Sexually Transmitted Diseases

AIDS

What is HIV?

• HIV is acronym for Human Immunodeficiency Virus (HIV)
• HIV virus causes AIDS
• HIV by itself is not an illness and does not instantly lead to AIDS
• An HIV infected person can lead a healthy life for several years before he/she develops AIDS.
• HIV is found only in human beings and not in any other living organism
• The person infected with HIV is said to be ‘HIV+’ or ‘HIV positive

What is AIDS?

• Aids is acronym for Acquired Immune Deficiency Syndrome
• A-stands for ACQUIRED i.e.; contracted not genetic or inherited.
• I-stands for IMMUNE i.e., power to resist disease
• D-stands for DEFICIENCY   i.e., insufficiency
• S-stands for SYNDROME, i.e., a number of complaints and signs indicative of a particular disease.
• HIV attacks the human body by breaking down its immune system that is meant to fight diseases. Over a period of time, the immune system weakens and the body loses its natural ability to fight diseases. At this stage, various diseases affect the infected person.

Types of HIV

• There are two types of HIV, HIV-1 and HIV-2. Worldwide the predominant virus is HIV-1, and generally when people refer to HIV without specifying the type of virus, they will be referring to HIV-1.
• Both HIV-1 and HIV-2 cause the body to produce antibodies within 3 to 6 months.

Modes of HIV Transmission

A person can get infected with HIV through the following routes.

• Unprotected Sex

If a person engages in sexual intercourse with an HIV infected person without using a condom, he/she can get infected.

• Sharing of improperly sterilized needles and hospital tools

If surgical devices like syringes and scalpels, or even certain instruments, used on the infected person, are used on another person without proper sterilization, they can transmit the infection.

• Unsafe blood transfusion

A person can get the infection; if he/she is given blood transfusion of HIV infected blood.

• Infected parent to child

An HIV positive mother can transmit the virus to child during pregnancy or at birth. Breast-milk can also act as a transmission medium..

• Shaking hands
• Eating along with HIV infected person
• Light kiss
• Through air or by coughing and sneezing
• Through food or water
• Through sweat and tears
• By sharing cups, plates and utensils with an infected person
• By touching, hugging an infected person
• By sharing toilets and bathrooms with an infected person
• By sharing clothes with an infected person
• By living with an infected person
• By mosquitoes, fleas, or other insects

• HIV and other STIs can impact upon each other. The presence of STIs in an HIV infected person can increase the risk of HIV transmission.

• For HIV infection to take place in this way, the needle would need to contain infected blood with a high level of infectious virus.

• If instruments contaminated with blood are not sterilized and used on another person there is a risk of HIV transmission. However, people who carry out body piercing or tattoos should follow procedures called ‘universal precautions ‘which are designed to prevent the transmission of blood borne infections such as HIV and Hepatitis B.

• The risk to health care workers being exposed to HIV is extremely low, especially if they follow universal health care procedures. The main risk is through accidental injuries from needles or other sharp object that may be contaminated with HIV.

• Transmission of HIV in a health care setting is extremely rare. All health professionals are required to follow infection control procedures when caring for any patient.

• Research suggests the risk of HIV infection in this way is extremely small. A very small number of people, usually in a health care setting, have become infected with HIV as a result of blood splashes in the eye.

• Infection with HIV in this way is unusual. There have only been stray cases  of HIV transmission resulting from biting. In these particular cases, severe tissue tearing and damage were reported in addition to the presence of blood.

• There is a possibility of becoming infected with HIV if you share injecting equipment with someone who has the virus. If HIV infected blood remains within the bore (inside) of the needle or in the syringe and someone else then injects themselves with it, that blood can be flushed into the blood stream. Sharing needles, syringes can pass on the virus.

• An infected pregnant woman can pass the virus on to her unborn baby either before or during birth. HIV can also be passed on during breast-feeding. If a woman knows that she is infected with HIV, there are drugs that she can take to greatly reduce the chances of her child becoming infected, as well as other options such as choosing to have a caesarean section delivery and not breast-feeding, as HIV is found in breast milk.

• Some people have been infected through a transfusion of infected blood. However, nowadays, all the blood used for transfusions is being tested for HIV. Hence, HIV infection through blood transfusions is becoming rare.

• While HIV may live for some time outside the body, HIV transmission has not been reported as a consequence of contact with spillages of blood, semen or other bodily fluids. Just because someone comes into contact with tiny quantities of HIV in dried blood, it does not follow that infection will occur. Scientists agree that HIV does not survive well in the environment, making the possibility of environmental transmission remote. Drying of HIV- infected human blood or other body fluids reduces the theoretical risk of environmental transmission.

• Research has shown that circumcised men are up to 70% less likely to contract HIV through sex. This is because the inner lining of the foreskin is thought to be particularly vulnerable to HIV. However, circumcision does not mean you cannot get HIV, it just means it’s less likely. Circumcised men can also pass on the virus just as easily as those whose foreskin has not been removed.

• Even if you are on treatment or your tests show that you have very low levels of HIV  in your blood, the virus is never totally eradicated and you are therefore still capable of infecting others.

World AIDS Day

World AIDS Day is held on 1 December each year and is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. World AIDS Day was the first ever global health day and the first one was held in 1988.

For more details visit: World Health Organization

Syphilis

What is Syphilis?

• Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum.

How do people get Syphilis?

• Syphilis is passed from person to person through direct contact with syphilis sore. Sores occur mainly on the external genitals, vagina, and anus or in the rectum. Sores can also occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What are the signs and symptoms in adults?

• Many people infected with syphilis do not have any symptoms for years.

Primary Stage

• The primary stage of syphilis is usually marked by the appearance of a single or multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The sore is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. It lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.

Secondary Stage

• Skin rash and mucous membrane lesions characterize the secondary stage. The rash usually does not cause itching. The rash may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.

Late Stage

• The latent (hidden) stage of syphilis begins when secondary symptoms disappear. In the late stages of syphilis, it may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

How does syphilis affect a pregnant women and her baby?

• Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth. An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die.

What is the link between Syphilis and HIV?

• Genital sores (chancres) caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present.

Will syphilis recur?

• Having syphilis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.

How can syphilis be prevented?

• The surest way to avoid transmission is to abstain from sexual contact . Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior.

Chlamydia

What is chlamydia?

• Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs.

How do people get chlamydia?

• Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.
• Any sexually active person can be infected with chlamydia.

What are the symptoms of chlamydia?

• In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. When the infection spreads from the cervix to the fallopian tubes (tubes that carry eggs from the ovaries to the uterus), some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods.
• Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis

What complications can result from untreated chlamydia?

• If untreated, chlamydial infections can progress to serious reproductive and other health problems with both short-term and long-term consequences. In women, untreated infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). Women infected with chlamydia are up to five times more likely to become infected with HIV, if exposed. Complications among men are rare.

How can chlamydia be prevented?

• The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Gonorrhea

What is gonorrhea?

• Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.

How do people get gonorrhea?

• Gonorrhea is spread through contact with the penis, vagina, mouth, or anus. Gonorrhea can also be spread from mother to baby during delivery.

What are the signs and symptoms of gonorrhea?

• Any sexually active person can be infected with gonorrhea.

• Although many men with gonorrhea may have no symptoms at all, some men have some signs or symptoms that appear two to five days after infection; symptoms can take as long as 30 days to appear. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles.

• In women, the symptoms of gonorrhea are often mild. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods.

How does gonorrhea affect a pregnant woman and her baby?

• If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby. Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult a health care provider for appropriate examination, testing, and treatment, as necessary

How can gonorrhea be prevented?

• The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Pregnancy with STD

Can pregnant women become infected with STDs?

• Yes, women who are pregnant can become infected with the same sexually transmitted diseases (STDs) as women who are not pregnant.

How do STDs affect a pregnant woman and her baby?

• STDs can have many of the same consequences for pregnant women as women who are not pregnant. STDs can cause cervical and other cancers, chronic hepatitis, pelvic inflammatory disease, infertility, and other complications. Many STDs in women are silent; that is, without signs or symptoms.

• A pregnant woman with an STD may also have early onset of labor, premature rupture of the membranes surrounding the baby in the uterus, and uterine infection after delivery.

• STDs can be passed from a pregnant woman to the baby before, during, or after the baby's birth. Some STDs (like syphilis) cross the placenta and infect the baby while it is in the uterus (womb). Other STDs (like gonorrhea,chlamydia, hepatitis B, and genital herpes) can be transmitted from the mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the placenta during pregnancy, infect the baby during the birth process, and unlike most other STDs, can infect the baby through breastfeeding.

• The harmful effects of STDs in babies may include stillbirth (a baby that is born dead), low birth weight (less than five pounds), conjunctivitis (eye infection), pneumonia, neonatal sepsis (infection in the baby's blood stream), neurologic damage (such as brain damage or lack of coordination in body movements), blindness, deafness, acute hepatitis, meningitis, chronic liver disease, and cirrhosis.

Should pregnant women be tested for STDs?

Treatment of Sexually Transmitted Diseases recommend that pregnant women be screened on their first prenatal visit for STDs which may include:

• Chlamydia
• Gonorrhea
• Hepatitis B
• Hepatitis C
• HIV
• Syphilis

Can STDs be treated during pregnancy?

• Chlamydia, gonorrhea, syphilis, trichomonas, and bacterial vaginosis (BV) can be treated and cured with antibiotics during pregnancy. There is no cure for viral STDs, such as genital herpes and HIV, but antiviral medication for herpes and HIV may reduce symptoms in the pregnant woman. For women who have active genital herpes lesions at the time of delivery, a cesarean delivery (C-section) may be performed to protect the newborn against infection. C-section is also an option for some HIV-infected women. Women, who test negative for hepatitis B, may receive the hepatitis B vaccine during pregnancy.

How can pregnant women protect themselves against infection?

• The surest way to avoid transmission of sexually transmitted diseases is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Pelvic inflammatory disease (PID)

What is PID?

• Pelvic inflammatory disease (PID) is a general term that refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs.

How do women get PID?

• PID occurs when bacteria move upward from a woman's vagina or cervix (opening to the uterus) into her reproductive organs. Many different organisms can cause PID, but many cases are associated with gonorrhea and chlamydia, two very common bacterial STDs. Sexually active women in their childbearing years are most at risk, and those under age 25 are more likely to develop PID than those older than 25. This is because the cervix of teenage girls and young women is not fully matured, increasing their susceptibilty to the STDs that are linked to PID.

What are the signs and symptoms of PID?

• Symptoms of PID vary from none to severe. When PID is caused by chlamydial infection, a woman may experience mild symptoms or no symptoms at all, while serious damage is being done to her reproductive organs. Women who have symptoms of PID most commonly have lower abdominal pain. Other signs and symptoms include fever, unusual vaginal discharge that may have a foul odor, painful intercourse, painful urination and irregular menstrual bleeding.

How can PID be prevented?

• The surest way to avoid transmission of STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Herpes

What is genital herpes?

• Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2).

How do people get genital herpes?

• Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected.

What are the signs and Symptoms of genital herpes?

• Most people infected with HSV-2 are not aware of their infection. The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years. Other signs and symptoms are flu-like symptoms, including fever and swollen glands.

Is there a treatment for herpes?

• There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.

How can herpes be prevented?

• The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Related resources

1. National AIDS Control Organisation
2. National Guidelines on Prevention, Management and Control of Reproductive Tract Infections and Sexually Transmitted Infections