Sexually Transmitted Diseases, noBODY wants them…but they happen.
Written by Shawn Shanahan, APRN-WHNP
Perhaps it has been a few years since your health education class in high school. If so, or if you just want a crash course in all things sexually transmitted disease (STD) and sexually transmitted infections (STI’s), read on!
STI is a newer term relating to the fact that one may have contracted a sexually transmitted organism, i.e., infection. STI’s can be asymptomatic, meaning a person may have the infection, but not have any signs or symptoms. STD’s, on the other hand, are symptomatic meaning a person is having signs or symptoms of the infection.
Although STD’s are preventable now more than ever, the rates of both those persons with a newly acquired STD and those with an existing STD have been rising in recent years across the nation and in Montana. The number of gonorrhea cases alone in Montana rose 50% from 2017 to 2018 for a total of 1,181 cases. According to the Centers for Disease Control and Prevention (CDC), on any given day in 2018 20% of the US population had a sexually transmitted disease. This statistic includes only chlamydia, trichomonas, genital herpes, human papillomavirus (HPV), gonorrhea, syphilis, hepatitis B, and human immunodeficiency virus (HIV), but lesser-known infections such as molluscum contagiosum, scabies, and pubic lice also exist.
In 2018 women accounted for 25% of direct health care costs due to STD’s, and youth ages 15-24 years accounted for 26%. Chlamydia and gonorrhea can cause infertility and pelvic inflammatory disease that may lead to hospitalization for intravenous antibiotic therapy or surgery. Due to the fact that sexually active youth are the highest risk population for these infections, the CDC recommends that all sexually active women under 25 be screened annually for chlamydia and gonorrhea either through urine, off a pap smear, or from a cervical or vaginal swab available at health clinics. Annual physical exams provide a convenient time to have this screening done.
Although chlamydia, trichomonas, genital herpes and HPV (wart virus) are the most common sexually transmitted infections (STI’s), hepatitis C is another STI that should not be ignored. While it may be carried long term without recognition, it can alternately damage the liver even leading to death. Therefore, the U.S. Preventive Services Task Force recommends that all adults aged 18 to 79 obtain a blood screening from their provider at least once.
Another population identified for routine STI screening is pregnant women. STI’s can cause serious, life threatening and even lifelong infections for babies of infected mothers. For example, syphilis can cause not only preterm labor resulting in the many complications of an immature newborn, but it can affect the baby’s brain, eyes, ears, heart, teeth, bones and skin. Chlamydia and gonorrhea may also contribute to preterm labor or premature rupture of membranes leading to low-birth weight infants, or these diseases may prompt miscarriage. Chlamydia present during delivery may cause eye infection or pneumonia in the newborn, while gonorrhea present during delivery may cause blindness, joint or blood infections in the newborn.
Two viral STD’s that can necessitate delivery by C-section are genital warts, if they are so large as to block the birth canal, and genital herpes, which can cause serious or even life-threatening damage to the newborn’s lungs, kidney, liver or central nervous system as well as sores on the skin and eyes. Medication is routinely prescribed for a woman with a history of genital herpes to take daily for a month prior to delivery to avoid a herpes outbreak at the time of delivery, allowing the mother to deliver vaginally rather than by C-section. This practice speaks to the importance of early and regular prenatal care to ensure a pregnant woman’s history is known and screening to detect unrecognized infections is done in time for adequate management. Antibiotics are also routinely administered to newborns’ eyes to prevent eye damage from possible exposure to bacterial STI’s.
Though most viral STD’s such as herpes and HPV are not curable, they are treatable. The key is early detection. Some subtypes of HPV can cause cancer, so regular pelvic exams and routine pap smears are recommended for women starting at age 21. Anyone at risk for STD’s should be screened routinely for infection. Some risk factors include having multiple partners, having a partner who has other partners, sexual activity without condoms, sexual activity with a new partner, males having sex with males, having a partner who uses injectable drugs or who trades sex for drugs or money.
Recommendations for reducing risk include communicating with potential partners to know their risk of spreading disease to you. Use internal (female) condoms or external (male) condoms with new partners. Internal condoms provide a greater surface area of coverage and barrier to contact, but they are not as widely available in local stores as external condoms. Use barriers with all sites of sexual activity. Limit the number of sexual partners. Avoid sexual activity with a partner who has symptoms. Insist that partners be checked before engaging in sexual activity with you. Obtain the HPV vaccine and complete the series of injections. The Gardasil HPV vaccine is approved for males and females 9-45 years old and is most effective in covering the nine most common subtypes of the virus that cause genital warts and cancer when given at the youngest age possible. If you participate in activity with high risk of contracting HIV, talk to your care provider about taking medication that is available to prevent HIV.
You should feel comfortable talking with your care provider openly about any symptoms you are experiencing or other concerns you may have. Your care provider is there to help you, make you feel better and assist with the concerns you have. Contact your care provider if you experience any symptoms of sores, bumps, rashes, discharge, odor, pain, urinary urgency or frequency, bleeding, nausea, clay-colored stools, yellow skin, weight loss, night sweats, or excess fatigue. When in doubt, call your provider, your local health department, or seek urgent medical attention at an urgent care clinic or emergency room.
Call us at Kalispell OB/GYN 406- 752-5252 to make an appointment if you have concerns about your obstetric or gynecological health– our mission is to provide the best care for women in all stages of life!
Resources:
www.uspreventiveservicestaskforce.org