Sexually Transmitted Infections

Sexually Transmitted Infections (Diseases) or Venereal Diseases (VD) are diseases that are passed on from one person to another through sexual contact, and sometimes by genital contact – the infection can be passed on via vaginal intercourse, oral sex, and anal sex.

STIs are a major public health problem in both resource-rich and limited conditions. STIs are frequently asymptomatic and can lead to various complications. The immediate goal of screening for STIs is to identify and treat infected person(s) before they develop complications and to identify, test, and treat their sex partners to prevent transmission and reinfections.

Risk factors of STDs / STIs

Risk factors for STIs can be broadly divided into sexual behavior that increases the risk of exposure to STIs and risk groups that have a high prevalence of STIs. The risk of STIs is particularly high among sexually active adolescents and young adults.

Behavioral risk factors include:

• New sex partner in past 60 days
• Multiple sex partners or sex partner with multiple concurrent sex partners
• No or inconsistent condom use outside a mutually monogamous sexual partnership
• Trading sex for money or drugs
• Sexual contact (oral, anal, penile, or vaginal) with sex workers
• Meeting anonymous partners on the internet

Risk groups are demographic groups identified as having a high prevalence of STIs.

• Young age (15 to 24 years old)
• Men who have sex with men (MSM)
• History of a prior STI
• Unmarried status
• Lower socioeconomic status, or high school education or less
• Admission to correctional facility or juvenile detention center
• Illicit drug use

Common STIs:

• Chlamydia
• Gonorrhea
• Syphilis
• Chancroid
• Genital Herpes
• HIV
• Human Papilloma Virus
• Trichomoniasis (Trichomonas Vaginalis)
• Hepatitis A
• Hepatitis B
• Hepatitis C

Complications caused by STIs / STDs

STIs if untreated, can causes multiple complications which includes but not limited to

• Upper Genital Tract Infection
• Infertility
• Chronic Pelvic Pain
• Cervical Cancer
• Infection with Hepatitis Virus
• Infection with HIV

Screening and Diagnosis of Sexually Transmitted Infections / Diseases

The approach to STI diagnosis and management is based upon disease or symptom-specific syndromes, including vaginal discharge, urethral discharge, ulcerative genital disease, nonulcerative genital disease, and pelvic pain. However, many patients have asymptomatic disease, which increases the risk of complications and sustained transmission in the community. Thus, screening is an important approach to identify and treat infected individuals, who would otherwise go undetected.

Screening starts with a thorough history mainly aimed at assessing risk factors and sexual history. The components of which includes

• Partners
• Practices
• Protection from STIs
• Past history of STIs

Further testing for sexually transmitted infections generally involves a blood test and/or self-collection of relevant body fluid specimens. There are specific tests done looking for specific organisms.

Management

Treatment of sexually transmitted infections depends on the specific infection. Diagnosis of non-viral STIs generally should result in prompt treatment, since a few individuals may develop complications in the interval between screening and treatment.

Sex partners should be notified, examined, and treated for the STI identified or suspected in the index patient. Patients with non-viral STIs and their sex partners should abstain from sexual intercourse until seven days after initiating treatment.