Sexually transmitted infection
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Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs), are infections that are commonly spread by sexual activity, especially vaginal intercourse, anal sex and oral sex.[1][5] Many times STIs initially do not cause symptoms.[1] This results in a greater risk of passing the disease on to others.[6][7] Symptoms and signs of disease may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain.[1] STIs can be transmitted to an infant before or during childbirth and may result in poor outcomes for the baby.[1][8] Some STIs may cause problems with the ability to get pregnant.[1]
More than 30 different bacteria, viruses, and parasites can be transmitted through sexual activity.[1] Bacterial STIs include chlamydia, gonorrhea, and syphilis.[1] Viral STIs include genital herpes, HIV/AIDS, and genital warts.[1] Parasitic STIs include trichomoniasis.[1] While usually spread by sex, some STIs can be spread by non-sexual contact with donor tissue, blood, breastfeeding, or during childbirth.[1] STI diagnostic tests are usually easily available in the developed world, but this is often not the case in the developing world.[1]
The most effective way of preventing STIs is by not having sex.[2] Some vaccinations may also decrease the risk of certain infections including hepatitis B and some types of HPV.[2] Safer sex practices such as use of condoms, having a smaller number of sexual partners, and being in a relationship where each person only has sex with the other also decreases the risk.[1][2] Circumcision in adult males may be effective to prevent some infections.[1] During school, comprehensive sex education may also be useful.[9] Most STIs are treatable or curable.[1] Of the most common infections, syphilis, gonorrhea, chlamydia, and trichomoniasis are curable, while herpes, hepatitis B, HIV/AIDS, and HPV are treatable but not curable.[1] Resistance to certain antibiotics is developing among some organisms such as gonorrhea.[10]
In 2015, about 1.1 billion people had STIs other than HIV/AIDS.[3] About 500 million were infected with either syphilis, gonorrhea, chlamydia or trichomoniasis.[1] At least an additional 530 million people have genital herpes and 290 million women have human papillomavirus.[1] STIs other than HIV resulted in 108,000 deaths in 2015.[4] In the United States there were 19 million new cases of sexually transmitted infections in 2010.[11] Historical documentation of STIs date back to at least the Ebers papyrus around 1550 BC and the Old Testament.[12] There is often shame and stigma associated with these infections.[1] The term sexually transmitted infection is generally preferred over sexually transmitted disease or venereal disease, as it includes those who do not have symptomatic disease
More than 30 different bacteria, viruses, and parasites can be transmitted through sexual activity.[1] Bacterial STIs include chlamydia, gonorrhea, and syphilis.[1] Viral STIs include genital herpes, HIV/AIDS, and genital warts.[1] Parasitic STIs include trichomoniasis.[1] While usually spread by sex, some STIs can be spread by non-sexual contact with donor tissue, blood, breastfeeding, or during childbirth.[1] STI diagnostic tests are usually easily available in the developed world, but this is often not the case in the developing world.[1]
The most effective way of preventing STIs is by not having sex.[2] Some vaccinations may also decrease the risk of certain infections including hepatitis B and some types of HPV.[2] Safer sex practices such as use of condoms, having a smaller number of sexual partners, and being in a relationship where each person only has sex with the other also decreases the risk.[1][2] Circumcision in adult males may be effective to prevent some infections.[1] During school, comprehensive sex education may also be useful.[9] Most STIs are treatable or curable.[1] Of the most common infections, syphilis, gonorrhea, chlamydia, and trichomoniasis are curable, while herpes, hepatitis B, HIV/AIDS, and HPV are treatable but not curable.[1] Resistance to certain antibiotics is developing among some organisms such as gonorrhea.[10]
In 2015, about 1.1 billion people had STIs other than HIV/AIDS.[3] About 500 million were infected with either syphilis, gonorrhea, chlamydia or trichomoniasis.[1] At least an additional 530 million people have genital herpes and 290 million women have human papillomavirus.[1] STIs other than HIV resulted in 108,000 deaths in 2015.[4] In the United States there were 19 million new cases of sexually transmitted infections in 2010.[11] Historical documentation of STIs date back to at least the Ebers papyrus around 1550 BC and the Old Testament.[12] There is often shame and stigma associated with these infections.[1] The term sexually transmitted infection is generally preferred over sexually transmitted disease or venereal disease, as it includes those who do not have symptomatic disease
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Sexually transmitted infections include:
Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. In women, symptoms may include abnormal vaginal discharge, burning during urination, and bleeding in between periods, although most women do not experience any symptoms.[55] Symptoms in men include pain when urinating, and abnormal discharge from their penis.[56] If left untreated in both men and women, Chlamydia can infect the urinary tract and potentially lead to pelvic inflammatory disease (PID). PID can cause serious problems during pregnancy and even has the potential to cause infertility. It can cause a woman to have a potentially deadly ectopic pregnancy, in which the egg implants outside of the uterus. However, Chlamydia can be cured with antibiotics.
The two most common forms of herpes are caused by infection with herpes simplex virus (HSV). HSV-1 is typically acquired orally and causes cold sores, HSV-2 is usually acquired during sexual contact and affects the genitals, however either strain may affect either site.[57] Some people are asymptomatic or have very mild symptoms. Those that do experience symptoms usually notice them 2 to 20 days after exposure which last 2 to 4 weeks. Symptoms can include small fluid-filled blisters, headaches, backaches, itching or tingling sensations in the genital or anal area, pain during urination, Flu like symptoms, swollen glands, or fever. Herpes is spread through skin contact with a person infected with the virus. The virus affects the areas where it entered the body. This can occur through kissing, vaginal intercourse, oral sex or anal sex. The virus is most infectious during times when there are visible symptoms, however those who are asymptomatic can still spread the virus through skin contact.[58] The initial infection and symptoms are usually the most severe because the body does not have any antibodies built up. After the primary attack, one might have recurring attacks that are milder or might not even have future attacks. There is no cure for the disease but there are antiviral medications that treat its symptoms and lower the risk of transmission (Valtrex). Although HSV-1 is typically the "oral" version of the virus, and HSV-2 is typically the "genital" version of the virus, a person with HSV-1 orally CAN transmit that virus to their partner genitally. The virus, either type, will settle into a nerve bundle either at the top of the spine, producing the "oral" outbreak, or a second nerve bundle at the base of the spine, producing the genital outbreak.
The human papillomavirus (HPV) is the most common STI in the United States.[59] There are more than 40 different strands of HPV and many do not cause any health problems. In 90% of cases the body's immune system clears the infection naturally within 2 years.[60] Some cases may not be cleared and can lead to genital warts (bumps around the genitals that can be small or large, raised or flat, or shaped like cauliflower) or cervical cancer and other HPV related cancers. Symptoms might not show up until advanced stages. It is important for women to get pap smears in order to check for and treat cancers. There are also two vaccines available for women (Cervarix and Gardasil) that protect against the types of HPV that cause cervical cancer. HPV can be passed through genital-to-genital contact as well as during oral sex. It is important to remember that the infected partner might not have any symptoms.
Gonorrhea is caused by bacterium that lives on moist mucous membranes in the urethra, vagina, rectum, mouth, throat, and eyes. The infection can spread through contact with the penis, vagina, mouth or anus. Symptoms of gonorrhea usually appear 2 to 5 days after contact with an infected partner however, some men might not notice symptoms for up to a month. Symptoms in men include burning and pain while urinating, increased urinary frequency, discharge from the penis (white, green, or yellow in color), red or swollen urethra, swollen or tender testicles, or sore throat. Symptoms in women may include vaginal discharge, burning or itching while urinating, painful sexual intercourse, severe pain in lower abdomen (if infection spreads to fallopian tubes), or fever (if infection spreads to fallopian tubes); however, many women do not show any symptoms.[61] There are some antibiotic resistant strains for Gonorrhea but most cases can be cured with antibiotics.
The two most common forms of herpes are caused by infection with herpes simplex virus (HSV). HSV-1 is typically acquired orally and causes cold sores, HSV-2 is usually acquired during sexual contact and affects the genitals, however either strain may affect either site.[57] Some people are asymptomatic or have very mild symptoms. Those that do experience symptoms usually notice them 2 to 20 days after exposure which last 2 to 4 weeks. Symptoms can include small fluid-filled blisters, headaches, backaches, itching or tingling sensations in the genital or anal area, pain during urination, Flu like symptoms, swollen glands, or fever. Herpes is spread through skin contact with a person infected with the virus. The virus affects the areas where it entered the body. This can occur through kissing, vaginal intercourse, oral sex or anal sex. The virus is most infectious during times when there are visible symptoms, however those who are asymptomatic can still spread the virus through skin contact.[58] The initial infection and symptoms are usually the most severe because the body does not have any antibodies built up. After the primary attack, one might have recurring attacks that are milder or might not even have future attacks. There is no cure for the disease but there are antiviral medications that treat its symptoms and lower the risk of transmission (Valtrex). Although HSV-1 is typically the "oral" version of the virus, and HSV-2 is typically the "genital" version of the virus, a person with HSV-1 orally CAN transmit that virus to their partner genitally. The virus, either type, will settle into a nerve bundle either at the top of the spine, producing the "oral" outbreak, or a second nerve bundle at the base of the spine, producing the genital outbreak.
The human papillomavirus (HPV) is the most common STI in the United States.[59] There are more than 40 different strands of HPV and many do not cause any health problems. In 90% of cases the body's immune system clears the infection naturally within 2 years.[60] Some cases may not be cleared and can lead to genital warts (bumps around the genitals that can be small or large, raised or flat, or shaped like cauliflower) or cervical cancer and other HPV related cancers. Symptoms might not show up until advanced stages. It is important for women to get pap smears in order to check for and treat cancers. There are also two vaccines available for women (Cervarix and Gardasil) that protect against the types of HPV that cause cervical cancer. HPV can be passed through genital-to-genital contact as well as during oral sex. It is important to remember that the infected partner might not have any symptoms.
Gonorrhea is caused by bacterium that lives on moist mucous membranes in the urethra, vagina, rectum, mouth, throat, and eyes. The infection can spread through contact with the penis, vagina, mouth or anus. Symptoms of gonorrhea usually appear 2 to 5 days after contact with an infected partner however, some men might not notice symptoms for up to a month. Symptoms in men include burning and pain while urinating, increased urinary frequency, discharge from the penis (white, green, or yellow in color), red or swollen urethra, swollen or tender testicles, or sore throat. Symptoms in women may include vaginal discharge, burning or itching while urinating, painful sexual intercourse, severe pain in lower abdomen (if infection spreads to fallopian tubes), or fever (if infection spreads to fallopian tubes); however, many women do not show any symptoms.[61] There are some antibiotic resistant strains for Gonorrhea but most cases can be cured with antibiotics.
Trichomoniasis is a common STI that is caused by infection with a protozoan parasite called Trichomonas vaginalis.[65] Trichomoniasis affects both women and men, but symptoms are more common in women.[66] Most patients are treated with an antibiotic called metronidazole, which is very effective.[67]
HIV (human immunodeficiency virus) damages the body's immune system, which interferes with its ability to fight off disease-causing agents. The virus kills CD4 cells, which are white blood cells that help fight off various infections. HIV is carried in body fluids, and is spread by sexual activity. It can also be spread by contact with infected blood, breast feeding, childbirth, and from mother to child during pregnancy.[68] When HIV is at its most advanced stage, an individual is said to have AIDS (acquired immunodeficiency syndrome).[69] There are different stages of the progression of and HIV infection. The stages include primary infection, asymptomatic infection, symptomatic infection, and AIDS. In the primary infection stage, an individual will have flu like symptoms (headache, fatigue, fever, muscle aches) for about 2 weeks. In the asymptomatic stage, symptoms usually disappear, and the patient can remain asymptomatic for years. When HIV progresses to the symptomatic stage, the immune system is weakened, and has a low cell count of CD4+ T Cells. When the HIV infection becomes life-threatening, it is called AIDS. People with AIDS fall prey to opportunistic infections and die as a result.[55] When the disease was first discovered in the 1980s, those who had AIDS were not likely to live longer than a few years. There are now antiretroviral drugs (ARVs) available to treat HIV infections. There is no known cure for HIV or AIDS but the drugs help suppress the virus. By suppressing the amount of virus in the body, people can lead longer and healthier lives. Even though their virus levels may be low they can still spread the virus to others
HIV (human immunodeficiency virus) damages the body's immune system, which interferes with its ability to fight off disease-causing agents. The virus kills CD4 cells, which are white blood cells that help fight off various infections. HIV is carried in body fluids, and is spread by sexual activity. It can also be spread by contact with infected blood, breast feeding, childbirth, and from mother to child during pregnancy.[68] When HIV is at its most advanced stage, an individual is said to have AIDS (acquired immunodeficiency syndrome).[69] There are different stages of the progression of and HIV infection. The stages include primary infection, asymptomatic infection, symptomatic infection, and AIDS. In the primary infection stage, an individual will have flu like symptoms (headache, fatigue, fever, muscle aches) for about 2 weeks. In the asymptomatic stage, symptoms usually disappear, and the patient can remain asymptomatic for years. When HIV progresses to the symptomatic stage, the immune system is weakened, and has a low cell count of CD4+ T Cells. When the HIV infection becomes life-threatening, it is called AIDS. People with AIDS fall prey to opportunistic infections and die as a result.[55] When the disease was first discovered in the 1980s, those who had AIDS were not likely to live longer than a few years. There are now antiretroviral drugs (ARVs) available to treat HIV infections. There is no known cure for HIV or AIDS but the drugs help suppress the virus. By suppressing the amount of virus in the body, people can lead longer and healthier lives. Even though their virus levels may be low they can still spread the virus to others
Viruses in semen
Twenty-seven different viruses have been identified in semen. Information on whether or not transmission occurs or whether the viruses cause disease is uncertain. Some of these microbes are known to be sexually transmitted.[71] Those found in semen are listed by the CDC.[71]
Microbes known to be sexually transmissible (but not generally considered STIs) include:
Marburg virus – Virus in semen for seven weeks after clinical recovery.[72]
HTLV (both types 1 and 2) – Sexually transmissible, consumption of breast milk breastfeeding, and once mistaken as a HIV, risk of leukemia
Microbes known to be sexually transmissible (but not generally considered STIs) include:
Marburg virus – Virus in semen for seven weeks after clinical recovery.[72]
HTLV (both types 1 and 2) – Sexually transmissible, consumption of breast milk breastfeeding, and once mistaken as a HIV, risk of leukemia
Diagnosis
Testing may be for a single infection, or consist of a number of tests for a range of STIs, including tests for syphilis, trichomonas, gonorrhea, chlamydia, herpes, hepatitis and HIV. No procedure tests for all infectious agents.
STI tests may be used for a number of reasons:
as a diagnostic test to determine the cause of symptoms or illness
as a screening test to detect asymptomatic or presymptomatic infections
as a check that prospective sexual partners are free of disease before they engage in sex without safer sex precautions (for example, when starting a long term mutually monogamous sexual relationship, in fluid bonding, or for procreation).
as a check prior to or during pregnancy, to prevent harm to the baby
as a check after birth, to check that the baby has not caught an STI from the mother
to prevent the use of infected donated blood or organs
as part of the process of contact tracing from a known infected individual
as part of mass epidemiological surveillance
Early identification and treatment results in less chance to spread disease, and for some conditions may improve the outcomes of treatment. There is often a window period after initial infection during which an STI test will be negative. During this period, the infection may be transmissible. The duration of this period varies depending on the infection and the test. Diagnosis may also be delayed by reluctance of the infected person to seek a medical professional. One report indicated that people turn to the Internet rather than to a medical professional for information on STIs to a higher degree than for other sexual problems
Testing may be for a single infection, or consist of a number of tests for a range of STIs, including tests for syphilis, trichomonas, gonorrhea, chlamydia, herpes, hepatitis and HIV. No procedure tests for all infectious agents.
STI tests may be used for a number of reasons:
as a diagnostic test to determine the cause of symptoms or illness
as a screening test to detect asymptomatic or presymptomatic infections
as a check that prospective sexual partners are free of disease before they engage in sex without safer sex precautions (for example, when starting a long term mutually monogamous sexual relationship, in fluid bonding, or for procreation).
as a check prior to or during pregnancy, to prevent harm to the baby
as a check after birth, to check that the baby has not caught an STI from the mother
to prevent the use of infected donated blood or organs
as part of the process of contact tracing from a known infected individual
as part of mass epidemiological surveillance
Early identification and treatment results in less chance to spread disease, and for some conditions may improve the outcomes of treatment. There is often a window period after initial infection during which an STI test will be negative. During this period, the infection may be transmissible. The duration of this period varies depending on the infection and the test. Diagnosis may also be delayed by reluctance of the infected person to seek a medical professional. One report indicated that people turn to the Internet rather than to a medical professional for information on STIs to a higher degree than for other sexual problems
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