All infections involve an organism that invades the body in some way. These organisms are mainly parasites, bacteria and viruses. In sexually transmitted infections, the organism spreads through sexual contact. Affected areas can be the penis, the cervix or vagina, the anus, the area around the genitals, and the throat and mouth. All too often, people make the mistake of thinking that infections other than HIV are not serious! However, these sexually transmitted infections can be just as significant.
Human papilloma virus (HPV) has recently become one of the most newsworthy STI concerns. Several subtypes have been linked with cancer of the cervix, the penis, or the mouth and throat. In addition, a number of HPV subtypes are associated with the very contagious and very difficult to treat genital warts.
Women are ‘catching’ this virus from their male sexual partners. Many men do not have any symptoms for years. However, within three years of contact, a young woman can develop pre-cancerous changes of the cervix. Without detection (the Pap test) and treatment, this cancer can go on to kill many women in their prime.
Prevention is simple – immunization! One current vaccine (Gardasil) is effective against the four worst offending viruses in this class. This vaccine prevents almost all cancers of the cervix and penis (and of related throat cancers), and almost all genital warts. In Canada, many provinces offer this vaccine free of charge to all girls in Grade 5, and now to boys as well. In Alberta, any youth under the age of 18 can get the vaccine free from public health; older adults can pay for it, or get it through their insurance plans. This vaccine is very important, as it will prevent many cancers and serious genital wart infections.
As a number of different HPV strains cause cancer and warts, people with an existing HPV infection should still be immunized to protect themselves against these other strains. The current vaccine is effective for people ages nine through 50. Anyone who has not had the vaccine, especially if starting a new sexual relationship at almost any stage in life, should be immunized.
Herpes simplex virus (HSV) has two main strains: HSV 1 and HSV 2. Blood tests or swabs are used to diagnose and distinguish one from the other. These cause blistering lesions in the area of infection. Most people are familiar with the blisters of HSV 1. When they appear on the lips, they are often called cold sores or fever blisters. Oral sex can transfer this virus to the genitals or other areas on the buttocks, inner thighs and lower abdomen. HSV 2 was long thought to exist only below the waist, as it affects areas on or around the genitals. However, this virus can be transferred elsewhere on the body through intimate contact.
An initial infection with either HSV strain causes an outbreak of tiny, painful blisters at the site of contact with the vulnerable skin. Viral illness symptoms, like fever, aching and fatigue, will also often develop. After this first infection, the virus cannot be eliminated from the body. It will retreat along a nerve, back toward the nerve origin at the spinal cord. When the skin is irritated by dryness, friction or other means, the virus travels from its retreat and appears as blisters near to or at the exact place it first appeared. An outbreak of blisters can also be triggered if the immune (defence) system is taxed, as with physical or emotional stress. Before the blisters emerge, there will often be a tingle for a few hours. This warns of blisters to come.
Spread of the virus can occur with direct contact with the fluid in the blister. This lasts up to seven to ten days, until the blister crusts over completely. The presence of the virus in the fluid during this time is called viral shedding. The effects can be very serious if the virus is active during vaginal childbirth, as it will infect the baby. It is also very serious for anyone whose immune system is weakened. This includes those on chemotherapy, or ill for other reasons. Prevention is essential.
To prevent spreading HSV, avoid any intimate contact (including kissing) during the active or viral shedding phases of the infection. Be very aware of an outbreak, and honest with your partner before intimacy. Condoms will often not cover the area of infection well enough to prevent spread. Unfortunately, no immunization has been developed yet for the herpes virus.
The treatment is antiviral medications, which are most effective if started as soon as the tingling sensation first appears. This prevents blisters and the shedding of the virus in the blister. It is essential to carry a supply of antiviral medications, so that treatment begins within hours of the warning signs. Starting too late will not stop the blisters or the shedding of the virus.
People who have frequent outbreaks (more than two per month) may wish to go on suppression therapy. This means taking the anti-viral medication daily for a prolonged period – six months to one year, or longer. Discuss this with a family doctor.
Pregnant women who have HSV in the genital, buttock, or upper thigh area will need to discuss delivery options with their doctor. An active infection may mean that delivery must be by Caesarean section.
This infection is caused by bacteria, which spread by direct contact with secretions from the penis, anus and vagina. In men, the symptoms may be very mild, with some crusting or irritation at the tip of the penis. The infection spreads easily to an unprotected partner. In women, the infection can cause inflammation of the cervix, with a discharge from the vagina. In many situations, the woman is not aware she has any infection at all, unless it is found during an examination and swab testing.
If the bacteria spread to the mouth or throat, sores and pain can be the result. To diagnose this infection, special swabs of the throat must be done.
Left untreated, chlamydia can go on to cause serious infection in a man’s prostate. Symptoms include swelling, difficulty passing urine, and pain. In a woman, it can travel to the fallopian tubes. There it can cause serious infection in the pelvis, scarring the tubes. This leads to infertility.
To prevent it, use condoms for all intimate encounters with anyone who has not been tested since being with the last partner.
Treatment in the early stage is a course of antibiotics, which often works well. However, resistant strains are emerging. Infections that have moved into other areas, such as the prostate or fallopian tubes, may need aggressive treatment over several weeks. In some cases, IV antibiotics or hospitalization are necessary. All intimate contacts of an infected person must be traced to prevent further spread of the infection.
A pregnant woman will be tested at the beginning of pregnancy, and often again later if she is at high risk. If the infection spreads to the baby, organs like the lungs and heart can be affected.
Gonococcus bacteria have been around for a very long time. In the past, it was known as ‘the clap.’ In men, it causes discharge from the penis, and in women, a discharge from the vagina. For a number of years, it has been less common and less discussed than other newer sexually transmitted infections. As well, for many years, it has been relatively easy to treat with antibiotics.
However, gonococcus is fighting back. It has now become a ‘super infection’ resistant to many antibiotics. It has been able to spread more in the past several years. In many cases, a person infected with gonorrhea requires a long course of multiple antibiotics.
Doctors are testing for gonorrhea more routinely, and almost always check for it when testing for other infections. Missing this important infection, and especially not treating it aggressively enough, results in serious illness and drug resistance. Finding and treating it during pregnancy is also very important to prevent harm to the baby.
To prevent infection, use condoms for any intimate encounter until your partner has been tested and declared free of infection since their last intimate partner.
One of the most helpful new developments for genital chlamydia and gonorrhea is a new urine test that detects both. It is almost as accurate as direct swabs. People who are reluctant to visit a clinic for fear of having a swab done (to the penis or vagina) can now be tested more easily. Being squeamish is no longer a reason to avoid testing.
A bacteria causes syphilis. It spreads through contact – in many ways, but especially sexually. Though described briefly here, it is a complicated condition. The initial infection is on the skin, often of the genitals or genital area. It causes a sore traditionally called a chancre. If caught at this stage, a course of antibiotics will often be enough to treat it. However, if not caught, the skin lesion will often heal over. Then, the bacteria travel through the body. It can show up in many places, or stay hidden while multiplying in great numbers. Next, secondary infections develop in places like the brain, the spinal cord, the lungs, and the eyes. Passing it to a baby during delivery can lead to blindness and other infections in the infant.
This infection has started to become more common again, so awareness, prevention and early treatment are very important.
HIV (human immunodeficiency virus and AIDS) is caused by a virus. It certainly has not gone away in our society.
HIV is spread through body secretions (mainly blood and semen). It is still a very serious and life threatening infection, though not as deadly since new treatments have been discovered. It is making a comeback in a number of places, and the greatest caution is still needed to avoid it.
Prevention involves using condoms – every time. Use them during all sexual encounters (including oral sex) with anyone who has not been absolutely shown to be clear of the infection through a series of blood tests. Once a person is infected, the treatment is a lifetime of complicated and expensive anti-viral drugs. In some cases, these are difficult to obtain. Life expectancy is cut short, although not as much as in previous decades. There is still no known cure.
Sexually transmitted infections are becoming more aggressive, and more common in many cases. It has never been more necessary to take every step to prevent them and their spread. Condoms, immunization, regular testing for anyone with a new sexual partner (or anticipating a new sexual relationship), and early and regular testing for any suspicious symptom, will provide protection from infection, infertility, and a number of cancers.
The health care system in Canada is set up to assist with early detection and treatment as well. If you need testing or treatment, all you have to do is contact your family doctor. Sexual health clinics run by local public health offices also provide free, confidential testing and treatment for everyone.