Medical data regarding STI

SEXUALLY TRANSMITTED INFECTIONS (STI)

Sexually transmitted infections are the most common communicable infections in the world and this is unlikely to change because the rate of increase in the spread of these diseases, at the bacteriologist's bench, is truly frightening. The World Health Organisation estimated, some 30 years ago, that cases of gonorrhoea exceeded 250 million and over 50 million with syphilis. Regrettably the UK contributes to these vast numbers by an ever rising tide of STD.

These infections so readily spread by seemingly unrestrained human activity are a truly global challenge and of great medical concern. The rising incidence of Gonorrhoea can be linked to the penicillin resistance problem in the 1950's and 1960's. Between 2002 and 2003 new episodes of sexually transmitted infections seen in Genito-Urinary Medicine clinics in England, Wales and Northern Ireland increased from 1.5 million to 2.1 million.

This subject excites endless interest yet the unrelenting rise in the year on year national statistics suggest more of a participatory fascination rather than stunned incomprehension. Whereas such statistics are perhaps unfairly associated with uninformed youth there are surprising figures in other age groups which, literally, produce uncomfortable reading.

Much medical interest and energy is expended to influence better health by encouraging lifestyle changes in the field of acquired heart disease, cancer and other diseases. Whereas the desire to avoid acquiring any form of cancer appears to have captured public imagination the multi-faceted and trickier heart disease requires foregoing certain pleasurable activities such as smoking, avoiding exercise and a threatening diet. It should not surprise us therefore that health professionals working to reduce such STI statistics find the inertia for change in the field of human sexuality a daunting task. So it is that disease statistics continue to rise alarmingly.

What is surprising is that STI figures are not exclusively a youth related issue. Statistics in the UK from 2002 - 2006 showed a rise of 50% for Chlamydia and 139% rise in Syphilis for the 45 - 65 years age group and, for the same groups, elsewhere across the globe, increases of much the same order are being recorded. It is extraordinary that after a near lifetime's experience people in these age groups have yet to grasp the simple message that 'prevention is better than cure'. Sexual abstinence does not appear to be an option. These statistics point to the fact that the humble condom - which can help prevent and limit the spread of these infections - remains unused and points to a feckless attitude in modern Britain, where even basic precautions are not heeded yet the same medical advice remains clear; avoid casual sexual contacts and always use a condom.

Genito Urinary Medicine (GUM) Clinics specialising in these diseases are under such immense pressure that many of them are quite unable to cope. These clinics are usually found within a major hospital and are completely confidential - even the GP will not be informed without the patient's consent. It is even possible to attend anonymously.

Twenty years ago Syphilis was almost eradicated in the UK but now it has increased in a truly alarming fashion. In the years 1995 - 1999 Chlamydia increased by 76%, Gonorrhoea by 55% and Syphilis by 54%. In the year 1999 - 2000 Gonorrhoea in men increased by 29% and in women by 24%. In homosexual men it increased by 45%. In the same period Chlamydia in men increased by 19% and in women by 17%. In homosexual men the increase was 36%. In 2003 Chlamydia rose again by 18%, the rise in Syphilis cases increased by 55% and Gonorrhoea by 27%. From the example of WHO figures much of these increased numbers are on a very high baseline.

There is no greater testament to the necessity for adjusting collective lifestyle than such figures. Much of the increase may be explained in the process of successful or unsuccessful contact chasing and subsequent treatment to ensure elimination of infection. In the case of Gonorrhoea, and certainly through the 1970's and thereafter, strains of the infecting organism showed an evident increase in resistance to penicillin making treatment ever more difficult to manage for both doctor and patient.

It must also be remembered that Syphilis can produce long term health consequences and Chlamydia can produce loss of fertility and is also linked to cervical cancer.

Modern achievements in human ingenuity barely begin to rival the complex mechanisms employed by disease causing bacteria and viruses. They produce poisons which can damage the host's immune system, they also produce enzymes that can partly inactivate the immune system and their enzymes can also neutralise or destroy some of the sophisticated drugs used against them.

Medicine; the art and science given to adjusting human biology to counteract the effect of disease, operates in a scene of controlled scientific risk. However, seen through the prism of medical idealism much of our current social behaviour unwittingly neutralises medical achievements and makes us all poorer for it. Such an example is in the field of human sexuality where as infection rates soar more infection requires more treatment, and more treatment means more widespread exposure of current antibiotics with the inevitability of their activity being reduced by bacteria becoming resistant to their action. This compromises the care of more deserving medical and surgical cases and destroys the value of such drugs. Thus we are all losers. We are all aware of how our hospitals are involved in dealing with resistant strains of C. difficile, E. coli and MRSA. It will be a crisis indeed if the organisms associated with STI ever reaches similar levels of resistance making any kind of treatment useless.

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Some of the more common forms of STI are;

Gonorrhoea.
Caused by the organism Neisseria gonorrhoeae.

In men. The incubation period is from 2 - 10 days and onset of infection is heralded by a tingling sensation in the urethra - the tube that carries urine from the bladder and out through the penis - and a few hours later by painful urination and the appearance of infected cells in the urine; an infected discharge. The urethra is highly sensitive and the discomfort of urination in this infection is described as 'exquisite'. The fact that medical advice to 'drink plenty of fluids' - to dilute the organism cluster - only adds to the urination discomfort and is of little comfort in the treatment process. Local inflammation in the penis will make the experience equally memorable. This whole experience is best avoided.

In women. The infection is largely without symptoms but if these are present will be noticed within 7 to 21 days after infection. Symptoms, when they appear, are usually trivial but can sometimes be severe with painful urination, frequency and vaginal discharge. Longer term complications are a loss of fertility and even ectopic pregnancy. The whole reproductive area can become involved with infection.

In both sexes rectal gonorrhoea is quite common and this can be symptomless in men.

Syphilis.
Caused by a special type of organism with a spiral shape (spirochete) Treponema pallidum.

The incubation period is from a few days to three months. It is a complex disease characterised by periods of active appearance and by years of subdued and symptomless quiet. It can affect any tissue or organ in the body and be passed from an expectant mother to her unborn child.
At the site of infection the primary chancre develops as a red papule which soon erodes forming a painless ulcer. Most of these occur in the genital area in both sexes. Depending on the type of individual activity these can occur on lips, tongue, fingers and tonsils.
The danger of syphilis for individuals is that the symptoms are not very specific and can be easily ignored or overlooked. The reality is that the disease is long lasting and it is absolutely essential that specialist treatment is obtained to achieve correct diagnosis and eradication of the disease. Left untreated in the longer term it can eventually affect the heart or brain which can prove fatal.
Chlamydia.
Caused by the bacteria Chlamydia trachomatis.
Many infections with chlamydia are undiagnosed because the infection is of a low grade character with weak symptoms - usually of low grade abdominal discomfort - and can therefore be easily overlooked or ignored.
It can however cause bleeding and discharge from the vagina with abdominal pain and a fever. Inflammation of the cervix is also involved.
In the male it can produce a watery or milky discharge from the penis, and this can be accompanied by swollen or tender testicles. As can be expected, very uncomfortable burning pain on urination is a usual feature of a urinary infection.
Longer term complications can be particularly severe in the female where it can lead to the condition of pelvic inflammatory disease. This can produce ectopic pregnancy and infertility. Of children born to infected women some 20% - 50% will carry the infection. Moreover, chlamydia is the principal cause of neonatal conjunctivitis in babies and this is a cause of blindness.
Currently antibiotic treatment is available and successful.
Genital Warts: Genital warts are caused by a papilloma virus, usually transmitted sexually and are often the result of poor personal hygiene. They have an incubation period of from 1 - 6 months and occur mostly on warm, moist surfaces in the genital area.
Genital warts usually appear as soft, moist, pink or red minute swellings which grow rapidly and become longer in shape. Several may be found in the same area of skin often producing a cauliflower type of appearance. Treatment is available with a podophyllum preparation in a spirit base.

Genital herpes
Infection of the genital skin area with herpes simplex virus Type 1 or Type 2.
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This disease has been increasing in frequency and has been one of the most common causes of genital ulceration. It is moderately contagious and usually spread in direct contact with an infected person during intercourse. The ulcers (blister like in initial appearance) are painful. The ulcer frequently develops 4 to 7 days after infective contact and the condition tends to relapse. Because of this it is well recognised that a carrier state exists.

This condition has been linked to cancer of the cervix and in pregnancy can be dangerous to the baby during delivery. It is a long term condition without cure but some antiviral drugs can be used to reduce severity of the symptoms.

Type 1 is associated with oral sex and Type 2 associated with sexual intercourse.

STI is a specialist area of medicine and possible infection should be taken very seriously indeed. They can be acutely painful, uncomfortable and worrying. It appears to be a weakness in the human condition that to trade the safety of the humble condom for a share in the risk of one of these diseases requires a special kind of logic. There can be no question that in every case of risk of STI personal protection is a practical imperative.