Most sexually transmitted diseases (STDs) are transmitted through sexual intercourse. In addition, close body contact, kissing, oral and anal intercourse can also create transmission routes. Contaminated blood, blood products and organ transfers, injury with sharps contaminated with patient blood, and direct contact are among the other modes of transmission for some of these diseases. Another importance of STDs is that they are passed from mother to baby and can lead to chronic diseases. HIV/AIDS and other STDs are most commonly detected in the 15-35 age group, where sexual activity is most intense. The fact that most of the sexually transmitted diseases do not show any symptoms at the beginning causes delays in diagnosis. In addition, asymptomatic infections can easily be transmitted to others and cause serious complications, especially in women. For example, some STIs in women can lead to pelvic infection and infertility if left untreated. Learning about diseases in the early period increases the chance of being treated and reduces the risk of transmitting these diseases to others. For this reason, even if there are no signs (symptoms) after a suspicious sexual intercourse, these tests should be done. These infections can only be recognized using laboratory tests. Therefore, it is very important to make a quick and accurate diagnosis and to treat both the patient and his sexual partner, even if there are no signs or symptoms of infection.
COMPLICATIONS OF SEXUALLY TRANSMITTED INFECTIONS
Sexually transmitted infections negatively affect fertility in both sexes. In women, pelvic infection, chronic pelvic pain and infertility may develop as a result of the spread of STI agents from the lower genital organs to the upper genitals. The main infectious agents causing pelvic infection are C. trachomatis and N.gonorrhoeae. Another consequence of pelvic infection is infertility. More than half (55-85%) of women with untreated pelvic infections have been shown to be infertile. STIs also increase the risk of ectopic pregnancy (ectopic pregnancy). STIs affect the fetus as well as the mother during pregnancy and childbirth. Studies have shown that more than two-thirds of pregnant women with syphilis are infected by transfer of the agent to the amniotic fluid, and 40% of infected pregnancies result in miscarriage, stillbirth, or perinatal death. Pregnant women with gonorrhea and chlamydia cervicitis infect their fetuses during delivery, and neonatal conjunctivitis and chlamydial pneumonia occur in the newborn.
STIs can also result in infection or infertility in men. Gonorrhea and chlamydia infections spread from the urethra to the epididymis, causing urethritis and epididymitis. If appropriate treatment is not given, it is inevitable to encounter urethral stenosis and infertility.
It is known that people with another sexually transmitted disease are more likely to develop AIDS. Due to the tissue damage they cause, other STIs facilitate the transmission of HIV infection from one person to another. Therefore, when sexually transmitted diseases are detected, HIV should definitely be considered and investigated. Studies to reduce the transmission of STIs are also effective in reducing HIV transmission.
There are some symptoms of STD that should be suspected in men and women. If you have some of these symptoms, you should get tested for STD. These:
- If the woman has had a vaginal discharge or abnormal bleeding,
- If the woman has pain, bleeding, discomfort during or after sexual intercourse,
- If the woman has wounds in the genital area or different wart-like formations on the skin,
- If a man has a discharge from the urinary tract,
- If men have problems such as skin ulcers, wart-like structures in the genital area, ulcers or swelling of the glands in the groin,
- If one of the partners has had sexual intercourse with others,
In addition, in the following cases, it is recommended to have these tests with or without any symptoms:
- If you had sex with a person from whom you could not obtain information about his past sexual behavior without using a condom,
- If you have multiple sexual partners and your polygamy preference will continue,
The tests to be used to identify STD are various. The patient samples to be taken to study these tests vary according to the tests to be performed. These samples can be blood, urine or swab samples.
The most common STDs and their causative agents are:
- AIDS (HIV)
- hepatitis B infection (HBV)
- hepatitis C infection (HCV)
- Genital herpes (HSV)
- Genital wart (HPV)
- Syphilis/Syphilis (Treponema pallidum)
- Mycoplasma and Uroplasma infection
- Gonorrhea/ Gonorrhea (N. gonorrhea)
- chlamydia infection
- Trichomonas vaginalis infection
TRICHOMONAS VAGINALIS INFECTION
The causative agent of Trichomonas infection is Trichomonas vaginalis, a unicellular parasite. At least 1/3 of women encounter this infection at any time. Its incubation ranges between 5-30 days. Trichomonas infection is usually asymptomatic especially in men, but it is the causative agent of vaginitis in women and urethritis, more rarely in men. It causes yellow-green, copious and foamy discharge in women. There may also be itching in the vagina and vulva. Simultaneous treatment of sexual partners is necessary to prevent re-contamination or infection. The most commonly used antibiotic for treatment is metronidazole.
GONORE (COLD COLD)
Gonorrhea is transmitted by having unprotected sex with an infected person. Infection occurs after an incubation period of 1-8 days. Although the infection is asymptomatic in some of the infected men, symptoms of urethritis usually appear 3-6 days after exposure to the agent. These can be listed as burning when urinating, urinating more often than usual, and purulent discharge from the penis. In most infected women, the infection is completely asymptomatic. The most important symptom in symptomatic patients is a greenish yellow discharge from the cervix and the appearance of cervicitis. The most dangerous aspect of this infection is the spread of the infection to the uterus and fallopian tubes. This condition, which causes pelvic infection, can cause severe fever, abdominal pain, infertility and even death. In addition, newborn babies may become infected while passing through the birth canal of the infected mother, and inclusion conjunctivitis may develop in these babies. This condition, if left untreated, can lead to infection and blindness.
Ceftriaxone is the first choice drug in the treatment of gonorrhea today. Apart from this, treatment can be done with ofloxacin, ciprofloxacin and levofloxacin. Avoiding sexual intercourse during treatment or using condom correctly during sexual intercourse is the surest way to avoid this disease. After the diagnosis of gonorrhea, sexual partners should be treated together.
Chlamydia infection
Chlamydia infection is an infection caused by Chlamydia trachomatis. In recent years, it has become the most common STI in the world. The incubation period of the disease ranges from 7 to 21 days. Most of the infections occurring in men are symptomatic, 25% of them are asymptomatic. Symptoms include dysuria (burning while urinating) and urethral discharge. Most infections in women are asymptomatic. Therefore, women can transmit the infection to their spouses and babies. It is the most common cause of cervicitis in women. There is an off-white and sometimes smelly discharge coming from the cervix. It is a dangerous infection for women; because it progresses silently over months and can progress to a pelvic infection, which can lead to infertility, chronic pain, and even death. Culture or antigen-seeking tests are used for diagnosis. The first-choice drug in chlamydia infections is azithromycin, which is used as a single dose all over the world. Avoiding sexual intercourse during treatment or using condom correctly during sexual intercourse will prevent the transmission of bacteria from person to person.
SYPHILIS (syphilis)
Syphilis is the oldest known sexually transmitted infection. It is caused by a bacterium called Treponema pallidum. The microorganism enters the body through intact mucous membranes or a small crack in the skin. Since it is not resistant to the external environment, infection is not transmitted by using the same items and sharing the same toilet with the patient.
Syphilis consists of three stages:
A. Early Period:
Primary Syphilis: A painless skin ulcer occurs in the genital area approximately 21 days after ingestion of the bacterium. This ulcer usually heals spontaneously in 10-14 days. During this period, the patient is highly contagious.
Secondary Syphilis: Flu-like symptoms such as headache, sore throat, fever, muscle pain and loss of appetite and lymphadenopathy occur 2-10 weeks after the ulcer, due to the spread of the bacteria through the blood. Widespread skin rashes (roseola) occur all over the body, including the palms and soles. During this period, kidney, liver, central nervous system, bones and cartilages may also be involved.
Latent Period: There are no signs and symptoms in this period; only serological tests are positive. This situation can last for years.
Late Syphilis: Many organs and tissues may be involved in the last period. Serious disease manifestations occur in the cardiovascular system and central nervous system. One of the most important among these is aortic aneurysm and rupture. During this period, swellings called “gom” occur in many organs, especially in the skin and bones. During this period, the patient is not contagious.
As with many sexually transmitted infections, syphilis is transmitted from mother to baby. This condition is called congenital syphilis.
The diagnosis of syphilis is made with serological-based nontreponemal (RPR, VDRL) and treponemal (FTA-ABS, TPHA) tests. Nontreponemal tests become positive 7-10 days after the appearance of the skin ulcer. It is not useful in the advanced stages of the disease. In addition, these tests are used to monitor treatment success. Positive treponemal tests can be detected in the second week of the disease. It remains positive for life, albeit at a low titer. These tests are used to confirm the diagnosis if the screening with nontreponemal tests is positive.
Penicillin is the first choice for treatment. Avoiding sexual intercourse during treatment or using condoms during sexual intercourse is the safest way to avoid this disease.
MYCOPLASMA AND UROPLASMA INFECTION
Mycoplasma and Uroplasmas are one of the causative agents of nongonococcal urethritis in adults. These microorganisms also cause diseases such as endometritis, pelvic inflammatory disease and pyelonephritis. However, these microorganisms are known as opportunistic pathogens due to their high percentage of normal flora elements in the genital area. However, especially M. hominis and U. urealyticum infections are still a serious problem. These bacteria cause sexually active individuals to colonize each other by infecting each other and then cause infection. Culture is not a preferred method in diagnosis. Today, indirect fluorescence and PCR methods are frequently used. Tetracycline is used in the treatment of mycoplasmas, and erythromycin is used in uroplasmas.
GENITAL HERPES (HERPES SIMPLEX VIRUS)
Genital herpes is usually caused by Herpes Simplex Virus Type-2. It is an infection that occurs in the penis in men and in the vagina and external genitalia in women. Sometimes it can be completely asymptomatic. This makes it easier for the disease to be transmitted to sexual partners. In symptomatic cases, the disease occurs 2-20 days after exposure.
The first symptom of the disease is usually a tingling, itching or burning sensation in the area where the herpes will originate. Later, that area becomes red and many vesicles appear on it. The vesicles then turn into ulcers. Ulcers are very painful. Patients may also experience symptoms such as fever, fatigue, muscle pain, and inguinal lymphadenopathy. Ulcers heal by crusting within 5-10 days. Genital ulcers may be accompanied by a feeling of fullness in the abdomen, groin pain, burning during urination (especially in women), and discharge from the genitals.
After primary infection, the herpes virus may remain latent in the nerve ganglia, reappear from time to time, and reappear in the same body area. How often the disease will recur varies from person to person.
Antigen search and nucleic acid tests are used in diagnosis. There is no definitive treatment. However, with antiviral drugs, it can be ensured that the symptoms heal faster and the contagion lasts shorter.
GENITAL WARTS (HUMAN PAPILLOM VIRUS)
HPV, which is an infectious agent in humans, is a common sexually transmitted infection agent. It causes various lesions on the skin and mucous membranes and uterine cervical cancer.
The virus can be transmitted indirectly through contaminated surfaces, items such as towels, or directly through cracks in the skin and mucous membranes. It can be transmitted to partners during sexual intercourse or to babies born through an infected birth canal. Having sexual intercourse with more than one partner or having a history of intercourse with multiple partners is a risk factor for HPV infection. HPV infections are common in sexually active women aged 18-30 years. The incidence of cervical cancer increases after the age of 35.
While the incubation period is 1-2 months in some HPV types, it may take years in some HPV types. Symptoms may appear after a few months, sometimes several years after infection. In fact, sometimes the virus can remain in the body for years without any symptoms.
The clinical manifestations of HPV infections vary. Infections can sometimes be asymptomatic and benign, but sometimes recurring and resistant to treatment. Some of these can turn into cancer. The variable clinical picture varies depending on the type of virus, the location of the lesion, and the immunity of the individual.
Genital warts may appear as soft, flat, raised or sometimes cauliflower-shaped flesh-colored warts. Warts may appear weeks or months after sexual intercourse with an infected individual. HPV infections in the genital area vary depending on the person’s immune response and HPV type:
1. Some of the infections with low-risk HPV types are inactive. Findings suggestive of infection rarely occur here.
2. Often, low-risk HPV types are observed in the form of warts around the anus and in the external genital area, which occurs in men and women. These lesions may regress spontaneously in 3-4 months or may sometimes increase in number and size.
Active HPV infections in the genital area are often caused by high-risk types. Lesions are seen in the areas around the external genitalia and anus. Its causative agent is HPV types 16 and 18. These lesions cause cancer formation in the future. Regular and routine Pap smears in women can prevent cervical cancer or provide early treatment.
Nucleic acid tests (PCR) in which HPV types are determined are used for diagnosis. There is no effective treatment for the disease. Even if warts are removed with processes called freezing or burning, the disease may recur. The easy recognition of genital warts by clinical appearance requires people with this disease to inform them about STIs and condom use.
AIDS (HIV)
HIV is a virus that attacks cells of the immune system and destroys immune cells. There are two types of HIV. HIV-1 is responsible for the vast majority of infections and AIDS cases in the world. HIV-2 is more common in West Africa. The virus gradually destroys the immune system of the infected person over many years, weakening it so that it cannot fight the disease. Symptoms or illnesses related to HIV may not appear for many years after exposure. Most people can lead many years of healthy life after being infected with HIV. However, even if the person feels well, they can transmit the disease to others.
Sexual intercourse, parenteral transmission and mother-to-child transmission are the main transmission routes of infection. Sexual intercourse is the leading mode of transmission of the disease with a rate of 75% worldwide. The virus enters the recipient’s body through cracks in the rectal or oral mucosa or by direct contact with cells on the mucosal surface. Contamination with blood and blood products has decreased a lot with the precautions taken today. HIV infection is not transmitted through social interactions at home, at school or at work.
People with HIV may not develop symptoms or clinical signs for years, and these people may transmit the virus to their environment without even knowing that they are infected. Early identification of the infection and taking the necessary precautions are extremely important in terms of individual and public health.
HIV infection follows a 3-stage course:
Acute HIV infection: 2-4 weeks after the virus enters the body, flu-like symptoms such as fever, sore throat, headache, enlarged lymph nodes, rash, nausea, vomiting, diarrhea, muscle and joint pain can be seen. During this period, a large amount of virus is produced. The most contagious period of the patient is the acute infection period. During this period, which can last for several weeks, it may not be possible to diagnose with standard antibody screening tests. Since antibodies are not yet formed in this early period, the diagnosis can only be made by looking at HIV-RNA or p24 antigen positivity.
Quiet (asymptomatic) period: After the acute infection period has passed, the virus can be transmitted in the body for an average of 8-10 years without causing any complaints. During this period, there is a virus in the blood and patients are contagious. Enlargements in lymph nodes can be seen at this stage. The asymptomatic period can last as short as a few years or much longer than 10 years.
Advanced stage (AIDS): The most advanced stage of HIV infection is called AIDS. As a result of HIV infection that lasts for many years, the immune system is destroyed. Patients who have not received any treatment until this period lose all their resistance against infections and cancers during this period. The picture of AIDS emerges with opportunistic infections and cancers.
About 7-10 days after HIV infection, HIV RNA first appears and can be detected by PCR testing in this person. However, the diagnosis of HIV/AIDS is often made with blood tests that look for antibodies that develop in the body against the virus that causes the disease, or antigens that are part of the virus together with the antibodies. The immune system starts to develop antibodies against the virus 3-8 weeks after the virus enters the body. Antibodies are formed in 97% of patients within the first 3 months after exposure to the virus. Very rarely, it may take up to 6 months for antibodies to develop against the virus. 3rd generation ELISA tests that detect these antibodies can be used. However, tests that search for the p24 antigen and the antibody together start to become positive earlier than the tests that search for the antibody alone. With these tests, a positive test result can be obtained from the 3rd week after infection. For this reason, the 4th generation test (Combo Test), which detects both HIV-specific antibodies and p24 antigen simultaneously, is more frequently used.
HEPATITIS B INFECTION
Hepatitis B is one of the most common STIs that cause systemic infection in men and women, tend to become chronic. HBV infection can be transmitted through blood and blood products, sexual intercourse and close contact. Acute hepatitis B has an incubation period of 4-12 weeks. Although only 25% of people infected with HBV have symptoms such as weakness, fever, loss of appetite, abdominal pain, nausea, vomiting, jaundice, darkening of urine color, arthralgia, and rash, most of the patients do not have any symptoms. Tenderness in the right upper quadrant of the abdomen, hepatomegaly, splenomegaly, and icterus in the sclera and/or skin may be detected. During this period, a significant elevation in transaminases (ALT) is detected.
It is a hepatitis B vaccine. Therefore, one of the most important means of prevention is active immunization. In our country, the hepatitis B vaccine is administered to newborn babies as part of the routine vaccination program. According to the results of HbsAg, anti-HBc and anti-HBs examinations, hepatitis B vaccine can be administered to people with risky behavior in terms of sexually transmitted infections.
HEPATITIS C INFECTION
The main mode of transmission of HCV is parenteral. However, although rare, transmission can also be seen through high-risk sexual behaviors. The incubation period is 6-8 weeks. Infection is often passed without any symptoms. In cases recovering from acute illness, the virus is cleared from the body. However, 50-80% of hepatitis C becomes chronic. The only symptom in chronic patients is fatigue. Anti-HCV is tested in patients with chronic HCV. In cases with positive anti-HCV, HCV-RNA should be checked to identify active or past infection. There is no vaccine for HCV that can be used for protection.