Sexually Transmitted Diseases

It is a group of diseases transmitted by sexual intercourse and sometimes by other means (sperm, blood, vaginal discharge), and their incidence is increasing in our society. Such diseases can sometimes be transmitted from the sick mother to the baby during pregnancy or childbirth. It can also be transmitted through blood products or needle sticks. These diseases can be caused by bacteria, parasites or viruses.

What Are Sexually Transmitted Diseases?

Sexually transmitted diseases are bacterial or viral infections. There are more than 30 sexually transmitted bacteria and viruses.

Syphilis, gonorrhea, trichomonas infection, genital warts (HPV), genital herpes, soft chancre (chancroid), genital chlamydia infections, genital mycoplasma and ureaplasma infections, AIDS, and hepatitis B are the primary sexually transmitted infections. Hepatitis C infection can also be transmitted sexually. However, this risk is lower than hepatitis B and HIV.

What Are The Symptoms Of Sexually Transmitted Diseases?

2-5 weeks after suspected sexual intercourse, diseases may show symptoms such as discharge, odor, wound, itching. It is also possible to have headaches, joint pains, rashes, weakness, fever in a more extended period.

  • Wound in the genital area, in the mouth or the anal area, with or without fluid-filled swelling
  • Discharge from the penis or vagina
  • Swelling and pain in the inguinal region
  • Pain and burning when urinating

These symptoms may occur in a short time (a few days) after sexual intercourse, or they may appear for a more extended period, such as three months.

What Are The Risk Factors?

The following conditions are considered risk factors for sexually transmitted diseases.

  • Having unprotected sexual intercourse
  • Having sexual intercourse with a large number of people
  • Having one or more sexually transmitted diseases
  • Being addicted to alcohol or substances

What Is The Significance Of These Diseases?

Asymptomatic patients who do not show any symptoms cause the spread of these diseases. Since they are infectious diseases, it is necessary to start treatment as soon as possible. Most of them are treatable and preventable diseases. These diseases do not heal without treatment, the symptoms spread, and they may cause very different complications. As a result of pelvic inflammatory disease (PIH), the most critical complication of sexually transmitted infections, tubal constriction, infertility, and ectopic pregnancy may develop. As a result of HPV infections, anogenital cancer may occur. It can lead to complications such as miscarriage, premature birth, low birth weight baby, or congenital infections.

Along with the patients, their partners or spouses are also affected by these diseases. For this reason, in case of suspicion of such a disease, the patient should consult a doctor as soon as possible, together with the partner if possible, or the partner should be informed of this situation as quickly as possible.

 How Is The Diagnosis Made?

Patients with signs of a sexually transmitted disease can be diagnosed by examining blood, urine, or discharge samples according to the type of disease.

A diagnosis can be made by the use of many methods. The method to be studied can be determined according to the approximate time elapsed over the suspicious intercourse and the symptoms seen in the person:

  • 1-3 weeks: Tests performed with discharge, swabs, and urine detect an acute infection during this period.
  • 2-3 months: Blood tests require more time to pass since the suspected condition because antibodies should be formed in the blood.

Some Of The Tests That Can Be Done To Detect Sexually Transmitted Diseases

VDRL, TPHA, RPR, FTA, Gonorrhea: They are tests for syphilis or gonorrhea. These are the names given to working with different techniques for the exact result of the same test. It is studied from the blood. These tests can be done if wounds and small lesions occur approximately 15-25 days after the suspicious situation or if fatigue, headache, joint pains, and rashes are observed 3-5 months later.

Trichomonas Vaginalis, Gardnerella, Candida: They are studied from urine and discharge. These tests can be done if there is a smelly discharge and itching. These symptoms appear a few days after the suspected intercourse.

Chlamydia Antigens: It is studied from urine and discharge. Its symptoms appear 6-10 days after the suspected intercourse.

Mycoplasma, Ureoplasma: They are studied from urine and discharge. Since they do not show their symptoms very clearly, the study rates are less than other tests.

HPV (Human Papillomavirus): It is one of the most dangerous results. The virus settles in normal cells in the cervix and carries the risk of forming cancer even years later. A positive HPV diagnosis is usually understood from a smear test, because there is no other blood test and culture to detect the virus. Apart from smears, genetic analysis of up to 100 direct streams is possible (HPV-RNA). This is the definitive diagnosis, and the riskiest 6, 11, 12 types and the similar 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, 73, 82 types should be determined with this method. If it is found that they exist, although it is not cancer, follow-up and guidance from a doctor are necessary to eliminate the possibility.

HSV Type 2 (Herpes Simplex Virus Type 2): It is a herpes virus found in the genital area. If this virus has been previously exposed to and its IgG type has been detected, protection has been created as if the person has been vaccinated. However, if the IgM type is detected, it is an indication that the infection is acutely present and newly acquired. Its symptoms are genital herpes and discharge.

HIV Testing: HIV (AIDS) virus is a test that enters the blood through secretion and becomes Anti-HIV positive after an immune response occurs in the blood. Until the response is formed (within about three months), a complete and reliable decision on the presence of the disease cannot be made. If the applicant does not want to wait three months after the suspected intercourse, it is possible to detect it in a shorter time by P24 test within 2-21 days or HIV RNA test within 7 days. However, these are costly tests.

HBs Ag (Hepatitis B Virus Antigen): It is not only sexually transmitted. It can also be transmitted by contact of the carrier’s blood or fluid through the blood from an unknown open wound, crack, or trauma.

Anti HCV (Hepatitis C Virus Antibody): It has the same properties as hepatitis C. To be identified, a certain period must elapse after the suspicious intercourse. It should be repeated in the first and third months. HCV-RNA testing can be done for definitive diagnosis.

What Are The Treatments?

They can be treated with appropriate drugs (antibiotics, antiviral, antiparasitic) aimed at the factors that cause the disease.

What Are The Points That Patients Should Pay Attention To?

Monogamy should be preferred for protection and healthy sexual life. Condoms should be used. Risky sexual activity should be avoided. Attention should be paid to non-sexual transmissions (such as blood and blood products). A doctor should be consulted without embarrassment in the case of skin rash and discharge in the genital area. The patient should be examined and should not have sexual intercourse during this period.

When the treatment is started, the drugs should be used in the specified dose and time.

References:

1) Hacettepe Medical Journal 2006; 37:21-34

2) Rational Use of Antibiotics and Community-Acquired Infections in Adults Symposium Series No: 31 • November 2002; pp. 233-242

3) Documents of Uludağ University FR-HYE-04-434-15

4) Patient Information Brochure of the Venerology Working Group of the Turkish Dermatological Association