About sexually transmitted diseases

Diseases transmitted through sexual contact are still a subject burdened with a lot of shame and embarrassment. People struggling with STDs find it extremely difficult to start a dialogue even with loved ones, let alone doctors. We fear harsh judgment and being labeled as irresponsible or promiscuous. However, it is true that in recent years more and more people have been suffering from STDs, often without even knowing it – infections can be asymptomatic. Additionally, they occur not only during vaginal intercourse, but also during oral or anal contact and through seemingly mundane activities, such as using the same towels.

Venereal diseases – let's talk about them!

First of all, I would like to point out that getting infected with any of the STDs should not make you feel ashamed. You can prevent infection by talking to your partner about their sexual history, using condoms, and maintaining hygiene after intercourse . If, despite these measures, you get infected – don't worry. Throw away the shame and take action. Become a link in this chain that will not only take care of yourself, but also stop the spread of the disease.

It is known that, like everything in this world, sexually transmitted diseases are divided into two groups: the "milder" ones, where we simply have to "cure", refrain from sexual contact and forget about them after some time, and the moderate ones, which are not so easy to get rid of and we have to suffer with them a bit. In some cases, they stay with us forever and we have to learn to live with them - and this, as we know, is not so easy.

Fungal infections

These include vaginal and vulvar fungal infections caused by the presence of Candida albicans yeast . They were also discussed in another gynecological post . As I mentioned in it, very often they simply depend on a disruption of the microbiological balance in the vagina (immunity, amount of sugar consumed, antibiotics, etc.). However, we must be aware that factors such as additional bacteria or fungi from the outside, micro-injuries during intercourse and sperm remaining in the vagina (which is a brilliant breeding ground for bacteria!) contribute to inflammation of the reproductive organs. Regarding the rules of conduct, I will not repeat myself and refer you to the above-mentioned article, but there is one thing that I did not mention there, namely: can you have sex during vaginal infection therapy? Basically, it would be good to hold off for a while, but if you have an overwhelming desire for intercourse, there are no absolute contraindications to it. The medication is usually inserted vaginally at night, so if you want to have sex, it's best to do it during the day, with a condom and a shower afterwards (you can have sex together!) :)

Bacterial sexually transmitted diseases

Bacterial infections that are sexually transmitted also include the STDs mentioned in the previous article:

• Syphilis (caused by the bacteria Treponema pallidum – pale spirochete). Early diagnosed syphilis can be cured with antibiotics. Untreated, however, it can lead to irreversible changes, including in the nervous system. It can be transmitted during any type of intercourse (vaginal, anal, oral), as well as intrauterine (as a result of transmission from mother to fetus, which is why all pregnant people are tested for it). What do we look for? The primary lesion, i.e. a painless lump/ulcer in the genital area (sometimes in the oral cavity!), and enlarged lymph nodes. In the early stages, syphilis may manifest itself as a rash on the face or pain during urination.
• Gonorrhea . This is a sexually transmitted disease caused by the gonorrhea bacteria ( Neisseria gonorrhoeae ). The route of infection is similar to that of syphilis - through vaginal, oral or anal contact. The disease can also be transmitted from mother to fetus. Such infection most often occurs during the passage of the child through the birth canal during delivery, which is why every newborn has 1% silver nitrate solution instilled in their eyes after birth (of course, if the parent agrees), which prevents gonococcal conjunctivitis leading to permanent vision loss. As with syphilis, all pregnant women are tested for gonorrhea, and often (if infected) are offered a cesarean section to reduce the risk of infecting the child. What symptoms should you look out for? For purulent vaginal discharge, purulent discharge from the urethra, pain during urination or abscesses forming in the area of ​​external and internal genitalia in people of any sex. Untreated gonorrhea leads to damage and changes in other body systems. Treatment is based on antibiotic therapy - penicillins or other antibiotics (depending on the resistance of the bacteria).
• Chlamydia . It is one of the most common sexually transmitted diseases. The bacterium Chlamydia trachomatis is responsible for its development . In most cases, chlamydia is asymptomatic, but it can cause some symptoms. Women should pay attention to, among other things, bleeding during the menstrual cycle or after intercourse, vaginal burning, abnormal vaginal mucus or lower abdominal pain. In the case of men, purulent or milky discharge from the penis and prostatitis are worrying. Regardless of gender, the infection may cause pain during urination or an unpleasant urge to urinate. Chlamydia is the most common cause of pelvic inflammatory disease, it also causes non-gonococcal urethritis. It is often accompanied by pain, itching of the genitals and the anus, and discomfort during urination.

Other bacterial STDs include chancroid , bacillary dysentery , and infections with bacteria from the Mycoplasma or Ureaplasma family . It is impossible to discuss them all in one article, but you will certainly find additional information below for those particularly interested in this topic :)

Sexually transmitted viral diseases

Sexually transmitted diseases can also be caused by viruses: HSV ( herpes simplex virus ), human papilloma virus ( HPV ) , HBC ( hepatitis B virus ), HCV ( hepatitis C virus ) , HTLV ( human T-lymphotropic virus ) or HIV ( human immunodeficiency virus ). Unfortunately, the matter of curing viral diseases is more complicated and often impossible. One element of their prevention is education, so let's start.

Herpes simplex virus (HSV ) – subtypes

There are two types of HSV:

• type 1 – mainly responsible for cold sores,
• type 2 – causing genital herpes.

These are viruses that are common in the population and depending on the source, it is estimated that from ¼ to even ⅓ of the population are carriers of one of the types mentioned. Infection occurs in exactly the same way as with the previously mentioned STDs, i.e. through sexual contact with a carrier, through contact with the partner's secretions, transfer from mother to fetus intrauterine or during childbirth. We must remember that the infection itself is very often asymptomatic, and the symptoms of the disease may be caused by weakened immunity or stress.

Genital herpes – symptoms

• Fluid-filled blisters on the labia, penis or around the anus,
• enlarged lymph nodes,
• abnormal discharge from the genitals or anus – whitish or yellowish, lumpy discharge,
• pain in legs and buttocks,
• vaginal burning,
• pain when urinating.

For herpes, we have a widely available drug – acyclovir, used in different schemes depending on the time that has passed since the pathogen entered, the onset of symptoms or the result of a pregnancy test. And here comes my renewed appeal: if you notice anything unusual – see a doctor. Genital herpes can recur because the virus that causes it enters the nervous system and remains there in a dormant state!

Genital warts – a disease caused by HPV

The common human papillomavirus (HPV) was discussed in my previous post on cervical cancer. Low-risk HPV types (6, 11, 42, 43, 44) are responsible for genital warts. These are non-cancerous skin lesions that usually take the form of small, cauliflower-like growths. In women, they usually appear on the labia minora, as well as around the anus and perineum, while in men, genital warts are usually located on the inside of the foreskin or on the glans penis. Rarely, but there are cases where genital warts appear in the oral cavity (for example, on the tongue or larynx). A test to diagnose a possible HPV infection is commonly used to diagnose cervical cancer, which is caused by papilloma.

Hepatitis virus infection

Now we are entering the realm of somewhat more difficult topics, namely: hepatitis B and C viruses and the HIV virus . These are microorganisms that cause diseases with much greater consequences and getting rid of them is not the easiest, and is often downright impossible.

HCV (Hepatitis C) is sometimes listed as an STD, but this is not a clear-cut issue, and despite living in the 21st century, we still do not know whether this disease is transmitted during sexual intercourse. Hepatitis C is mainly associated with sharing needles while taking drugs, performing medical procedures, or tattooing and body piercing – all of which, of course, in a situation where basic conditions for sterilization and protection of equipment are not met.

HCV mainly affects sexual contact, during which the mucous membrane is damaged. The greatest risk occurs during anal intercourse due to pure mechanics - the vaginal walls are more durable, more stretchy and therefore more resistant to injuries during penetration. The virus itself causes inflammation of the liver leading to cirrhosis, but a large number of people do not experience any symptoms for many years. Hepatitis C is a curable disease. In recent years, many clinical trials have been conducted, as a result of which almost complete cure has been achieved. However, we must realize that everything depends on the time of diagnosis and application of treatment. The method of prevention and "safety net" is, of course, using condoms.

In the case of HBV (hepatitis B), infection occurs through transmission through sexual intercourse, intrauterine from mother to child, and also in the ways mentioned in the case of HCV. Like hepatitis C, HBV leads to liver cirrhosis and all the complications associated with it, including the occurrence of hepatocellular carcinoma. The infection can remain asymptomatic for many years.

Treatment is complicated and depends on the course of the disease, its serological markers and the patient's health. It involves administering antiviral drugs in various regimens. Complete recovery is impossible - the goal of pharmacotherapy is to stop the virus from multiplying so that it does not harm our body any further. Unlike HCV, there is a vaccine for hepatitis B, which is given to all newborns and which is repeated according to the vaccination schedule in force in our country since 1994. Is it worth getting "vaccinated"? Before surgical procedures - absolutely, but it all depends on the level of antibodies in your blood. Consult your doctor, and based on tests, he will tell you what is best for you.

HIV ( human immunodeficiency virus )

This brings us to the most difficult topic related to sexually transmitted diseases – HIV infection. This virus attacks T lymphocytes contained in the blood. They are a kind of shield and determine the cellular response to emerging pathogens that may pose a threat to health. Aggressive HIV causes a decrease in the presence of T lymphocytes, which significantly weakens the immune system. AIDS ( acquired immunodeficiency syndrome ) is a disease caused by HIV, which develops precisely when the immune system is significantly weakened. The symptoms of AIDS are very diverse – you can read about the course of the disease, its stages and accompanying ailments here .

Like other diseases in this group, HIV is transmitted through any type of sexual intercourse, contact with the semen or blood of the partner, and through the milk of a person after giving birth. However, the virus is not transmitted through kissing. There are so few of its particles in saliva that you would have to "drink" several liters of secretion! As with other sexually transmitted diseases, we protect ourselves against this virus by using condoms. However, this is such a broad topic that I will certainly devote a separate post to it.

Parasitic sexually transmitted diseases

A separate group of sexually transmitted diseases are parasitic diseases, such as:

• pediculosis (pubic louse – Pthirus pubis ),
• scabies ( Sarcoptes scabei ),
• amoebiasis ( Entemoeba histolytica ),
• Trichomonas .​

What characterizes the pathogens mentioned here is the fact that infection often occurs not only during sexual intercourse, but also by using the same towels, underwear or sleeping in the same bed with someone.

I won't deny that the first two parasitic sexually transmitted diseases I mentioned are now very rarely encountered in a gynecologist's office - due to the increase in the standard of living and hygiene awareness in society. However, they very often affect homeless people and are usually diagnosed in dermatological departments. However, this does not mean that they do not occur at all, so when you see that "something" is jumping around in your pubic hair - it may be a louse , which lays characteristic eggs called nits at the base of your hair. Go to a gynecologist or dermatologist, and they will apply the appropriate treatment and thanks to this you will get rid of uninvited guests.

What causes scabies ? Itching, often active at night, "minks" in your skin and so-called excoriations, i.e. damage to the epidermis associated with scratching. The lesions are located on the genitals, around the anus or buttocks, as well as around the nipples or navel. Treatment consists of local application of ointments and increased hygiene. Don't worry - you will get rid of it!

When I hear " trichomoniasis ", I immediately associate greenish-yellow frothy discharge with an unpleasant smell. This is one of those pathogen-symptom connections that I would mention if asked at 3 a.m., woken from the deepest sleep :) Additionally, dysuria symptoms join the course of the infection, i.e. frequent urination and pain during urination, in both women and men (in whom trichomoniasis can lead to prostatitis). How is the infection treated? The symptoms of the disease themselves sound worrying, but fortunately the therapy is one of the simpler ones. The most commonly used antibacterial drug is metronidazole.

Amoebiasis is known mainly as a disease of the digestive system, but one of its extraintestinal forms is the amoebic disease of the genitourinary system. Infection usually occurs through the ingestion of cysts, excreted by the carrier in the feces, but transmission has been proven through both same-sex and heterosexual intercourse. Amoebiasis is asymptomatic in some cases, but the following symptoms may occur: diarrhea, deterioration of liver function, liver abscesses, infections or pain during urination. This disease shows us that we live in an open world and you don't have to drink water straight from a spring in Thailand to get infected with this parasite ;) All you need is a partner who has traveled a lot in the past or slept with a person infected with a sexually transmitted disease.

Prevention and treatment of sexually transmitted diseases

Venereal diseases are an extremely broad topic and it is impossible to discuss them all in detail in a short talk. Besides, that was not my goal :) I want to make you aware that they do not only concern poor, dirty and promiscuous people from the end of the world, but can happen to any of us regardless of gender.

Let's watch. If something appears that wasn't there before, let's go to the doctor. Treatment of venereal diseases involves the use of antibiotics, administered intramuscularly or intravenously. The regimens vary from country to country, but are often based on the use of generally available drugs. However, each case must be analyzed individually, depending on the duration of the infection and comorbidities.

Untreated venereal diseases – complications

Untreated venereal diseases can lead to complications that are dangerous to health and life:

• cancer,
• inflammation of the liver and kidneys,
• infertility,
• heart disease,
• mental health problems.

We need to be careful when choosing sexual partners, and when we start a relationship with someone or feel like having casual sex, let's not forget about a condom. Just because our number of sexual partners is small doesn't mean that our partners haven't gathered a larger group. We can't blame them for how many people they've slept with or what their past was like. However, we need to realize that each new partner carries a new risk. Any changes in the genital area should refer us to a doctor, because it's better to go and hear that the disturbing symptoms are not caused by venereal diseases, but by, for example, an ingrown hair :)

Some STDs can be vaccinated against (for example, HPV and HBV), and research into an HIV vaccine has also been ongoing for several decades.

So let's talk, use condoms and take care of our intimate hygiene. And if we have any doubts, let's just get tested! How can we check if we are not carriers of the disease if we do not have any symptoms? Commercial laboratories offer both basic and extended packages for sexually transmitted diseases - maybe it is worth investing in them and getting tested? We can perform HIV tests free of charge and anonymously at diagnostic and consultation points .

Venereal diseases without taboo!

In this article, I would like to point out many fantastic events organized by medical students within IFMSA (International Federation of Medical Students) and its SCORA (Sustainable Program on Reproductive Health and AIDS). They give lectures on STD, AIDS, genital cancers or the first visit to a gynecologist. They take place, among other things, on the occasion of "white Sundays" and also in educational institutions. If you are an event organizer or a teacher in a secondary school, you can contact the person responsible for such initiatives in your province and prepare a meeting - you can find the contact on the websites of the individual IFMSA branches.

The conclusion of this post? Sexually transmitted disease infection is an extremely broad and complicated topic. Sex is a wonderful experience, but at the moment of intimacy, let's remember about our own health and that of our partner.

Addresses of AIDS diagnostic and consultation points: aids.gov.pl/pkd

SCORA – IFMSA-Poland Project Database: baza.ifmsa.pl/category/scora

AC Billet, AS Rousseau, L. Piroth, C. Martins, An underestimated sexually transmitted infection: amoebiasis , "BMJ Case Reports" 2019, vol. 12, i. 5).
Chlamydia , https://www.labtestsonline.pl/test/chlamydia-badania [accessed 20/04/2021].
Major progress in HIV vaccine development , https://cordis.europa.eu/article/id/422576-a-major-boost-for-hiv-vaccine-identification-and-development/pl [accessed 20/04/2021].
PTG recommendations on sexually transmitted infections in obstetrics and gynecology , https://www.forumginekologiczne.pl/artykul/rekomendacje-ptg-w-zakresie-zakazen-przeniosłoch-droga-plciowa-w-poloznictwie-i-ginekologii/2046 [accessed on 08/05/2021].