Note
Studied by 35 people
Module 6 STI
Overview of Sexually Transmitted Diseases (STDs)
Definition of STDs:
Sexually Transmitted Diseases (STDs) are infections that are primarily spread through sexual contact.
Modes of Transmission:
Vaginal intercourse: The most common mode of transmission, where pathogens can easily spread through vaginal secretions.
Oral intercourse: Although considered a lower risk, certain STDs can still be transmitted.
Digital intercourse: Transmission can occur through finger contact with infected areas.
Rectal intercourse: This mode poses a high risk, as the rectal mucosa is sensitive and can facilitate the entry of pathogens.
High-Risk Activities:
Both vaginal and rectal intercourse carry the highest risk for contracting STDs due to direct mucosal contact.
The presence of mucous membranes creates an entry point for infectious agents into the bloodstream.
Transmission Factors:
The presence of cuts or sores, which can provide additional pathways for infection.
The frequency of sexual encounters, with higher exposure leading to greater risk.
The number of sexual partners; more partners typically increase the risk of exposure to STDs.
Importance of Prevention:
Understanding these various modes and factors of transmission is vital for the development of effective prevention strategies and public health initiatives aimed at reducing the incidence of STDs.
Importance of Public Health Perspective
While complete abstinence from sexual activity is the only foolproof method of preventing STDs, it is often considered impractical as a public health solution.
STDs represent a significant global health challenge, being a major cause of acute illness, infertility, long-term health complications, and mortality.
Each year, millions of individuals worldwide are affected, resulting in severe medical, psychological, and economic consequences that span populations.
Notification Rates and Epidemiology in Australia
According to the Australian Institute of Health and Welfare, notification rates are valuable for public health monitoring but provide an incomplete picture of STD incidences.
Variations in testing practices and public awareness campaigns significantly influence reported rates.
Notable trends include:
Gonorrhea notification rates surged by 53% from 2013 to 2016, indicating a possible increase in transmission or improved testing efficiency.
Syphilis cases exhibited an alarming 83% rise in the same period, underscoring the need for targeted interventions.
Chlamydia notifications also rose considerably, necessitating careful consideration of evolving testing patterns and access to healthcare services.
Pathogens Causing STDs
Over 30 distinct sexually transmissible pathogens exist, which can be categorized into different types:
Bacterial Pathogens:
Neisseria gonorrhoeae (Gonorrhea): A gram-negative bacterium responsible for gonorrhea, which affects mucosal surfaces of the genital tract, rectum, and throat. If untreated, it can lead to severe reproductive health complications, including pelvic inflammatory disease (PID) in women, which may result in infertility.
Chlamydia trachomatis (Chlamydia): Another gram-negative bacterium, Chlamydia is highly prevalent and is known for asymptomatic cases. Untreated chlamydia can cause serious reproductive complications, including PID and increased risk of HIV infection.
Treponema pallidum (Syphilis): A spirochete bacterium responsible for syphilis, which progresses in stages. If left untreated, it can lead to severe health complications, including damage to the heart, brain, and other organs during the tertiary stage.
Viral Pathogens:
Human Papillomavirus (HPV): A DNA virus that includes various strains, some of which are associated with significant health issues, including cervical cancer, other genital cancers, and genital warts. Vaccination with Gardasil can effectively prevent the most common high-risk HPV types.
Herpes Simplex Virus (HSV): Divided into two types: HSV Type 1, commonly associated with oral herpes (cold sores), and HSV Type 2, which is typically linked to genital infections. Both types can be transmitted even when no symptoms are present, making awareness and prevention critical.
Hepatitis B Virus (HBV): A virus that affects the liver and can lead to chronic liver disease and liver cancer. Vaccination is available and recommended for at-risk populations.
Parasitic Pathogens:
Pubic Lice (Pthirus pubis): Also known as crab lice, these parasites infest the hair in the genital region, causing itching and discomfort depending on the level of infestation. They are typically spread through close body contact.
Trichomonas vaginalis: A protozoan parasite responsible for trichomoniasis, an STD that often presents with symptoms such as itching, burning, and unusual discharge. It can also increase the risk of other STDs.
Epidemiological Note:
Chlamydia remains the most commonly reported STD in Australia, with the highest prevalence observed among young people aged 15-29.
This demographic requires increased awareness, screening, and prevention efforts, as many infections are asymptomatic yet highly contagious.
Underreporting is common due to limited access to health services and stigma surrounding STDs, contributing to the urgent need for comprehensive public health initiatives to combat these infections effectively.
Common STD’s
Chlamydia
Pathogen:
C. trachomatis - a gram-negative bacterium that is the causative agent of chlamydia, one of the most frequently reported sexually transmitted infections (STIs) worldwide.
Transmission:
Chlamydia is primarily transmitted through rectal and vaginal intercourse.
Oral transmission is also possible, although it occurs less frequently.
The bacteria can enter the body through mucous membranes, particularly during unprotected sex with an infected partner.
Asymptomatic Cases:
More than 50% of female infections and up to 33% of male infections are asymptomatic.
This high rate of asymptomatic cases amplifies the risk of transmission, as individuals may unknowingly spread the infection to their sexual partners, leading to increased prevalence rates in the community.
Symptoms:
In males, chlamydia can cause urethral inflammation, which is often characterised by painful urination, discharge from the urethra, and in some cases, pain during intercourse.
Women may experience cervicitis, which includes symptoms such as abnormal vaginal discharge, bleeding between periods, and pain during intercourse.
If left untreated, both genders may develop more severe complications, such as pelvic inflammatory disease (PID) in women, which can lead to infertility, and epididymitis in men, which may affect fertility.
Treatment:
Chlamydia can be effectively treated with antibiotics.
Commonly prescribed medications include azithromycin (typically a one-time dose) and doxycycline (administered over a week).
Prompt diagnosis and treatment are critical to prevent long-term health issues and further transmission.
Prevention:
The consistent and correct use of barrier methods, particularly condoms, significantly reduces the risk of transmission.
Public health campaigns also emphasize the importance of reducing the number of sexual partners and regular screening to catch infections early.
Screening Recommendations:
The Centre of Disease Control (CDC) recommends that sexually active women under 25 years of age undergo annual screenings for chlamydia.
Additionally, individuals at higher risk—such as those with multiple partners or previous STIs—should also be screened regularly to facilitate early detection and treatment.
Statistics:
In 2016, over 70,000 cases of chlamydia were reported in Australia, with the majority occurring in the 15-29 age group.
Unofficial estimates suggest that the actual prevalence of infections in this demographic may exceed 250,000 due to underreporting and the asymptomatic nature of many infections.
This statistic underscores the importance of targeted public health initiatives aimed at education, prevention, and increased screening access.
Gonorrhoea
Pathogen:
Neisseria gonorrhoeae: This is a gram-negative bacterium that is the causative agent of gonorrhoea, a common sexually transmitted infection affecting both men and women.
Transmission:
The highest risk for transmission is associated with receptive anal intercourse and vaginal intercourse, where direct mucosal contact facilitates the spread of the bacteria.
Oral sex also poses a risk, as the bacterium can infect the throat, leading to pharyngeal gonorrhoea.
It's important to note that transmission can occur even when the infected individual shows no symptoms, contributing to the spread of the disease.
Symptoms in Males:
Symptoms may manifest within 1 to 14 days after infection, typically including:
Painful urination (dysuria), characterised by a burning sensation.
Purulent discharge from the urethra, which is often yellow or green in colour.
Some men may also experience swelling or pain in the testicles, although this is less common.
Symptoms in Females:
Often, females remain asymptomatic (no symptoms), which complicates timely diagnosis and treatment.
When symptoms do occur, they may include:
Cervicitis, leading to abnormal vaginal discharge, bleeding between periods, and during sex.
Pelvic pain, which may accompany urinary tract infections (UTIs) that can remain undiagnosed.
Serious complications can arise if the infection ascends to cause pelvic inflammatory disease (PID), potentially leading to infertility.
Prevention:
Consistent use of latex condoms during sexual activity is highly recommended, as they are effective in reducing the risk of gonorrhoea transmission when used consistently and correctly.
Spermicides may offer additional protection; however, relying solely on this method is not advisable.
Regular screenings, especially for sexually active individuals and those with multiple partners, can help in early detection and treatment, reducing the potential for transmission.
Statistics:
In 2016, gonorrhoea cases reached approximately 24,000 in Australia, reflecting a 29% increase from the previous year, highlighting a concerning trend of rising incidence rates.
The increase in cases underscores the critical need for enhanced public health strategies, including education campaigns aimed at safe sexual practices, increased access to testing, and community engagement to address stigma surrounding STIs.
Transmission: The highest transmission risk is associated with receptive anal and vaginal intercourse; oral sex is also a risk factor.
Symptoms in Males: Symptoms can include painful urination and production of a purulent discharge from the urethra.
Symptoms in Females: Often asymptomatic, but may present with cervicitis or urinary tract infections that can go undiagnosed.
Prevention: Consistent use of latex condoms is highly recommended, while the use of spermicides can offer additional protection.
Statistics: In 2016, gonorrhoea cases reached approximately 24,000, reflecting a 29% increase from the previous year, calling for enhanced prevention strategies.
Syphilis
Pathogen:
Treponema pallidum is a gram-negative bacterium that is uniquely adapted to survive in the host's body and is the causative agent of syphilis, a common sexually transmitted infection (STI).
Transmission:
Syphilis is primarily transmitted through direct contact with syphilitic sores, which are most commonly found on the genital area, but can also appear on the mouth and other body parts. The risk of transmission increases significantly during high-risk sexual behaviors, including unprotected sex, intravenous drug use, and engaging with sex workers. Additionally, pregnant women can transmit the infection to their unborn child, which can lead to congenital syphilis.
Stages of Infection:
Primary Stage:
The primary stage features the appearance of a painless sore called a chancre at the site of infection, typically occurring 3 weeks after exposure. This chancre can go unnoticed as it is often painless and may heal without treatment, leading to an increase in transmission rates.
Secondary Stage:
In this stage, which can occur weeks to months after the primary chancre, systemic manifestations arise, including skin rashes (often red-brown spots), mucous membrane lesions known as mucous membrane pemphigus, and flu-like symptoms such as fever and swollen lymph nodes. At this time, the individual is highly contagious.
Latent Stage:
Characterized by a lack of symptoms, the latent stage can last for years. Although the bacteria remain in the body, infected individuals do not exhibit any physical signs or symptoms. The disease can remain dormant, but relapse into secondary stage symptoms may occur.
Tertiary Stage:
This late stage can develop years after the initial infection and may lead to severe complications affecting various systems of the body, including the cardiovascular system (cardiovascular syphilis) and central nervous system (neurosyphilis). Neurosyphilis can result in serious neurological issues, and cardiovascular syphilis may lead to conditions such as aortic aneurysms.
Treatment:
The primary treatment for syphilis is penicillin, usually administered via intramuscular injection. For early stages of syphilis, a single dose may be adequate, but for later stages, a series of three doses is recommended to ensure complete resolution of the infection. Regular follow-up visits are necessary to monitor for treatment success.
Statistics:
In Australia, there were approximately 3,000 notifications of syphilis in 2016. High-risk populations include men who have sex with men (MSM), where significant incidents are reported, as well as Indigenous populations who experience higher rates of infection. Continuous public health monitoring and targeted interventions are essential to address these disparities and increase awareness around syphilis prevention and treatment.
Herpes Simplex Virus (HSV)
Types:
Herpes Simplex Virus exists in two primary forms, each associated with different clinical manifestations. HSV Type 1 (HSV-1) typically affects the oral mucosa, leading to the development of cold sores or fever blisters around the lips and mouth, known as herpes labials.
However, through oral-genital contact, HSV-1 can also cause genital herpes. On the other hand, HSV Type 2 (HSV-2) is more prevalent in genital herpes cases, usually resulting in painful sores in the genital and anal regions.
While both types can interchangeably cause oral and genital infections, the association of HSV-1 with genital infections is becoming increasingly recognised due to evolving sexual practices, such as oral sex.
Transmission:
The transmission of HSV is primarily through direct contact with an infected person's lesions or bodily fluids.
Importantly, the virus can also spread through skin-to-skin contact even when no visible lesions are present, due to asymptomatic shedding.
Evidence suggests that more than half of primary HSV infections occur as a result of asymptomatic shedding, meaning that individuals may unknowingly transmit the virus to their partners without displaying any noticeable symptoms.
This characteristic of HSV significantly complicates prevention and control efforts, as it can spread silently among individuals who are unaware of their infection status.
Symptoms:
Initial infection with HSV can lead to systemic symptoms similar to flu, including fever, malaise, and swollen lymph nodes, followed by lesions that typically manifest as painful blisters.
These lesions are often fluid-filled and can occur on the mouth, genitals, or surrounding areas.
Following the initial phase, the virus remains latent in the nerve ganglia, from where it can reactivate.
Symptoms during reactivation often include sore, painful lesions that develop in the same area as prior outbreaks, along with flu-like symptoms such as chills and muscle aches.
The frequency and severity of recurrent outbreaks can vary among individuals, but they are generally less severe than the first episode yet can still cause significant discomfort.
Treatment:
Currently, there is no definitive cure for HSV; however, antiviral medications can significantly alleviate symptoms.
Common antiviral treatments include acyclovir, valacyclovir, and famciclovir. These medications are effective in reducing both the severity and duration of outbreaks.
They can also highlight the importance of early initiation of treatment at the first signs of an outbreak, which is critical to improving outcomes and controlling symptoms.
Furthermore, suppressive antiviral therapy can reduce the frequency of outbreaks and the risk of transmission to partners, providing an additional layer of protection for those with recurring infections.
Prevention:
To mitigate the risk of HSV transmission, consistent and correct use of barrier methods, particularly latex condoms, is highly recommended during all forms of sexual activity.
However, due to the nature of HSV and the fact that it can be transmitted from skin not covered by the condom, it is important to recognise that condoms do not offer complete protection against the virus.
Education on the importance of open communication about HSV status with potential sexual partners is fundamental for managing outbreaks and reducing transmission risks.
While research continues towards developing an effective vaccine, no comprehensive vaccination against HSV is currently available.
Therefore, awareness and preventive measures remain essential in managing HSV in both individual and public health contexts.
Human Papillomavirus (HPV)
Characteristics:
HPV is a complex DNA virus that consists of more than 120 distinct subtypes. Out of these, approximately 40 strains are known to be sexually transmissible, with significant implications for public health.
Certain high-risk HPV types, particularly 16 and 18, are known to cause various cancers, most notably cervical cancer, as well as cancers of the anal and oropharyngeal regions.
Low-risk strains, such as types 6 and 11, primarily lead to the development of benign conditions like genital warts, which, while not cancerous, can significantly affect quality of life.
The ability of HPV to remain latent in the body contributes to the widespread prevalence of the virus, often going unnoticed until symptoms appear or complications arise.
Symptoms:
A notable characteristic of HPV infections is their often asymptomatic nature.
It is estimated that a large percentage of individuals infected with HPV do not display any symptoms.
However, some may develop visible manifestations, mainly genital warts, which can appear as raised bumps or clusters in the genital area, anal and perianal region.
These warts may vary in size and shape, and they can be bothersome or uncomfortable.
Persistent infections with high-risk HPV types can lead to cellular changes in the cervix that may progress to cervical dysplasia and, ultimately, cervical cancer.
These precancerous lesions often exhibit no immediate symptoms, making regular screening for early detection crucial.
Transmission:
HPV is primarily transmitted via sexual contact, including vaginal, anal, and oral intercourse.
Notably, the virus can spread through skin-to-skin contact in the genital area, independent of penetrative sex.
This mode of transmission also highlights the risk posed by asymptomatic carriers, who may be unknowingly spreading the virus to their partners.
The ability of HPV to be transmitted through such casual contact underscores the importance of preventative measures and education about safe sexual practices, as many individuals may not be aware of their HPV status or the implications of transmitting the virus.
Prevention:
While the consistent use of barrier methods, such as latex condoms, can provide a level of protection against HPV transmission, they do not offer complete immunity due to the potential for exposure to skin not covered by the condom.
The Gardasil vaccine has emerged as a vital public health tool against HPV, effectively targeting the most common cancer-associated strains, including types 6, 11, 16, and 18.
Vaccination is particularly recommended for pre-adolescents aged 11 to 12, before they become sexually active, but it can also be administered to individuals up to age 26.
The vaccine has been shown to significantly reduce the incidence of HPV-related diseases and is a critical component of comprehensive sexual health strategies, including regular screenings for individuals at risk.
Statistics:
Since the launch of the HPV vaccination programs in 2007, there has been a substantial decline in the incidence of genital warts among vaccinated populations.
Studies indicate that vaccination has led to a significant reduction in vaccine-type HPV infections and related health complications, particularly among young women.
This success highlights the effectiveness of HPV vaccination campaigns and underscores the need for continued public health efforts focused on education, awareness, and increasing vaccine uptake to address and combat the prevalence of HPV and its associated risks.
Knowledge and Risk Behaviours in Adolescents
The 2013 Australian Secondary Students Sexual Health Survey revealed critical deficiencies in knowledge among adolescents regarding Sexually Transmitted Diseases (STDs), which encompass vital aspects like transmission pathways and preventive measures necessary to safeguard sexual health.
Knowledge Gaps and Misconceptions:
Transmission Methods: Many respondents displayed notable gaps in understanding how STDs are transmitted, leading to misinformed practices that could potentially expose them to infections. Education around varying transmission routes, including vaginal, anal, and oral intercourse, is vital.
Symptoms and Long-Term Effects: A significant portion of the population remains unaware of the typical symptoms associated with STDs or the grave long-term complications that may arise from untreated infections, such as infertility and chronic health issues. This lack of awareness can deter prompt medical consultation and treatment.
High-Risk Behaviours Observed:
Condom Usage: Only 43% of adolescents reported consistent use of condoms. This alarming statistic indicates a clear need for enhanced education and behavioural interventions aimed at increasing safe sex practices.
Influence of Substance Use: The survey also linked substance use (both alcohol and drugs) with declining adherence to safe sexual practices. Impaired decision-making under the influence can result in higher engagement in unprotected sex, significantly elevating the risk of STD transmission.
Comprehensive Intervention Strategies:
Education and Awareness: Designing comprehensive sexual health education programs that clarify the modes of transmission, symptoms, and consequences of STDs is essential. Workshops, seminars, and educational materials should be developed targeting adolescents to foster improved understanding.
Promoting Condom Use: Reinforcing the importance of consistent and correct condom usage is crucial. Campaigns must highlight different types of contraceptives available, their effectiveness, and how to use them properly, addressing any barriers or misconceptions young people may have.
Regular Screening Campaigns: Implementing campaigns that promote routine screenings is key in ensuring early detection and treatment of STDs. Young individuals should be made aware of local health services where they can access discrete and free or low-cost testing.
Improving Access to Healthcare: Efforts should be focused on eliminating access barriers to sexual health services. This can include training healthcare providers to be sensitive to the needs of young people, ensuring confidentiality, and promoting outreach programs that extend services into schools or communities where adolescents feel secure seeking help.
Peer-Led Programs: Encouraging peer-led education, where trained adolescents deliver health information to their peers, can enhance relatability and acceptance of the information being shared. This method can effectively establish trust and openness among young individuals.