Assistant Professor, College of Medicine and College of Science and Health
Charles R. Drew University of Medicine and Science
Worldwide on an annual basis, more than 300 million Sexually Transmitted Infections (STIs) are reported to the World Health Organization. In the U.S., it is estimated there are approximately 20 million new cases of STIs reported annually to the Centers for Disease Control and Prevention (CDC Factsheet “Reportable STDs in the United States, 2015 National Data for Chlamydia, Gonorrhea and Syphilis”). Over 50% of the STIs reported in the U.S. are diagnosed in young people aged 15 to 24. There are over 25 different STIs which individuals can acquire. The primary STIs which are reported to the CDC fall into two main categories: bacterial and viral STIs. Bacterial STIs are treatable and curable but most viral STIs are not curable but most are treatable. For a majority of viral STIs, once infected with one or more of them, an individual is infected for life. Within the last several years, individuals with Hepatitis C infection do have access to new medications which can cure Hepatitis C.
The most common bacterial STIs are Gonorrhea, Chlamydia, and Syphilis. Other STIs include crabs, public lice or scabies, which can be transmitted non-sexually by coming in contact with infected clothing, bed sheets and/or towels. Individuals can also contract yeast infections, including bacterial vaginosis trichomonas by sexual contact.
Many STIs are reportable to the CDC including: Chlamydia, Chancroid, Gonorrhea, Hepatitis B Virus, Hepatitis C Virus, and HIV/AIDS (Source www.verywell.com ) African Americans have some of the highest rates of STIs in the country. The rates of STIs among African Americans tend to be 10 to 20 times the rates among whites. STIs, including gonorrhea, chlamydia, syphilis, herpes, HIV and genital warts are 100% preventable.
National Trends in STIs
In 2008, the majority of individuals being infected with STIs in the U.S. were infected with Human Papillomavirus and there were 14, 100,000 new cases; with Chlamydia there were 2,860,000 new cases reported, with Trichomonas’s there were 1,090,000 new cases reported, with Gonorrhea there were 820,000 new cases reported, with Herpes Simplex Virus-2 there were 776,000 new cases reported, with Syphilis there were 55,400 new cases reported; with HIV there were 41,000 new cases reported and with Hepatitis B there were 19,000 new cases reported. The prevalence of these STIs in 2008 in the U.S. totaled over 110 million cases: 79,100,000 cases of HPV; 24,100,000 cases of HSV-2; 3,710,000 cases of Trichomonas; 1,570,000 cases of Chlamydia; 908,000 cases of HIV; 427,000 cases of Hepatitis B; 270,000 cases of Gonorrhea; and 117,000 cases of Syphilis. The economic burden for provision of lifetime treatment of these STIs annually is estimated at 16 billion. (CDC Fact Sheet: “Incidence, Prevalence and Costs of STIs in the U.S.” 2008)
STIs in California
In 2014, there were increases in syphilis in California. Syphilis cases rose 18% from 2010 to 2011 in the State of California. There was also a 5% increase in chlamydia cases and a 1.5% increase in gonorrhea cases in the state. In 2011, there were 164,000 cases of chlamydia reported; 27,000 gonorrhea cases reported and 2,000 cases of syphilis cases reported. (LA Times Article, August 15, 2012).
STIs in Los Angeles County
A total of 66,276 cases of HIV and STIs were reported in Los Angeles County in 2013. Of these reportable diseases, 72.6% were related to infection with Chlamydia, 18.8% were related to infection with Gonorrhea, 5.5% were related to infection with Syphilis, and 2.7% were related to infection with HIV/AIDS. Many of these STIs were reported among young people and ethnic/minorities continue to experience the highest burden of disease of STIs in the nation and in Los Angeles County (LACDPH, 2014 Annual HIV/STD Surveillance Report).
Link Between STIs and Contracting HIV
Having an STI increases the chance of acquiring HIV. When someone has an STI, there are sometimes open sores and leisions which, if HIV is present, facilitate the transmission of HIV by providing easy entry of HIV into the body. Additionally, STIs increase the number of white blood cells at the site of infection, thus increasing the number of target cells for HIV to infect. Someone with an STI having unprotected sex with an HIV infected person is 3 to 5 times more likely to contract HIV from that person.
Gonorrhea and Chlamydia
The most common bacterial STIs are gonorrhea, chlamydia, and syphilis. Symptoms of gonorrhea in females include painful urination, abnormal vaginal bleeding and pain during sex. Gonorrhea symptoms in men are similar with painful urination and disseminated gonococcal infection. Chlamydia infection has symptoms similar to gonorrhea; in women, abnormal vaginal discharge and pain during sex. Complications, if not treated for gonorrhea and chlamydia in females include pelvic inflammatory disease (PID). Chlamydia symptoms in men can include discharge from the penis (may be runny, whitish), burning on urination. Complications of chlamydia in men, if not treated can include swollen and tender testicles (epididymitis). Gonorrhea and chlamydia are treatable with antibiotics.
There are three stages of syphilis infection called primary, secondary and tertiary stages. In the initial stage, symptoms include a painless sore called a “chancre”, which may be located on the genitals, lips, anus, or other area of direct contact with the syphilis bacteria.
The chancre will last 1-5 weeks and heal without treatment. The person can easily pass it on to sex partners. If not treated, the infection progresses to the secondary stage. During the secondary stage, there is the development of skin rashes lasting 2 – 6 weeks (average of 4 weeks) on the palms of the hands, bottoms of the feet, or any part of the body. Other symptoms in the secondary stage include fever, swollen lymph glands, headache, hair loss, and/or muscle ache. Symptoms will go away without treatment but the person may be able to pass the infection on to their sex partners. The final tertiary stage of syphilis can cause paralysis, insanity, blindness, damage to knee joints, personality changes, impotency, aneurysm (ballooning of a blood vessel), and/or a tumor on the skin or internal organs called “Gumma”. Syphilis is treatable in all of these stages with antibiotics.
Common Viral STI
Herpes Simplex Virus
The most common viral STIs are Herpes Simplex Virus (HSV) Type I and Type II, Human Papillomavirus, and Hepatitis A, B and C.
There are 2 types of HSV: HSV-1 and HSV-2. HSV-2 causes most genital infections. HSV-1 causes oral infections (cold sores, fever blisters) and some genital infections. Symptoms include numerous painful lesions (sores) on the penis, vulva, cervix, anus, buttocks, thighs, mouth or fingers. These lesions can last up to 4 – 21 days. Other symptoms include headache, fever, muscle aches, swollen lymph nodes, and difficult urination. Symptoms may or may not come back. Herpes can be treated by culturing the lesions or a blood test and the infection is treated with antivirals. Many people with HSV do not have any symptoms or do not recognize that they have symptoms. Most people with herpes can pass the virus to sex partners even when they do not have symptoms.
There are over 100 different strains of Human Papillomavirus (HPV), some of which infect the genital area.
The incubation period is unclear. HPV can infect men, women and newborns. The person can easily pass it on to sex partners
The types of HPV that infect the genital area are labeled “low-risk” or “high-risk” depending on whether they can cause cancer or not.
Low-risk HPV types can cause genital warts. High-risk HPV types can cause serious cervical lesions, cervical cancer, and other genital cancers. Usually HPV infection is asymptomatic and brief (6 – 12 months). There is currently no test for genital warts. Depending upon the health of one’s immune system, one can “clear” HPV out of your system. The body’s immune system clears most HPV naturally within 2 years (90%) though some infections persist. Some low risk HPV cause genital warts which can lead to the development of warts on the penis, vagina, anus or urethra. Individuals rarely may have itching, bleeding, burning, or pain along with the warts. The warts may go away on their own, stay about the same, or get worse. High risk HPV types can cause cervical lesions or anal lesions. There is no test for genital warts. Several types of treatment are available. The warts can be burned off, cut off, or dissolved. However, the warts may grow back. With cervical lesions there is the possibility that one can develop cervical cancer. However, regular Pap smears are the best way to detect serious lesions and prevent cervical cancer. Pap smear screening is recommended for all sexually active women. HPV infection is usually asymptomatic but can be detected by Pap smear or a Pap smear of the anus. Most warts will go away on their own. But, some will persist and need to be followed-up with by a healthcare provider. Most women with high-risk HPV types do not develop cervical cancer.
HIV is a viral STI and can be life threatening. Body fluids which transmit HIV include blood, precum, semen, vaginal fluids
and breast milk. HIV is contracted by unprotected anal, oral, or vaginal sex. as well as by sharing HIV contaminated needles and syringes and drug paraphernalia. Today, there is very low risk of maternal-to-child transmission if the HIV infected mother receives prenatal care and drug treatment prior to pregnancy, during labor and the baby receives treatment after birth. One’s personal risk for HIV infection can be lowered by practicing abstinence, limiting the number of sex partners, not using drugs and alcohol with sex, getting regular STI check-ups and STI screenings. If infected with an STI, you need to seek immediate treatment. Sexually active individuals always need to use condoms, male or female, with every sex act. Sexually active individuals need to have open and honest communication with their intimate sexual partners at all times. There is currently very effective treatment for HIV infection. HIV infection is no longer a death sentence. With early treatment and intervention, HIV infected individuals can reduce their chances of progressing to AIDS, which is the end-stage of the disease. You can be screened for HIV antibodies with a blood test, finger prick, or an oral swab test. The most utilized of these tests are called “HIV rapid tests” where you can obtain your test result in 1 to 20 minutes and these tests are 99% accurate.
Much of the information presented in this article was taken from a CDC power point titled” STDs 101 for Non-Clinicians” and was developed by the Training and Health Communications Section in the Program Development and Support Branch, Division of STD Prevention, NCHSTR, CDC). For additional information on HIV/AIDS and STIs go to www.cdc.gov.