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6 February 2018 | Feature Article

Sexually Transmitted Infections

Sexually Transmitted Infections

Sexually Transmitted Infections
Half of sexually transmitted infections occur in individuals aged 15-24 years.

Many organisms could be transmitted during sexual intercourse. The list includes HIV, Hepatitis A, B, and C; Pubic lice, scabies mycoplasma. We shall limit our discussion to the common ones.

Symptoms Of Sexually Transmitted Infections
Females:
Vaginal discharge
Pain on voiding urine
Right sided Upper abdominal pain
Bleeding between periods,
Heavier and prolonged menstrual period.
Pelvis infections and pain in the lower abdomen.
Males:
Pain on voiding urine
Scrotal pain and swelling
Urethral itch
Both:
Rash on the skin, palm and soles of the feet, mouth

Ulcers on genitals
Warts on the genitals
Viral hepatitis
Joint infection
CHLAMYDIA TRACHOMATIS.
Commonest STD.
Majority of affected persons have no symptoms.
Symptoms may be so mild, that most teens ignore these symptoms.

In males:
Chlamydia presents as mild discomfort on voiding urine, or itch near the tip of the penis.

Persons may have scanty mucoid penile discharge, which usually disappears without treatment.

Pain in the testis is also common
Females:
Infections are usually asymptomatic.
Girls may have scanty mucoid vaginal discharge
Spotting between periods.
Chlamydia and infertility:
Chlamydia may involve the fallopian tubes usually,(with no symptoms) and can damage the tubal linings leading to infertility and ectopic pregnancies. Because of the silent destruction of the fallopian tubes and future infertility, it is recommended that all sexually active females less than age 24 years, should be screened and treated for chlamydia infections.

Diagnosis of Chlamydia
Testing for chlamydia, using Nucleic Acid Amplification test(NAAT) on first voided urine sample, cervical, vaginal and urethral swabs.

Treatment
Azithromycin 1000mg orally x1 dose
Or,
Doxycycline 100mg twice daily for 7 days.
Reinfection from sex partners in very common So, all treated persons should be retested after 3 months.

GONORRHEA (GONOCOCCUS)
About 87% of persons infected with gonococcus (GC)have no symptoms.

Symptoms include:
severe pain on voiding urine
Scrotal pain and
Copious urethral and vaginal discharge.
These symptoms do make infected individuals rash to seek medical help.

When left untreated, the bacteria may become disseminated in the body,

. forming reddish skin rashes with small pus in the middle.

. spreading to joints to cause joint pain. Dissemination may also, cause

. Right sided upper abdominal pain, as the germs spread into the liver region.

DIAGNOSIS OF GC
Urine samples and vaginal swabs are tested using NAAT (nucleic acid amplification tests)

Treatment:
Ceftriaxone single 250mg intramuscular dose. Plus, Azithromycin 1000mg to cover chlamydial infections

Hospitalization is required for those disseminated GC infection manifesting as joints pain, reddish skin rash with pus in the middle.

Ceftriaxone 1000mg daily, is the initial treatment.

HUMAN PAPILLOMA VIRUSES(GENITAL WARTS)
There are more than 100 HPV viruses, and an individual could be infected with more than one type. Warts may be found on many sites of the boy, depending on the viral type.

Types 6 & 11 infection account for 97% of genital warts,

HPV can cause changes in the female cervix, and penis leading to cervical and penile cancers

HPV causes throat cancers, as well
The dangerous types:16, 18, 31 & 45 cause 80% of cervical cancers, with Type 16 alone causing 40-60% of cervical cancers.

HPV infection is very high among females aged 12-29 years, and males aged 20-29 years.

It takes 6-30 weeks, or longer, for warts to develop, after sexual contact.

Warts may be small, flat flesh-colored bumps, or tiny cauliflower-like bumps

In females, warts are found on the vulva, vagina, cervix, vestibule

In males, warts are found on the penis, between penis and scrotum, or near the anus.

Anal warts usually, denote anal sex.
HPV infection in young women is usually self-limiting; and it has been recommended not to begin PAP smears until after age 21 years, regardless of age at first sexual intercourse.

TREATMENT
Removal of visible warts.
This is done with topical application of podofilox 0.5% gel, or imiquimod 5% cream.

Physicians may apply TCA 80% or cryotherapy with liquid nitrogen.

Physicians may also, remove warts, surgically.
PREVENTION OF HPV
Vaccination is aimed at cancer prevention, and any of the 3 available HPV vaccines may be used.

. 9 valent: HPV9 vaccine (containing HPV types 6, 11,16, 18,31, 33,45,52,58)

. 4 valent (HPV4, containing type 6, 11, 16, and 18) vaccine

. 2 valent (HPV 2 containing type 16 & 18)
Female Children 11-12 years old are given 3 doses at 0, 2, and 6months.

The series may be started at age 9 years
Vaccination is also recommended for males 13-26 years old with no prior HPV vaccination.

HPV4 & HPV9 are given to males aged 9-26years.
GENITAL HERPES
2 viruses Herpes simplex 1(HS1) and HS2 cause genital blisters.

Initial infections may be associated with fever, headaches and general malaise.

Symptoms usually start 2-20 days after sexual exposure.

There is burning sensation, itching followed by redness, and then blisters formation, usually 15-30 blisters. 2-4 days later.

The blisters open and coalesce to form ulcers
In females, lesions may involve the vulva, cervix, clitoris, urethra, perineum.

In males, lesions may be found on penile shaft, glans, prepuce, or urethra.

There may be adenitis in the groin
After the infection has resolved, the virus may remain latent in the local nerve endings, and are reactivated, during times of stress, like Fever, Menstruations, causing recurrences.

If recurrences occur on the cervix, the person may not be aware of this, but could spread infection to her sex partners.

A third of adolescent males, may have asymptomatic recurrences. They are capable of infecting their sex partners.

TREATMENT
Acyclovir 400mg PO 3 times daily for 5days.
Famciclovir 125mg PO twice daily for 5 days.
Valacyclovir 1000mg daily for 5 days.
These agents reduce viral shedding, and duration of symptoms.

Medications are usually started within 1 day after onset of lesions.

Suppression:
Acyclovir 400mg twice daily, (and the other anti-herpes medications), may be taken daily, as suppressive therapy, in individuals with more than 6 recurrences during a year.

SYPHILIS
Primary syphilis
2-3 weeks after exposure, Chancre, a painless ulcer, develops at site of intimate sexual contact.

Size of the ulcer (chancre) varies from a few millimeters to several centimeters. Multiple ulcers may be present. Untreated, the chancre disappears in 3-6 weeks.

Secondary syphilis. The bacteria enter the general circulation. Fever, malaise, sore throat, swollen glands, may occur

6-8 weeks after chancre appears in untreated persons, rash appears, initially on the trunk and arms then spreads to the entire body, including the palms, soles and mucus membranes.

The rash disappears spontaneously 3-12 weeks after its appearance. The person, then enters the latent phase of syphilis

DIAGNOSIS
2 types of serological tests: Treponemal(FTA-ABS) and non-treponemal (RPR, VDRL)

RPR is used for screening and confirmation with the specific fluorescent treponemal antibody absorbed(FTA-ABS)

All person, with syphilis must be tested for HIV.
TREATMENT
Benzathine penicillin, given parenterally.
PREVENTION OF STDs
Abstinence from sexual intercourse
Practice monogamy with uninfected partner.
Use condoms at all times.

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