Sexually transmitted infections (STI) are on the rise especially among the younger age groups. Some earlier reports have shown a higher incidence of STI among women aging between 17 and 24 who are sexually active. The reasons are usually due to deficient sex education thus most of the women at that age are not using proper protection as condoms. The presence of multiple sexual partners whether successive or at the same time is a major factor. There are various types of sexually transmitted infections:
Gonorrhoea is caused by Neisseria Gonorrhoea, a 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. Gonorrhoea 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. Gonorrhoea of the rectum can occur in people who practice anal intercourse. With pregnant women, gonorrhoea can be passed from an infected woman to her newborn infant during delivery if left untreated. The early symptoms of gonorrhoea are often mild, and many women who are infected have no visible symptoms of the disease. If symptoms of gonorrhoea 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.
Syphilis is another type of infection, which is a dangerous and life-threatening bacterial disease. After infection, the bacteria are transported through the body via the bloodstream and adversely affects vital organs such as the heart, brain, nervous system and spine.
AIDS is a potentially lethal sexually transmitted disease and is caused by the HIV virus. HIV invades and destroys the immune system, which protects the body from infection. This leaves the infected person prone to many different illnesses and may die from diseases that are usually harmless to healthy people. The use of drugs and the presence of multiple partners are main risk factors. The virus is found in bodily fluids such as blood, sperm and vaginal secretions, and can pass through little scratches that may occur during sexual intercourse.
Genital herpes is a highly contagious viral condition caused by the herpes simplex virus (HSV). It principally infects the skin and mucous membranes of the genitals and rectum, but can also appear in areas such as the mouth. It is transmitted primarily through physical and sexual contact. During pregnancy, the presence of an active infection on the genitalia or in the birth canal is a serious threat to the baby. Infection in the baby can lead to herpetic meningitis, where the outer cover of the brain is infected. The disease can reach the blood stream as well causing severe illness and chronic skin infection. The symptoms of herpes simplex virus usually occur a week after infection, but sometimes take longer to appear. Initially, the skin becomes reddened and multiple small blisters filled with a clear, straw-coloured fluid appear. Prior to the presence of blisters, the infected individual may also experience increased skin sensitivity, tingling, burning or pain at the site where blisters will appear. Later, the blisters burst leaving shallow, painful ulcers, which eventually scab and heal over a period of 7 to 14 days.
Chlamydia This is an infection caused by a tiny bacterium called Chlamydia trachomatis. It is the most common STI in many European countries as the UK, but many studies done in Egypt reveal a high prevalence of the disease. It affects both sexes, although young women are more at risk. Chlamydia can be treated, but it often has no symptoms in either men or women, so remains undetected.
Infection may only be diagnosed once chlamydia has led to complications by that time treatment may be too late to stop permanent damage to the genital organs.
Symptoms of Chlamydia
Some women may experience cystitis which is bladder infection, change in vaginal discharge, some may complain of mild lower abdominal pain.
These are very ‘non-specific’ symptoms and can be caused by other infections and diseases. If you visit your gynaecologist with such symptoms, make sure that you are tested for chlamydia.
In men, chlamydia is the most common cause of discharge from the penis. Sometimes chlamydia can cause mild irritation at the tip of the penis (urethra) that disappears after two or three days. Many men will ignore their symptoms. While the discomfort may disappear, the man can still harbour the infection. If in doubt, it is better to get tested. Otherwise, men could put themselves at risk of inflamed and swollen testicles, and pass chlamydia on to their partners.
What complications can chlamydia cause?
In some women chlamydia can cause pelvic inflammatory disease (PID), also know as pelvic infection. It can damage the Fallopian tubes that carry eggs from the ovaries to the womb. The tubes may stop working properly and can become completely blocked.
Chlamydia is the most common preventable cause of infertility in women. When the Fallopian tubes are blocked, no pregnancy is possible naturally. One option is IVF (in-vitro fertilisation), but it is very costly and has variable success rates depending on the centre where it is performed.
Women with damaged tubes do occasionally fall pregnant, but there is an increased risk of the pregnancy developing outside the womb usually in one of the tubes. This is called an ectopic pregnancy. The tube can burst causing serious pain and bleeding. The bleeding is very serious and can be life threatening. Some women now days die from haemorrhage due to undiagnosed ectopic pregnancy.
Infection sometimes leads to pain in the lower abdomen that is often mistaken for some other problem rather than pelvic infection.
Chlamydial infection can affect sperm function and male fertility. It is the most common cause of inflammation in the testicles and tubes that allow the passage of sperms in men under the age of 35. This causes pain, swelling and redness on the affected side of the scrotum, or even on both sides.
Should I get tested?
Chlamydia is almost always transmitted through sexual intercourse, so the likelihood of having the infection depends on your sexual behaviour. If you’ve had sex and not used a condom, you are at risk of chlamydia.
The more partners you have, the more likely you will be exposed to infection. This isn’t about promiscuity, as you only need to have unprotected sex with one person who happens to have the infection to get chlamydia.
What are the available tests?
The tests available in Egypt are either a swab taken form the upper vagina using a speculum (instrument inserted into the vagina having to blunt blades that move apart) to allow the gynaecologist to reach and visualise the cervix and upper vagina. A urine sample can be tested as well.
For men, a urine sample is good enough and avoids the discomfort of a swab from inside the tip of the penis (urethra).
Both men and women can have as well blood tests to detect the presence of chlamydial antibodies.
When being examined by your gynaecologist, make sure that the speculum is either disposable and package opened in front of you. Or if it is the metal reusable type ensure it has been kept in the sterilizer and not left in a large metal bowl with other speculums. As It has been shown that speculums can harbour a variety of sexually transmitted infections.
How is Chlamydia treated?
Chlamydia is treated with a variety of antibiotics. Tetracyclines: the usual prescribed drug is doxycycline. One tablet should be taken twice a day for a week. Azithromycin, another type of antibiotic, is the most convenient treatment because it is taken only once as four tablets at the same time. During pregnancy a different antibiotic called erythromycin can be used, which is safe to the baby.
Make sure your husband also gets treatment. Otherwise, the treated partner becomes re-infected. Repeated infections can cause far worse fertility problems in women.
How to reduce Chlamydial infection?
It is very important to think about the health and safety of our children. Discussing sex has never been easy for anyone, but surveys suggest that kids like to hear about sex and relationships from a parent in preference to anyone else.
Decent sex education in schools would help young people understand the consequences of their actions. Making an informed decision, and knowing where to go if there are any concerns, as it is essential to get help promptly.
Human papilloma virus (HPV) can lead to the development of genital warts, or condylomata acuminate. Up to nine 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. Recently there has been the launch of a new vaccine in Egypt against the virus to reduce the incidence of cervical cancer. Therefore, it is important that this condition is diagnosed and treated as early as possible
What HPV is
Human papilloma viruses are known as HPV. They can affect the skin and the moist membranes that line parts of the body, including the lining of the mouth and throat,the cervix and the anus. There are more than 100 different types (or ‘strains’) of human papilloma virus (HPV). Each type has a different number.
HPV is common. Most people have the virus at some time in their lives. For most people it causes no symptoms and goes away on its own. It is much more common in young people, probably because we develop immunity to the virus as we get older.
Some types of HPV can cause changes in the cells of the cervix or the lining of the mouth and throat. They are known as high risk HPVs. Doctors call these changes in cells ‘dysplasia’. The changed cells have an increased risk of becoming cancerous.
Other types of HPV can cause warts and verrucas. These types of HPV are sometimes called the ‘wart virus’ or ‘genital wart virus’ and they include types six and eleven. Warts and verrucas are most common on the hands and feet, in the genital area and around the anus. But they can be on any part of the body. Types of HPV that cause warts and verrucas do not usually cause cell changes that may develop into cancer. They are called low risk HPVs.
How you get HPV
Types of HPV that affect the skin can be passed on by skin contact with an affected person. The types of HPV that affect the mouth and throat can be passed on through kissing. Genital HPV is usually spread through intimate, skin to skin, contact during sex.
You can have the genital HPV virus for years and not have any sign of it. So it isn’t unusual to have a long term partner and then be told you have the virus after medical tests such as cervical screening. Many people then worry that their partner has been unfaithful, or will think they have been unfaithful. But finding out you have HPV doesn’t necessarily mean that you or your partner have been unfaithful. There is no way of knowing how long you have had the virus. It could be weeks, months or years.
HPV and Cervical Cancer
Some types of HPV can increase the risk of developing cervical cancer, particularly types 16, 18, 31, 33 and 45. They are called high risk types. Almost all women with cervical cancer have at least one of these types of HPV in the cells of their cervix.
Of the different types of HPV, types 16 and 18 cause about 7 out of 10 (70%) cancers of the cervix. The other types cause most of the remaining 30% of cervical cancers.
Do remember that most women with high risk HPV don’t develop cervical cancer. We know from research that other factors affect whether you develop cancer, such as how well your immune system is working or whether you smoke. Women who smoke and have a high risk type of HPV infection are more likely to go on to get cervical cancer.
Remember that regular cervical screening will pick up abnormal cervical cells before they become cancerous. So even if you have HPV and smoke, you can prevent cervical cancer if you go for screening when you are invited.
People with low immunity also have an increased risk of cervical cancer. Your immunity may be low because you take certain medicines for another condition, or because you have an illness that affects your immunity, such as HIV AIDS. If you have low immunity, it is particularly important to have regular cervical screening.
Treatment for cervical HPV
Treatment can get rid of any visible signs of HPV infection, such as warts, but no treatment can get rid of the virus.
Women who test positive for high risk types of HPV are more likely to need treatment for borderline or mildly abnormal cervical smears.
If you have a mildly abnormal cervical smear, you may have a certain examination called colposcopy straight away. Or your doctor may ask you to come back for another smear in 6 months time. If the abnormality doesn‘t go away by itself (as it sometimes does), your doctor will suggest a colposcopy.
Preventing cervical HPV infection
Using a condom can help lower your risk of genital HPV but won’t prevent it completely. The virus can be spread through contact with the skin around the genital area, including contact with the vulva and the scrotum.
Vaccines are now available to prevent infection with types of HPV that can lead to cervical cancer. The Gardasil and Cervarix cervical cancer vaccines were licensed in the UK in 2007. These vaccines will help to prevent this type of cancer in the future. These vaccines are now available in Egypt, please ask your gynaecologist.
All girls aged 12 or 13 should be offered the cervical cancer vaccine. It is up to them and their parents whether they have it.
Concern about getting infected again
Many women worry about becoming infected again after they have had treatment for an abnormal smear. Viruses are difficult to treat and your body gets rid of them by developing immunity to them. This may take from a few months to a few years.
Some women worry about whether their partner has the virus and could reinfect them. Men aren’t routinely tested for HPV because the only way for a man to find out if he has the virus is to have several biopsies. Even then, a negative result only means that HPV wasn’t found on those biopsies and not necessarily that he doesn’t have HPV at all. Because our bodies clear the virus, even if a man has the virus when he has the test, his immune system may get rid of it before the test result comes back.
As there more than 100 types of HPV, it is possible to be immune to one type but not another. So it may seem that you have been reinfected but in fact you may just have a different type of HPV.