Sexually Transmitted Infections Overview

Sexually Transmitted Infections (STIs)

STIs are caused by over 25 organisms and syndromes, including AIDS and Hepatitis B.
Approximately 20 million people are infected with STIs each year, with a significant portion (1.5 million) in the 15-24 age group.
Risk factors include being single, non-white, adolescent, a woman, low socio-economic status, medically underserved, multiple partners, drug use, and having other STIs.
Incidence of STIs is increasing in the U.S., with 25% of people contracting an STI in their lifetime.
Factors contributing to the increase include a young population that may not always treat STIs, greater sexual freedom leading to more partners and higher risk, resistant strains of disease, and decreased use of barrier contraceptives.
Drug use is related to STI incidence and transmission, including sharing needles.
STIs disproportionately affect women. Men transmit STIs to women more easily than vice versa.
Women often have fewer or less obvious symptoms compared to men.
Complications in women can include: pelvic inflammatory disease (PID), ectopic pregnancy, infertility, preterm labor, rupture of membranes, spontaneous abortion, and cancer.
Infants born to a woman with an STI can have complications like Group B strep, premature delivery, brain damage, pneumonia, and death.

Bacterial STIs

Chlamydia is a common bacterial STI in the US.
Causative agent is Chlamydia trachomatis.
Complications include premature rupture of membranes (PROM), pelvic inflammatory disease (PID), ectopic pregnancy, and infertility.
Infant complications can include conjunctivitis and low birth weight.
Symptoms in women are often asymptomatic. Symptoms in women may include thin or mucopurulent discharge and a friable cervix.
Treatment often involves a single dose of Azithromycin (1 gram) or Doxycycline (100mg BID for 7 days), except during pregnancy.
Sexual partners should be treated and abstinence is encouraged for 7 days after treatment.
Gonorrhea is also a bacterial STI commonly linked to Chlamydia.
Causative agent is Neisseria gonorrhoeae.
Transmission is through vaginal, oral, or anal sex.
80% of women are asymptomatic.
Symptoms include purulent (green/yellow) vaginal discharge, dysuria (painful urination), urinary frequency, swollen/eroded cervix, and bilateral lower abdominal pain.
Complications can include premature rupture of membranes (PROM), premature delivery, chorioamniotis, and postpartum endometritis.
Infants may experience intrauterine growth restriction (IUGR) or ophthalmia neonatorum (can cause blindness).
Treatment involves a single dose of Ceftriaxone (500mg IM) and Azithromycin (1gm oral). Doxycycline should not be used during pregnancy.
Partners should be treated.
Prevention for infants includes applying erythromycin ointment to eyes within 1 hour of birth.

Syphilis

Causative agent is Treponema pallidum.
Incidence increased in the 1980s and is increasing again, particularly among gay and bisexual men.
Pregnant women are screened for syphilis during prenatal visits and again in the third trimester, using VDRL or RPR blood tests.
Three stages:
Primary: painless chancre (sore) that persists for 4 weeks and then disappears; possible fever, weight loss, malaise.
Secondary: skin eruptions (condylomata lata), rash on palms and soles, enlarged liver and spleen, non-tender lymph nodes; 6 weeks to 6 months after initial infection.
Tertiary: Neurosyphilis; damage to internal organs; 2-30 years after initial infection in 10% cases.
Treatment involves a single dose of penicillin G IM.
Partners should also be treated.

Viral STIs

HPV (Human Papillomavirus) is a common viral STI.
Some strains are linked to cervical dysplasia (cancer).
HPV transmission occurs via oral, vaginal, or anal sex.
Symptoms are often asymptomatic, but can include itchy and/or painful intercourse, and soft gray/pink cauliflower-like lesions in the genital area.
HPV vaccination is now recommended for both males (ages 11-26) and females (ages 11-26).
Three doses over 6 months are recommended.
Women with HPV need frequent Pap tests to assess for cervical dysplasia.
Genital herpes is another common viral STI, caused by Herpes Simplex virus-2 (HSV-2) or Herpes simplex virus-1 (HSV-1).
Incidence of infection is about 1 in 6 people between 14-49 years old; recurrent life-long infection.
Transmission: Oral, vaginal, or anal sex; skin-to-skin contact is also possible.
The primary episode often involves blister-like vesicles that appear hours to 20 days after exposure and result in painful open sores.
Recurrent outbreaks are triggered by stress, menstruation, ovulation, pregnancy, frequent intercourse, poor health, or weakened immune systems.
Complications: Transmission to the neonate can occur (spontaneous abortions or low birth weight).
Treatment does not cure but can manage symptoms.
Patient education includes taking sitz baths and wearing loose-fitting cotton clothing during outbreaks and C-section delivery for pregnant women with active herpes.

HIV/AIDS

Causative agent: retrovirus that attacks and destroys T-lymphocytes.
Risk factors include IV drug use, multiple sexual partners, bisexuality, maternal history of STIs, and blood transfusion.
Common symptoms include fatigue, flu-like symptoms, weight loss, lymphadenopathy, rash, and anemia.
Treatment: antiviral therapy to suppress viral replication and reduce viral load. There is no cure.
Pregnant women with HIV: consider delivery by C-section around 38 weeks.
Infants should be bathed before receiving immunizations and should not be breastfed.
Retrovir (Zidovudine) is administered to the infant at birth for the first 6 weeks.

Vaginal Infections/PID

Bacterial vaginosis is an infection, not a sexually transmitted disease.
Caused by overgrowth of normal anaerobic bacteria and not typically transmitted from a sexual partner.
Factors include frequent unprotected sex, douching, cigarette smoking, new sexual partners, increased psychosocial stress, and vitamin D deficiency, among other things.
Symptoms include vaginal discharge (thin, gray), fishy odor, burning, and itching.
Treatment options: Metronidazole 500mg PO BID for 7 days in nonpregnant women and 250mg PO TID for 7 days during pregnancy.
Complications may include preterm labor, premature rupture of membranes (PROM), chorioamnionitis, and pelvic inflammatory disease (PID).
Client education should emphasize that it is not a sexually transmitted disease, discourage douching, and counsel patients to avoid alcohol while taking metronidazole.
Vulvovaginal Candidiasis.
Caused by Candida albicans.
Risk factors include glycosuria (glucose in urine), diabetes mellitus, use of oral contraceptives, antibiotics, and pregnancy.
Symptoms include non-malodorous white or thick vaginal discharge, severe itching, painful urination (dysuria), painful intercourse (dyspareunia), and swollen labia.
Treatment options: OTC Monistat or Diflucan 150mg PO single dose.
Trichomoniasis, a protozoan infection, is caused by Trichomonas vaginalis.
Sexual activity is a risk factor.
Symptoms are frequently asymptomatic, but can include yellow-green, frothy, odorous vaginal discharge, vulvar itching, dysuria, and dyspareunia.
Treatment: antibiotics as prescribed by medical professionals.
Partners should also be treated.
PID risk factors are often related to STIs.

Risk Reduction/Promoting Health Lifestyle

Know your partner.
Reduce the number of partners.
Test with new partners.
Have low-risk sex, including condom use.
Avoid exchanging body fluids.
Vaccination (Hep B, A, HPV).

IDD and STIs

A myth exists that people with disabilities are asexual, which may impact education and resources related to sexual health.
People with disabilities are at increased risk for STIs. Risk factors include poverty, unemployment, sexual abuse, lack of sexual health knowledge, unsafe sexual practices, and compromised immune systems.