Which Are the Common STDs?

DR. STEPHEN GENUIS

Many continue to not only support the condom as the major warrior against STDs, but vociferously deny and oppose education which includes the serious shortcomings of condom use for so-called "safer sex". It is time to critically assess the effectiveness of this type of protection and to implement an alternate plan of prevention to curb the ongoing devastation in the lives of young and old alike.

I recently had the pleasure of speaking at a local school to a group of Junior High School students on the topic of STDs. After the session was over, a young adolescent boy sheepishly inquired “If you give an STD to your partner, you get rid of it yourself, don't you?” Although the question may sound humorous, it certainly illustrates the need for a clear understanding of the ramifications and significance of various STDs. In order to have this clear understanding, however, one must acquire a basic knowledge of what the common diseases are, and recognize some of the particular idiosyncrasies peculiar to each infective agent. And to answer the student's question: No, the infecting organisms enter, invade and inhabit the new host, but also remain an integral part of the old host.

A variety of expressions have been, and are being used to describe infections caught by having sexual relations with an infected partner. The vernacular has included such terms as venereal diseases, “the dose”, “clap”, “V.D.”, and many other colorful terms and phrases. The term Sexually Transmitted Diseases, or STDs, as they are affectionately known, is the current umbrella term which encompasses afflictions for which sexual contact is an important, though not necessarily the only, avenue of acquisition.

There are different groups of infective organisms which have the potential to cause illness. Some of the more common categories are Bacteria, Viruses, Protozoa, Parasites, and Fungi. Each group of organisms has particular characteristics and it is important to distinguish between them as certain treatments can be effective against one type of organism but not against the others. For example, antibiotics are very efficient at treating certain types of bacterial infections, but these potentially lifesaving and miraculous drugs are usually ineffective against viral infections. This is clearly illustrated in the case of the common cold, a malady usually caused by a virus. The use of antibiotics in an effort to cure the viral cold frequently results in frustration and possibly even side effects from the drug itself.

There are many infections which may be passed by sexual contact and which have the potential to cause serious damage. However, I would like to give a brief overview of six common organisms and one common clinical presentation that account for the overwhelming majority of the STDs that we are currently witnessing. These common STDs have been chosen for discussion as they permit the illustration of some of the concerns and principles that need emphasis. A more detailed and comprehensive study of these and other STDs may be found in other excellent reference books. We will discuss Gonorrhea, Chlamydia, and Syphilis from the bacterial contingent; Genital Herpes, Human Papilloma Virus, and the AIDS virus (HIV) from the viral section; and mention will be made of a condition called NonGonococcal Urethritis (NGU) in males and its counterpart Muco-Purulent Cervicitis (MPC) in women.


Gonorrhea

Gonorrhea is caused by a bacterial organism known as Neisseria gonorrheae. It can have many sites of infection but most commonly it affects the cervix in women and the anterior portion of the urethra in men. The rectal area, the throat, and the eyes are also potential sites of infection in both sexes and, if untreated, the organism can potentially spread to different areas in the body.

Men may complain of burning discomfort when they urinate and may also notice a discharge of pus from the end of their penis. Although the majority of men who are infected recognize some symptoms, it is felt that about twenty per cent have no complaints and carry the bacteria silently. When the organism is carried in the throat, there are usually no symptoms at all. Without medical attention, this organism can spread to infect the man's prostate or testicles and may be transmitted to sexual partners.

The infection is particularly insidious in females as about eighty per cent of women have no symptoms in the early stages of the infection. There may be some vaginal discharge or some discomfort when urinating.

If the infection is unrecognized, as is often the case, the organism frequently spreads to infect the uterus and the fallopian tubes and may result in sterility.

In children, there are two types of infection. The eyes of a newborn may be infected as a result of acquiring the disease at or during birth with the potential to cause serious damage and even blindness. In addition, a young boy or girl may be afflicted with this bacteria as a victim of direct sexual contact from another individual carrying the organism.

When the illness is recognized and then treated with appropriate antibiotic agents, the infecting organism that causes gonorrhea usually is eradicated effectively. However, damage caused by the organism is not usually reversed once the acute infection is treated.


Chlamydia

Over the last few years, chlamydia has been recognized as one of the most prevalent and most damaging sexually transmitted infections. The organism, Chlamydia trachomatis, is a type of bacterium which grows within living cells. Much research in the last few years has allowed easier recognition and treatment.

The manifestations of this problem vary between the sexes. In the man, chlamydial infection is often without symptoms, although about half of the men infected have some complaints. Common presentations of this illness include pain on urination, discharge from the tip of the penis, or an altered or itchy sensation at the end of the penile area.

Chlamydia, like some other STDs, appears to be sexist in nature in that women bear a disproportionate incidence of complications and consequences. Once again, the vast majority of women carrying this infection have no symptoms at early stages of the infective process. Even in the absence of any noticeable symptoms, damage of the female reproductive organs may progress to result in a variety of serious complications.

The newborn child is also a potential victim of this kind of infection. The predominant sites of infection are the eyes and the lungs. Chlamydia may cause corneal scarring and visual impairment if left untreated, and also has the potential to cause pneumonia.

There are now effective and easily available tests to diagnose this condition if the infected individual or their physician suspects a problem. Although therapy with appropriate antibiotics usually eliminates these bacteria, there is frequently significant residual damage if the infection is not treated in the early stages.


Syphilis

This particular organism has a long and sordid past, having infected and destroyed many famous individuals over the centuries. It is thought by many that this disease is a thing of the past, but this sinister germ is in the process of making a resurgence, including a profound escalation in the newborn population.

Syphilis is caused by an organism called Treponema pallidurn, and is transmitted by direct contact with an infected sore. If left untreated, the disease passes through a series of phases. About three weeks after the initial contact, the new recipient develops a painless lesion in the genital area, the hallmark of Primary Syphilis. This lesion spontaneously heals in a few weeks and is followed by the appearance of numerous skin lesions and a flu-like illness about six weeks later. This stage subsides in about three weeks and the disease enters the Latent Stage. At this point, there are generally no significant complaints or noticeable changes noted by the victim.

Following this latent phase, the disease appears to have a variable course if left untreated. The process may remain in the latent phase with intermittent relapses similar to secondary syphilis; the infection has been reported to be spontaneously cured in some fortunate individuals; or the illness may proceed to tertiary syphilis which may affect various organs in the body including the brain, the heart, the bones and other sites.

The infection appears to be most contagious during the Primary, Secondary, and early Latent phases of the illness. But one of the most serious tragedies in our current world is the increase in the rates of congenital syphilis-when a newborn child has been infected while developing in the mother's uterus prior to birth. The child may pass away, or may have a variety of serious defects, including central nervous system abnormalities and bone alterations.

Antibiotic therapies remain extremely effective in treating and eliminating the infecting agent from the human system. Appropriate therapy is determined by the site and stage of infection but the complications and damage caused by syphilis may persist even after treatment. <


Human Papilloma Virus (HPV)

In the last few years, it has become increasingly evident that HPV is a sexually transmitted infection of major proportion and with serious ramifications.

This virus had previously been recognized to cause genital warts (known in the medical world as condylomata accuminata) in a minority of individuals -infected with this virus. These small, painless growths, found in the genital area, pose a nuisance as they are sometimes hard to eradicate and often spread quickly. Even after initial removal of the growths, the virus itself still remains present, with the potential to cause recurrent warts. These fleshy, cauliflower lesions may be found in many sites in the genital area including the penis, scrotum, and anus in men. In women, common sites include the vagina, vulva, clitoris, and anus. The virus has also been isolated from the oral cavity in adults and has been associated with small growths on the vocal cords of children who may have contacted the infecting organism at birth.

As with many of the other STDs, this viral infection is often without symptoms in the early stages and was previously considered by many to be of minimal concern. However, recent evidence strongly suggests that HPV may cause precancerous and cancerous changes of certain areas of the female genital tract. This accounts for the serious increase in the incidence of cervical cancer in the last decade. There is also suspicion that it may cause cancer in other sites in the body and current research is beginning to shed more light in this direction. In addition, HPV infection is associated with impaired healing of the perineum after childbirth (the perineum is the area of skin below the outer vagina which may require healing after the birth process). [1] Some medical professionals have labelled HPV as the “STD of the 1990s”. Yet, it has received little attention as it is overshadowed by the more lethal AIDS virus.

The HPV infection is highly contagious and appears to spread easily upon sexual contact. There is at least a 50% chance of transmission with a single sexual encounter with an infected person. [2] Once acquired, there is no current method of eliminating it. Although the usual avenue of spreading this virus is by sexual relations, it is believed that transmission by certain objects such as toilet seats and towels is possible. [3]


Genetal Herpes - Herpes Simplex Virus (HSV)

Herpes simplex virus appears to cause infection by direct contact from a sore of an infected person to the skin of the recipient, often during sexual contact. Newly infected individuals will often develop a first episode or outbreak of herpes. Initial attacks vary in intensity but frequently involve a cluster of painful sores or ulcers which may last for up to three weeks prior to healing. During this time, the virus migrates up the nerve fibres where it often remains dormant for varying lengths of time.

The infected individual may then develop recurrent attacks for the remainder of his or her life. In these recurrent episodes, the sores typically last for up to a week after which they usually clear up and the virus returns to a dormant stage. Available antiviral therapies appear to shorten the outbreaks, and when taken on a chronic basis, certain drugs may diminish the frequency of recurrences. However, the disease cannot be cured in that there are no means to destroy and eradicate the virus from the infected person.

When this disease is contacted by a newborn, it has a devastating potential for death or serious neurological consequences.


Aids - Human immunodeficiency virus (HIV)

HIV, Human Immunodeficiency Virus, is the accepted name designated to the virus, or viruses, that are responsible for causing Acquired Immunodeficiency Syndrome, commonly known as AIDS. HIV is a type of virus, referred to as a Retrovirus, which has the special ability to invade the normal cells of the infected individual, and to command these normal cells to become HIV producing cells.

These viruses have a particular attraction to certain cells which are part of the immune system, the mechanism within the body that is normally responsible for preventing and defending against infection and cancerous growths. With time, the normal cells are destroyed and lose their indispensable ability to protect the individual, thus leaving the person vulnerable to serious infections, tumor formation, and eventually to death.

AIDS refers to a condition found when HIV infected persons suffer from a variety of infections or cancerous complications secondary to a deficient immune system. After initially acquiring the AIDS virus, the vast majority of infected people feel perfectly well and often have no awareness of their infected state or no insight into the fact that they are infectious to others. It is not fully understood why some infected individuals develop fully expressed AIDS shortly after contacting the AIDS virus, and why others seem to carry the virus for a considerable length of time before developing serious symptoms. There appear to be some additional factors, or other influences which may come to bear on the rapidity of disease expression. From various epidemiologic studies, it appears that in adults the average time from the initial HIV infection to development of AIDS is 7-10 years. [4] In very young children, the development of full blown AIDS often occurs within two years of infection with the virus.


Non-Gonoccocal Urethritis

Many STDs can be delineated and diagnosed according to the infecting organism. However, health professionals frequently encounter patients complaining of a specific set of symptoms that, as a set, have become somewhat recognizable and given medical titles.

A frequent complaint heard in physicians' offices from male patients is that of burning discomfort on urination. The patient may also complain of an associated discharge from the end of his penis. This condition is often suggestive of urethritis. This type of infection, often sexually transmitted, may be caused by Chlamydia or gonorrhea, but it is sometimes caused by organisms which cannot be identified and thus enters the category of a so-called non-gonococcal urethritis.

Similarly, in the female, complaints of abnormal vaginal discharge, or irregular spotting may sometimes point to an inflammation of the cervix. This alteration of the cervix may be attributable to an infection by a variety of organisms, including chlamydia, herpes, gonorrhea and others. This presentation in the female patient may be described as muco-purulent cervicitis.


Endnotes

  1. Snyder RR, Hammond TL., et al.: Human papilloma virus associated with poor healing of episiotomy repairs. Obstetrics and Gynecology 76: 664-667, 1990. Back to text.
  2. Beutner RR: Human papilloma virus infection. Journal of the American Academy of Dermatology 20: 114-123, 1990. Back to text.
  3. Rapini RP: Venereal warts. In Nixon SA (ed): Primary Care, Clinics in Office Practice 17(1): 127, 1990. Back to text.
  4. Moss AR, Bacchetti P: Natural history of human immunodeficiency virus infection. AIDS 3: 55-61, 1989. Back to text.

 

 



ACKNOWLEDGEMENT

Genuis, Stephen, “Which Are the Common Stds?” In Risky Sex, 25-34. Edmonton, Alberta: Winfield Publishing, 1992.

Risky Sex, along with the following other materials by Dr. Stephen Genuis, are available through Winfield Publishing.

Teen Sex: Reality Check (book or audio-book) Using stories, case presentations and current medical research, this book addresses the issue of STDs and teen sex, the factors predisposing adolescents to risky sexual behaviors and the various strategies used to address the challenge of early adolescent sexual involvement.

Teen Sex: Strikes Back (video or DVD) In this dynamic video, Dr. Stephen Genuis, well-known speaker and author, presents adolescent lifestyle options and encourages viewers to make health enhancing decision. Using dramatic scenes acted by teens, a variety of myths regarding teen sex and sexually transmitted diseases are examined. Timely issues, such as 'sex and cyberspace' and meeting internet contacts, are explored.

Teen Sex: Challenge and Decision (video) Available in Spanish or French. This video, which won a "Best Video Award" from the Society of Obstetricians and Gynecologists of Canada, presents important information about sexually transmitted diseases and healthy decision making in the areas of sexuality. Using images that teenagers and young adults can relate to, a variety of myths and different lifestyle options are explored.

Reproduction Rollercoaster (book) This book provides a straightforward discussion of miscarriage, infertility, infertility assessment and treatment, and reproductive technologies.

Order Information: Toll free from the USA or Canada: 1-888-404-9419 Fax: (740)282-4336 Phone: 1-740-282-3413 Address: 655 Lawson Ave, Steubenville, Ohio, U.S.A., 43952

THE AUTHOR

Dr. Stephen Genuis practices Obstetrics and Gynecology in Alberta, Canada. He is a leading authority in the area of teenage sexuality and speaks widely on the topics of STDs, trends in youth behaviour, sexuality education programs, adolescent pregnancy, successful strategies for dealing with the challenge of adolescent sexuality, etc. Dr. Genuis has had articles published in The Lancet, Adolescent and Pediatric Gynecology, the Journal of the Society of Obstetricians and Gynecologists of Canada among others. He presently serves as a board member on the Premier's Council in Support of Alberta Families and is a member of the Physicians Continuing Care Committee for the college of Physicians and Surgeons of Alberta. His commitment to community education is evidenced by his many presentations to community groups, schools, and professional gatherings. His emphasis on education was acknowledged when he received the Resident of the Year Award from the University of Alberta graduating medical class of 1983.

Copyright © 1992 Winfield Publishing




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