ABDULAZEEZ ROHEEMAH BOLUWATIFE

FACULTY OF APPLIED SCIENCES

MEDICAL LABORATORY SCIENCE

LCU/UG/22/23134

100 LEVEL

HEE 117

SEXUALLY TRANMITTED DISEASES

 INTRODUCTION
More than 30 different bacteria, viruses and parasites are known to be transmitted
through sexual contact, including vaginal, anal and oral sex. Some STIs can also be
transmitted from mother-to-child during pregnancy, childbirth and breastfeeding.
Eight pathogens are linked to the greatest incidence of STIs. Of these, 4 are
currently curable: syphilis, gonorrhea, chlamydia and trichomoniasis. The other 4
are incurable viral infections: hepatitis B, herpes simplex virus (HSV), HIV and
human papillomavirus (HPV).
In addition, emerging outbreaks of new infections that can be acquired by sexual
contact such as monkeypox, Shigella sonnei, Neisseria meningitidis, Ebola and
Zika, as well as re-emergence of neglected STIs such as lymphogranuloma
venereum. These herald increasing challenges in the provision of adequate services
for STIs prevention and control.
A sexually transmitted infection (sexually transmitted disease) is a serious condition
that can develop after you have sex. Common STI symptoms include itching and
burning around your genital area. The good news is that most STI treatments can
cure the infection, but not all types. You can get an STI again, even after treatment
to cure it. Symptoms and Causes Diagnosis and Tests Management and Treatment
Prevention Outlook/Prognosis Living With

OVERVIEW
What is a sexually transmitted infection (sexually transmitted disease)?
Sexually transmitted infections (STI) are infections or conditions that you can get
from any kind of sexual activity involving your mouth, anus, vagina or penis.
Another common name for STIs is sexually transmitted diseases, or STDs. There
are several types of STIs. The most common symptoms are burning, itching or
discharge in your genital area. Some STIs are asymptomatic, meaning you may not
have any symptoms.
Sexually transmitted infections are highly contagious. If you’re sexually active, you
can have (and pass on) an STI without even knowing it. The Centers for Disease
Control and Prevention (CDC) recommends regular STI screenings or testing if
you’re sexually active. STIs are serious illnesses that need treatment. Some, like the
human immunodeficiency virus (HIV), have no cure and can be life-threatening
without treatment.
What is the difference between a sexually transmitted infection and a sexually
transmitted disease?
A sexually transmitted infection is the same as a sexually transmitted disease. STI is
the most accurate term to describe the condition.

What are the types of sexually transmitted infections?

The most common types of sexually transmitted infections include:
a. Chlamydia: Caused by the bacterium Chlamydia trachomatis, chlamydia is one of
the most common STDs worldwide. It can be transmitted through vaginal, anal, or
oral sex, as well as from mother to child during childbirth. Symptoms may include
abnormal discharge, painful urination, and pelvic pain.
b. Gonorrhea: Caused by the bacterium Neisseria gonorrhoeae, gonorrhea is another
widespread STD. It can be transmitted through various sexual activities and can
also be passed from mother to child during childbirth. Symptoms may include
painful urination, abnormal discharge, and genital itching.
c. Syphilis: Caused by the bacterium Treponema pallidum, syphilis is a highly
contagious STD that progresses in stages if left untreated. It is transmitted through
direct contact with syphilis sores during sexual activity. Symptoms can vary
depending on the stage and may include sores, rashes, fever, and neurological
issues.
d. Human Papillomavirus (HPV) Infection: HPV is a viral infection that can be
transmitted through vaginal, anal, or oral sex. It is one of the most common STDs,
and while many infections clear on their own, certain high-risk types can cause
cervical, anal, and other types of cancer. Symptoms may include genital warts or no
symptoms at all.
e. Herpes: Caused by the herpes simplex virus (HSV), herpes is a lifelong viral
infection that can be transmitted through oral, vaginal, or anal sex. It can also be
passed from mother to child during childbirth. Symptoms may include painful sores
or blisters around the genital or oral area.
f. Human Immunodeficiency Virus (HIV) Infection: HIV is a viral infection that
attacks the immune system, leading to acquired immunodeficiency syndrome
(AIDS) if left untreated. It is primarily transmitted through unprotected sexual
intercourse, sharing contaminated needles, or from an HIV-positive mother to her
child during childbirth. Symptoms can vary, and HIV may initially present with flu-
like symptoms, followed by a long asymptomatic period.
g. Hepatitis B and C: Hepatitis B and C are viral infections that primarily affect the
liver. They can be transmitted through sexual contact, sharing needles, or from
mother to child during childbirth. Symptoms may include jaundice, fatigue,
abdominal pain, and liver damage.
How common are sexually transmitted infections?
Sexually transmitted infections are common. More than 25 million sexually
transmitted infections occur each year in the United States. Around the world, an
estimated 374 million sexually transmitted infections occur each year. According to
the CDC, there were approximately 2.5 million cases of chlamydia, gonorrhea and
syphilis in the U.S. in 2021. About half of these cases occur in people ages 15 to 24.

SYMPTOMS AND CAUSES

What are the symptoms of sexually transmitted infections?
Symptoms of sexually transmitted infections (sexually transmitted diseases) vary by
type. You might not have any symptoms. If you do have symptoms, they may
appear around your genital region and could include:
 Bumps, sores or warts on or near your penis, vagina, mouth or anus.
 Swelling or severe itching near your penis or vagina.
 Discharge from your penis.
 Vaginal discharge that has a bad odor, causes irritation or is a different color
or amount than usual.
 Vaginal bleeding that’s not your period.
 Painful sex.
 Painful urination or frequent urination.
In addition, you may also have symptoms throughout your body, including:
 A skin rash.
 Weight loss.
 Diarrhea.
 Night sweats.
 Aches, pains, fever and chills.
 Jaundice (yellowing of your skin and whites of your eyes).
What causes sexually transmitted infections?
Sexually transmitted infections develop when various bacteria, viruses or parasites
infect your body. You can get these microorganisms from bodily fluids (like blood,
urine, semen, saliva and other mucous-lined areas) during sex — usually vaginal,
oral and anal sex or other sexual activities.

Are sexually transmitted infections contagious?

Yes, sexually transmitted infections (sexually transmitted diseases) are contagious.
Most STIs pass from person to person by sexual contact through bodily fluids or
from skin-to-skin contact by touching the infected part of a person’s body, usually
the genitals. Some STIs, like syphilis, can spread while giving birth to a baby.
If you have an STI, it’s important to visit a healthcare provider to receive treatment.
Some STIs are curable. You can prevent the spread of STIs by getting tested
regularly if you’re sexually active, talking to your sexual partners about your
diagnosis and using protection during sex.

What are the risk factors for sexually transmitted infections?

If you’re sexually active, you’re at risk of developing a sexually transmitted
infection (sexually transmitted disease).
You can also get an STI if you share personal items like needles that contain your
blood. This may occur in the following instances:
Unregulated tattoos.
Unregulated piercings.
Sharing needles while using intravenous drugs (substance use disorder).
A lack of communication due to stigma or shame about having an STI can put you
and your partner(s) at a greater risk of spreading the infection. Before having sex,
you should ask your partners the following questions:
Do you have an active STI?
When was your last STI test?
Are you currently being treated for an STI?
Do you consistently use protection with your sexual partners?
Asking these questions can help you protect yourself.
It’s common to feel strong emotions after an STI diagnosis. You might want to
avoid telling your sexual partner because you feel embarrassed. Being open and
honest with your sexual partners helps build trust and understanding. If you have an
STI, you can reduce the risk of spreading the infection to your sexual partner(s) by
talking it over with them before engaging in sexual activities.
What are the complications of sexually transmitted infections?
 Sexually transmitted infections can cause lifelong complications if left
untreated. Common complications from untreated STIs include the following:
 HIV can lead to AIDS.
 Syphilis can damage your organs, nervous system and infect a developing
fetus.
 Risk of spreading STIs to your sexual partners.
 STI complications for women or people assigned female at birth (AFAB)
include:
 Pelvic inflammatory disease (PID), which can damage your uterus and cause
infertility.
 Ectopic pregnancy.
 Infertility.
 Chronic pelvic pain.
In men or people assigned male at birth (AMAB), untreated STIs can lead to:
 Infections in the urethra and prostate.
 Swollen, sore testicles.
 Infertility.

DIAGNOSIS AND TESTS

How are sexually transmitted infections diagnosed?
A healthcare provider will diagnose a sexually transmitted infection (sexually
transmitted disease) after a physical exam and testing. Your provider will ask about
your symptoms and your medical and sexual history — answer honestly, so you can
get the help you need. After a positive STI diagnosis, you need to notify your sexual
partner(s) that they should also get tested.
This can be a very emotional process, but telling your partners can help them get
the care they need and prevent the spread of the infection.

What is STI testing?

A sexually transmitted infection test is a medical test to determine if you have an
STI. A healthcare provider will review your symptoms and offer a test or tests to
determine the cause. There are different tests for each type of STI. Your provider
will talk to you about what test(s) you need. STI testing could include:
 Urine test.
 Cheek swab.
 Blood test.
  A fluid sample from skin sores.
 A discharge or cell sample from your body (usually the vagina, urethra,
cervix, penis, anus or throat).
STI testing is mostly painless. You might feel a small pinch during a blood test or a
sting from a swab touching a sore.

How often should I get tested for STIs?

Most healthcare providers recommend annual sexually transmitted infection testing.
You may choose to get tested more often, like every 3 to 6 months, if you have
multiple sexual partners.
Some providers recommend testing before having sex with a new partner. Regular
testing helps find and treat STIs you may not even know you have. Talk to a
healthcare provider about a testing schedule that makes sense for you.

MANAGEMENT AND TREATMENT

How are sexually transmitted infections treated?
The goal of sexually transmitted infection (sexually transmitted disease) treatment
is to:
 Cure many (not all) STIs.
 Lessen your symptoms.
 Reduce your likelihood of spreading the infection.
 Help you get healthy and stay healthy.
 Treatment for STIs could include taking medications like:
 Antibiotics.
 Antivirals.
You can take these medicines orally (by mouth), or a provider will give you an
injection.

Should I get the HPV vaccine?

The human papillomavirus (HPV) is the most common viral STI in the U.S. People
with HPV may have no symptoms, or they may develop warts or bumps around the
genitals. High-risk HPV can even cause cervical cancer.
There’s a vaccine to prevent HPV and genital warts. Healthcare providers advise
children ages 11 to 12 to receive it because it’s most effective before you become
sexually active. Providers recommend the vaccine for everyone up to age 26, and
updated information shows people up to the age of 45 years may benefit from the
HPV vaccine. Talk to your healthcare provider to see if it’s right for you.

What is expedited partner therapy?

Expedited partner therapy (EPT) is where your healthcare provider gives you a
prescription for your partner without examining them when you’re diagnosed with
chlamydia or gonorrhea. Typically, the healthcare provider would wait to examine
your partner before providing a prescription. But the logical assumption is that if
you have one of these STIs, then your partner probably does, as well. This prevents
reinfection and stops additional transmission as soon as possible.

How soon after treatment will I feel better?

If your provider gave you antibiotics or antivirals to treat a sexually transmitted
infection, you should start feeling better within a few days. Make sure to complete
all the medicine as directed, even if you’re feeling better. And never share
medicines — don’t give your medicine to others, and don’t take someone else’s
medication for your symptoms.
Care at Cleveland Clinic
Sexually Transmitted Infections Treatment
Find a Doctor and Specialists
Make an Appointment

PREVENTION
Six tips to reduce your risk of developing a sexually transmitted infection.
There are steps you can take to protect yourself and your partner from sexually
transmitted infections.
How can I lower my risk of developing a sexually transmitted infection?
The only way to reduce the risk of sexually transmitted infections is to abstain from
sex (not have sex). If you’re sexually active, you can:
 Use a latex condom whenever you have any kind of sex. If you or your partner
has a vagina, use a dental dam for oral sex.
 Choose sex partners carefully. Don’t have sex if you suspect your partner has
an STI.
 Get checked for STIs regularly. Doing so helps prevent the spread of STIs to
other people. Ask any new sex partner to get tested before having sex for the
first time.
 Avoid alcohol or drugs before having sex. People who are under the influence
may engage in sexual activities without taking safety precautions.
  Learn the signs and symptoms of STIs. If you notice symptoms, visit a
healthcare provider quickly.
 Educate yourself about STIs. The more you know, the better you can protect
yourself and your partners.

Can the spread of sexually transmitted infections be prevented?

You can take steps to protect yourself and others from sexually transmitted
infections:
 If you have symptoms of an STI, don’t have sex until you see a healthcare
provider and receive treatment. You can resume sex when your healthcare
provider says it’s OK.
 Follow your healthcare provider’s instructions for treatment.
 Return to your healthcare provider to get rechecked after completing
treatment.
 Be sure your partner(s) know about your positive diagnosis and also receive
treatment.
 Use condoms whenever you have sex, especially with new partners.
 Get vaccinated for certain STIs (HPV) to prevent complications.

OUTLOOK / PROGNOSIS
What can I expect if I have a sexually transmitted infection?
Most STIs go away after treatment. Some may require lifelong management with
medications.
You can develop the same STI after it goes away if you get infected with it again.
People who get an STI diagnosis may feel embarrassed or ashamed. But STIs can
happen to anyone — millions of people have them. Statistics show that most people
will get an STI at least once. If you’re experiencing anxiety or stress about your STI
diagnosis, consider reaching out to a friend, loved one or mental health professional
for support.

What if I have an STI and I’m pregnant?

If you’re pregnant and have an STI, talk to your healthcare provider right away.
They’ll discuss treatment options to keep you and the fetus safe.
What’s the outlook for sexually transmitted infections?
Many sexually transmitted infections (sexually transmitted diseases) can be cured.
Unfortunately, there isn’t a cure for all STIs. Conditions like HIV require lifelong
care and treatment. You can get an STI again, even after treatment to cure it.

LIVING WITH
How do I take care of myself if I have a sexually transmitted infection?
If your healthcare provider gave you a sexually transmitted infection diagnosis, take
steps to keep yourself healthy:
 Take all of the medication your provider prescribed as instructed.
 Don’t have sex while you’re getting STI treatment. Wait until your healthcare
provider gives you the all-clear.
 Let your sexual partners know you have an STI so that they can talk to their
healthcare provider about testing and treatment.
 When you resume having sex, use a condom. If you or your partner has a
vagina, be sure to use a dental dam while having oral sex.

When should I see a healthcare provider?

Visit a healthcare provider if you notice that you or your partner has symptoms of
an STI. You should also regularly visit a healthcare provider for annual or more
frequent STI testing if you’re sexually active.
What questions should I ask my doctor?
If you’re sexually active or you’ve had an STI, ask your healthcare provider:
How can I prevent STIs?
Will the STI cause any complications or problems in the future?
Should I get checked regularly for STIs?
Should my partners get checked?
Sexually transmitted infections are common. If you feel uncomfortable burning or
itching around your genitals or other signs of a possible STI, talk to a healthcare
provider. Antibiotics can usually treat the infection successfully. Most of the time,
you can cure an STI without long term complications. In some instances, like with
HIV, you may need lifelong treatment. Using a condom or other STI preventative
measures when you’re sexually active can reduce your risk of STIs.
SCOPE OF THE PROBLEM
STIs have a profound impact on sexual and reproductive health worldwide.
More than 1 million STIs are acquired every day. In 2020, WHO estimated 374
million new infections with 1 of 4 STIs: chlamydia (129 million), gonorrhea (82
million), syphilis (7.1 million) and trichomoniasis (156 million). More than 490
million people were estimated to be living with genital herpes in 2016, and an
estimated 300 million women have an HPV infection, the primary cause of cervical
cancer and anal cancer among men who have sex with men. An estimated 296
million people are living with chronic hepatitis B globally.
STIs can have serious consequences beyond the immediate impact of the infection
itself.
STIs like herpes, gonorrhea and syphilis can increase the risk of HIV acquisition.
Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low-
birth weight and prematurity, sepsis, neonatal conjunctivitis and congenital
deformities.
HPV infection causes cervical and other cancers.
Hepatitis B resulted in an estimated 820 000 deaths in 2019, mostly from cirrhosis
and hepatocellular carcinoma. STIs such as gonorrhoea and chlamydia are major
causes of pelvic inflammatory disease and infertility in women.

PREVENTION OF STIS
When used correctly and consistently, condoms offer one of the most effective
methods of protection against STIs, including HIV. Although highly effective,
condoms do not offer protection for STIs that cause extra-genital ulcers (i.e.,
syphilis or genital herpes). When possible, condoms should be used in all vaginal
and anal sex. Safe and highly effective vaccines are available for 2 viral STIs:
hepatitis B and HPV. These vaccines have represented major advances in STI
prevention. By the end of 2020, the HPV vaccine had been introduced as part of
routine immunization programme in 111 countries, primarily high- and middle-
income countries. To eliminate cervical cancer as a public health problem globally,
high coverage targets for HPV vaccination, screening and treatment of precancerous
lesions, and management of cancer must be reached by 2030 and maintained at this
high level for decades.
Research to develop vaccines against genital herpes and HIV is advanced, with
several vaccine candidates in early clinical development. There is mounting
evidence suggesting that the vaccine to prevent meningitis (MenB) provides some
cross-protection against gonorrhea.
More research into vaccines for chlamydia, gonorrhea, syphilis and trichomoniasis
are needed.
Other biomedical interventions to prevent some STIs include adult voluntary
medical male circumcision, microbicides, and partner treatment. There are ongoing
trials to evaluate the benefit of pre- and post-exposure prophylaxis of STIs and their
potential safety weighed with antimicrobial resistance (AMR).

DIAGNOSIS OF STIs
STIs are often asymptomatic. When symptoms occur, they can be non-specific.
Moreover, laboratory tests rely on blood, urine or anatomical samples. Three
anatomical sites can carry at least one STI. These differences are modulated by sex
and sexual risk. These differences can mean the diagnosis of STIs is often missed
and individuals are frequently treated for 2 or more STIs.
Accurate diagnostic tests for STIs (using molecular technology) are widely used in
high-income countries. These are especially useful for the diagnosis of
asymptomatic infections. However, they are largely unavailable in low- and middle-
income countries (LMICs) for chlamydia and gonorrhea. Even in countries where
testing is available, it is often expensive and not widely accessible. In addition, the
time it takes for results to be received is often long. As a result, follow-up can be
impeded and care or treatment can be incomplete.
On the other hand, inexpensive, rapid tests are available for syphilis, hepatitis B and
HIV. The rapid syphilis test and rapid dual HIV/syphilis tests are used in several
resource-limited settings.
Several other rapid tests are under development and have the potential to improve
STI diagnosis and treatment, especially in resource-limited settings.

TREATMENT OF STIs
Effective treatment is currently available for several STIs.
Three bacterial (chlamydia, gonorrhea and syphilis) and one parasitic STIs
(trichomoniasis) are generally curable with existing single-dose regimens of
antibiotics.
For herpes and HIV, the most effective medications available are antivirals that can
modulate the course of the disease, though they cannot cure the disease.
For hepatitis B, antivirals can help fighting the virus and slowing damage to the
liver.
AMR of STIs – in particular gonorrhea – has increased rapidly in recent years and
has reduced treatment options. The Gonococcal AMR Surveillance Programme
(GASP) has shown high rates of resistance to many antibiotics including quinolone,
azithromycin and extended-spectrum cephalosporins, a last-line treatment (4).
AMR for other STIs like Mycoplasma genitalium, though less common, also exists.
STI case management LMICs rely on identifying consistent, easily recognizable
signs and symptoms to guide treatment, without the use of laboratory tests. This
approach – syndromic management – often relies on clinical algorithms and allows
health workers to diagnose a specific infection based on observed syndromes (e.g.,
vaginal/urethral discharge, anogenital ulcers, etc). Syndromic management is
simple, assures rapid, same-day treatment, and avoids expensive or unavailable
diagnostic tests for patients with symptoms. However, this approach results in
overtreatment and missed treatment as the majority of STIs are asymptomatic.
Thus, WHO recommends countries to enhance syndromic management by
gradually incorporating laboratory testing to support diagnosis. In settings where
quality assured molecular assays are available, it is recommended to treat STIs
based on laboratory tests. Moreover, STI screening strategies are essential for those
at higher risk of infection, such sex workers, men who have sex with men,
adolescents in some settings and pregnant women.
To interrupt transmission and prevent re-infection, treating sexual partners is an
important component of STI case management.

CONTROLLING THE SPREAD

Behaviour change is complex. Despite considerable efforts to identify simple
interventions that can reduce risky sexual behaviour, behaviour change remains a
complex challenge.
Information, education and counselling can improve people’s ability to recognize
the symptoms of STIs and increase the likelihood that they will seek care and
encourage a sexual partner to do so. Unfortunately, lack of public awareness, lack
of training among health workers, and longstanding, widespread stigma around
STIs remain barriers to greater and more effective use of these interventions.
Health services for screening and treatment of STIs remain weak.
People seeking screening and treatment for STIs face numerous problems. These
include limited resources, stigmatization, poor quality of services and often out-of-
pocket expenses.
Some populations with the highest rates of STIs – such as sex workers, men who
have sex with men, people who inject drugs, prison inmates, mobile populations
and adolescents in high burden countries for HIV – often do not have access to
adequate and friendly health services.
In many settings, STI services are often neglected and underfunded. These
problems lead to difficulties in providing testing for asymptomatic infections,
insufficient number of trained personnel, limited laboratory capacity and inadequate
supplies of appropriate medicines.
WHO response Our work is currently guided by the Global health sector strategy on
HIV, Hepatitis and Sexually Transmitted Infections, 2022–2030. Within this
framework, WHO: develops global targets, norms and standards for STI prevention,
testing and treatment; supports the estimation and economic burden of STIs and the
strengthening of STI surveillance; globally monitors AMR to gonorrhea; and
leads the setting of the global research agenda on STIs, including the development
of diagnostic tests, vaccines and additional drugs for gonorrhea and syphilis.
As part of its mission, WHO supports countries to: develop national strategic plans
and guidelines; create an encouraging environment allowing individuals to discuss
STIs, adopt safer sexual practices, and seek treatment; scale-up primary prevention
(condom availability and use, etc.); increase integration of STI services within
primary healthcare services; increase accessibility of people-centered quality STI
care; facilitate adoption of point-of-care tests; enhance and scale-up health
intervention for impact, such as hepatitis B and HPV vaccination, syphilis screening
in priority populations; strengthen capacity to monitoring STIs trends; and
monitor and respond to AMR in gonorrhea.