=U.
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About the author: Bryant Roosevelt Sabur is a feminist, sexual and reproductive health and rights advocate, and medical student in Jakarta, Indonesia.
- WHO. Sexually transmitted infections (STI). 2019 Jun 14. https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis)
- Shahab Qureshi. Chlamydia (Chlamydial Genitourinary Infections). 2018 Sep 25. https://emedicine.medscape.com/article/214823-overview#showall
- Pranatharthi Haran Chandrasekar. Syphilis. 2017 Jul 11. https://emedicine.medscape.com/article/229461-overview#showall
- Darin Scott Smith. Trichomoniasis. 2020 Jan 2. https://emedicine.medscape.com/article/230617-overview#showall
- Brian Wong. Gonorrhea. 2018 Sep 7. https://emedicine.medscape.com/article/218059-overview#showall
- Peter A. Gearhart. Human Papillomavirus (HPV). 2020 Feb 20. https://emedicine.medscape.com/article/219110-overview#showall
- Shelley A. Gilroy. HIV infection and AIDS. 2020 Aug 20. https://emedicine.medscape.com/article/211316-overview#showall