5.2. Prevention and treatment of Sexually Transmitted Infections (STIs)

Sexually transmitted infections (STIs) play an important role in the spread of HIV infection:
* HIV is potentially the most deadly STI - that is why we have dedicated this cellbook to the subject.
* People with STIs are more at risk of contracting HIV if they don't practise safe sex.
* Using a condom will prevent the sexual transmission of curable STIs and HIV.
* STI treatment of patients who are sexually active can reduce STIs and HIV infections.
* STI treatment is important in populations with early or growing HIV epidemics.
* IF a man has been circumcised - this is not a form of protection. He still needs to use a condom when he has sex.
* Being faithful to your partner also reduces your risk of getting STIs. The less sexual partners a person has, the lower the risk of infection.
* Most STIs can be cured if they are diagnosed and treated in their early stages.
The most common STIs
CHLAMYDIA is the most common and fastest spreading sexually transmitted disease. It stems from a bacterium called Chlamydia trachomatis. Women diagnosed with Chlamydia can also infect their newborn infant during delivery. Symptoms usually appear approximately 7 to 21 days after infection and are different for men, women and children.
Chlamydia symptoms in men:
* red and swollen urethra (the bladder duct within the penis)
* stinging feeling when urinating (passing water)
* discharge (secretion) from penis
* possible itchiness around the opening
* pain or tenderness in the testicles.
Chlamydia symptoms in women:
* stinging feeling when urinating (passing water)
* unusual vaginal discharge
* pain caused by pelvic tenderness
* pain during sex
* in some cases, bleeding between periods (when not menstruating)
Chlamydia symptoms in infants:
* red and swollen eye (conjunctivitis) at birth
* problems breathing
* premature (early) birth
* pneumonia (is not that common)
Testing for Chlamydia:
One of the most common ways to test for Chlamydia is for the GP to collect a cell sample from the infected area (cervix or penis) with a cotton swab. This is then sent to a laboratory for testing. If the diagnosis is not definite, you may be referred to a specialist clinic for further testing. Treatment consists of antibiotics, both for the patient and the patient's partner. A further swab is recommended once treatment has ended to check that the infection has cleared.
GONORRHEA is caused by bacteria that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth or rectum. In women, the cervix is the most common site of infection. However, the disease can also spread to the uterus (womb) and fallopian tubes causing pelvic inflammatory disease leading to infertility. Gonorrhea is most commonly spread during genital contact but can also be passed from the genitals of one partner to the throat of the other during oral sex. Gonorrhea of the rectum can occur in people who practise anal sex. In pregnant women, gonorrhea can be passed from an infected woman to her newborn infant during delivery if left untreated.
The early symptoms of gonorrhea are often mild and many women who are infected have no visible symptoms of the disease. If symptoms of gonorrhea develop, they usually appear within 2 to 10 days after sexual contact with an infected partner although a small percentage of patients may be infected for several months without showing symptoms.
Gonorrhea symptoms in women:
* painful, burning feeling when urinating (passing water)
* yellowish or bloody discharge from the vagina
* bleeding between periods
* stomach pain
Gonorrhea symptoms in men (more likely to show than women):
* burning feeling when urinating
* yellowish-white discharge from the penis
* Itching, discharge around rectal area or painful bowel movements
Testing for Gonorrhea:
A diagnosis is made through detecting bacteria in samples taken from the urethra, cervix, throat or rectum. The condition is treated with antibiotics and treatment should also be given to the patient's partner. As with Chlamydia, further testing is recommended once treatment has ended to check if the infection has cleared.
HERPES GENITALIS (GENITAL HERPES) is a highly infectious and transferable virus. It mainly infects the skin and mucous membranes of the genitals and rectum but can also appear in areas such as the mouth. It is transmitted mainly through physical and sexual contact. During birth, the presence of herpes simplex virus on the genitalia or in the birth canal is a threat to the infant. Infection in the newborn infant can lead to herpetic meningitis, herpetic viremia (herpes virus particles present in the blood) and chronic skin infection.
The symptoms of herpes simplex virus (HSV) usually occur a week after infection but sometimes take longer to appear. At first, the skin becomes reddened and multiple small blisters filled with a yellowish fluid appear. Before the blisters, the infected person may also experience increased skin sensitivity, tingling, burning or pain where the blisters will appear. Later, the blisters burst leaving shallow, painful ulcers that eventually scab and heal over a period of 7 to 14 days.
Genital herpes symptoms:
* Sensitive skin around the genitals and rectum (or mouth) that tingles or burns before small blisters appear
* swelling and tenderness of the lymph nodes in the groin area
* in women, vaginal discharge and pain when urinating
* in men, a possibility of painful urination if the blisters are near the opening of the urethra
* fever
Testing for genital herpes:
In most cases, a description of the condition and the appearance of the blisters will be enough to make a diagnosis. The GP may also refer you to a specialist clinic to confirm the diagnosis.
There is no cure for the herpes simplex virus; once infected, patients will remain a carrier for the rest of their lives. Some remedies, however, can reduce how long the blisters last. Also, by being more aware of the initial symptoms of recurrence (skin sensitivity and tingling), immediate treatment with medication such as aciclovir will often stop the outbreak of blisters.
The best way to avoid transmission is to avoid direct contact with an open blister. People with herpes simplex virus should avoid sexual contact when the blisters are present.
Even if the symptoms of genital herpes are not present, infected people must inform their partner that they have the disease. This will encourage both parties to use barrier protection (condoms) to prevent the spread of the illness. Using condoms and not sharing towels will reduce the chance of infection.
GENITAL WARTS are caused by the human papilloma virus (HPV). Up to 9 months can pass from the time of infection to the actual development of warts. In women, human papilloma virus can lead to changes in the cervix and to the development of cervical cancer. Therefore, it is important that this condition is diagnosed and treated.
Symptoms of genital warts:
* rough, cauliflower-like growths that may occur singly or in clusters
* in men, they are usually found around the head of the penis and tend to be drier
* in women, they appear most often around the vaginal opening and may spread to the rectal area or may appear near the cervix as whitish, flat-like lesions (wounds), usually only detectable through close visual examination of the cervix (colposcopy)
* In both men and women, lesions (sores) may also be present in the mouth and throat
Testing for genital warts:
A diagnosis is made when a characteristic lesion (cut or sore) is visible. By swabbing the skin with 5% acetic acid, 'invisible' warts will appear as white-coloured patches. A doctor can treat the warts by freezing and swabbing but if this does not help the patient may be referred to a genitourinary specialist who can offer more specialised treatment. Note that treatment does not always offer a complete cure. In general, symptoms can get worse if the immune system is weakened, or during pregnancy or if the person has diabetes. The warts are very contagious so safe sex is advisable.
SYPHILIS is a dangerous and life-threatening bacterial disease. After infection, the bacteria are transported through the body via the bloodstream and attack vital organs such as the heart, brain, nervous system and spine.
Syphilis symptoms are divided into three stages:
Up to 12 weeks after the time of infection: one or more red lesions (sores) will develop on the penis, labia (lips of the vagina), anus and sometimes on the mouth and lips. These lesions disappear after a week.
Up to 6 months after the time of infection: a red rash appears on the chest, back, arms, legs, hands and soles of the feet, the patient will have a high fever, sore throat, muscular tiredness and will generally feel uncomfortable. Anyone experiencing these symptoms should contact their doctor immediately.
If the illness is not treated by the second stage, it will disappear for a while. However, the disease can lie dormant (sleeping) in the body and return up to 20 years later.
At this more advanced stage syphilis symptoms will be:
* heart failure
* paralysis
* insanity
* possible death
Testing for Syphilis:
The diagnosis is made by identifying the micro-organism or antibodies in the blood. In its early stages, syphilis can easily be treated with antibiotics.
For further guidance on other infections and illnesses, speak to your healthcare worker or contact the HIV Clinicians' Society on 011 341 0162 or sahivsoc@sahivsoc.org.
- end of chapter -



NOTE! Read more about HIV and AIDS by following the menu on the left.