Sexually Transmitted Infections

STIs are spread predominantly by sexual contact, including vaginal, anal and oral sex. Some STIs can
also be spread through non-sexual means such as via blood or blood products. Many STIs—including
syphilis, herpes B, HIV, chlamydia, gonorrhoea, herpes, and HPV—can also be transmitted from
mother to child during pregnancy and childbirth.
A person can have an STI without having obvious symptoms of the disease. Common symptoms of STIs
include vaginal discharge, urethral discharge or burning in men, genital ulcers, and abdominal pain.

STDs interview with Patricia Ntuli of SA FM

More than 30 different bacteria, viruses and parasites are known to be transmitted through sexual contact. Eight of these pathogens are linked to the greatest incidence of sexually transmitted disease. Of these 8 infections, 4 are currently curable: syphilis, gonorrhoea, chlamydia and trichomoniasis.
The other 4 are viral infections that are incurable: heaps B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV). Symptoms or diseases due to incurable viral infections can be reduced or modified through treatment.

Safe Sex
A definite way to prevent STIs is to abstain from having sex which is not feasible. Hence practising safe sex is very important:

  • Always use condoms during sexual intercourse and remembering that some STIs (HPV, HSV) can be transmitted
  • Avoiding sex if you or your partner has symptoms of STIs
  • Monogamous relationship

Understanding the STIs transmission, symptoms and prevention is very helpful in avoiding them. If you have a new partner be open and ask them about the history of STIs and also their last STIs check. If you have sufficient intimacy to have sex you should have enough intimacy to discuss your
health. Once you have this conversation you will have more understanding of your risks. It is advisable to use condoms for the first 3 months of a new relationship and then have a STIs screen for both of you. If it’s all clear you can stop using condoms assuming you do not need it for contraception purposes. I am referring to monogamous relationships. If you are in a polygamous relationship you should always use condoms and be aware of STIs that can be transmitted despite condoms use.

People who are at most risk of STIs are often from marginalized populations such as sex workers, men who have sex with men, people who inject drugs, prisoners, mobile populations and adolescents who often do not have access to adequate health services.

Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60% and provides some protection against other STIs, such as herpes and HPV.

Vaccination: Safe and highly effective vaccines are available for 2 STIs: herpes B and HPV. These vaccines have represented major advances in STI prevention. The vaccine against herpes B is included in babies immunization programmes in 95% of countries and prevents millions of deaths from chronic liver disease and cancer every year.

The HPV vaccination prevents cervical cancer and is indicated for children age 11 to 15 years. Ideally, the HPV vaccine should be given before sexual activity begins, however, we use it in sexually active adults too. In a private school, boys and girls are vaccinated. Public schools in South Africa vaccinate girls only as of
the most effective intervention.

Pre-exposure prophylaxis (or PrEP)

  • is a medication that is taken daily to prevent getting HIV. PrEP can stop HIV from taking hold and spreading throughout your body. When taken daily, PrEP is highly effective for preventing HIV from sex or injection drug use. PrEP is much less effective when it is not taken consistently.

Post-exposure prophylaxis (PEP)

  • is taking medication to prevent HIV are having contact (sexual or through the blood) with an HIV positive person. PEP is commonly used in health workers are needlestick injuries and in rape victims. Another PEP is used for Chlamydia, Gonorrhoea, Trichomoniasis.

Diagnosis of STIs
Some STDs are easily diagnosed when paents have parcular symptoms, for example burning when passing urine, vaginal discharge, irregular bleeding with Chlamydial infecon

  • painful genital lesions with herpes
  • grey discharge, itchiness and burning with Trichomoniasis
  • yellowing discharge and burning when passing urine with Gonorrhea

Majority of people have no symptoms of STIs, hence, it is very important to have regular STIs tests if you are having unprotected sex. The current STIs screening test include

  • Blood test for HIV, Syphilis, Hepas B and C
  • PCR (vaginal swab or urine) test for Chlamydia and Gonorrhoea
  • PCR test for HPV
  • Trichomoniasis vaginal swab or urine in men
  • PCR Herpes test – from lesions to check for current infection or blood antibody test for
    exposure

Unfortunately, the full screen is expensive. It is useful to consult the specialist to determine what tests you require.
You can see below the laboratory charges for STIs tests, the full screen will cost you around R4,500.

Effective treatment is currently available for several STIs.

  • Three bacterial STIs (chlamydia, gonorrhoea and syphilis) and one parasitic STI (trichomoniasis) are generally curable with existing, effective single-dose regimens of anxious.
  • For herpes and HIV, the most effective medications available are antivirals that can modulate the course of the disease, though they cannot cure the disease.
  • For heaps B, antiviral medications can help to fight the virus and slow damage to the liver.
  • HPV does not have treatment. We observe changes in the cells of the cervix (or vagina or vulva) and treat the lesion. Genital warts are treated with creams or removal with lasers.

At times in low- and middle-income countries rely on identifying consistent, easily recognizable signs and symptoms to guide treatment, without the use of laboratory tests. This is called syndromic management. This approach, which relies on clinical algorithms, allows health workers to diagnose a specific infection on the basis of observed syndromes (e.g., vaginal discharge, urethral discharge, genital ulcers, abdominal pain).
Syndromic management is simple, assures rapid, same-day treatment, and avoids expensive or unavailable diagnostic tests for patients that present with symptoms. This approach results in overtreatment and missed treatment as the majority of STIs are asymptomatic.
To interrupt transmission of infection and prevent re-infection, treating sexual partners is an important component of STI case management.

Key facts from the World Health Organisation

More than 1 million sexually transmitted infections (STIs) are acquired every day worldwide

  • Each year, there are an estimated 376 million new infections with 1 of 4 STIs: chlamydia, gonorrhoea, syphilis and trichomoniasis
  • More than 500 million people are estimated to have genital infection with herpes simplex virus (HSV)
  • More than 290 million women have a human papillomavirus (HPV) infection
  • The majority of STIs have no symptoms or only mild symptoms that may not be recognized as an STI
  • STIs such as HSV type 2 and syphilis can increase the risk of HIV acquisition
  • 988 000 pregnant women were infected with syphilis in 2016, resulting in over 350 000 adverse birth outcomes including 200 000 stillbirths and newborn deaths
  • In some cases, STIs can have serious reproductive health consequences beyond the immediate impact of the infection itself (e.g., infertility or mother-to-child transmission)
  • STIs like herpes and syphilis can increase the risk of HIV acquisition three-fold or more.
  • Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low birth weight and prematurity, sepsis, pneumonia, neonatal conjunction, and congenital deformities.

Approximately 1 million pregnant women were estimated to have active syphilis in 2016, resulting in over 350 000 adverse birth outcomes of which 200 000 occurred as stillbirth or neonatal death (5).

  • HPV infection causes 570 000 cases of cervical cancer and over 300 000 cervical cancer deaths each year (6).
  • STIs such as gonorrhoea and chlamydia are major causes of pelvic inflammatory disease (PID) and infertility in women.

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