SEXUALLY transmitted infections (STIs) previously termed sexually transmitted diseases (STDs) or venereal diseases are as the name implies infections that are mainly spread through sexual intercourse.
We moved from the term sexually transmitted diseases to sexually transmitted infections as the previous term only implied the presence of symptoms. But we know that in most cases one may have a sexually transmitted infection without any symptoms. That’s why we moved from STDs to STIs.
At least one billion people are infected by an STI annually and about 100 000 people die from complications of STIs annually globally. About 15 percent of the world population has been infected by at least one STI in their lifetime. This means about one in every six people has had an STI in their lifetime. This is a significant percentage and it is the reason why STIs are continuing to affect people globally.
STIs are mainly divided into three sub-types namely, bacterial, viral and parasitic STIs. Examples of bacterial STIs include syphilis, gonorrhea and chancroid. Viral STIs include human papilloma virus (HPV) which causes genital warts, herpes simplex virus which causes genital herpes and HIV/AIDS. Trichomonas vaginalis is a good example of a parasitic STI. Please note that there are more than 30 sub types of STIs.
In terms of symptomatology, symptoms vary with different types of STIs and also they could vary with sex. Before we go any further please note that most people with STIs do not have any symptoms. Syphilis for example will give you a firm, painless non itchy skin ulcer normally on the pubic area called a syphilis chancre. It can further give you a skin rash and later on it can affect your central nervous system and your cardiovascular system which can eventually lead to death. Death from Syphilis is now low due to the ease of availability of penicillins like amoxicillin.
Gonorrhea is caused by the bacteria Neisseria gonorrhoeae and it typically gives you a discharge. In men we say if you see any discharge coming out of the urethra it’s almost always equal to an STI. That’s why it was nicknamed drop because droplets of a pus like discharge will be noted from the urethra. Urine and semen during ejaculation are the only normal fluids expected from the urethra.
If you see any discharge coming out of the urethral orifice, suspect it’s an STI. The discharge in gonorrhea can be whitish to yellow. In women if the discharge now changes colour from white or colourless to cream or yellowish suspect it could be gonorrhea. If the discharge of foul smells has increased in quantity then chances of it being gonorrhea are high. Other symptoms could include a burning sensation during urination, lower abdominal pain, and in men testicular pain.
The main symptom in someone who has chancroid is a painful sore on the genitals. It can also give you some swollen groin lymph nodes. It can give you pain during sexual intercourse especially in women. Dysuria (pain during urination) is also a common feature. In the early stages it can also be asymptomatic.
HPV is the virus that causes genital warts. In up to about 90 percent of individuals it gives no symptoms at all. Herpes simplex virus on the other hand gives small pimples that normally appear in a cluster. The pimples are usually painless, water filled in a group of 3 to 8 pimples.
HIV/AIDS will be covered separately in future editions.
The diagnosis of STIs is mainly clinical. This means the diagnosis is mainly based on what the patient tells the doctor and what the doctor sees on examining the patient. Yes there are tests that can be done to confirm the diagnosis. But the tests are not very accurate in most cases, that even if we do the test and it comes back negative yet you have symptoms we will still treat you. And at times one partner has symptoms and the other is asymptomatic, we still have to treat both parties regardless of the absence of symptoms in the other party.
The commonest parasitic STI is called trichomoniasis caused by the parasite trichomonas vaginalis. This STI mainly affects women as the term implies it’s mainly resident in the vagina. It can cause vaginal itchiness, pain when urinating and a thin foul smelling watery discharge.
Treatment of STIs also vary with the type. Bacterial STIs can be cured. Viral STIs can only be treated but cannot be cured. Parasitic STIs can be cured. When we say a disease is cured we mean that after treatment it’s gone for good. If it comes back it means it’s a new infection. If we say a condition is only treatable but incurable it means if we treat you the symptoms will go but the virus will permanently be in your system so that it can resurface later in life even without getting a new infection.
With bacterial infections just a single or two injections and a course of oral antibiotics for 3 to 7 days the STI will be cured forever. In women we normally also add an anti-parasitic agent like metronidazole to combat trichomoniasis. So you will notice we normally give 2 types of oral tablets for the woman and only one type to men. When it comes to viral STIs there are certain antiviral agents that we use to suppress the viral infection but this will not eliminate the virus from your body for life. They only suppress it and make sure the symptoms disappear.
Complications of STIs are varied depending on the type of STI and length of infection with the STI. For example Syphilis if untreated for years will complicate to tertiary syphilis that can cause aneurysms (dilatations of major arteries like the aorta) with potential to rupture and cause sudden death. Gonorrhea has the potential to block the fallopian tubes in women and the epididymis in men and cause subfertility. HPV in women has been shown to be the leading cause of cervical cancer.
It is with all these potentially fatal complications in mind that we encourage you to visit your doctor if you see or suspect any of the above symptoms without delay or hesitation. To minimise your chances of contracting any STI we encourage vaccination against certain STIs like HPV, abstinence before marriage, Condomisation and having one faithful partner whom you are also faithful to.
Remember a healthy you, a healthy me to a healthy world. By Josephat Chiripanyanga
Josephat Chiripanyanga is a Harare-based medical practitioner. You can contact him on joechiripanyanga@gmail.com or on www.drjoe263.com