The
term ‘sexually transmitted disease’ or STD is used for all infections
that are transmitted mainly through sexual contact, during unprotected
vaginal or anal intercourse. Some
are also transmitted from mother to child before or during birth, and
through unsafe blood donations.
Most
STDs affect the male and female reproductive tracts, and therefore are
also known as ‘reproductive tract infections’.
Female reproductive tract infections include sexually transmitted
infections and others due to, for example, unsafe abortion or child
delivery techniques and lack of access to good hygiene.
Some STDs such as syphilis, hepatitis B and HIV, can affect other
parts of the body, for
example, the eyes, mouth, nervous system, rectum or urinary tract.
More
than 20 disease-causing organisms are transmitted through sexual contact.
A few are viruses, like HIV, and cannot be treated with
antibiotics. But common STDs such as syphilis, gonorrhea, chancroid and
chlamydia are caused by bacteria and can be cured.
Common
STD problems include vaginal and urethral discharge, genital itching, pain
when urinating and during sexual intercourse, painful genital and/or anal
sores (ulcers), painful swelling in the lymph glands in the groin and
scrotum, and lower abdominal pain. STDs can affect the foetus during
pregnancy, causing maternal ill-health and infant death through
miscarriage, stillbirth and premature birth.
Syphilis often infects infants during the birth process, causing
severe eye infections that can lead to blindness.
Serious
complications can result if these infections are not treated. Women may be
at greater risk of cervical cancer. Untreated
infections of the lower reproductive tract (the external genitals,
vagina and cervix) can rise to affect the upper reproductive tract (the
uterus, fallopian tubes and ovaries). This may be linked with unhygienic
IUD insertion, and unsafe abortion and childbirth techniques. These
complications are known as pelvic inflammatory disease (PID).
PID results in chronic pelvic pain and discomfort, infertility and
entopic pregnancy (in the fallopian tubes), which can cause the woman’s
death through internal bleeding.
In
men, untreated STDs, especially gonorrhea and chlamydia, can cause painful
inflammation of the testes, and infertility by blocking the sperm ducts.
People
are sometimes reluctant to seek treatment because of health workers’
attitudes.
In
the past, STD control was less effective because it relied on treating the
few people (mostly men) with symptoms who decided to seek medical
attention. Staff still sometimes lack training in STD care, or people
decide not to go to special STD clinics because they feel embarrassed or
ashamed. People often visit private doctors, pharmacists or traditional
practitioners, rather than specialised STD services. Many, especially
women, may not realise that they have an STD, because they do not have, or
do not recognise, the symptoms.
Prevention
and care at the primary level
The
sexual transmission of all STDs (including HIV) can be prevented by having
safer sex — using condoms or having non-penetrative sex. Prevention
and education programmes are an essential part of STD control, aiming to
raise people’s awareness about STDs and the importance of early
treatment, to reduce stigma, and to provide affordable condoms.
Another
key aspect of STD control is the early diagnosis and treatment of disease,
preferably during the person’s first visit to their health worker. This
prevents the development of complications, limits the spread of infection,
and provides a valuable opportunity for one-to-one HIV/STD education.
Ideally STD care should be integrated into the most accessible and
well-used health services: local dispensaries and health centres, and
family planning and antenatal clinics.
Resources
are often limited and it can make good sense to provide services for
people who may be more at risk, and who have limited access to care.
For economic, cultural or social reasons, many people - young men
and women, sex workers, men away from home or with male sexual partners -
lack access to or feel unable to use STD services.
The needs of women in stable relationships (often infected by their
male partners) are also much ignored, unless they are using family
planning or antenatal services that provide STD education and care.
WHO
and other international agencies are now promoting a new and effective
approach called syndromic management, which is enabling health workers to
diagnose and treat most STDs at the primary.
Staff are also trained to provide health education about STDs and
the need for partners to be treated.
One of the reasons for the failure to control STDs has been the
increasing resistance to drugs by the bacteria that cause gonorrhea and
chancroid. Standard
management guidelines also help to ensure correct treatment with effective
drugs, and hence delay the development of resistance.
Dr Monir Islam and Dr Peter Piot, WHO/GPA, Geneva.
STDs In Pictures
Sores on the Penis of a Man
Sores on the Vagina of a Women
Think Leakage from a Vagina of a woman
Swellings in the Groin of a man
Growth in a Woman
Discharge in the eyes of a new born Baby