Sexually Transmitted Diseases
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Sexually transmitted diseases (STDs) are infections that can be spread by either secretions or fluids from the skin and mucosal surfaces of the genitals. There are may different STDs, but the most common ones in the U.S. are herpes simplex virus (HSV) type II, chlamydia, gonorrhea, syphilis and genital warts. Some infections which can be spread by sex, such as the human immunodeficiency virus (HIV) and hepatitis B virus, are not traditionally referred to as STDs since they also can be spread by other means.
Symptoms vary depending on the type of infection. HSV tends to produce painful ulcers on the skin of the genitalia of both sexes, and in the vagina in women. Although the first episode of HSV may also produce fever and swollen lymph glands in the groin, subsequent episodes of genital herpes usually produce only a few ulcers. In men, chlamydia and gonorrhea can cause a penile discharge and a "burning" discomfort during urination. In women, these same infections tend to cause a vaginal discharge and lower abdominal pain. Initially, syphilis produces only painless genital ulcers; however, in later stages of this infection there may be other symptoms, including: rash, swollen lymph nodes, meningitis, and/or other neurological problems.
Your doctor will perform an examination focusing on the genital area. He or she will also examine the anal area, perform a pelvic exam in women, and possibly order blood tests to check for syphilis or HSV infections. Your doctor may swab the urethra (the tube traveling through the penis which carries urine from the bladder) in men, or take a sample of any cervical discharge in women. Specimens are examined under the microscope and sent to the microbiology laboratory for culture. Similar measures may be done with any visible sores. Rarely, your doctor may use a needle to obtain a sample from inside a swollen lymph gland to confirm a specific diagnosis. HIV tests are often suggested by doctors since this virus can be spread more easily during an STD, and many people with STDs are at increased risk of being infected. Your doctor may make an initial diagnosis based on the results of your physical examination. For example, painful sores would suggest genital herpes, while painless ulcers might indicate syphilis. In this way, you can begin treatment for your infection as soon as possible, even before results of laboratory tests are available.
In the case of herpes, gonorrhea, and chlamydia infections, a definite diagnosis can only be made with culture, while a blood test is needed to confirm syphilis. Some specialized facilities can also diagnose syphilis with the use of a darkfield microscope, looking for the bacteria on a smear specimen.
The duration of STDs varies, depending on the specific type of infection. In some cases, although symptoms may resolve without treatment, the patient remains infected and can pass their STD to a partner during unprotected sexual activity. In patients with syphilis or gonorrhea, treatment with antibiotics can shorten symptoms by many days.
You can help prevent STDs by:
· practicing abstinence
· having a monogamous relationship (only one sex partner) with an uninfected person
· consistently using male latex condoms during sexual activity, with or without a spermicide
Caution to condom users: Although condoms can help reduce your exposure to STDs, they are not foolproof.
People who are diagnosed with an STD may be contacted by their local health department so that their sex partners can be evaluated and treated. Most physicians urge patients to tell their sex partners about any diagnosed STD so that their partners can seek medical attention. This is done for two reasons. First, some STDs are fairly silent infections and can be passed unnoticed between sex partners. For example, chlamydia may not cause symptoms in all those infected; however, the scarring effect of the bacteria can lead to infertility, especially in women. Second, STDs are seen as threats to public health, and with proper identification and treatment, the rates of infection can be reduced.
Recent television and print advertisements have focused on herpes virus suppression with medication such as Valtrex (valacyclovir). Because herpes is often shed into genital secretions without symptoms, daily use of antiviral medications can reduce this asymptomatic shedding by 95%. However, since there is currently no definite proof that this approach decreases herpes transmission, most physicians do not routinely prescribe daily antiviral medication for HSV II. Condoms remain the best way to avoid potential herpes infection, since the virus can be present without any obvious sores or ulcers.
The treatment of STDs depends on the suspected infection. In the case of gonorrhea or chlamydia, your doctor may prescribe oral antibiotics such as azithromycin or ofloxacin, or give an injection of an antibiotic called ceftriaxone followed by oral doxycycline. Genital herpes is usually not treated, but people can have flares of the virus, and if that happens more than six times a year, your doctor may recommend suppressive antiviral therapy. Syphilis is usually treated with injections of penicillin. Genital warts can be removed by freezing or by application of ointments meant to dissolve the wart.
Since this is an overview of STDs, treatments for less common infections are not discussed here. However, you can always learn more about any STD by searching this web site for information about that specific infection.
Call your doctor immediately if you find a sore in your genital area, or if you notice an abnormal discharge from your urethra or vagina. You should also call your doctor for an evaluation if your sex partner has had an STD, even if you have no symptoms.
Most STDs respond well to treatment. However, many patients develop repeat episodes of STDs because their sex partners are not treated, or because they continue to be exposed to STDs through unprotected sex. To help avoid STD re-infection, all sex partners should also be treated whenever any patient has an STD.
Genital herpes cannot be cured, since the virus remains dormant in nerves for the rest of a patient's life. However, many people do not notice any recurrences after the initial infection, and even the initial infection of HSV II often goes unnoticed. In people who do notice recurrent herpes flares, about 40% have more than six flares over a lifetime, while less than 10% have more than six flares a year. In patients with HSV II, antiviral therapy can successfully suppress repeated episodes of genital ulcers, but it will not eradicate the virus.
The human papilloma virus, which causes genital warts, is also responsible for producing abnormal pap smears and has been implicated as the cause of cervical cancer.
For more information about STDs, you can call the national Centers for Disease Control and Prevention (CDC). The CDC's toll-free STD Hotline is: 800-227-8922, and is open Monday through Friday, 8am to 11pm.
Centers
for Disease Control and Prevention
1600 Clifton Rd., NE
Atlanta, GA 30333
Telephone: (404) 639-3311
www.cdc.gov
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