Infections

Sexually transmitted diseases

STD stands for the English term “sexually transmitted diseases”. Nowadays, this term is used instead of the somewhat outdated “venereal diseases” term for those infectious diseases that are caused by pathogen agents and that mainly spread through sexual intercourse. STD agents are for example bacteria, chlamydia, mycoplasmas, viruses, fungi and parasites. More than 30 pathogens spread through a sexual contact. STDs may be asymptomatic or have only mild and non-specific symptoms. For this reason, you should get yourself tested for STDs after any unprotected casual sexual contact.

Sample taking means withdrawing blood which is quick and painless. Even though it takes only a few minutes, many of us are scared of it. It is understandable, as sexually transmitted diseases are intimate problems and may result in unpleasant symptoms and severe complications. Many times STDs are diagnosed when complications have already occurred such as pelvic inflammatory disease, prostatitis, infertility or cervical cancer. 

The most common sexually transmitted diseases:

Bacterials

 

Gonorrhea

Gonorrhea, also called clap, is a sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae which infects the urethral, cervical, rectal and pharyngeal mucosa or the conjunctiva of the eye. 

How does gonorrhea spread?

Gonorrhea spreads through sexual contact which includes oral sex, too.

The pathogen can spread in the bloodstream and then settle down mainly in the skin and joints. The ascending infection of the female genital tract can damage pelvic organs causing pelvic pain and fertility disorders.

Symptoms

In men the first symptoms present 2-7 days after the infection in the form of irritation in the urethra. In a few hours it is followed by mild to severe pain during urination and the discharge of pus from the penis. Men develop a frequent and sudden urge to urinate which worsens as the infection spreads to the upper part of the urethra. The urethral opening might become red and swollen.

In women the first symptoms present 7-21 days after the infection. Infected women are often free of symptoms for weeks or months, and their infection is only recognized after their male partner is diagnosed with it. Their symptoms are usually mild, but in some cases they might be severe including frequent urination, painful urination, vaginal discharge and fever. The infection can reach the cervix, the uterus, the fallopian tubes, the ovaries, the urethra and the rectum resulting in pelvic pain and soreness during sexual intercourse. The pus seemingly comes from the vagina, but it actually originates from the cervix, the urethra or from the glands around the vaginal opening.

People who engage in anal intercourse might develop a rectal infection which can lead to irritation around the anus and discharge. The area around the anus becomes red and moist, while mucus and pus might be seen in the stool.

Having oral sex with an infected partner might lead to pharyngeal gonorrhoea. The infection usually does not have any symptoms, but sometimes it causes a sore throat and difficulty swallowing. If any infected fluid contacts the eye, an outer eye infection might develop. Newborns can get infected by their mother during childbirth, and it leads to the infection of both eyelids and the discharge of pus. The symptoms are similar in adults but usually affect only one eye, and if the infection is left untreated, it can result in blindness.

Diagnosis

Diagnosis can be established almost promptly with the identification of bacteria under microscope. The examination of the excretion of the penis has diagnostic values in 90% of men; however, in women, this procedure has only 60% efficacy with the examination of cervical secretion. If no bacteria can be detected under microscope, the sample is sent to the laboratory for bacteria culturing.

In the case of suspected infection of the pharynx and rectum, they should be sampled for culturing. Although, there is no blood test for diagnosing gonorrhea infection, blood is taken from the patient in order to exclude syphilis and HIV infection. It can happen that the patient suffers from more than one sexually transmitted diseases at a time.

Treatment

Gonorrhea is usually treated with only one intramuscular injection or with one week orally taken course of antibiotics. If the infection is already spread by blood in the body, the patient is treated in a hospital, usually with intravenous antibiotics. Patients with gonorrhea are often suffering from “difficult to diagnose“ Chlamydia infection, therefore, they receive combined antibiotic therapy.

If symptoms return back or still persist after finishing treatment, a new sample should be taken to make sure the patient is healed, because in case of men, symptoms of urethral inflammation (urethritis) can appear again. This symptomatic group, also called post-gonococcal urametics, is caused by unresponsive Chlamydia or other species. This is common in those patients who did not follow the treatment instructions. Treatment of symptomatic groups called post-gonococcal urametics is caused by unresponsive Chlamydia or other species, especially analysts who did not follow the new treatment instructions.

More informations:

https://belvarosiorvosicentrum.hu/en/gonorrea-clap

Syphilis

Syphilis – or skeletal blood – is a sexually transmitted disease caused by the bacterium Treponema pallidum.
The number of syphilis patients reached a peak during World War II, then fell sharply until the 60s, and then began to rise again. During this time many cases of homosexual men were observed. The ratio remained largely stable until the mid-1980s, then as a result of the AIDS epidemic, the practice of safe sex was emphasized, so the incidence of syphilis began to decline gradually. Consequently, the number of syphilis patients also declined.

 However, this decline was followed by a rapid increase in the number of new cases among crack cocaine users, mainly affecting women and their newborns. As a result of recent prevention programs, the recurrence of syphilis has decreased again in most of the US.
After the healing process the infected person will not become immune to the disease and can get infected again.

 How does it infect?

 The bacterium enters the body through the mucosa of the vagina or the mouth, or possibly through the skin. In a few hours it reaches the nearest lymph nodes, and from there it spread through the body via the bloodstream. During pregnancy it infects the fetus in a few hours causing birth defects and other changes. 

 Symptoms

 Symptoms of a syphilis infection usually present themselves in the first 1-13 (usually 3-4) weeks after transmission. There are multiple stages of Treponema pallidum infection: the first, the second, the latent and the tertiary. The infection can last for years, and as a rare complication, it can cause heart disease, brain damage and death.

 During the first stage a painless sore (a „chancre”) appears at the site of transmission: on the penis, the vulva (the outer female sex organ) or in the vagina. The sore can appear in the anus or the rectum, on the lips, the tongue and the throat, on the cervix, the fingers and rarely on other parts of the body, too. There is usually only one sore, but in rare cases multiple sores can develop.

 The chancre is a small, red, bumpy spot and it progresses into an open sore that is still painless. It does not bleed but scratching can induce the secretion of a highly infective, clear fluid. The nearby lymph nodes are usually enlarged, but these are painless, too. Since these symptoms do not cause many complaints, patients usually ignore these. The half of infected women and the third of infected men are unaware of this sore. It usually disappears in 3-12 weeks and the patients seem to completely recovered. 

 The second stage typically begins with a rash that develops 6-12 weeks after the transmission. In every fourth patient, the healing sore is still visible. The rash can disappear but it can last for months as well. It often resolves in untreated patients, too, but in a few weeks or months other symptoms can develop.

 In the second stage 80% of the patients develop mouth sores, 50% of them have enlarged lymph nodes throughout their body and 10% present suffer from an eye inflammation. The inflammation of the eyes does not usually cause symptoms, however, the optic nerve might swell that can lead to blurred vision. 10% of the patients have severe pain in their bones and joints. The inflammation of the kidneys can cause the presence of excess proteins in the urine, while the inflammation of the liver can cause jaundice. The inflammation of the outer membranes of the brain can cause headache, stiff neck and sometimes hearing loss, too.

 Elevated lesions might appear at the skin-mucosa margin (e.g. at the inner border of the labia majora and the vulva) and at moist areas of the skin. These are called condyloma latum, they are highly contagious and in time they flatten, and they turn either grey or a pale shade of pink. Hair falls out in patches leaving behind a moth-eaten appearance. Additional symptoms include malaise, loss of appetite, nausea, fatigue, fever and anemia.

 After the patient recovers from the second stage, the disease enters an asymptomatic latent phase. This stage can last for years or decades (in some cases until the patient’s death). In the first part of this stage the contagious ulcers might reappear.

 In the third stage of the disease (late syphilis) the patient is not contagious anymore. Symptoms vary from mild to devastatingly severe. There are three groups of symptoms: benign late syphilis, cardiovascular syphilis (affecting the heart and vessels) and neurosyphilis (affecting the nervous system).

 Benign late syphilis occurs rarely and presents with the appearance of growths (called „gummas”) on different organs. They grow and heal slowly and leave scars. They can appear anywhere on the body but usually present on the legs below the knee, the upper torso, the face and the scalp. They can affect bones as well which leads to deep, piercing pain that is typically worse at night. 

 Cardiovascular syphilis develops 10-25 years after the initial infection causing the formation of an aneurysm (the weakening and bulging of the wall) of the aorta (the main vessel originating from the heart) or insufficiency of the aortic valve. These complications can present with chest pain and heart failure and might be lethal.

 Neurosyphilis (syphilis of the nervous system) affects cca. 5% of all untreated patients.

 Diagnosis

 The clinical suspicion of syphilis is based on the symptoms and the final diagnosis is confirmed by laboratory results and by findings of the patient’s physical examination.

 In the first and second stage syphilis can be diagnosed by the microscopic examination of tissue taken from the ulcers of the skin or the oral mucosa, while detection of certain antibodies in the blood can be used as a screening test. In the third stage diagnosis is based on symptoms and antibody tests.

 Treatment

Since patients in the first and second stages are contagious, they (and their sexual partners) have to avoid any sexual activities before finishing their treatment. 

 Penicillin, which is the most effective medication in any stage, is usually administered intravenously.

 First, second and latent stage patients have an excellent prognosis after being treated, however, the prognosis of the third stage, which affects the brain and the heart, is quite poor as its complications are usually irreversible.

 More informations:

https://belvarosiorvosicentrum.hu/en/syphilis-lues

Limfogranuloma venereum (Chlamydia trachomatis)

LGV

Lymphogranuloma venereum is a sexually transmitted disease, which is caused by an intracellular bacterium named Chlamydia trachomatis.

The Chlamydia trachomatis strain causing lymphogranuloma venereum is not identical with those that cause urethral and cervical inflammation (urethritis and cervitis). Infection is most common in tropical and subtropical regions, and it is rarely found in the US. According to a study made in 1994-1995, Chlamydia trachomatis bacteria infect 11.4% of 15 to 19 year-old pregnant women in Hungary.  

Symptoms

Symptoms occur within 3 to 12 or more days after the infection. Usually it begins with a small, painless lump filled with fluid on the penis or in the vagina. This lump becomes a pustule, and then it heals quickly, mostly without being unnoticed. Then the inguinal lymph nodes on one or both sides become swollen and sensitive. The skin covering the infected region becomes warm and red, and in untreated cases, fistulas are formed above the lymph nodes. Pus and bloody secretions are generally excreted through the tracts. 

The condition usually heals by itself, but scarring can occur and fistulas can recur. The patient suffers from fever, malaise, headache, joint pain, lack of appetite, vomiting and back pain. Rectal infection with bloody pus discharge can also develop. 

Lymphatic vessels can be blocked due to the chronic and recurrent inflammation, which lead to the swelling of the tissues. The rectal infection can cause scarring and consequential narrowing of the passageway.

Diagnosis
The suspicion of lymphatranuloma venereum is based on typical symptoms. The diagnosis is confirmed by the detection of antibodies against Chlamydia trachomatis from the blood.

Treatment
The early onset of antibiotic therapy quickly heals the patient. After the treatment, the doctor should check regularly whether the infection has stopped. It is advisable to get in touch with the sexual partners of the infected person in order to examine them and treat them if necessary. 

https://belvarosiorvosicentrum.hu/en/chlamydia-trachomatis

https://www.cdc.gov/std/tg2015/lgv.htm

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