Everything you need to know about sexually transmitted diseases

In this article, we give you answers to all the questions that, surely on more than one occasion, you have asked yourself about sexually transmitted diseases or infections.

What are sexually transmitted diseases?

Sexually transmitted diseases (STDs) are transmitted from person to person through sexual intercourse. The agents that transmit these diseases include various bacteria, viruses, fungi, etc….

STDs are a major public health problem, both because of the burden of disease they generate and because of the complications and sequelae they cause if they are not diagnosed and treated early. Additionally, STDs become relevant because they increase the risk of acquiring and transmitting HIV infection.

Among the most frequent sexually transmitted infections are: human papillomavirus (HPV) infection, genital herpes, gonorrhea, syphilis, Chlamydia infection, HIV and hepatitis B.

STDs presenting with urethral syndrome

What is gonorrhea? How can it be acquired?

Gonorrhea is a sexually transmitted disease caused by a bacterium (Neisseria gonorrhoeae) that multiplies and grows in the moist areas of the reproductive tract. It can also grow in other moist areas of the body such as the mouth and throat.

It usually results in purulent urethral discharge, often associated with voiding discomfort. It is one of the most frequent causes of infectious urethritis in man and its treatment is relatively simple, usually consisting of the administration of a single dose of antibiotic (intramuscular ceftriaxone).

Can gonorrhea have complications?

One of the most important complications of urethritis in males is epididymitis and/or orchitis (inflammation of the epididymis and testicles), although these are infrequent (less than 3%). Epididymo-orchitis in men under 35 years of age is usually due to sexual transmission (usually by N. gonorrhoeae and/or C. trachomatis), unlike those affecting older men, which are often caused by germs that produce urinary tract infections.

Also, although it occurs infrequently, hematogenous spread from infected mucous membranes can occur, resulting in arthralgias, arthritis and tenosynovitis (Reiter’s syndrome).

Can I have urethritis that is not gonococcal?

Indeed, there are many other microorganisms capable of generating infectious urethritis besides Gonococcus, the main ones being Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma genitalium and Trichomonas vaginalis, easily identifiable through specific microbiological tests. Urethritis caused by these microorganisms usually cause a mucoid urethral discharge of less intensity, unlike what happens with Gonococcus that results in a whitish-purulent discharge. These germs respond very well to oral antibiotics such as azithromycin or doxycycline.

Can all these microorganisms affect women as well?

Chlamydia and Gonococcus can cause cervicitis and pelvic inflammatory disease in women, with consequent reproductive sequelae if not treated early.

Chlamydial cervicitis in women may be asymptomatic in 70% of cases, constituting the most frequent cause of sexually transmitted disease in this group. When it produces symptoms, they are characterized by scanty mucopurulent cervical discharge, lower abdominal pain, pain during sexual intercourse or scanty bleeding. Chlamydia can ascend via the canalicular route, producing endometritis, salpingitis and pelviperitonitis, being a frequent cause of pelvic inflammatory disease.

STDs leading to genital ulcers

What are the symptoms of syphilis?

Syphilis is a sexually transmitted disease widely distributed in the world. It is caused by a bacterium (Treponema pallidum) that is spread by direct contact with a syphilitic ulcer through vaginal, oral and anal intercourse.

Syphilis is a disease that manifests itself in several stages:

The primary phase begins approximately three weeks after infection and consists of the appearance of an ulcer with indurated edges and progressive growth (the so-called “syphilitic chancre”) generally located in the genital area.

The secondary phase begins after the disappearance of the chancre, and is composed of a wide spectrum of symptoms, including generalized skin lesions with palmo-plantar involvement, mowed prairie tongue, hair loss following a moth-eaten morphology and the appearance of characteristic genital lesions called condyloma plana.

If syphilis is not identified and treated in any of the previous stages, the symptoms will progressively disappear and the so-called latency phase will be reached, in which patients are still infected with syphilis but can only be diagnosed by means of a specific laboratory test because they are asymptomatic.

What if I have had syphilis for a long time and I don’t know it?

Usually nothing. It is possible for a routine examination to detect a positive serology for syphilis without you remember having any symptoms. This is usually due to previous unprotected sexual intercourse. If you are not aware of which sexual contact may have been responsible for the infection, you would be in what we call late latency phase, i.e., you have been infected for probably more than a year and the infection is not generating symptoms. With three injections of penicillin-benzathine you will be cured.

However, those with undiagnosed, untreated syphilis of many years’ duration may enter a phase called late syphilis, which can involve severe long-term vascular and neurological complications.

It is therefore very important to have routine check-ups to rule out the most common STDs in case you have had unsafe sex.

In addition, syphilis is associated with an increased risk of acquiring and transmitting HIV, and HIV infection alters the course of syphilis by increasing its progression.

Can syphilis be easily treated?

Yes, and it is a disease that, if diagnosed and treated early, has no complications.

The treatment of choice is the administration of intramuscular penicillin G (a single dose in early syphilis, and three doses in late syphilis). In patients allergic to penicillin, doxycycline or tetracycline should be administered. Treated patients should undergo subsequent follow-up to confirm that the response to treatment is adequate and that there is no reinfection.

What other STDs can cause genital ulcers?

There are other STDs that can cause genital ulcers in addition to syphilis. The dermatologist is usually able to differentiate the most frequent causes of genital ulcers using clinical criteria and complementary tests if necessary.

These include genital herpes, chancroid, lymphogranuloma venereum and donovaniosis, the last three being exceptional in our environment.

How do I know if I have genital herpes?

Genital herpes is a sexually transmitted disease caused by the simple virus HSV-1 and HSV-2, which results in the appearance of small vesicles on or around the genitals and rectum, which often rupture to form painful ulcers.

In many cases, the first time we come into contact with herpes simplex through sexual intercourse with an infected person, there are usually no symptoms (only in some cases the first infection is symptomatic). However, this virus has the capacity to enter a latency phase and reactivate in the future, leading to recurrences of lesser intensity. These recurrences are typical of the evolution of genital herpes. However, always consult your dermatologist to confirm the diagnosis.

How many recurrences per year will I have if I am infected with genital herpes?

The number of recurrences that each person will suffer will depend on a number of factors, the most important of which is the individual’s immune response to the presence of the virus. Ninety percent of patients present at least 1 episode, 38% present 6 or more episodes and 20% present more than 10 episodes a year after primary infection. The frequency and intensity is gradually reduced with or without suppressive treatment. The clinical lesions of recurrences usually have only local symptoms and are of shorter duration and intensity than the primary infection.

Immunosuppressed patients may develop chronic lesions characterized by genital ulcers of prolonged course.

Other sexually transmitted infections

What is human papillomavirus (HPV) and what problems can it cause?

HPV infection is a large family as there are more than 100 types of HPV, of which more than 30 are transmitted through sexual intercourse.

It is estimated that 75-80% of the population is infected with this virus. However, not all people who come into contact with the virus develop genital warts or condylomas, which is the most frequent manifestation of this virus. The appearance of these lesions and their severity will depend on several factors such as immunity and the amount of virus present in the infecting person. When they appear, condylomas are recognized as small, single or multiple, millimeter-sized brownish skin masses found on the genitals, perineum or around the anus (and more rarely in the mouth).

Most of the time these lesions are benign and easily treated by your dermatologist in a few sessions. However, some of these viruses have the capacity to cause cancer in the area where they are located (these are the so-called high-risk viruses). Within this group, there are some HPV types that are especially important since they have the ability to settle on a woman’s cervix and produce cervical cancer many years later (or anal-rectal cancer in men who have sex with men). To minimize this risk, it is sufficient to perform regular cytological controls in women with condylomata acuminata or whose partner has had them.

Is it true that Molluscum contagiosum can be sexually transmitted?

Molluscum contagiosum is a benign viral infection, caused by a poxvirus, which usually affects children between 2 and 5 years of age, reaching incidence rates of between 5 and 8% in developed countries. Transmission usually occurs by direct contact with lesions, self-inoculation or through utensils such as towels.

However, in sexually active adults they usually present as lesions on the pubis, abdomen, buttocks, genital skin, proximal thigh region, oral mucosa or perioral region. They account for 1-3% of diagnoses in STD units.

Are hepatitis A, B and C sexually transmitted infections?

Indeed, hepatitis A, B and C can be transmitted sexually, with varying degrees of effectiveness depending on the type of virus.

The hepatitis A virus is transmitted via the oral-fecal route and is usually acquired through the ingestion of contaminated food or water. However, it can be acquired through certain sexual practices, being more frequent in men who have sex with men.

Hepatitis B virus is highly infectious and is found in high concentrations in the blood of infected patients, with lower concentrations found in semen, vaginal exudate and saliva. Transmission is highly effective when the skin or mucosa of a healthy individual is exposed to the blood or blood-containing body fluids of an infected patient, with unprotected sex being one of the most important routes of transmission. Hepatitis B vaccination should be offered routinely to all unvaccinated individuals presenting with an STD.

The hepatitis C virus is transmitted mainly through blood. However, it can rarely be transmitted through sexual intercourse in high-risk groups (heterosexual patients with multiple sexual partners and men who have sex with men), especially if they have HIV infection.