Sexually Transmitted Diseases The Facts

Sexually Transmitted Diseases:
The Facts

Dr O E O Hotonu MB ChB BSc (Hons) MRCOG

Dr Hotonu is a Member of the Royal College of Obstetricians and Gynaecologists. She has worked as a senior registrar in Obstetrics
and Gynaecology, and as a Clinical Fellow in Genitourinary Medicine.

©2001 The Christian Institute

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Introduction

The UK has a serious problem with the increasing growth in the number of people contracting sexually transmitted diseases (STDs). The Department of Health have admitted that the UK is in a state of "poor sexual health":

"Virtually all the sexually transmitted infections (STIs) are increasing. The number of attendances at departments of genitourinary medicine/sexually transmitted diseases now totals 1 million per year, a doubling over the last decade. The commonest conditions are genital warts (some types of which can be associated with the subsequent development of carcinoma of the cervix), chlamydia and gonorrhoea, which if untreated can result in ectopic pregnancy and infertility. Chlamydial infection seen in clinics has risen by 21% between 1996 and 1997, and a further 13% from 1997 to 1998 (latest figures). Population surveys have reported rates of chlamydia as high as 20%, particularly in young women.

There has been no reduction in the annual number of new diagnoses of HIV made and the latest annual figures (1999) saw the highest number of new HIV diagnoses ever recorded."¹

This situation is brought sharply into focus because the Government proposes wider availability of the morning after pill in chemists and schools. One study has already shown that use of the morning after pill will lessen the likelihood that a condom will be used.²

This booklet shows the dangerous consequences of unprotected sex. The tables below show the most common STDs and the symptoms and consequences.³ It makes disturbing reading.

Serious risks to health

Sexually transmitted diseases such as chlamydia may cause many unpleasant complications, the most notable being ectopic pregnancy,⁴ and cancer of the cervix⁵.

Cancer of the cervix may also be caused by having unprotected sex under the age of 16. Susan Blunt, a consultant obstetrician and gynaecologist, has written:

"If a girl has sexual intercourse before she is 16, when the cervix is rapidly growing and dividing, she significantly increases her cancer risk. The more partners, the greater the risk."⁶

The most common STDs
The most common sexually transmitted diseases are

Chlamydia
Syphilis
Genital Warts
Hepatitis B and C
HIV
Genital Herpes
Gonorrhoea

Trichomona and thrush are common STDs, they have some unpleasant symptoms but they do not have significant consequences.

Disease	Symtoms	Complications
Chlamydia	Most women infected with Chlamydia have no symptoms.	If untreated a chlamydial infection often ascends to the fallopian tubes, where inflammation may cause pain and scarring may cause infertility and ectopic pregnancy. Chlamydia may infect the covering of the liver and the area surrounding the liver (perihepatitis). This may lead in the long term to chronic upper abdominal pain. Chlamydia may infect the whites of the eyes (conjunctivitis) and cause eye pain and discharge.
Syphilis	Syphilis is an unusual disease because if it is untreated, symptoms may occur many years after the initial infection. Symptoms start with a painless ulcer. In the next stage of the disease symptoms range from a rash, mouth sores, hair loss, fatigue and fever, along with inflammation of the eyes (causing blurred vision), inflammation of the liver (causing jaundice), inflamed bones and joints (causing pain) and in a small number of people, inflammation of the lining of the brain, that is, meningitis (causing headaches, neck stiffness and sometimes deafness).	In the third stage of the disease which may appear up to 25 years after the initial infection, both the heart and the brain may be affected. In the heart, there may be a weakening and swelling of the aorta (the main artery leaving the heart), if this ruptures (bursts), the patient will die. Effects on the brain include a loss of sensation in the feet leading to open sores in the soles, loss of sensation of pain leading to injury to the joints and loss of sensation to the bladder, whereby urine builds up, causing a loss of bladder control and repeated urinary tract infections. Patients may also develop dementia.
Genital warts	Genital warts occur on the vulva, the vaginal wall, the cervix, the skin surrounding the vaginal area, the anus and the rectum. Multiple warts often grow in the same area. They grow very rapidly in pregnant women, in people with an impaired immune system (for example, from AIDS or treatment with immunosuppressive drugs), and in those who have inflammation of the skin.	Papillomavirus types 16 and 18, which occur in the cervix but do not cause warts on the external genitals, may cause cervical cancer. The younger a woman?s age at first sexual intercourse, the greater the risk of cervical cancer, especially if she is under 16. The risk of this cancer also increases with each subsequent sexual partner.41 Other papillomaviruses may cause cancer of the vagina, vulva, anus, penis, mouth, throat and gullet. No treatment is completely satisfactory: relapse is common and requires retreatment. It is very difficult to treat in those whose immune system is reduced (such as patients with HIV).
Hepatitis B and C	Contaminated blood or blood products may transmit hepatitis B and C. The sexual transmission of hepatitis C is much less common than that of B. Symptoms include jaundice, anorexic, nausea, vomiting and a fever. Occasionally a person develops joint pains and itchy patches on the skin. [The sexual transmission of hepatitis A is mainly through anal intercourse].	5 to 10% of people infected with hepatitis B and 75% of people infected with hepatitis C will develop a chronic form of the disease. A carrier of the chronic form may eventually develop liver cancer. A healthy carrier of hepatitis B and C may infect others.
Human Immunodeficiency (HIV) Disease	HIV disease is caused by two related viruses, HIV-1, which is more common in the West, and HIV-2, which is commoner in Africa. The HIV infection destroys those blood cells in the body that help protect us from developing infection and cancer. These are called helper T lymphocytes or CD4+ cells. The virus spreads through the blood and is also found in other body fluids such as semen, vaginal secretions, and breast milk. Therefore it is transmitted by contact with any body fluid from an infected person, for example during sexual intercourse; from an infected mother to her child before or during birth or whilst breastfeeding; by a transfusion of contaminated blood or blood products; or when an infected drug addict shares a needle. Sadly a person may be infected even though they have no symptoms and consequently put others at risk from this disease. The initial symptoms, which may last from 3 to 14 days, include a fever, rashes, swollen lymph glands and general discomfort. Later, sometimes after a period of years, there is weight loss, fatigue, a fever that comes and goes, and repeated episodes of diarrhoea, anaemia, and thrush. Ultimately a person develops full-blown AIDS (autoimmune deficiency syndrome), which is characterised by certain distinctive diseases and cancers. AIDS is the terminal phase of HIV disease.	A person with AIDS has a low CD4+ count and therefore is vulnerable to infection by bacteria and viruses that don?t cause disease in healthy people. These cause, among other things, pneumonia, tuberculosis, and long-term diarrhoea. Unusual cancers such as Kaposi?s sarcoma and a cancer of the lymph glands may also develop. The HIV infection may infect the brain as well, causing dementia. Usually it is the cumulative effects of these infections and cancers that causes death.
Genital Herpes	There are 2 types of herpes: simplex virus 1 and 2. The virus may infect the genitals and the skin around the rectum, as well as the mouth and lips, the eyes and the hands (especially the nail beds). The first outbreak of herpes is more painful, prolonged and widespread than subsequent ones. It is associated with fever, and feeling ill as well as exquisitely painful sores that make urinating and walking very painful. They heal in 10 days but may leave scars. In people with impaired immune systems, for example those infected with HIV, herpes sores may spread to other areas of the body, persist for weeks or longer, and, uncommonly, become resistant to treatment.	Patients may develop meningitis causing vomiting, headaches, neck stiffness, and leg weakness. The virus may also travel through the blood stream to the skin, joints, liver or lungs. (These are rare complications). Commonly genital herpes recurs, in some people the outbreaks recur frequently for many years. Patients with a history of herpes may be infectious to their sexual partners even when they are not aware of an outbreak.
Gonorrhoea	It infects: The inner lining of the urethra, cervix, rectum, throat and the whites (conjunctivae) of the eyes. It may spread through the bloodstream to other parts of the body, especially the skin and joints. In women, gonorrhoea may ascend the genital tract to infect the membranes inside the pelvis, causing pelvic pain and infertility. Symptoms are often absent or mild in women, but if they are severe they include a frequent urge to urinate, vaginal discharge of pus, fever, and pelvic pain notably during intercourse. If infected fluid comes into contact with eyes, an external eye infection may develop. Blindness may occur if this infection is not treated.	Infected joints (arthritis) become extremely painful and swollen with limited movement. Pain may move from joint to joint. Skin manifestations are pus-filled spots. (These complications are rare). The interior of the heart (endocarditis) and the covering of the liver (perihepatitis) may also become infected. The latter causes pain that is similar to that of gallbladder disease. Recovery from arthritis and endocarditis can be slow.

References
1 National Sexual Health and HIV Strategy, Department of Health, 25th September 2000 at http://www.doh.gov.uk/nshs/background.htm
2 Easier access to morning-after Pill? Judith Roizen, Letter to the editor The Times, 16 December 2000
3 See The Merck Manual of Medical Information, which can be found online at http://www.merckhomeedition.com
4 Merck Manual, Chapter 189, Sexually Transmitted Diseases, at http://www.merck.com/pubs/mmanual_home/sec17/189.htm on
5 Chlamydia ?linked to cervical cancer? at http://news.bbc.co.uk/hi/english/health/newsisd_1097000/1097665.stm on 3/01/01
6 Susan Blunt MD, MRCOG consultant obstetrician and gynaecologist, Birmingham Women?s Hospital writing in Reader?s Digest January 2001 from http://www.readersdigest.co.uk/magazine/blunt.htm on 11/01/01