STD/STI sexually transmitted infections and sexually transmitted disease testing, treatment, and partner treatment. Gonnorhea, chlamydia, syphilis, trichomoniasis, herpes, hepatitis, and HIV testing.
OverviewSTD

Sexually Transmitted Diseases (STD) Overview

Chelsea Mynyk
What is an STD/STI?

STD is an acronym for sexually transmitted disease and can be interchanged with the term sexually transmitted infection (STI) meaning the same thing. STD’s are very common but also can be preventable. According to the Center for Disease Control and Prevention (CDC), in 2017 over two million STD cases were reported in the United States. STD’s are transmitted from person to person by oral, vaginal, or anal sex, sharing needles, or an infected mother may pass it to her baby during pregnancy, birth, or breastfeeding.

What are the most common STD’s ?

  Chlamydia

Chlamydia is the most common STD accounting for 1.7 million cases in 2017 (CDC, 2018). When left untreated, chlamydia can have detrimental effects on women’s health including pelvic inflammatory disease (PID), infertility, chronic pelvic pain, an increased risk for ectopic pregnancy, and infection in the newborn (CDC, 2016). Chlamydia is easily treated and curable but testing is needed to determine the presence of this infection. Chlamydia is treated with a 7-day course or a one-time dose of antibiotics. It is important to complete the entire regimen of medication and abstain from sexual activity during this course of treatment or seven days after completing the one-time dose. Repeat testing is recommended in 3 months (CDC, 2016).

Gonorrhea

Gonorrhea is another common STD accounting for approximately 550,000 cases in 2017 (CDC, 2018). Gonorrhea can be cured with the correct treatment, however, recently there is an increase rate of resistance to the antibiotics commonly used to treat gonorrhea. Although antibiotics will treat the infection it will not reverse any damage that has taken place prior to treatment. Untreated gonorrhea can lead to scar tissue in the fallopian tubes resulting in increased infertility, tubal pregnancy, PID, chronic pelvic pain, and infection in the newborn (CDC, 2014, 2018).

Syphilis

Syphilis is increasing in rates among women and newborns. Syphilis accounted for approximately 31,000 cases in 2017. This is a 76% increase from 2013 (CDC, 2017). Syphilis is treatable but left untreated can cause severe health complications and even death among newborns. There are four different stages of syphilis (primary, secondary, latent and tertiary). Symptoms can vary for each stage. A single dose of Benzathine penicillin G injection will treat syphilis in the early stages. Left untreated, syphilis can cause damage to the heart, brain, and other organs (CDC, 2017). It is important for pregnant women to be tested for syphilis at their first prenatal visit so treatment can be initiated promptly.

Hepatitis

Hepatitis is a viral infection that can cause liver damage. There are five types of hepatitis A–contracted by food contamination, self-limiting, B–contracted through sexual contact, sharing needles, and infected mother to newborn, C–contracted through needle sharing, can be self-limiting, no vaccine, and treatment only for chronic HCV, D–contracted via blood products, self-limiting or chronic, no vaccine, only seen in persons with positive HBV, and E–contracted through feces such as in contaminated water, self-limiting, and no vaccine. Symptoms of hepatitis B are mild to no noticeable symptoms. Untreated hepatitis can become chronic leading to liver damage, liver failure, or cancer. Hepatitis is most preventable with vaccination. There are new treatments available to delay the disease progression and may reverse liver damage (CDC, 2019). Pregnant women are tested for hepatitis B at their first prenatal visit. Screening and testing is done for at risk persons such as those who inject drugs, men who have sex with men, HIV positive, healthcare and public safety workers, immunosupressive therapy, end stage renal disease, and blood or tissue donor (CDC, 2019).

Herpes

There are two types of the herpes simplex virus (HSV): HSV-1 oral and HSV-2 genital. HSV-1 is the common cold sore that is usually contracted as a child or young adult through non-sexual contact with saliva. HSV-2 is transmitted through sexual contact. Herpes is a common STD that most people do not experience any symptoms. More than 1 out of 6 people have genital herpes between the ages of 14-50 (CDC, 2017).  It is important to let your health care provider know if you have or you are concerned about herpes. Herpes in pregnancy can be passed to the newborn during the birth. If you have a breakout during your pregnancy, let your provider know and you can start suppressive therapy at the end of pregnancy. If you have an active lesion in labor, a cesarean section will most likely be recommended. Herpes for the newborn can lead to a potential deadly outcome (neonatal herpes) (CDC, 2017). There is no cure for herpes but there are treatment options to reduce and prevent occurrence.

HIV/AIDS

HIV is an acronym for human immunodeficiency virus. HIV is a potent virus that destroys cells in the body that are essential for your immune system to fight infection. Having an STD increases your risk for getting HIV (CDC, 2018). Approximately 39,000 new cases of HIV are diagnosed each year in the U.S. (CDC, 2018). There are various ways to prevent transmission of HIV such as never sharing needles, abstaining from sex, limiting partners, and using condoms correctly and every time. The only method that is 100% is abstinence–abstaining from oral, vaginal, or anal sex (CDC, 2018). According to the CDC, there is no effective cure for HIV but there are treatments to help control the virus (2018). Testing is required to diagnose HIV. The CDC recommends that everyone ages 13-64 is tested at least once (2018). All pregnant women are tested for HIV at their first prenatal appointment. If positive, then early treatment in pregnancy can decrease the risk of transmission to herb baby. HIV is tested by obtaining a blood sample and the results are usually provided within the next week.

Trichomoniasis

Trichomoniasis (“Trich”) is a common and treatable STD caused by a parasite. About 70% of people do not exhibit any symptoms. Symptoms associated with this STD my include itching, burning, unusual and “fishy” smell to discharge. Untreated trichomoniasis can increase one’s risk for HIV and in pregnancy, can lead to preterm (early) birth (CDC, 2017). Testing requires a either a vaginal swab or urine sample. The provider can then use a microscope to visualize the presence of trich parasites. Treatment is easily completed with a one-time dose of either metronidazole or tinidazole. It is important not to drink alcohol within 24 hours of taking this medication.

Human Papillomavirus (HPV)

HPV is the most common STD accounting for approximately 80 million cases in the U.S. and primarily in teens and young adults (CDC, 2017). There are multiple types of HPV that can cause different health issues such as genital warts and cancer. HPV can have no symptoms for years making it difficult to know if you are infected. There are no tests for diagnosing HPV. Your provider can visualize and diagnose genital warts. Screening for cervical cancer (Pap smear) associated with HPV is recommended for women 30 years of age and older. Early detection of possible cervical cancer is helpful in attaining prompt treatment. There is a vaccine for HPV that is recommended by the CDC. However, at CRM we do not prescribe this vaccine but would be open to discussing this and preventative measures with you.

What are the symptoms?

STD’s can either have no apparent symptoms or mild symptoms such as burning with urination, itching, sores, rashes, unusual discharge, poor appetite, or low grade fever. Despite the lack of obvious symptoms, if left untreated these infections can cause long-term health disparity and affect quality of life. Complications from untreated STD’s include infertility–every year approximately 20,000 cases of women struggling with infertility related to STD’s occur in the U.S. (CDC, 2018), cancer, organ damage, stroke, or blindness (CDC, 2018).

Who needs to be tested?Image result for STD testing

The following recommendations for who should be tested are made by the CDC (2014):

ALL sexually active women less than 25 years of age should be tested every year for chlamydia and gonorrhea.

Women over the age of 25 with risk factors such as a new partner or multiple partners should be tested annually.

ALL women, ages 13-64, should be tested at least once for HIV.

ALL pregnant women should be tested for syphilis, HIV, and hepatitis B early in their pregnancy. Pregnant women younger than 25 years or women older than 25 years with risk factors mentioned above should also be tested for chlamydia and gonorrhea early in the pregnancy. An STD panel including syphilis, HIV, hepatitis B, chlamydia and gonorrhea is usually completed at the first prenatal visit.

ANYONE who has unsafe sex or shares needles should be tested once a year for HIV.

What to expect at my appointment

Discussing your sexual health can be difficult but it is important to voice any concerns to ensure the best testing and treatment for you. At CRM, we strive to maintain your privacy and confidentiality to help with this process. There are a few STD’s that are considered mandatory reporting to the CDC if the test result is positive (chlamydia, gonorrhea, HIV, hepatitis, syphilis, and chancroid). During your appointment you will receive a questionnaire to complete about risk factors and history to help determine what tests are the most appropriate for you. You will then receive a vaginal swab kit–you can complete yourself–or a sterile urine container to collect a sample. The test will be sent to a local laboratory for processing. Most test results are available within a week. Your provider will discuss your test results, plan of treatment if positive, or plan for prevention if negative. If you are pregnant, an STD panel will be completed at your first prenatal visit via a lab draw.

References

Center for Disease Control and Prevention (CDC) (2019). Hepatitis B questions and answers for health professionals. Retrieved from https://www.cdc.gov/hepatitis/hbv/hbvfaq.htm#treatment.

Center for Disease Control and Prevention (CDC) (2018). HIV basics. Retrieved from https://www.cdc.gov/hiv/basics/index.html.

Centers for Disease Control and Prevention (CDC) (2018). Sexually Transmitted Disease Surveillance 2017. Atlanta: U.S. Department of Health and Human Services. doi: 10.15620/cdc.59237

Center for Disease Control and Prevention (CDC) (2016). Sexually transmitted disease: Chlamydia. Retrieved from https://www.cdc.gov/std/chlamydia/default.htm.

Center for Disease Control and Prevention (CDC) (2014, 2018). Sexually transmitted disease: Gonorrhea. Retrieved from https://www.cdc.gov/std/gonorrhea/default.htm.

Center for Disease Control and Prevention (CDC) (2017). Sexually transmitted disease: Herpes. Retrieved from https://www.cdc.gov/std/herpes/default.htm.

Center for Disease Control and Prevention (CDC) (2017). Sexually transmitted disease: Human papillomavirus. Retrieved from https://www.cdc.gov/std/hpv/stdfact-hpv.htm.

Center for Disease Control and Prevention (CDC) (2014). Sexually transmitted disease: Prevention. Retrieved from: https://www.cdc.gov/std/prevention/screeningreccs.htm.

Center for Disease Control and Prevention (CDC) (2017). Sexually transmitted disease: Syphilis. Retrieved from https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm.

Center for Disease Control and Prevention (CDC) (2017). Sexually transmitted disease: Trichomoniasis. Retrieved from https://www.cdc.gov/std/trichomonas/stdfact-trichomoniasis.htm.