Sexually transmitted diseases (STDs) are infections that can be transmitted through oral, anal, and vaginal sex. These diseases may be transmitted from person to person through blood, semen, vaginal secretions, and breast milk. STDs are sometimes called sexually transmitted infections (STIs) because they involve passing a disease-causing microorganism (e.g. bacteria or viruses) to another person during sex.
STDs are among the most common infectious disease in the United States. Researchers estimate that 13 million Americans become infected with STDs each year.
There are more than 20 different STDs. Examples of common STDs include chlamydia, genital herpes, gonorrhea, HIV (human immunodeficiency virus), human papilloma virus (HPV), pelvic inflammatory disease (PID), syphilis, and trichomoniasis.
HIV is the most dangerous STD because it progresses to AIDS (acquired immune deficiency syndrome), which is an incurable and fatal disease. However, many other STDs, such as syphilis, may also be life threatening if left untreated.
Certain patients have an increased risk of developing STDs. This includes patients who have multiple sexual partners, engage in unprotected sex (oral, anal, or vaginal), or who have sexual partners who have or have previously had an STD. In addition, men who have sex with men (MSM) are more likely to develop many STDs because they are more likely to engage in risky or unsafe sexual behavior.
It is important that patients, especially those at high risk, are regularly tested for STDs. This is because patients do not always experience symptoms of diseases or infections. If a patient has an STD and is not tested, he/she may unknowingly pass the disease onto his/her sexual partner(s).
Treatment and prognosis depends on the specific type of STD. Not all STDs can be cured. Some STDs, such as HIV, HPV, and genital herpes, require lifelong medication and treatment to manage symptoms and prevent complications.
Patients should always take medications exactly as prescribed. This is especially important for patients who are taking antibiotics to treat bacterial infections, such as gonorrhea or syphilis. Even if symptoms go away, medications should not be stopped early because the bacteria may still be present in the body. If the medication is stopped too early, the remaining bacteria in the body may mutate and become resistant to treatment. Once the bacteria are resistant to a medication, the antibiotic is no longer effective.
There are many ways to reduce the risk of developing STDs. Individuals should practice safe sex, avoid risky behaviors (e.g. sharing needles or having multiple sex partners), and undergo routine screenings for STDs. Patients should also follow the recommended safety precautions to avoid exposure to blood or other bodily fluids. For instance, individuals should wear rubber gloves when applying first aid to someone who is bleeding.
Acquired immune deficiency syndrome, AIDS, antibiotics, antiretrovirals, chlamydia, Chlamydia trachomatis, condyloma acuminate, genital warts, gonorrhea, herpes, herpes simplex type 2, HHV-2, HIV, HPV, human immunodeficiency virus, human papilloma virus, pelvic inflammatory disease, PID, sexually transmitted, STD, syphilis, trichomoniasis, venereal diseases, venereal warts.
Overview: Chlamydia is a curable sexually transmitted infection (STI) of the genital tract. If left untreated, chlamydia may damage the genital tract and lead to serious illnesses, including pelvic inflammatory disease (PID) in females and inflammation of the tubes that carry semen (epididymitis) in males.
According to the U.S. Centers for Disease Control and Prevention (CDC), nearly three million Americans become infected with chlamydia each year. Although chlamydia can affect people of all ages, in the United States it is most common among teenagers.
A bacterium called Chlamydia trachomatis causes chlamydia. Most cases of chlamydia are transmitted from person to person through oral, anal, or vaginal sex. Pregnant women may also pass the infection onto their babies during vaginal childbirth. This is because the newborn is exposed to the mother's blood and other bodily fluids during birth.
Symptoms: During the early stages of chlamydia, most patients experience few or no symptoms of an infection. In general, symptoms usually develop one to three weeks after the bacterium has entered the body.
If patients develop the infection after vaginal sex, common symptoms include painful urination, vaginal or penile discharge, lower abdominal pain, painful sexual intercourse in women, and testicular pain in men.
If patients develop the infection after anal sex, rectal inflammation usually occurs. This inflammation typically causes pain and mucus discharge.
If patients touch their eyes after touching bodily secretions (e.g. semen or vaginal discharge) that are infected with chlamydia, they may develop an eye infection called pinkeye (conjunctivitis). Left untreated, pinkeye may lead to permanent blindness.
Newborns who contract chlamydia during childbirth usually develop pneumonia and/or severe eye infections, which may lead to blindness.
Complications: Patients infected with chlamydia are more vulnerable to other STDs, including the human immunodeficiency virus (HIV), gonorrhea, and syphilis, if they are exposed to them. Therefore, patients who test positive for chlamydia are often tested for other STDs.
Females with untreated chlamydia may develop pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.
Males with untreated chlamydia may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. Symptoms may include fever, scrotal pain, and swelling.
The infection may also spread to the prostate gland in males, causing inflammation (prostatitis). Symptoms of prostatitis may include pain during or after sex, fever, painful urination, and lower back pain.
Diagnosis: Patients should talk to their healthcare providers to determine how often they should be tested for chlamydia. Patients who have symptoms of chlamydia or suspect that they may have been exposed to chlamydia should be tested. The CDC recommends that all pregnant women are screened for chlamydia during the first prenatal examination and possibly later on in the pregnancy.
The standard diagnostic test for chlamydia is a culture swab. For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. In some cases, the healthcare provider may swab the anus. The sample is then rubbed on a petri dish. If the patient has chlamydia, Chlamydia trachomatis will grow on the petri dish.
A urine analysis may also be performed. A sample of the patient's urine is analyzed in a laboratory for the presence of the disease-causing bacteria.
Treatment: Chlamydia is curable. Patients take prescription antibiotics, such as azithromycin (Zithromax®), doxycycline, or erythromycin (ERYC® or Ery-Tab®), by mouth. Treatment may last up to 10 days. Patients should take their medications exactly as prescribed. Even if symptoms go away, medications should not be stopped early because the bacteria may still be present in the body.
The patient's sexual partner(s) will also require treatment, even if they do not have symptoms of the infection. Otherwise, the patient may become re-infected with chlamydia.
Overview: Genital herpes, also called herpes simplex type 2 (HHV-2), is an incurable viral infection that is characterized by painful sores on the genitals.
Genital herpes can only be contracted through direct sexual contact, including genital-to-genital, mouth-to-genital, or hand-to-genital contact with an infected partner. Individuals cannot contract the virus through kissing. Occasionally, oral-genital contact can spread oral herpes to the genitals (and vice versa). Individuals with active herpes lesions on or around their mouths or on their genitals should only engage in oral sex if they use a condom or place a small piece of latex, called a dental dam, over the vagina or anus.
The chance of a pregnant woman passing herpes to her baby is highest if the first infection occurs near the time of delivery. The virus can be transmitted to the fetus through the placenta during pregnancy or during vaginal childbirth. First-time infection during pregnancy leads to an increased risk of miscarriage, decreased fetal growth, and preterm labor. About 30-50% of infants who are born vaginally to a mother with first-time infection become infected with the herpes virus. Of babies born to women experiencing recurrent outbreaks at the time of birth, one to four percent become infected with the herpes-simplex virus.
After an initial or primary infection, herpes viruses establish a period called latency, during which the virus is present in the cell bodies of nerves that attach to the area of the original viral outbreak (e.g. genitals, mouth, and lips). At some point, this latency ends and the virus becomes active again. While active, the virus begins to multiply (called shedding) and becomes transmittable again. This shedding may or may not be accompanied by symptoms. During reactivation, the virus multiplies in the nerve cell and is transported outwardly via the nerve to the skin. The ability of herpes virus to become latent and reactive explains the long-term, recurring nature of a herpes infection.
Recurrence of the viral symptoms is usually milder than the original infection. Recurrence may be triggered by menstruation, sun exposure, illnesses that cause fevers, stress, immune system imbalances, and other unknown causes. However, not all patients experience a second outbreak.
Symptoms: Genital herpes typically causes painful, watery blisters to develop on the skin, mucous membranes (e.g. the mouth or lips), or genitals. The location of these blisters depends on where contact was made during transmission. Lesions heal with a crust-forming scab, the hallmark of herpes. Many individuals with recurrent disease develop pain in the area of the infection even before any blisters or ulcers can be seen. This pain is due to irritation and inflammation of the nerves leading to the infected area of skin. These are signs that an outbreak is about to start. An individual is particularly contagious during this period, even though the skin still appears normal.
Diagnosis: A viral culture uses specimens taken from the blister, fluid in the blister, or sometimes spinal fluid. The samples are sent to a laboratory where they are analyzed. It takes between one and 14 days to detect the virus in the preparation made from the specimen. This test is useful, but it is sometimes difficult to detect the virus in the sample.
immunofluorescence assay is a diagnostic technique used to identify antibodies to the HHV-2. These antibodies are proteins that help the body fight against HHV-2. If the specific antibodies are present, a positive diagnosis is made. This test is less expensive, more accurate, and faster than a viral culture. However, it may take up to 30 days for antibodies to build up to detectable levels. Therefore, if herpes is highly suspected and results are negative soon after possible exposure to the virus, a repeat test may be recommended.
A polymerase chain reaction (PCR) test may also be performed to determine whether the virus itself is present in the patient's blood. A sample of the patient's blood is taken and sent to a laboratory. If the virus' genetic makeup (DNA) is present, a positive diagnosis is made. The virus can even be detected during the latent stages of the infection.
Treatment: Although there is no cure for genital herpes, medications are available to minimize the number of outbreaks, reduce the likelihood of viral shedding, and decrease the likelihood of transmission.
There are three antiviral medications that the U.S. Food and Drug Administration (FDA) has approved for the treatment of genital herpes. Approved antiviral drugs include acyclovir (Zovirax®), valacyclovir (Valtrex®), and famciclovir (Famvir®). Antiviral medication is commonly prescribed for patients having a first episode of genital herpes, but they can be used for recurrent episodes as well. There are two kinds of treatment regimens: episodic therapy and suppressive therapy.
With episodic therapy, the patient begins taking the medication at the first sign of an outbreak. The medication is then taken for several days to hasten the recovery or healing or to prevent a full outbreak from fully occurring. All three of the approved medications help shorten the amount of time that a person may experience symptoms of herpes. However, results may vary from person to person.
Suppressive therapy is used in individuals with recurrent genital herpes who want to prevent outbreaks. Patients who have six or more outbreaks per year may take antiviral medications on a regular basis, before symptoms appear. For these individuals, studies have reported that suppressive therapy may reduce the number of outbreaks by at least 75% while the medication is being taken. Suppressive therapy may completely prevent outbreaks in some patients. Suppressive therapy may need to be taken for the rest of the patient's life.
Side effects of antiviral medicines include
stomach upset, loss of appetite, nausea, vomiting, diarrhea, headache, dizziness, and/or weakness.
Overview: Gonorrhea, sometimes called the clap, is a curable bacterial infection that affects the sex organs. If left untreated, gonorrhea may lead to infertility.
Gonorrhea is caused by a bacterium called Neisseria gonorrhoeae. Gonorrhea is transmitted through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired.
Pregnant females with untreated gonorrhea may pass the infection onto their babies during vaginal childbirth (not cesarean section).
The bacterium can only live outside of the body for a few seconds. Therefore, the infection cannot be transmitted through toilet seats or other objects such as towels or clothing.
Symptoms: Most patients develop symptoms of gonorrhea one to 10 days after the bacterium enters the body. Some patients may be infected for months before symptoms develop. More than 50% of females with gonorrhea do not experience any symptoms.
Common symptoms of gonorrhea include thick or bloody discharge from the penis or vagina, pain or burning sensation during urination, frequent urination, and pain during sexual intercourse.
Anorectal gonorrhea may develop in males or females after anal intercourse with an infected person. In some cases, the infection may spread from the genitals to the anus. Anorectal gonorrhea may cause some discomfort in and discharge from the anal area, but many patients do not experience any symptoms.
Oral sex can cause pharyngeal gonorrhea. Symptoms of pharyngeal gonorrhea commonly include pain when swallowing and redness of the throat and tonsils.
If a patient touches an eye after touching bodily fluids that contain the bacteria, it may cause pinkeye (conjunctivitis). Symptoms may include reddening and inflammation of the eye(s).
Newborns with gonorrhea may develop permanent blindness and infection of the joints and blood.
Complications: In females, untreated gonorrhea may lead to pelvic inflammatory disease (PID). This is an infection of the fallopian tubes, uterus, and cervix. If left untreated, PID may cause permanent damage to the reproductive tract, which may lead to infertility. It may also lead to long-term pelvic pain.
Males with untreated gonorrhea may develop a condition called epididymitis. This condition is characterized by inflammation of the tubes near the testicles that carry semen. Symptoms may include fever, scrotal pain, and swelling.
In rare cases, Neisseria gonorrhoeae may enter the bloodstream and infect other parts of the body, such as the skin, joints, or internal organs. Symptoms may include fever, swelling, joint pain and stiffness, rash, and skin sores.
Diagnosis: Patients should talk to their healthcare providers to determine how often they should be tested for gonorrhea. Patients who have symptoms of gonorrhea or suspect they may have been exposed to gonorrhea should be tested.
The standard diagnostic test for gonorrhea is a culture swab. For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. In some cases, the healthcare provider may swab the anus. The sample is then rubbed on a petri dish. If the patient has gonorrhea, Neisseria gonorrhoeae will grow on the petri dish.
A urine analysis may also be performed. A sample of the patient's urine is analyzed in a laboratory for the presence of the disease-causing bacteria.
Treatment: Gonorrhea is curable. Patients typically take antibiotics, such as ciprofloxacin (Cipro® or Cipro XR®), ofloxacin (Floxin®), and levofloxacin (Levaquin®).
Babies with gonorrhea also receive antibiotics. In addition, medication, such as silver nitrate, is usually applied to the baby's eyes immediately after birth. This has been shown to help prevent the infection from spreading into the eyes.
Even if symptoms go away, medications should not be stopped early because the bacteria may still be present in the body. If the medication is stopped too early, the remaining bacteria in the body may mutate and become resistant to treatment. Once the bacterium is resistant to a medication, the antibiotic is no longer effective.
Overview: The human immunodeficiency virus (HIV) is a virus that progresses to AIDS (acquired immune deficiency syndrome). HIV primarily attacks the immune defense system, making the patient extremely vulnerable to opportunistic infections. Opportunistic infections are illnesses that occur in individuals who have weakened immune systems.
HIV primarily infects and destroys immune cells called CD4 T-cells. Healthy individuals have a CD4 cell count between 600 and 1,200 cells per microliter of blood. HIV patients who are not receiving treatment have less than 600 CD4 cells per microliter of blood. AIDS patients, who have CD4 cell counts that are lower than 200, have the greatest risk of developing opportunistic infections that may be fatal.
HIV is transmitted from person to person via bodily fluids including blood, semen, vaginal secretions, and breast milk. Therefore, it can be transmitted through sexual contact with an infected person, by sharing needles/syringes with someone who is infected, through breastfeeding, during vaginal birth or, less commonly (and rare in countries where blood is screened for HIV antibodies), through transfusions with infected blood.
Symptoms: Many patients experience no symptoms when they first become infected with HIV. After one or two months, an estimated 80-90% of HIV patients develop flu-like symptoms including headache, fever, fatigue, and enlarged lymph nodes. These symptoms usually disappear after one week to one month and are often mistaken for another viral infection, such as the flu. Despite having minimal or no symptoms during this stage, individuals are very infectious because the virus is present in large quantities in bodily fluids.
After the initial infection with HIV, the next stage is called clinical latency. Although patients experience few or no symptoms during the clinical latency stage, the infection may still be passed to others. Once infected with HIV, the clinical latency stage may last 10 or more years in adults or up to two years in children who are born with HIV infection. The length of this asymptomatic period varies in individuals. Some people may start to experience more serious symptoms within a few months, while others may be symptom-free for several years. The virus can also hide inside infected cells and lay dormant. Patients can still transmit the virus to others when the virus is dormant.
As the immune system continues to weaken many symptoms appear, including inflamed lymph nodes (swollen glands) that may be enlarged for longer than three months. Other symptoms often experienced months to years before the onset of AIDS include fatigue, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes, flaky skin, pelvic inflammatory disease (PID) in women that does not respond well to treatment, and short-term memory loss.
In addition, some individuals develop a painful nerve disease called shingles or frequent and severe herpes infections that cause sores to develop on the mouth, genitals, or anus. Infected children may be sick often, grow or gain weight slowly, or take longer to develop important mental and motor skills.
Although treatment can slow the progression of HIV, nearly all patients eventually develop AIDS. Once the patient's CD4 T-cell count is less than 200 cells per microliter of blood, their condition has progressed to AIDS, the final stage of the disease. Some patients are diagnosed with AIDS after they developan AIDS-defining illness, such as Pneumocystis jiroveci pneumonia (formerly called Pneumocystis carinii or PCP). The first symptoms of AIDS often include moderate and unexplained weight loss, recurring respiratory tract infections, and oral ulcerations.
Patients with AIDS have the greatest risk of developing opportunistic infections and tumors. Opportunistic infections and tumors may include tuberculosis, thrush, herpes viruses, shingles, Epstein-Barr virus, pneumonia, and a type of cancer called Kaposi's sarcoma (KS). In the last stages of AIDS, it is common for individuals to develop respiratory infections, including cytomegalovirus or mycobacterium avium complex (MAC) infections.
Diagnosis: HIV is diagnosed after HIV antibodies or HIV itself is detected in the patient's body. As soon as the virus enters the body, the immune system produces antibodies, which are proteins that detect and bind to HIV. The presence of these antibodies, which may take months to build up to detectable levels in the blood, oral fluid, and urine, can be used to determine whether HIV is in the body.
It may take some time for the immune system to produce enough antibodies for the antibody test to detect them. This time period, known as the "window period," varies among patients. Most people will develop detectable antibodies two to eight weeks after exposure, with the average being 25 days. However, some individuals might take longer to develop detectable antibodies. Ninety-seven percent of patients develop antibodies within the first three months following the time of their infection. In very rare cases, it can take up to six months to develop antibodies to HIV. Therefore, if a patient tests negative for HIV in the first three months after possible exposure, repeat testing should be considered longer than three months after the exposure.
In the United States, the test results must remain confidential. Individuals who are younger than 18 years old can consent to or refuse to be tested for HIV, without the involvement of their legal guardians. Test results may not be released to the patient's legal guardian(s) without his/her consent
Treatment: Currently, there is no cure for HIV/AIDS. Patients may receive a combination of anti-HIV drugs called antiretrovirals. These drugs interfere with the virus's ability to multiply, which subsequently boosts the immune system. HIV patients typically receive a combination of antiretroviral drugs, called highly active antiretroviral therapy (HAART), because a single patient may have several different strains (types) of the virus circulating in the blood. The combination of drugs also helps prevent mutations from occurring. The different strains of the virus may respond differently to specific types of drugs. HAART is a combination of at least three drugs from at least two different classes. There are four major classes of antiretrovirals: fusion inhibitors, protease inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Each drug class disrupts different stages of HIV's life cycle.
Although HAART may help patients live longer lives, these drugs do not reduce the risk of transmitting the disease to someone else.
Many new HIV drugs are under investigation. The U.S. Food and Drug Administration is expected to approve a CCR5 receptor antagonist, called maraviroc (Celsentri®), and an integrase inhibitor, called raltegravir (Isentress®), in late 2007.
human papilloma virus (hpv)
Overview: The human papilloma virus (HPV) is a viral infection that sometimes causes genital warts (also called venereal warts). There are more than 100 different types of HPV, but only a few cause genital warts
HPV is highly contagious. The infection may be transmitted through direct contact with the virus during oral, anal, or vaginal sex. It may also be transmitted after touching objects (e.g. towels, bed linens, or clothing) that have come into contact with an infected person.
There is currently no cure for HPV. Although treatment can help manage symptoms, females with HPV have a much greater risk of developing cervical cancer than females who are not infected with HPV. It has also been associated with other types of genital cancers,
including cancer of the penis, anus, vulva, and vagina.
In June 2006, the U.S. Food and Drug Administration (FDA) approved the first HPV vaccine called Gardasil®. The vaccine is expected to prevent most cases of cervical cancer due to HPV types included in the vaccine. However, patients will not be protected if they
have been infected with the HPV type(s) prior to vaccination, and the drug does not protect against less common types of HPV.
Symptoms: Most patients develop symptoms within three months of exposure to HPV. However, some patients may not develop symptoms for several years, and others may not experience any symptoms at all.
Common symptoms include small swellings in the genital area, multiple warts that form cauliflower-shaped clusters, itching or discomfort in the genital area, and bleeding during intercourse. Warts may spread to other areas of the body. Symptoms may worsen during pregnancy.
Complications: HPV has been shown to cause cervical cancer in females. In addition, certain types of HPV have also been associated with cancer of the anus, vagina, vulva, and penis. Regular pelvic exams and Pap tests are recommended to diagnose and treat infections quickly.
Genital warts may also lead to complications during pregnancy. In some patients, the warts may enlarge, making it difficult to urinate. Also, warts on the vaginal wall may reduce flexibility of the vaginal tissues during childbirth. In rare cases, a baby born to a mother with genital warts may develop warts in the throat. In such cases, surgery may be required to remove the warts and prevent airway obstruction.
Diagnosis: An acetic acid solution may be applied to the patient's genitals. This solution helps the healthcare provider detect warts because it turns warts a white color. Then, a specialized microscope, called a colposcope, is used to view the warts. If they are characteristic of HPV, a positive diagnosis is made.
It is especially important for women to undergo routine pelvic exams and Pap tests because HPV increases a female's risk of developing cervical cancer. Patients diagnosed with HPV may need to have a Pap test every three to six months. Patients should talk to their healthcare providers to determine how often they should be screened.
Treatment: There is currently no cure for HPV. However, many treatments are available to manage symptoms. Even if genital warts are no longer present, the virus is never eliminated from the body. This means warts may come back in the future.
Patients should not use over-the-counter wart removers for genital warts. These products are not designed for genital warts and they may cause serious side effects. Patients should consult their healthcare providers to determine the safest and most effective way to remove warts.
Many creams and ointments, such as imiquimod (Aldara®) and podofilox (Condylox®), may be applied directly to the skin to remove warts. Healthcare providers may also apply a chemical called trichloroacetic acid (TCA) to the skin to burn off warts. These medications may damage condoms, making them less effective.
Many surgical procedures, including cryotherapy, electrocautery, surgical incision, and laser removal, are available to remove warts. During cryotherapy, a healthcare provider applies liquid nitrogen to freeze off the wart. During electrocautery, an electrical current is used to burn off warts. Surgical incisions, which involve using a scalpel and other surgical instruments to remove the wart, may also be used. During laser treatments, the warts are removed with an intense beam of light. These procedures are usually only performed for severe warts that do not respond to other types of treatment.
Patients should not have sex while they are receiving treatment. Sexual partners of patients who have been diagnosed with HPV should be tested and treated for STDs.
pelvic inflammatory disease (pid)
Overview: Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that causes pain and swelling. If left untreated, PID may cause scarring and permanently damage the reproductive organs. Without treatment, some patients may become infertile or experience complications during pregnancy.
PID usually develops when a sexually transmitted bacteria enters the uterus and reproduces in the upper genital tract. The most common bacteria that causes PID also cause the sexually transmitted diseases (STDS) gonorrhea and chlamydia.
Symptoms: Common symptoms of pelvic inflammatory disease include pain in the lower abdomen and pelvis, irregular menstrual bleeding, foul-smelling vaginal discharge, lower back pain, fever, fatigue, diarrhea, vomiting, pain during intercourse, and difficulty or pain during urination.
Up to 50% of females with PID develop chronic pelvic pain that may last for months or years. PID may cause scarring in the fallopian tubes and other organs that may cause pain during exercise, ovulation, and sexual intercourse.
Diagnosis: Pelvic inflammatory disease (PID) is diagnosed after a pelvic examination, cervical cultures, and/or analysis of the vaginal discharge. The reproductive organs, including the uterus, will appear inflamed during a pelvic exam. Cervical cultures and/or analyses of vaginal discharge are performed to detect the presence of bacteria known to cause PID. If bacteria are present, a positive diagnosis is made.
Treatment: Antibiotics are the standard treatment for pelvic inflammatory disease. These medications, which are usually taken by mouth, kill the disease-causing microorganism. Severe infections that have spread to the kidneys may require hospitalization and intravenous antibiotics. Commonly prescribed antibiotics include amoxicillin (Amoxil® or Trimox®), nitrofurantoin (Furadantin® or Macrodantin), trimethoprim (Proloprim®), and trimethoprim/sulfamethoxazole (Bactrim® or Septra®). Symptoms usually start to improve after a few days of treatment.
Patients should take medications exactly as prescribed. Even if symptoms appear to go away, patients should take all of their medication because there may still be bacteria in the body. Stopping medication early may allow the infection to return. Also, stopping medication early may lead to antibiotic resistance. The few remaining bacteria in the body that survive most of the antibiotic therapy are the most difficult to kill. If the bacteria become resistant to treatment, the medications will no longer be effective if taken in the future.
Treating sexually transmitted diseases (STDs), such as gonorrhea, promptly reduces the risk of developing pelvic inflammatory disease (PID).
Sexual partners of patients who have been diagnosed with PID should be tested and treated for STDs.
Overview: Syphilis is a bacterial infection that initially causes skin sores and rashes to form on the genitals, skin, and mucus membranes. Although this infection is curable, it can be fatal if it is not treated quickly. If left untreated, syphilis may cause permanent damage to other organs, such as the brain and heart.
Syphilis is caused by a bacterium called Treponema pallidum. There are four different stages of syphilis: primary, secondary, latent, and tertiary. The disease is contagious during the primary and secondary stages, and sometimes, the latent period.
Most cases of syphilis are transmitted during oral, anal, or vaginal sex. A patient may also acquire the infection if his/her blood comes into contact with an infected patient's blood. It may also be transmitted through direct contact with an infected person's skin sore. An infected pregnant woman may also transmit the infection onto her fetus during pregnancy. This is because the mother's infected blood passes through the placenta and to the baby.
Treponema pallidum is not able to survive outside of the body. Therefore, the disease cannot be transmitted by sharing clothing, toilet seats, or other objects with an infected person.
Symptoms: Symptoms of syphilis vary with each stage. Initial symptoms during the primary stage typically develop 10 days to three months after exposure. Symptoms commonly include enlarged lymph nodes near the groin and a small painless chancre sore on the part of the body where the bacterium was transmitted. Chancre sores are most common on the tongue, lips, genitals, or rectum. Some patients may develop several sores. If patients do not receive treatment, the symptoms will go away on their own within three to six weeks. However, this does not mean that the infection is gone. In fact, it means that the infection is progressing to the secondary stage.
Symptoms of secondary syphilis develop two to 10 weeks after the first chancre sore appears. Symptoms may include a skin rash that causes small reddish-brown sores, fever, fatigue, general feeling of discomfort, soreness, and aching. If the patient does not receive treatment during this stage, symptoms may go away within a few weeks or repeatedly go away and come back for as long as one year. Even if symptoms are not present, the infection will continue to worsen without treatment.
Some patients experience a period called latent syphilis before tertiary symptoms develop. During the clinical latency stage, no symptoms are present. This stage may last one to two years.
The tertiary stage may develop immediately after the secondary stage or one to two years after the latent stage. This is the final and most severe stage of the infection. During the tertiary stage, syphilis may cause permanent organ damage and death. It often causes brain (neurological) problems, which may include stroke, infection and inflammation of the membranes that surround the brain and spinal cord (meningitis), numbness, poor muscle coordination, deafness, visual problems or blindness, changes in personality, and dementia. Syphilis may also affect the heart, causing bulging (aneurysm) and inflammation of blood vessels, including the aorta, which is the body's main artery. It may also cause valvular heart disease, such as aortic valve stenosis (when the valve becomes narrowed). All of these symptoms are potentially life threatening.
Babies born with syphilis may develop symptoms that are apparent at birth or several weeks after birth. Syphilis progresses much quicker and is more likely to cause complications in infants than adults. If the baby does not receive prompt treatment, serious and life-threatening complications may develop. Symptoms may include bone abnormalities, depressed nose bridge (saddle nose), vision and hearing problems (that may lead to deafness or blindness), swollen joints, screwdriver-shaped teeth (Hutchinson's teeth), and scarring where chancre sores developed.
Complications: In general, patients with syphilis have an increased risk of developing the human immunodeficiency virus (HIV). This is because a syphilis chancre sore provides an easy way for HIV to enter the body.
Diagnosis: In order to prevent life-threatening complications of syphilis, patients should be tested if they have symptoms of syphilis or suspect that they were exposed to syphilis. Doctors recommend annual STD screenings for patients who have increased risks of developing STDs. This includes patients who have multiple sexual partners, engage in unprotected sex, or who have sexual partners who have or have previously had an STD. Routine testing is especially important for detecting syphilis because symptoms may come and go.
If the patient has sores that are characteristic of syphilis, a healthcare provider may scrape a small sample of cells from affected skin. The cells are then analyzed under a microscope for the presence of Treponema pallidum. If the bacterium is present, a positive diagnosis is made. If patients do not have sores, a blood test may be used to diagnose syphilis. A sample of blood is taken from the patient and analyzed for antibodies to the bacterium that causes syphilis. These antibodies are proteins that are specialized to detect and help destroy the bacterium. If the antibodies are present, a positive diagnosis is made.
If it is suspected that the infection has spread to the brain, a healthcare provider may recommend a test called a lumbar puncture. During the procedure, a long thin needle is inserted into the lower back. A small sample of fluid from the spine (cerebrospinal fluid) is removed and analyzed under a microscope for the disease-causing bacteria.
Treatment: If treated early, patients with syphilis can expect a full recovery. Patients receive one to three injections of an antibiotic called penicillin. This medication kills the bacterium and cures syphilis. Even if a pregnant mother receives treatment for syphilis, the newborn should also receive antibiotics as a precautionary measure. Patients should avoid sexual contact with their partners during treatment in order to prevent transmitting the infection.
During the first day of antibiotic treatment, many patients experience the Jarisch-Herxheimer reaction. Researchers believe that this reaction occurs because so many bacteria are dying at once. Symptoms, which usually only last one day, may include fever, nausea, aching pain, and headache.
Sexual partners of patients who have been diagnosed with syphilis should be tested and treated for STDs.
Overview: Trichomoniasis is a sexually transmitted infection that usually causes pain, inflammation, and irritation in the vagina, penis, and urethral tissues. Although trichomoniasis may affect males or females, symptoms are more common among females.
Trichomoniasis is caused by Trichomonas vaginalis, a microscopic parasite, called a protozoan.
Symptoms: Females typically develop foul-smelling vaginal discharge that may appear foamy and yellow or green in color. Vaginal itching and pain during urination may also occur.
Males typically experience penile discharge, pain during urination, and pain and swelling of the scrotum (caused by epidiymitis).
Diagnosis: For females, the healthcare provider may swab the discharge from the cervix. For males, the healthcare provider inserts a thin swab into the tip of the penis to retrieve a sample of fluid from the urethra. The sample is then analyzed under a microscope. If the parasite is present, a positive diagnosis is made.
Treatment: Patients take the antibiotic metronidazole (Flagyl®) by mouth to kill the parasite and cure the infection. This drug is not safe during pregnancy. Pregnant females who are infected typically apply an antibiotic cream, called clotrimazole (Gyne-Lotrimin, Mycelex-7®), to the genitals. Patients should abstain from sex while they are receiving treatment.
Sexual partners of patients who have been diagnosed with trichomoniasis should be tested and treated for STDs.