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Infection
Public
health
Venereal
disease
Sexually
transmitted diseases (or STDs) are a varied group of infections that
usually are passed from person to person by sexual contact. Some also
spread from mother to child during pregnancy or childbirth.
Widespread around the world, STDs are particularly common among
people in their teens and early twenties. STDs range in severity from
pubic lice, which usually cause only discomfort, to AIDS, which has
caused millions of deaths in a worldwide epidemic.
Sexual
contact between people is one important way that many diseasecausing
organisms spread. More than 30 bacterial, viral, and parasitic
diseases can pass from person to person in this way. For some of
these, sexual contact is the main route of transmission. These are
the illnesses we generally call sexually transmitted diseases (STDs).
Most STDs
primarily affect only the sexual organs and other parts of the
reproductive system. That is true of chlamydial (kla-MID-i-al)
infections, gonorrhea (gon-o-REE-a), genital herpes, genital warts,
and trichomoniasis (trik-o-mo-NY-a-sis). Other STDs may enter through
the sexual organs but affect other parts of the body. That is what
happens in AIDS and syphilis.
Besides
AIDS, some STDs can have serious complications, especially for women.
Chlamydia and gonorrhea often cause no symptoms in women (and
sometimes in men), which means they can easily go untreated. But
Sexually
transmitted diseases affect many different parts of the body.
Sexually
transmitted diseases affect many different parts of the body.
if that
happens, these infections sometimes develop into pelvic inflammatory
disease. That can lead to infertility, meaning a woman finds it
difficult or impossible to get pregnant. In addition, if women are
infected with certain strains of the human papillomavirus, a sexually
transmitted virus, they may run a higher risk of getting cancer of
the cervix, part of the female reproductive system.
If
syphilis goes untreated in men or women, it can cause fatal heart
problems, as well as blindness, deafness, and insanity, many years
later.
Are All
Infections of the Genital Tract Spread by
Sexual
Contact?
No. For
instance, yeast infections of the genital tract usually do not
involve sexual contact. Most often, the yeast (a kind of fungus)
spreads from a person's own skin or intestinal tract, where it does
no harm, into the person's genital tract, where it can cause
symptoms. So a person could get such an infection even if he or she
had never engaged in sexual activity. The most common of these yeast
infections is called candidiasis (can-di-DI-a-sis).
Who Is at
Risk for STDs?
Just about
anyone who has sexual contact with another person can get an STD.
People who are infected with one STD are likely to have other STDs as
well. Once cured, they also are at higher risk of getting infected
again.
STDs are
particularly common among young people, aged 15 to 24. Experts see
several reasons for this: Young people are less likely to be married,
so if they engage in sex, they may tend to have more sexual partners
than older people. Young people more often fail to use condoms during
sexual activity, even though condoms can protect a person from most
sexually transmitted diseases. Young people may be too embarrassed,
too short of money, or too worried about privacy to get regular
checkups or to get prompt medical treatment for STDs. As a result,
they may stay infected—and may be able to infect others—for
longer than necessary.
In
general, people run a higher than usual risk of getting infected if
they begin sexual activity at an early age, have a number of sexual
partners, do not always use condoms, and do not get regular medical
checkups. But even a person who has sex only one time, with only one
partner, can get an STD if his or her partner is infected. The only
clear way to prevent getting an STD is to abstain from sexual
activity.
How Do
STDs Spread?
People
with STDs often do not realize they are infected, and so they spread
the disease to others, including people they love most—wives,
husbands, and children.
Sexual
contacts
These
diseases can spread through sexual contact between people of the
opposite sex (heterosexual sex) or between people of the same sex
(homosexual sex). Sexual activities that can spread STDs include
sexual intercourse, anal sex, and oralgenital sex.
Other
routes of transmission
STDs also
sometimes spread in nonsexual ways. Many of them—including HIV,
gonorrhea, chlamydia, syphilis, and genital herpes—can be spread
from mother to baby during pregnancy or childbirth. HIV can also
spread through breastfeeding.
HIV, the
virus that causes AIDS, can spread if an infected person shares
needles, or if contaminated blood is given in a blood transfusion. In
the United States, strict testing has made blood transfusions
extremely safe, but the risk may be higher in some other countries.
STDs that
cause sores on the skin, such as genital herpes, syphilis, and
chancroid * , can spread sometimes if the sores touch another
person's skin. The sores also can serve as a way for HIV to enter the
body, making infection with the AIDS virus more likely. Preventing or
treating these sores is important in the prevention of AIDS.
Most STDs
cannot be spread by contact with an object, such as a toilet seat.
One exception is trichomoniasis, which is thought to spread sometimes
through towels or bathing suits recently used by an infected person.
What
Happens When People Get STDs?
Symptoms
Several of
the most common of these diseases—chlamydia, gonorrhea, and
trichomoniasis—can cause pain during urination and a pus-like
discharge from the sexual organs. In many cases, however, there are
no symptoms in these illnesses. Several other STDs cause sores or
blisters in the genital region. These include syphilis, genital
herpes, and chancroid. The symptoms of HIV/AIDS include getting
frequent fungal and parasitic infections.
Diagnosis
From the
symptoms and a look at any skin sores that may be present, a doctor
may suspect an STD. Tests of various kinds can usually tell for sure
which infection, if any, a person has.
Because
chlamydia and gonorrhea are very common in young women, but often
cause no symptoms and can lead to infertility, doctors recommend that
young women who engage in sexual activity get tested routinely for
these illnesses so they can be treated.
In
addition, anyone whose sexual partner has been diagnosed with an STD,
or whose partner has symptoms of an STD, should be tested and treated
if they are also infected.
How Are
STDs Treated?
STDs can
be divided into curable illnesses and illnesses that can be treated
but not cured.
Curable
illnesses
Curable
illnesses usually are caused by bacteria or parasites. These include
chlamydia, gonorrhea, syphilis, and chancroid, all caused by
bacteria, and trichomoniasis, caused by a parasite. These can be
cured with medication. Syphilis and gonorrhea, in fact, often can be
cured by a single swallow or shot of medicine.
*
chancroid (SHANG-kroid) is a bacterial infection that causes painful
sores in the genital region. Relatively rare in the United States, it
mostly occurs in tropical and subtropical areas.
Non-STDs:
A Matter of Definition
Many
infections can spread through sexual contact but usually spread in
other ways. These illnesses generally are not classified as sexually
transmitted diseases. They include:
Hepatitis B and cytomegalovirus, viruses that usually spread through
blood
Bacteria like salmonella, parasites like amebas, and the virus
Hepatitis A, all of which usually spread through water or food that
has been contaminated with feces from an infected person
Treatable
illnesses
Ilnesses
that are treatable, but not curable, usually are caused by viruses.
These include HIV/AIDS, genital herpes, and genital warts. These
cannot be cured with drugs, because the viruses remain in the body.
But, in most cases, medication or other treatment can reduce
symptoms. In the case of people with HIV infection, medication can
increase the life span and the quality of life.
How Can
STDs Be Prevented?
Abstinence
and safer sex
The only
sure way to avoid getting an STD is not to have sexual contact with
anyone (called abstention or abstinence).
For people
who do engage in sex, the safest relationship is when two people who
are not infected have sexual contact only with each other. The
problem is that it is impossible to know for sure whether someone is
infected or not. People may not always tell the truth about their
sexual behavior in the past—or they may mistakenly think they were
protected in the past. Many people with an STD do not know or believe
they have one.
That is
one reason why health officials recommend that people who engage in
sex always use latex condoms unless they are trying to get pregnant.
Using latex condoms can lower the risk of getting an STD, but the
condoms must be used properly, and they must be used every time a
person engages in sexual activity.
Education
and awareness
At the
public health level, education is an important part of preventing
STDs. Awareness about the need to prevent STDs has greatly increased
in recent decades, largely because of the emergence of AIDS.
Information about how to prevent STDs is now widely published in the
media and taught in schools. Young people are being urged to abstain
from sex or to use condoms if they are sexually active.
Contact
tracing
In
addition, when a person is diagnosed with an STD, doctors or health
officials try to locate the person's sexual partners so they can be
tested and treated. This kind of confidential "contact tracing"
is done without revealing the infected person's name. It prevents the
person's sexual contacts from unknowingly spreading the disease.
But the
only sure way to prevent getting an STD is to abstain from sex.
The U.S.
and the World
Sexually
transmitted diseases take a heavy toll throughout the world. By the
end of 1998, AIDS had killed almost 14 million people worldwide,
including more than 400,000 people in the United States. More than 33
million people were living with HIV infection, mostly in
underdeveloped countries in Africa and Asia.
While
other sexually transmitted diseases seldom cause death, they do cause
a heavy burden of illness. In 1995, the World Health Organization
estimated that 333 million new cases of curable STDs occurred. That
included:
89
million cases of chlamydial infection
62
million cases of gonorrhea
12
million cases of syphilis
170
million cases of trichomaniasis
Throughout
the world, including the United States, STDs tend to be more common
in urban, unmarried teenagers and in young adults.
In the
United States, it is estimated that most adults will be infected with
a sexually transmitted disease at some time, although they may not
know it. Some form of the human papillomavirus, for instance, infects
most Americans. Some strains of human papillomavirus cause genital
warts; others can promote cervical cancer. And more than 1 in 5
Americans is thought to be infected with the virus that causes
genital herpes.
Of the
bacterial STDs, chlamydia is the most common. It is estimated to
cause about 4 million cases a year in the United States, although
only about 10 percent of those get reported to health agencies. It is
thought that 1 in 10 adolescent women and 1 in 20 adult women of
child-bearing age are infected.
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