Internal Medicine

STD - Sexually Transmitted Diseases

introduction

STD (for Sexually Transmitted Diseases) means translated "sexually transmitted diseases".
This means infectious diseases caused by bacteria, viruses, fungi and parasites and mainly transmitted through sexual contact.
The most common symptoms are pain in the lower abdomen and / or genital area, vaginal discharge, swelling of the inguinal lymph nodes, and ulceration.
However, since an infection can often remain asymptomatic for a long time, it is quickly resolved by unprotected sexual intercourse, i.e. by not using condoms.

Long-term non-treatment of STDs caused by certain pathogens can lead to the development of cancer.

causes

The underlying causes of sexually transmitted diseases are one or more infections caused by certain bacteria, viruses, fungi or parasites, which are mainly transmitted through unprotected sexual intercourse.
The risk is greatest with anal intercourse, then with vaginal intercourse and lowest with oral intercourse.
Infected people carry the pathogens in their body fluids such as semen, vaginal discharge and blood.
Since small tears in the mucous membrane very often occur during sexual intercourse, the pathogens can be transmitted in this way.

Other risk factors are frequently changing sexual partners, failure to treat the partner in the event of illness or, rarely, excessive vaginal hygiene.
The latter disturbs the environment of the vaginal mucosa and irritates it, which means that pathogens can penetrate better and multiply.

These symptoms can be used to identify an STD

If you have become infected with sexually transmitted pathogens, it can take a few days to weeks, depending on the pathogen, before the first symptoms appear.
In some people affected, there are even no symptoms at all; this is called “asymptomatic”.
Symptoms can only manifest themselves for the first time a few years after the infection, which is why the treatment of the partner is a very important aspect in the treatment of an STD.
Only when a clinical picture is present, one speaks of a sexually transmitted disease, until then one speaks of a sexually transmitted infection (STI).

Regardless of the pathogen, the most common symptoms that can occur as part of an STD are:

Pain in the lower abdomen and / or genital area,
Discharge from the vagina,
Swelling of the inguinal lymph nodes,
Ulcerations;

In addition to these symptoms, pathogen-specific symptoms can also occur.
Genital herpes can develop in the case of illness with the herpes simplex virus 1/2 (HSV).
So-called genital warts in the anogenital area are typical of the human papillomavirus.

The most common pathogens with their typical clinical pictures are listed below.

Viral pathogens:

Herpes Simplex Virus 1/2 (HSV): Genital herpes, mostly from HSV-2
Human papillomavirus (HPV): genital warts in the anogenital area; less often papillomas in the larynx
Hepatitis B: no local changes in the genital area
Human immunodeficiency virus (HIV): no local changes in the genital area

Bacterial pathogens:

Treponema pallidum (causative agent of syphilis): hard ulcer (“hard chancre”) in the genital area, usually not painful; weeping papules in the anogenital area
Gardnerella vaginalis: causes vaginosis, most of which is not clinical but causes symptoms such as itching, painful urination and typical vaginal discharge
Neisseria Ghonorrhoeae (“gonorrhea”): causes gonorrhea; Men often have urethritis with itching and painful urination; Women are more likely to be symptomless
Haemophilus ducreyi: soft, painful ulcer (“soft chancre”) in the genital area
Chlamydia trachomatis (D-K): causes the urogenital chlamydial infection: urethritis, epididymitis, inflammation of the prostate, inflammation of the vagina, ovaries, fallopian tubes, cervical inflammation
Chlamydia trachomatis (L1-L3): first painless ulcers, then painful lymph nodes in the groin area

Mushrooms:

Candida albicans: causes vaginal candidiasis with redness, itching, pain when urinating and during sexual intercourse

Parasites:

Trichomonas vaginalis: redness and blisters in the labia and vagina, itching and pain when urinating and during sexual intercourse, typical discharge

How contagious is that?

How contagious an infection with a pathogen through sexual intercourse can be always depends on the pathogen and the viral load of the carrier.
The risk of infection is particularly high during unprotected sexual intercourse.
It is greatest in anal intercourse, followed by vaginal intercourse, and it is lowest in oral intercourse.

Since the pathogens are present in body fluids such as blood, semen and vaginal discharge, they are transmitted during sexual intercourse through the development of micro-injuries to the mucous membrane.

If the partner has tested positive for a pathogen, it is strongly recommended that the sexual partner (s) also be tested and, if necessary, treated as well.

Although the risk of transmission through condoms is nowhere near as high as in unprotected intercourse, one should still be very careful.
Contact with the skin not covered by the condom during sexual intercourse can also lead to the transmission of pathogens.

This is how the treatment is done

Treatment of sexually transmitted diseases depends on the type of pathogen present.
If the disease is a bacterial infection, it is treated with antibiotics.
Common antibiotics come from the classes of macrolides, fluoroquinolones, or cephalosporins.

However, if viruses are responsible for the disease, the doctor uses so-called antiviral drugs that fight these viruses.
Common antivirals include Acyclovir, valaciclovir, ganciclovir, and tenofovir.
These can also be applied locally in the form of ointments, e.g. if infected with the human papillomavirus.

The human immunodeficiency virus even requires a combination of certain antivirals, which is why the treatment is also called combined antiretroviral therapy (cART).
However, the HIV infection is still not curable.

In the case of an infection with the HP virus, the surgical removal of the genital warts is the focus of therapy.
Preventive vaccination against HPV can reduce the risk of developing the disease.

It is important to know that the earlier the disease is diagnosed and treated, the better the success rate of therapy for both bacteria and viruses.
Therefore, if there is a confirmed suspicion, it is strongly advised to also test the sexual partner (s) and possibly treat them as well.

Duration / forecast

The duration and prognosis of a sexually transmitted disease depends on the pathogen, the point in time at which therapy is started and the associated progression of the disease over time.
It goes without saying that early therapy also shortens the duration of the disease and improves the prognosis.

Unfortunately, this does not apply to all venereal diseases.
Even after early diagnosis and therapy, the HIV disease is still not curable today.
Syphilis can still be cured in the first two stages with timely therapy.
From the third stage onwards, irreparable damage to the brain and nervous system occurs.

If a disease of hepatitis B becomes chronic if treatment is not given early enough, it can end in cirrhosis of the liver.
Cirrhosis of the liver can then promote the development of liver cancer.

Course of disease

If you become infected with a pathogen through sexual intercourse, it can take a few days to weeks, depending on the pathogen, before symptoms appear.
Often, however, there are no symptoms either, so that an infection cannot be clinically recognized.
The affected person then carries the pathogen and is contagious.

If an infection is suspected, asymptomatic patients can also have themselves tested for pathogens and start therapy immediately.
Early therapy has a beneficial effect on the course of the disease and can prevent transmission to other sexual partners.
Diagnostics and therapy should be started at the latest when typical symptoms appear, as already listed under “These symptoms are used to identify an STD”.

For example, an untreated chlamydial infection can, in the worst case, lead to infertility. Furthermore, the risk of miscarriages and premature births increases if the disease breaks out during pregnancy.

In summary, the earlier therapy is started, the milder and shorter the course of the disease can be.
The incurable HIV disease can also be well controlled in this way, so that both the quality of life of the patient with the disease improves and life expectancy becomes almost normal.

diagnosis

STDs can most often be diagnosed by dermatologists, gynecologists, or urologists.

In addition to examining the genital area for typical local changes, as described above, the doctor can also take blood to check for certain antibodies.
Urine examinations can also reveal pathogens from the urethra.
There are also special tests for some sexually transmitted diseases, such as the HIV test, chlamydia test and HPV test.
The pathogens, their constituents or antibodies are determined by certain test procedures.
Smears or sample biopsies from affected organs can also be taken as part of this test procedure and examined for pathogens or their components or antibodies.