STD

STD have plagued the word for hundreds and hundreds of years. Counseling about STD is always a difficult task for the clinician. There are various sexually transmitted diseases and numerous different treatment therapies for every one of them. An STD is an infection involving an organ or body system transmitted through sexual contact. Sexual contact can have various forms like for example sexual intercourse, either vaginally or anally, oral sex, sexual toys, kissing etc.

STD can differ in the way they present. They can be of a bacterial origin or viral. They can also be classified as an STD causing ulcers, cervicitis (inflammation of the cervix, which is the lower part of the uterus), infection of the pelvic organs and STD causing genital warts.

Even though there are emerging new strains of STD, the most common ones are the following:

1. Herpes (Ulcerative STD)
2. Syphylis (Ulcerative STD)
3. Lymphogranuloma Venereum (Ulcerative STD)
4. Chlamydia (Cervicitis causing bacteria or Pelvic Inflamatory disease)
5. Neisseria Gonorrhea ( Cervicitis causing bacteria or Pelvic Inflamatory disease)
6. Human Papilloma Virus (also called HPV, causing genital ulcers or precancerous cervical lesions)
7. Molluscum Contagiosum (dome shaped lesion with central ulceration)
8. Scabies (Highly contagious infection)
9. Pediculosis Pubis (Known as the crab louse)
10. Trichomoniasis: Infection by a parasaite called Trichomonas Vaginalis

Herpes: This is probably one of the most common STD that we see in our office and its also one of the most prevalent STD worldwide.  This is one of the most common std that causes psychological and psychosexual Herpes can be different presentations:

1. Primary or initial presentation
2. Non primary initial presentation
3. Recurrent infection
4. Subclinical infection.

After initial contact with the virus, ulcerative lesions present within 2 to 14 days of initial contact. The lesions can be multiple, bilateral in the genital area and painful. Patients often present with a burning pain, inguinal adenopathy ( pelvic nodes that are tender) and pain during urination. Diagnosis of this STD can be via culture of a lesion or via blood testing. The prefered method is culture. Treatment for herpes consists of antivirals for 7-10 days for the primary or initial presentation and for 5 days for recurrent or non primary disease.

Syphillis: This is another ulcerative STD caused by the bug called Treponema pallidum. It can be presented as various forms as well but the most common one is the painless chancre. A solitary painless ulcer that ocurrs at the site of inoculation. It has a longer incubation period of about 10-90 days. Diagnosis of this STD is via blood testing. Treatment used is with Penicillin.

Lymphogranuloma Venerum. This is another STD caused by the bacteria Chlamydia Trachomatis. Incubation period is around 4 to 21 days. The lesion can be a papule, ulcer, erosion, herpes like ulcer or non specific urethritis (infection of the urethra).  In women, it sometimes present in the cervix, vagina, rectal or even the vulva. Classic presentation for this disease its a diffuse adenopathy (inflamed nodes of the pelvis) causing what its called “buboes” which can lead to extensive adenopathy causing scarring and deformation of the genital area.  Recommended therapy for this disease its antibiotics for 21 days.

Neisseria Gonorrhea: This is a bacterial infection causing cervicitis and pelvic inflamatory disease. Presentation of this disease is a mucupurulent discharge, pain during urination and abnormal vaginal bleeding. Diagnosis of this condition is made with culture. Unfortunately, this bacteria has been creating resistance to common antibiotics regimens and most of the time Intramuscular medications its necessary to eradicate this STD. Concominant recommended therapy for Chlamydia is given since  they both can infect the genital tract at the same time.

Chlamydia: This is by far the most common STD reported to health agencies. This bacteria usually infects the women’s lower genital tract leading to mucupurulent cervicitis although the majority of time women are completely asymptomatic. This most of the time its an asymptomatic STD, and can lead to Pelvic Inflamatory Disease leading to chronic pelvic pain or even infertility. Incubation period is 1 to 3 weeks. Culture its the gold standard to detect this bacteria. Fortunately, this bacteria is easily eradicated if found early during its course. Single dose antibiotics are given for 1 day or there is a second option for a 7 day antibiotic therapy. Most of the time, the single course antibiotic regimen eradicates the bacteria. It is important to remember that your partner must be examined or treated along with you and avoid sexual intercourse for a few weeks until the bacteria dissapears. In the state of Texas, your gynecologist is allowed if he wishes to send treatment for your partner as well. There are various states that do not allow this and your doctor cannot prescribe antibiotics without examining your partner. A test of cure is not needed ( meaning getting tested for the same STD once again after therapy was given) if your doctor used the most common regimens for Chlamydia infection. However if symptoms persist, or there is a concern that you might be re infected , a test of cure can be done.

HPV or Human Papilloma Virus: To learn more about this virus, please visit my blog at Cervical Cancer STD

Trichomoniasis: Considered one of the most curable and treatable sexually transmitted diseases.  Very few people develop symptoms when infected. Women sometimes find that they have this parasite when having their pap smear done.  It can infect the vulva, vagina and urethra. Incubation period is 5 to 28 days. If symptoms are present, irritation, itchiness, pain during urination, pain during sex. Fortunately, if given Metronidazole or Tindamax, this STD infection should clear. Remember to tell your partner about it so he can be treated if not recurrences will be common.