STDs in Females

STDs IN FEMALES

Sexually transmitted diseases (STDs) are sometimes known as sexually transmitted infections. They're passed through vaginal, anal, or oral sexual contact. A female's symptoms of an STD can include:

• Vaginal itching
• Rashes
• Unusual discharge
• Pain

Many STDs presents no symptoms at all. If left untreated, STDs can lead to fertility problems and increase the risk of cervical cancer. These risks make it even more important to practice safe sex.

According to medical researchers, more than half of new chlamydia and gonorrhea cases occur in women between the ages of 15 and 24 years. Because many women hardly show symptoms with STDs, they may not know they need treatment. It's estimated that as many as one in every five women has genital herpes, but most of them are unaware that they have it.

STDs, SYMPTOMS, DIAGNOSIS & TREATMENTS

If a woman has sex (be it oral, anal or vaginal intercourse and genital touching) she can get an STD, also called a sexually transmitted infection (STI). Regardless of marital status or sexual orientation, she is vulnerable to STIs and its symptoms. Thinking or hoping a partner doesn't have an STI is no protection.

Condoms, when properly used, are highly effective for reducing transmission of some STDs. But no method is completely foolproof, and STI symptoms aren't always obvious. If one thinks they have STI symptoms or have been exposed to an STI, see a doctor. Also, people must inform their partner or partners so that they can be evaluated and treated appropriately. Some STIs are easy to treat and cure; others require more-complicated treatment to manage.

If left untreated, STIs can increase the risk of acquiring another STI such as HIV. This happens because an STI can stimulate an immune response in the genital area or cause sores, either of which might raise the risk of HIV transmission. Some untreated STIs can also lead to infertility, organ damage, and certain types of cancer or death.

Asymptomatic STIs

Many STIs have no signs or symptoms (asymptomatic). Even with no symptoms, however, a person can pass the infection to their sex partners. So it is absolutely important to use protection (e.g. a condom, during sex). People should pay regular visits to their doctor for STI screening so as to identify and treat an infection before it can be passed on.

Chlamydia

Symptoms

Chlamydia is a bacterial infection of the genital tract. Chlamydia could be difficult to detect because early-stage infections often cause few or no signs and symptoms. When they do occur, symptoms usually begin one to three weeks after being exposed to chlamydia, they may be mild but will be passed on quickly.

Signs and symptoms may include:

• Vaginal discharge
• Bleeding between periods
• Painful urination
• Lower abdominal pain
• Pain during sexual intercourse

Diagnosis of Chlamydia

Chlamydia can be detected on material collected by wiping the cervix during a traditional examination using a speculum, however, noninvasive screening tests done on urine or on patient-collected vaginal swabs are less expensive and often times more acceptable to patients. While the culturing of the organism can confirm the diagnosis, this method is limited to research laboratories and forensic investigations. For routine diagnostic use, newer and inexpensive diagnostic tests which depends upon the identification and amplification of the genetic material of the organism have replaced the previous time-consuming culture methods.

Treatment of Chlamydia

Treatment of chlamydia usually involves antibiotics. A convenient single-dose therapy for chlamydia is oral Zithromax (azithromycin). Some alternative treatments are often used however, because of the high cost of this medication. The most common of the alternative treatment is doxycycline (Vibramycin, Atridox, among others). Quite unlike gonorrhea, there has been little, if any, resistance at all of chlamydia to current antibiotics. There are many other antibiotics that also have been effective against chlamydia. Just like gonorrhea, a condom or other protective barrier effectively prevents the spread of the infection.

Gonorrhea

Symptoms

Gonorrhea is a bacterial infection of the human genital tract. The bacteria can also grow in other parts of the body like the throat, eyes, mouth and anus. The first gonorrhea symptoms generally appear within 10 days after exposure. However, some women may be infected for months before any signs or symptoms occur.

Signs and symptoms of gonorrhea may include:

• Thick, cloudy or bloody discharge from the vagina
• Heavy menstrual bleeding or bleeding between periods
• Painful bowel movements
• Anal itching

Testing and diagnosis of gonorrhea

Testing for gonorrhea is done by swabbing the infected site (rectum, throat, and cervix), then identifying the bacteria in the laboratory either through the culturing of the material from the swab (growing the bacteria) or identification of the genetic material from the bacteria. Sometimes the tests do not show bacteria because of possible sampling errors or other technical difficulties, even when the woman has an infection. More current tests to diagnose gonorrhea involve the use of DNA probes or amplification to identify the genetic material of the bacteria. These tests are more expensive than cultures but they typically yield more rapid results.

Treatment of gonorrhea

Until recently, the treatment of uncomplicated gonorrhea was quite simple. A single injection of penicillin cured almost every infected person. Unfortunately, there are new strains of gonorrhea that have become resistant to various antibiotics, including penicillin, and are therefore more difficult to treat. Fortunately, gonorrhea can still be treated by other injectable or oral medications.

Uncomplicated gonococcal infections of the cervix, urethra, and rectum, are usually treated by a single injection of ceftriaxone or by oral cefixime. For uncomplicated gonococcal infections of the pharynx, the recommended treatment is ceftriaxone in a single Intra Muscular dose.

Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, and rectum include spectinomycin in non-pregnant women or single doses of other cephalosporins such as ceftizoxime or cefoxitin. Treatment for gonorrhea should always include medication that will treat chlamydia (e.g. Zmax) or doxycycline (Vibramycin among others) as well as the gonorrhea, because gonorrhea and chlamydia frequently co-exists. Sexual partners of women who have had either gonorrhea or chlamydia must receive treatment for both infections because of the high likelihood that their partners may be infected as well. Treating the partners would also prevents the re-infection of the woman. Women suffering from PID or gonococcal arthritis require more aggressive treatment that is effective against the bacteria that cause gonorrhea as well as against the other organisms. These women often require intravenous administration of antibiotics.

It is worthy to note that doxycycline is one of the recommended drugs for treatment of PID, however it is not recommended for use in pregnant women.

Gonorrhea is one of the easier STDs to prevent because the bacterium that causes the infection can only survive under certain conditions. The use of condoms protects against gonorrhea and all other sexually transmitted infections.

Trichomoniasis

Symptoms

Trichomoniasis is a common STI caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who already has the infection.

Though the organism usually infects the urinary tract in men, it often causes no symptoms. Trichomoniasis typically infects the vagina in women. Symptoms of Trichomoniasis if they appear, will be within five to 28 days of exposure and would range from mild irritation to severe inflammation.

Signs and symptoms may include:

• Strong vaginal odor
• Vaginal itching or irritation
• Clear, white, greenish or yellowish vaginal discharge
• Pain during sexual intercourse
• Painful urination

Trichomoniasis Diagnosis

Trichomoniasis can be diagnosed by looking at a sample of vaginal fluid for women under a microscope. If the parasite can be seen under the microscope, no further tests would be needed. If this test isn't conclusive, other tests called rapid antigen tests and nucleic acid amplification may be used.

Trichomoniasis Treatment

The most common treatment for Trichomoniasis, even for pregnant women, is to swallow one mega dose of either Flagyl (metronidazole) or Tindamax (tinidazole). In some cases, the doctor might recommend a lower dose of metronidazole two times a day for seven days. Both partners will need treatment, sexual intercourse will have to be avoided until the infection is cured, which takes about a week.

Alcohol must be avoided for 24 hours after taking metronidazole or 72 hours after taking tinidazole, because alcohol can cause severe nausea and vomiting.

The doctor will most likely want to retest the patient for Trichomoniasis from two weeks to three months after treatment to be sure there has been no re-infection.

Untreated, Trichomoniasis can last for months to years

HUMAN IMMUNO-DEFICIENCY VIRUS (HIV)

Symptoms

HIV is an infection with the human immune-deficiency virus. HIV interferes with the body's ability to fight off viruses, bacteria and fungi that cause illness, and it can lead to AIDS, a chronic, life-threatening disease.

A person may have no symptoms when first infected with HIV. Some people develop a flu-like illness, usually two to six weeks after being infected. Yet, the only way to know if one has HIV is to be tested.

Early signs and symptoms

The early HIV signs and symptoms will usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, the person is highly infectious. More-persistent and/or -severe symptoms of HIV infection may not appear for 10 years or more after the initial infection.

Early-stage HIV symptoms may include:

• Fatigue
• Sore throat
• Fever
• Headache
• Swollen lymph glands
• Rash

As the virus continues to multiply it will destroy immune cells, the individual may develop mild infections or chronic signs and symptoms such as:

Swollen lymph nodes (one of the first signs of HIV infection)

• Cough and shortness of breath
• Diarrhea
• Weight loss
• Fever

Late-stage HIV infection

Signs and symptoms of late-stage HIV infection include:

• Swelling of lymph nodes for more than three months
• Persistent headaches
• Persistent, unexplained fatigue
• Soaking night sweats
• Shaking chills or fever for several weeks
• Chronic diarrhea

There are no specific symptoms or signs that confirm HIV infection, many people will develop a nonspecific illness two to four weeks after they have been infected.

This initial illness may be characterized by fever, vomiting, diarrhea, muscle and joint pains, headache, sore throat, and/or painful lymph nodes. On average, people fall ill for up to two weeks with the initial illness. In rare cases, the initial illness has occurred up to 10 months after infection. It is also possible to become infected with the HIV virus without having recognized the initial illness.

Averagely, it takes 10 years from infection to the development of symptoms related to a decreased functioning of the immune system (immunosuppression).

More serious complications include unusual infections or even cancers, weight loss, intellectual deterioration (dementia), and ultimately death.

When the symptoms of HIV become severe, the disease is referred to as the acquired immunodeficiency syndrome (AIDS). Numerous treatment options that are now available for HIV-infected individuals, allow patients to control the infection and delay the progression of the disease to AIDS

UNUSUAL, OPPORTUNISTIC INFECTIONS

Genital herpes symptoms

Genital herpes is a highly contagious STI caused by a type of the herpes simplex virus (HSV) that enters the body through small breaks in the skin or mucous membranes. Most people with HSV never know they have it, because they have no signs or symptoms or the signs and symptoms are so mild they go unnoticed.

When the signs and symptoms become noticeable, the first episode is generally the worst. Some people never have a second episode. Others, however, can have recurrent episodes for decades.

If present, genital herpes signs and symptoms may include:

Small red bumps, blisters (vesicles) or open sores (ulcers) in the genital and anal areas and areas nearby.

Pain or itching around the genital area, buttocks and inner thighs

Ulcers can make urination painful. One may also have pain and tenderness in the genital area until the infection clears. During an initial episode, a person may have flu-like signs and symptoms, such as a headache, muscle aches and fever, as well as swollen lymph nodes in the groin.

In some cases, the infection can be active and contagious even when sores aren't present.

Human papillomavirus (HPV) infection and genital warts

Symptoms

HPV infection is one of the most common types of STIs. Some forms of HPV put women at high risk of cervical cancer. Other forms cause genital warts. HPV normally has no signs or symptoms.

The signs and symptoms of genital warts will include:

• Bleeding with intercourse
• Small, flesh-colored or gray swellings in the genital area
• Several warts close together that take on a cauliflower shape
• Itching or discomfort in the genital area

Diagnosis of HPV and genital warts

The doctor might be able to diagnose HPV infection by looking at the warts. If genital warts aren't visible, one or more of the following tests will be needed:

Vinegar (acetic acid) solution test. A vinegar solution applied to HPV-infected genital areas turns them white. This may help in identifying difficult-to-see flat lesions.

Pap test. The doctor will collect a sample of cells from the cervix or vagina to send for laboratory analysis. Pap tests can reveal abnormalities that can lead to cancer.

DNA test. This test, conducted on cells from the cervix, can recognize the DNA of the high-risk varieties of HPV that have been linked to genital cancers. It's recommended for women 30 and older in addition to the Pap test.

A typical appearance of a genital lesion may prompt the physician to treat without further testing, especially in someone who has had prior outbreaks of genital warts. Genital warts usually appear as small, fleshy, raised bumps, but they can sometimes be extensive and have a cauliflower-like appearance. They may occur on any sexually-exposed area. In many cases genital warts do not cause any symptoms, but they are sometimes

How is HPV treated?

Treatment of external genital warts

There is no cure or treatment that can eradicate HPV infection, so the only treatment is to remove the lesions caused by the virus. Unfortunately, even the removal of the warts does not necessarily prevent the spread of the virus, and genital warts frequently recur. None of the available treatments are ideal or clearly superior to others.

Often, however, genital warts do not cause any symptoms. Genital warts may be as small as 1 millimeter in diameter or may multiply into large clusters. Warts can also develop in the mouth or throat of a person who has had oral sex with an infected person.

Hepatitis

Symptoms

Hepatitis A, hepatitis B and hepatitis C are all contagious viral infections that affect the liver. Hepatitis B and C are the most serious of the three, but each can cause the liver to become inflamed.

Some people never develop signs or symptoms. But for those who do, signs and symptoms may occur several weeks after exposure and may include:

• Dark urine
• Itching
• Loss of appetite
• Muscle or joint pain
• Fatigue
• Nausea and vomiting
• Abdominal pain or discomfort, especially in the area of the liver on the right side beneath the lower ribs
• Fever
• Jaundice, (characterized by yellowing of the skin and the white of the eyes)

Hepatitis Diagnosis

If one has symptoms or signs of viral hepatitis, a doctor can perform a blood test to check for the presence of an antibody. If a person has hepatitis B or C, more blood samples may be necessary at a later date, even if the symptoms vanish. This will be to check for complications and determine if there is a progression from acute to chronic disease. Viral hepatitis is often referred to as a silent disease because most people have vague or no symptoms at all.

The doctor may also require a liver biopsy, or tissue sample, in order to determine the extent of the damage. A biopsy is commonly performed by inserting a needle into the liver and drawing out a fragment of tissue, which is then sent to a lab to be analyzed.

Treatments for Hepatitis

The treatment for viral hepatitis depends on the type and stage of the infection. In the recent past, excellent treatments for both hepatitis B and C have become available. While more and improved treatments are being evaluated all the time.

The doctor should also be able to provide adequate care of the hepatitis. However, if the infection is severe, treatment by a hepatologist or gastroenterologist (specialists in diseases of the liver) may be required. Hospitalization is normally unnecessary unless the patient has problems with eating or drinking, or is vomiting.

Hepatitis A usually requires minimal treatment and the liver usually heals within 2 months. The patient must ensure to stay hydrated and well-nourished. Meanwhile, a vaccination can prevent one from getting hepatitis A, and once a person has had it, she/he cannot be re-infected.

Syphilis

Symptoms

Syphilis is a bacterial infection that affects the genitals, skin and mucous membranes, but it can also involve many other parts of the body, including the brain and heart.

The signs and symptoms of syphilis may occur in three stages (primary, secondary, and tertiary). Some people also experience latent syphilis, in which blood tests are positive for the bacteria but no symptoms are present.

At first, only a small, painless sore (chancre) may be present at the site of infection, usually the genitals, rectum, tongue or lips. As the disease worsens, symptoms may include:

• Rash marked by red or reddish-brown, penny-sized sores over any area of the body, including palms and soles
• Fever
• Enlarged lymph nodes
• Fatigue and a vague feeling of discomfort
• Soreness and aching

Without treatment, the syphilis bacteria may spread, leading to serious internal organ damage and possible death years after the original infection.

Some of the signs and symptoms of late-stage syphilis include:

• Dementia
• Paralysis
• Lack of coordination
• Numbness
• Blindness

There's also a condition known as congenital syphilis. This occurs when a pregnant woman with syphilis passes the disease to her unborn infant. Congenital syphilis can be disabling, even life-threatening, it is therefore important for pregnant women with syphilis to be treated.

Diagnosis of syphilis

Syphilis can be diagnosed by scraping the base of the ulcer and looking under a dark field microscope (special type of microscope) for the spirochetes. However, because these spirochetes are rarely detected, the diagnosis is most often made and treatment is prescribed based upon the appearance of the chancre. Diagnosis of syphilis is complicated by the fact that the causative organism cannot be grown in the laboratory. Therefore, cultures of affected areas cannot be used for diagnosis.

Some special blood tests can also be used to diagnose syphilis. The standardized screening blood tests for syphilis are called the Venereal Disease Research Laboratory (VDRL) and Rapid Plasminogen Reagent (RPR) tests. These two tests detect not the actual Treponema organism that causes the infection but the body's response to the infection. They are thus referred to as non-Treponemal tests. Although the non-Treponemal tests are very effective in detecting evidence of infection, they can also produce a positive result when no infection is actually present (so-called false-positive results for syphilis). Consequently, any positive non-Treponemal test must be confirmed by a Treponemal test specific for the organism that causes syphilis. These Treponemal tests directly detect the body's response to Treponema pallidum.

Treatment of syphilis

Depending on the stage of disease and the clinical manifestations, the treatment options for syphilis vary. Long-acting penicillin injections have been very effective in treating both early and late stage syphilis. The treatment of neurosyphilis for example requires the intravenous administration of penicillin. Alternative treatments include oral doxycycline or tetracycline.

Women who are infected during pregnancy can pass on the infection to the fetus through the placenta. Penicillin must be used in pregnant patients with syphilis since other antibiotics do not effectively cross the placenta to treat the infected fetus. If left untreated, syphilis in a pregnant woman can lead to blindness or even death of the infant.

Pubic lice and scabies (Ectoparasitic Infections)

These are infections that are caused by tiny parasitic bugs, such as lice or mites. They are transmitted by close physical contact, including sexual contact. The parasites affect the skin or hair and cause itching.

Pubic lice (pediculosis pubis)

Pediculosis pubis is an infection of the genital area caused by the crab louse (Phthirus pubis). The lice which are commonly called crabs are small bugs that are visible to the naked eye without the aid of a magnifying glass or microscope. The lice live on pubic hair or any other hair and cause itching.

TREATMENT

The treatment for pubic lice is usually with a permethrin cream rinse that is applied to the affected area and washed off after 10 minutes. Other treatments include pyrethrins with piperonyl butoxide also applied for 10 minutes before washing off. Because of their irritating properties, none of these treatments should be used anywhere near the eyes. The patient's bedding and clothing should be thoroughly washed with hot water. All sexual partners within the preceding month should be treated for pubic lice and evaluated for other STDs.

Scabies

Scabies is an ectoparasitic infection caused by a mite that is referred to and called Sarcoptes scabiei. It is not visible to the naked eye but can be seen with a magnifying glass or microscope. The parasite lives on the skin and cause itching over the hands, arms, trunk, legs, and buttocks. The itching usually begins several weeks after exposure to a person with scabies and is often associated with small bumps over the area of itching. The itching from scabies is usually worse at night.

TREATMENT

The standard treatment for scabies is a permethrin cream of 5% concentration. This is applied to the entire body from the neck down and then washed off after approximately 14 hours. The treatment is repeated after a week. The alternative is Ivermectin, which is a drug taken orally, and which has also been successfully used to treat scabies. Experts recommend that this drug is taken at a dosage of 200 micrograms per kilogram body weight as a single dose, followed by a repeat dose two weeks later. Patients might find that taking a drug by mouth is more convenient than application of the cream, however, Ivermectin has a greater risk of toxic side effects than permethrin and yet has not been proven to be superior to permethrin in eradicating scabies.

Another alternative treatment is a cream or lotion of lindane with 1% concentration, applied from the neck down and washed off after about eight hours. Unfortunately, itching may persist for up to two months after successful therapy. Lindane is known to cause seizures when it is absorbed through the skin, therefore it should not be used if skin is significantly irritated or wet, such as with a rash, or after a bath. As an additional precaution, lindane should not be used in pregnant or nursing women or children younger than 2 years old.

Just like pubic lice infection, both the bedding and clothing of an infected individual should be thoroughly washed in hot water. Again, all sexual and close personal and household contacts within the month before the infection should be examined and treated if infection is found

How STDs Impact Women Differently from Men

• Compared to a man, a woman's anatomy can place her at a unique risk for STD infections. The lining of the vagina is thinner and more delicate than the skin on a penis therefore it's easier for bacteria and viruses to penetrate, making the vagina a good environment (moist) for bacteria to grow.
• Compared to men, women are less likely to have symptoms of common STDs such as chlamydia and gonorrhea. Even if symptoms do occur, they can go away whilst the infection may remain.
• Women are more likely to confuse symptoms of an STD for something else. Women often have normal discharges or may think that burning/itching is related to a yeast infection. Men usually notice symptoms like discharge because discharges in men is unusual.
• Women may not see symptoms as easily as men do. Genital ulcers from herpes or syphilis can occur in the vagina but may not be easily visible. Men may be more likely to notice sores on their penis.
• STDs can lead to serious health complications and affect a woman's future reproductive plans. Untreated STDs can lead to pelvic inflammatory disease, which can result in infertility and ectopic pregnancies. Chlamydia, arguably one of the most common STDs results in very few complications in men.
• Women who are pregnant can pass STDs to their babies. Genital herpes, syphilis and HIV can be passed to babies during pregnancy. The harmful effects of STDs in babies may include babies born dead (stillbirth), low birth weight, brain damage, blindness and deafness. Human papillomavirus (HPV) is the most common sexually transmitted infection in women, it also is the main cause of cervical cancer. While HPV is also very common in men, most do not develop any serious health problems.

The Good News

• Women typically see their doctor more often than men do. Women should use the time with their doctor as an opportunity to ask for STD testing, and not assume STD testing as a part of their annual examination. While the Pap test for example screens for cervical cancer, it is not a good test for other types of cancer or STDs.
• There is a vaccine to prevent HPV; and other treatments are available for other STDs to prevent serious health consequences, such as infertility, if diagnosed and treated early.

Prevention

People should take certain preventive measures to avoid getting or transmitting STDs.

• Communicate

Honest communication with both the doctor and sexual partner about sexual history is essential.

• Get tested regularly

Women must ensure to get a Pap smear every three to five years. It's also important to ask to be tested for any other STDs and whether the HPV vaccination is suggested. Women should talk to their doctors about STD testing if they are sexually active.

• Use protection

Whether it's for vaginal, anal, or oral sex, a condom can help protect both partners. Female condoms and dental dams can provide a certain level of protection. Opinions are still divided as to their effectiveness compared to the male condom in preventing transmission of STDs. Spermicides, the birth control pill, and other forms of contraception may protect against pregnancy, but they don't protect against STDs.

STDs and pregnancy

Women can get STDs while pregnant. Because many infections don't show symptoms, some women don't realize they're infected. For this reason, doctors may run a full STD panel at the beginning of a pregnancy.

STD infections can be life-threatening to a woman and her baby. STDs can be passed on to an unborn embryo or fetus during pregnancy or birth, so early treatment is essential. All bacterial STDs can be treated safely with antibiotics during pregnancy. Viral infections can be treated with antivirals to prevent the likelihood of passing the infection to a child.

STDs IN FEMALES

Sexually transmitted diseases (STDs) are sometimes known as sexually transmitted infections. They're passed through vaginal, anal, or oral sexual contact. A female's symptoms of an STD can include:

• Vaginal itching
• Rashes
• Unusual discharge
• Pain

Many STDs presents no symptoms at all. If left untreated, STDs can lead to fertility problems and increase the risk of cervical cancer. These risks make it even more important to practice safe sex.

According to medical researchers, more than half of new chlamydia and gonorrhea cases occur in women between the ages of 15 and 24 years. Because many women hardly show symptoms with STDs, they may not know they need treatment. It's estimated that as many as one in every five women has genital herpes, but most of them are unaware that they have it.

STDs, SYMPTOMS, DIAGNOSIS & TREATMENTS

If a woman has sex (be it oral, anal or vaginal intercourse and genital touching) she can get an STD, also called a sexually transmitted infection (STI). Regardless of marital status or sexual orientation, she is vulnerable to STIs and its symptoms. Thinking or hoping a partner doesn't have an STI is no protection.

Condoms, when properly used, are highly effective for reducing transmission of some STDs. But no method is completely foolproof, and STI symptoms aren't always obvious. If one thinks they have STI symptoms or have been exposed to an STI, see a doctor. Also, people must inform their partner or partners so that they can be evaluated and treated appropriately. Some STIs are easy to treat and cure; others require more-complicated treatment to manage.

If left untreated, STIs can increase the risk of acquiring another STI such as HIV. This happens because an STI can stimulate an immune response in the genital area or cause sores, either of which might raise the risk of HIV transmission. Some untreated STIs can also lead to infertility, organ damage, and certain types of cancer or death.

Asymptomatic STIs

Many STIs have no signs or symptoms (asymptomatic). Even with no symptoms, however, a person can pass the infection to their sex partners. So it is absolutely important to use protection (e.g. a condom, during sex). People should pay regular visits to their doctor for STI screening so as to identify and treat an infection before it can be passed on.

Chlamydia

Symptoms

Chlamydia is a bacterial infection of the genital tract. Chlamydia could be difficult to detect because early-stage infections often cause few or no signs and symptoms. When they do occur, symptoms usually begin one to three weeks after being exposed to chlamydia, they may be mild but will be passed on quickly.

Signs and symptoms may include:

• Vaginal discharge
• Bleeding between periods
• Painful urination
• Lower abdominal pain
• Pain during sexual intercourse

Diagnosis of Chlamydia

Chlamydia can be detected on material collected by wiping the cervix during a traditional examination using a speculum, however, noninvasive screening tests done on urine or on patient-collected vaginal swabs are less expensive and often times more acceptable to patients. While the culturing of the organism can confirm the diagnosis, this method is limited to research laboratories and forensic investigations. For routine diagnostic use, newer and inexpensive diagnostic tests which depends upon the identification and amplification of the genetic material of the organism have replaced the previous time-consuming culture methods.

Treatment of Chlamydia

Treatment of chlamydia usually involves antibiotics. A convenient single-dose therapy for chlamydia is oral Zithromax (azithromycin). Some alternative treatments are often used however, because of the high cost of this medication. The most common of the alternative treatment is doxycycline (Vibramycin, Atridox, among others). Quite unlike gonorrhea, there has been little, if any, resistance at all of chlamydia to current antibiotics. There are many other antibiotics that also have been effective against chlamydia. Just like gonorrhea, a condom or other protective barrier effectively prevents the spread of the infection.

Gonorrhea

Symptoms

Gonorrhea is a bacterial infection of the human genital tract. The bacteria can also grow in other parts of the body like the throat, eyes, mouth and anus. The first gonorrhea symptoms generally appear within 10 days after exposure. However, some women may be infected for months before any signs or symptoms occur.

Signs and symptoms of gonorrhea may include:

• Thick, cloudy or bloody discharge from the vagina
• Heavy menstrual bleeding or bleeding between periods
• Painful bowel movements
• Anal itching

Testing and diagnosis of gonorrhea

Testing for gonorrhea is done by swabbing the infected site (rectum, throat, and cervix), then identifying the bacteria in the laboratory either through the culturing of the material from the swab (growing the bacteria) or identification of the genetic material from the bacteria. Sometimes the tests do not show bacteria because of possible sampling errors or other technical difficulties, even when the woman has an infection. More current tests to diagnose gonorrhea involve the use of DNA probes or amplification to identify the genetic material of the bacteria. These tests are more expensive than cultures but they typically yield more rapid results.

Treatment of gonorrhea

Until recently, the treatment of uncomplicated gonorrhea was quite simple. A single injection of penicillin cured almost every infected person. Unfortunately, there are new strains of gonorrhea that have become resistant to various antibiotics, including penicillin, and are therefore more difficult to treat. Fortunately, gonorrhea can still be treated by other injectable or oral medications.

Uncomplicated gonococcal infections of the cervix, urethra, and rectum, are usually treated by a single injection of ceftriaxone or by oral cefixime. For uncomplicated gonococcal infections of the pharynx, the recommended treatment is ceftriaxone in a single Intra Muscular dose.

Alternative regimens for uncomplicated gonococcal infections of the cervix, urethra, and rectum include spectinomycin in non-pregnant women or single doses of other cephalosporins such as ceftizoxime or cefoxitin. Treatment for gonorrhea should always include medication that will treat chlamydia (e.g. Zmax) or doxycycline (Vibramycin among others) as well as the gonorrhea, because gonorrhea and chlamydia frequently co-exists. Sexual partners of women who have had either gonorrhea or chlamydia must receive treatment for both infections because of the high likelihood that their partners may be infected as well. Treating the partners would also prevents the re-infection of the woman. Women suffering from PID or gonococcal arthritis require more aggressive treatment that is effective against the bacteria that cause gonorrhea as well as against the other organisms. These women often require intravenous administration of antibiotics.

It is worthy to note that doxycycline is one of the recommended drugs for treatment of PID, however it is not recommended for use in pregnant women.

Gonorrhea is one of the easier STDs to prevent because the bacterium that causes the infection can only survive under certain conditions. The use of condoms protects against gonorrhea and all other sexually transmitted infections.

Trichomoniasis

Symptoms

Trichomoniasis is a common STI caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who already has the infection.

Though the organism usually infects the urinary tract in men, it often causes no symptoms. Trichomoniasis typically infects the vagina in women. Symptoms of Trichomoniasis if they appear, will be within five to 28 days of exposure and would range from mild irritation to severe inflammation.

Signs and symptoms may include:

• Strong vaginal odor
• Vaginal itching or irritation
• Clear, white, greenish or yellowish vaginal discharge
• Pain during sexual intercourse
• Painful urination

Trichomoniasis Diagnosis

Trichomoniasis can be diagnosed by looking at a sample of vaginal fluid for women under a microscope. If the parasite can be seen under the microscope, no further tests would be needed. If this test isn't conclusive, other tests called rapid antigen tests and nucleic acid amplification may be used.

Trichomoniasis Treatment

The most common treatment for Trichomoniasis, even for pregnant women, is to swallow one mega dose of either Flagyl (metronidazole) or Tindamax (tinidazole). In some cases, the doctor might recommend a lower dose of metronidazole two times a day for seven days. Both partners will need treatment, sexual intercourse will have to be avoided until the infection is cured, which takes about a week.

Alcohol must be avoided for 24 hours after taking metronidazole or 72 hours after taking tinidazole, because alcohol can cause severe nausea and vomiting.

The doctor will most likely want to retest the patient for Trichomoniasis from two weeks to three months after treatment to be sure there has been no re-infection.

Untreated, Trichomoniasis can last for months to years

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HUMAN IMMUNO-DEFICIENCY VIRUS (HIV)

Symptoms

HIV is an infection with the human immune-deficiency virus. HIV interferes with the body's ability to fight off viruses, bacteria and fungi that cause illness, and it can lead to AIDS, a chronic, life-threatening disease.

A person may have no symptoms when first infected with HIV. Some people develop a flu-like illness, usually two to six weeks after being infected. Yet, the only way to know if one has HIV is to be tested.

Early signs and symptoms

The early HIV signs and symptoms will usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, the person is highly infectious. More-persistent and/or -severe symptoms of HIV infection may not appear for 10 years or more after the initial infection.

Early-stage HIV symptoms may include:

• Fatigue
• Sore throat
• Fever
• Headache
• Swollen lymph glands
• Rash

As the virus continues to multiply it will destroy immune cells, the individual may develop mild infections or chronic signs and symptoms such as:

Swollen lymph nodes (one of the first signs of HIV infection)

• Cough and shortness of breath
• Diarrhea
• Weight loss
• Fever

Late-stage HIV infection

Signs and symptoms of late-stage HIV infection include:

• Swelling of lymph nodes for more than three months
• Persistent headaches
• Persistent, unexplained fatigue
• Soaking night sweats
• Shaking chills or fever for several weeks
• Chronic diarrhea

There are no specific symptoms or signs that confirm HIV infection, many people will develop a nonspecific illness two to four weeks after they have been infected.

This initial illness may be characterized by fever, vomiting, diarrhea, muscle and joint pains, headache, sore throat, and/or painful lymph nodes. On average, people fall ill for up to two weeks with the initial illness. In rare cases, the initial illness has occurred up to 10 months after infection. It is also possible to become infected with the HIV virus without having recognized the initial illness.

Averagely, it takes 10 years from infection to the development of symptoms related to a decreased functioning of the immune system (immunosuppression).

More serious complications include unusual infections or even cancers, weight loss, intellectual deterioration (dementia), and ultimately death.

When the symptoms of HIV become severe, the disease is referred to as the acquired immunodeficiency syndrome (AIDS). Numerous treatment options that are now available for HIV-infected individuals, allow patients to control the infection and delay the progression of the disease to AIDS

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UNUSUAL, OPPORTUNISTIC INFECTIONS

Genital herpes symptoms

Genital herpes is a highly contagious STI caused by a type of the herpes simplex virus (HSV) that enters the body through small breaks in the skin or mucous membranes. Most people with HSV never know they have it, because they have no signs or symptoms or the signs and symptoms are so mild they go unnoticed.

When the signs and symptoms become noticeable, the first episode is generally the worst. Some people never have a second episode. Others, however, can have recurrent episodes for decades.

If present, genital herpes signs and symptoms may include:

Small red bumps, blisters (vesicles) or open sores (ulcers) in the genital and anal areas and areas nearby.

Pain or itching around the genital area, buttocks and inner thighs

Ulcers can make urination painful. One may also have pain and tenderness in the genital area until the infection clears. During an initial episode, a person may have flu-like signs and symptoms, such as a headache, muscle aches and fever, as well as swollen lymph nodes in the groin.

In some cases, the infection can be active and contagious even when sores aren't present.

Human papillomavirus (HPV) infection and genital warts

Symptoms

HPV infection is one of the most common types of STIs. Some forms of HPV put women at high risk of cervical cancer. Other forms cause genital warts. HPV normally has no signs or symptoms.

The signs and symptoms of genital warts will include:

• Bleeding with intercourse
• Small, flesh-colored or gray swellings in the genital area
• Several warts close together that take on a cauliflower shape
• Itching or discomfort in the genital area

Diagnosis of HPV and genital warts

The doctor might be able to diagnose HPV infection by looking at the warts. If genital warts aren't visible, one or more of the following tests will be needed:

Vinegar (acetic acid) solution test. A vinegar solution applied to HPV-infected genital areas turns them white. This may help in identifying difficult-to-see flat lesions.

Pap test. The doctor will collect a sample of cells from the cervix or vagina to send for laboratory analysis. Pap tests can reveal abnormalities that can lead to cancer.

DNA test. This test, conducted on cells from the cervix, can recognize the DNA of the high-risk varieties of HPV that have been linked to genital cancers. It's recommended for women 30 and older in addition to the Pap test.

A typical appearance of a genital lesion may prompt the physician to treat without further testing, especially in someone who has had prior outbreaks of genital warts. Genital warts usually appear as small, fleshy, raised bumps, but they can sometimes be extensive and have a cauliflower-like appearance. They may occur on any sexually-exposed area. In many cases genital warts do not cause any symptoms, but they are sometimes

How is HPV treated?

Treatment of external genital warts

There is no cure or treatment that can eradicate HPV infection, so the only treatment is to remove the lesions caused by the virus. Unfortunately, even the removal of the warts does not necessarily prevent the spread of the virus, and genital warts frequently recur. None of the available treatments are ideal or clearly superior to others.

Often, however, genital warts do not cause any symptoms. Genital warts may be as small as 1 millimeter in diameter or may multiply into large clusters. Warts can also develop in the mouth or throat of a person who has had oral sex with an infected person.

Hepatitis

Symptoms

Hepatitis A, hepatitis B and hepatitis C are all contagious viral infections that affect the liver. Hepatitis B and C are the most serious of the three, but each can cause the liver to become inflamed.

Some people never develop signs or symptoms. But for those who do, signs and symptoms may occur several weeks after exposure and may include:

• Dark urine
• Itching
• Loss of appetite
• Muscle or joint pain
• Fatigue
• Nausea and vomiting
• Abdominal pain or discomfort, especially in the area of the liver on the right side beneath the lower ribs
• Fever
• Jaundice, (characterized by yellowing of the skin and the white of the eyes)

Hepatitis Diagnosis

If one has symptoms or signs of viral hepatitis, a doctor can perform a blood test to check for the presence of an antibody. If a person has hepatitis B or C, more blood samples may be necessary at a later date, even if the symptoms vanish. This will be to check for complications and determine if there is a progression from acute to chronic disease. Viral hepatitis is often referred to as a silent disease because most people have vague or no symptoms at all.

The doctor may also require a liver biopsy, or tissue sample, in order to determine the extent of the damage. A biopsy is commonly performed by inserting a needle into the liver and drawing out a fragment of tissue, which is then sent to a lab to be analyzed.

Treatments for Hepatitis

The treatment for viral hepatitis depends on the type and stage of the infection. In the recent past, excellent treatments for both hepatitis B and C have become available. While more and improved treatments are being evaluated all the time.

The doctor should also be able to provide adequate care of the hepatitis. However, if the infection is severe, treatment by a hepatologist or gastroenterologist (specialists in diseases of the liver) may be required. Hospitalization is normally unnecessary unless the patient has problems with eating or drinking, or is vomiting.

Hepatitis A usually requires minimal treatment and the liver usually heals within 2 months. The patient must ensure to stay hydrated and well-nourished. Meanwhile, a vaccination can prevent one from getting hepatitis A, and once a person has had it, she/he cannot be re-infected.

Syphilis

Symptoms

Syphilis is a bacterial infection that affects the genitals, skin and mucous membranes, but it can also involve many other parts of the body, including the brain and heart.

The signs and symptoms of syphilis may occur in three stages (primary, secondary, and tertiary). Some people also experience latent syphilis, in which blood tests are positive for the bacteria but no symptoms are present.

At first, only a small, painless sore (chancre) may be present at the site of infection, usually the genitals, rectum, tongue or lips. As the disease worsens, symptoms may include:

• Rash marked by red or reddish-brown, penny-sized sores over any area of the body, including palms and soles
• Fever
• Enlarged lymph nodes
• Fatigue and a vague feeling of discomfort
• Soreness and aching

Without treatment, the syphilis bacteria may spread, leading to serious internal organ damage and possible death years after the original infection.

Some of the signs and symptoms of late-stage syphilis include:

• Dementia
• Paralysis
• Lack of coordination
• Numbness
• Blindness

There's also a condition known as congenital syphilis. This occurs when a pregnant woman with syphilis passes the disease to her unborn infant. Congenital syphilis can be disabling, even life-threatening, it is therefore important for pregnant women with syphilis to be treated.

Diagnosis of syphilis

Syphilis can be diagnosed by scraping the base of the ulcer and looking under a dark field microscope (special type of microscope) for the spirochetes. However, because these spirochetes are rarely detected, the diagnosis is most often made and treatment is prescribed based upon the appearance of the chancre. Diagnosis of syphilis is complicated by the fact that the causative organism cannot be grown in the laboratory. Therefore, cultures of affected areas cannot be used for diagnosis.

Some special blood tests can also be used to diagnose syphilis. The standardized screening blood tests for syphilis are called the Venereal Disease Research Laboratory (VDRL) and Rapid Plasminogen Reagent (RPR) tests. These two tests detect not the actual Treponema organism that causes the infection but the body's response to the infection. They are thus referred to as non-Treponemal tests. Although the non-Treponemal tests are very effective in detecting evidence of infection, they can also produce a positive result when no infection is actually present (so-called false-positive results for syphilis). Consequently, any positive non-Treponemal test must be confirmed by a Treponemal test specific for the organism that causes syphilis. These Treponemal tests directly detect the body's response to Treponema pallidum.

Treatment of syphilis

Depending on the stage of disease and the clinical manifestations, the treatment options for syphilis vary. Long-acting penicillin injections have been very effective in treating both early and late stage syphilis. The treatment of neurosyphilis for example requires the intravenous administration of penicillin. Alternative treatments include oral doxycycline or tetracycline.

Women who are infected during pregnancy can pass on the infection to the fetus through the placenta. Penicillin must be used in pregnant patients with syphilis since other antibiotics do not effectively cross the placenta to treat the infected fetus. If left untreated, syphilis in a pregnant woman can lead to blindness or even death of the infant.

Pubic lice and scabies (Ectoparasitic Infections)

These are infections that are caused by tiny parasitic bugs, such as lice or mites. They are transmitted by close physical contact, including sexual contact. The parasites affect the skin or hair and cause itching.

Pubic lice (pediculosis pubis)

Pediculosis pubis is an infection of the genital area caused by the crab louse (Phthirus pubis). The lice which are commonly called crabs are small bugs that are visible to the naked eye without the aid of a magnifying glass or microscope. The lice live on pubic hair or any other hair and cause itching.

TREATMENT

The treatment for pubic lice is usually with a permethrin cream rinse that is applied to the affected area and washed off after 10 minutes. Other treatments include pyrethrins with piperonyl butoxide also applied for 10 minutes before washing off. Because of their irritating properties, none of these treatments should be used anywhere near the eyes. The patient's bedding and clothing should be thoroughly washed with hot water. All sexual partners within the preceding month should be treated for pubic lice and evaluated for other STDs.

Scabies

Scabies is an ectoparasitic infection caused by a mite that is referred to and called Sarcoptes scabiei. It is not visible to the naked eye but can be seen with a magnifying glass or microscope. The parasite lives on the skin and cause itching over the hands, arms, trunk, legs, and buttocks. The itching usually begins several weeks after exposure to a person with scabies and is often associated with small bumps over the area of itching. The itching from scabies is usually worse at night.

TREATMENT

The standard treatment for scabies is a permethrin cream of 5% concentration. This is applied to the entire body from the neck down and then washed off after approximately 14 hours. The treatment is repeated after a week. The alternative is Ivermectin, which is a drug taken orally, and which has also been successfully used to treat scabies. Experts recommend that this drug is taken at a dosage of 200 micrograms per kilogram body weight as a single dose, followed by a repeat dose two weeks later. Patients might find that taking a drug by mouth is more convenient than application of the cream, however, Ivermectin has a greater risk of toxic side effects than permethrin and yet has not been proven to be superior to permethrin in eradicating scabies.

Another alternative treatment is a cream or lotion of lindane with 1% concentration, applied from the neck down and washed off after about eight hours. Unfortunately, itching may persist for up to two months after successful therapy. Lindane is known to cause seizures when it is absorbed through the skin, therefore it should not be used if skin is significantly irritated or wet, such as with a rash, or after a bath. As an additional precaution, lindane should not be used in pregnant or nursing women or children younger than 2 years old.

Just like pubic lice infection, both the bedding and clothing of an infected individual should be thoroughly washed in hot water. Again, all sexual and close personal and household contacts within the month before the infection should be examined and treated if infection is found

How STDs Impact Women Differently from Men

• Compared to a man, a woman's anatomy can place her at a unique risk for STD infections. The lining of the vagina is thinner and more delicate than the skin on a penis therefore it's easier for bacteria and viruses to penetrate, making the vagina a good environment (moist) for bacteria to grow.
• Compared to men, women are less likely to have symptoms of common STDs such as chlamydia and gonorrhea. Even if symptoms do occur, they can go away whilst the infection may remain.
• Women are more likely to confuse symptoms of an STD for something else. Women often have normal discharges or may think that burning/itching is related to a yeast infection. Men usually notice symptoms like discharge because discharges in men is unusual.
• Women may not see symptoms as easily as men do. Genital ulcers from herpes or syphilis can occur in the vagina but may not be easily visible. Men may be more likely to notice sores on their penis.
• STDs can lead to serious health complications and affect a woman's future reproductive plans. Untreated STDs can lead to pelvic inflammatory disease, which can result in infertility and ectopic pregnancies. Chlamydia, arguably one of the most common STDs results in very few complications in men.
• Women who are pregnant can pass STDs to their babies. Genital herpes, syphilis and HIV can be passed to babies during pregnancy. The harmful effects of STDs in babies may include babies born dead (stillbirth), low birth weight, brain damage, blindness and deafness. Human papillomavirus (HPV) is the most common sexually transmitted infection in women, it also is the main cause of cervical cancer. While HPV is also very common in men, most do not develop any serious health problems.

The Good News

• Women typically see their doctor more often than men do. Women should use the time with their doctor as an opportunity to ask for STD testing, and not assume STD testing as a part of their annual examination. While the Pap test for example screens for cervical cancer, it is not a good test for other types of cancer or STDs.
• There is a vaccine to prevent HPV; and other treatments are available for other STDs to prevent serious health consequences, such as infertility, if diagnosed and treated early.

Prevention

People should take certain preventive measures to avoid getting or transmitting STDs.

• Communicate

Honest communication with both the doctor and sexual partner about sexual history is essential.

• Get tested regularly

Women must ensure to get a Pap smear every three to five years. It's also important to ask to be tested for any other STDs and whether the HPV vaccination is suggested. Women should talk to their doctors about STD testing if they are sexually active.

• Use protection

Whether it's for vaginal, anal, or oral sex, a condom can help protect both partners. Female condoms and dental dams can provide a certain level of protection. Opinions are still divided as to their effectiveness compared to the male condom in preventing transmission of STDs. Spermicides, the birth control pill, and other forms of contraception may protect against pregnancy, but they don't protect against STDs.

STDs and pregnancy

Women can get STDs while pregnant. Because many infections don't show symptoms, some women don't realize they're infected. For this reason, doctors may run a full STD panel at the beginning of a pregnancy.

STD infections can be life-threatening to a woman and her baby. STDs can be passed on to an unborn embryo or fetus during pregnancy or birth, so early treatment is essential. All bacterial STDs can be treated safely with antibiotics during pregnancy. Viral infections can be treated with antivirals to prevent the likelihood of passing the infection to a child.