For Some STDs, the Numbers Are Still Increasing

Sexually transmitted diseases (STDs) affect millions of men and women each year. Many of these STDs initially cause no symptoms, especially in women. Also, health problems caused by STDs tend to be more severe for women than for men.

In the US, overall incidence of STDs has increased dramatically in recent years, and adds an estimated $13 billion dollars to the nation's healthcare costs each year. The US Centers for Disease Control and Prevention (CDC) estimates that 19 million new infections occur each year, almost half of them among young people ages 15 to 24.

Tyshunda Manning, MD, Assistant Professor of Obstetrics and Gynecology at the Medical College of Wisconsin, practices at the Lincoln Avenue Clinic. The conditions she sees most often in patients are genital herpes, genital warts (HPV), and chlamydia, addressed in the HealthLink article STD Prevention, Part 1: Get to Know Your Partner.

In addition to these three common STDs, Dr. Manning says that gonorrhea, syphilis, and hepatitis are still of concern, and HIV/AIDS continues to be a global threat.

Gonorrhea Can Lead to Long-Term Complications
Approximately 1-1/2 million cases of gonorrhea occur each year in the US. The most common symptoms of gonorrhea are a discharge from the vagina or penis and painful or difficult urination. The most common and serious complications occur in women and, as with chlamydial infection, these complications include Pelvic Inflammatory Disease (PID), ectopic pregnancy, and infertility.

Gonorrhea can grow in the cervix, uterus, and fallopian tubes in women, and in the urethra in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus. If it spreads to the blood or joints, it can be life threatening. In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS.

Several antibiotics can successfully cure gonorrhea in adolescents and adults. However, drug-resistant strains of gonorrhea are increasing in many areas of the world, including the United States, and successful treatment of gonorrhea is becoming more difficult. New antibiotics or combinations of drugs must be used to treat these resistant strains.

Syphilis Cases on the Rise
Syphilis has increased dramatically in recent years, with more than 33,401 new cases in 2004. Syphilis is passed from person to person through direct contact with a syphilis sore. The first symptoms of syphilis may go undetected because they are very mild and disappear spontaneously.

The initial symptom is a chancre, a painless open sore that usually appears on the penis or around or in the vagina. It can also occur near the mouth, anus, or on the hands. Transmission of the organism occurs during vaginal, anal, or oral sex.

If untreated, syphilis may go on to more advanced stages, including a transient rash and, eventually, can cause serious involvement of the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Chancres caused by syphilis make it easier to transmit and acquire HIV infection sexually. The full course of the disease can take years.

Penicillin remains the most effective drug to treat people with syphilis.

Disturbing Trend in HIV/AIDS
AIDS (acquired immunodeficiency syndrome) is caused by the human immunodeficiency virus (HIV), a virus that destroys the body's ability to fight off infection. People who have AIDS are very susceptible to many life-threatening diseases, called opportunistic infections, and to certain forms of cancer. Transmission of the virus primarily occurs during sexual activity and by sharing of needles used to inject intravenous drugs.

AIDS was first reported in the United States in 1981. Since the beginning of the epidemic, an estimated 944,306 people have developed AIDS in the United States.

HIV/AIDS is ravaging certain segments of the US population. In, fact, notes Dr Manning, "In 2004 (the most recent year for which data are available), HIV infection was the leading cause of death for African American women between 25 and 34 years old."

Hepatitis
Some types of hepatitis can be sexually transmitted. Although US rates of infection with hepatitis A, B, and C viruses have fallen to historic lows, the disease is still a concern.

Hepatitis is a swelling of the liver that makes it stop working properly. It can lead to scarring of the liver (cirrhosis) or cancer. Acute viral hepatitis is a short-term infection. Chronic viral hepatitis is a longer lasting, and generally life-long, viral infection. To determine whether a patient has acute or chronic hepatitis, physicians perform an evaluation that includes blood tests.

Rarely, other types of hepatitis, such as Hepatitis A, can be spread through sexual contact. At present, there are no specific treatments for the acute symptoms of viral hepatitis. Doctors recommend bed rest, a healthy diet, and avoidance of alcoholic beverages. A genetically-engineered form of a naturally occurring protein, interferon alpha, is sometimes used to treat people with chronic hepatitis B and C.

Some people with viral hepatitis have no signs of the infection. For other people, symptoms can include:

• Low-grade fever
• Headache
• Muscle aches
• Tiredness
• Loss of appetite
• Nausea
• Vomiting
• Diarrhea
• Dark-colored urine and pale bowel movements
• Stomach pain
• Jaundice, in which indicated by yellowing of skin and eyes

Of approximately 200,000 new HBV infections in the United States each year, approximately half are transmitted through sexual intercourse.

There is a vaccine for HBV, which requires three injections. Infants should get the vaccine, but older children and adults can get it as well. People who are traveling to countries where Hepatitis B is common should also receive the vaccine.

Hepatitis C is caused by the hepatitis C virus (HCV). HCV is spread primarily by direct contact with human blood, including sharing of needles for injection drug use and sex with someone with HCV. There is no vaccine to prevent hepatitis C.

For more information about hepatitis C, see the HealthLink article Hepatitis C Treatment is Slowly Improving the Odds.

Hepatitis D is caused by the hepatitis D virus (HDV), a defective virus that needs the hepatitis B virus to exist. HDV is found in the blood of persons infected with the virus. Infection occurs when blood from an infected person enters the body of a person who is not immune. Hepatitis B vaccine should be given to prevent HBV/HDV co-infection.

STDs and Pregnancy
Several STDs can be spread to a fetus or newborn baby. Some, like syphilis, cross the placenta and infect the fetus while it is in the uterus. Others, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can be passed from the mother to the newborn during delivery.

HIV/AIDS can cross the placenta during pregnancy, and infect the baby during delivery as well. However, Dr. Manning says, "If the mother is on antiviral medication throughout her pregnancy and delivery, the chance for transmission is only about 1%."

Chlamydia, gonorrhea, and syphilis can be treated with antibiotics during pregnancy, but there is no cure for viral STDs, such as genital herpes and HIV. For women who have active genital herpes lesions at the time of delivery, a cesarean delivery (C-section) can be performed to protect the newborn against infection. C-section is also an option for some HIV-infected women.

Women who are pregnant or planning to become pregnant should speak with their physician about testing for STDs, and treatment if necessary.

Screening, Early Treatment Recommended
Dr. Manning highly recommends regular screening for STDs. "Sexually active women under the age of 25, pregnant women, and women who have more than one sexual partner a year should have an annual screening for chlamydia," she says. "And the CDC recommends that everyone be tested for HIV at least once." Another HIV test should be performed each time a risk factor is added, she says. These include having a new sexual partner; injecting drugs with a shared needle; and having unprotected vaginal, anal, or oral sex with men who have sex with men, multiple partners, or anonymous partners.

Dr. Manning says that many STDs are treatable or curable. "Early detection and treatment can lead to fewer long-term consequences," she says. But prevention is of primary concern. Her recommendation: "Use condoms consistently for each and every sexual act."

P. J. Early
HealthLink Contributing Writer

This article includes information from The US Centers for Disease Control and Prevention (CDC), the National Institutes of Health, the United States Department of Health & Human Services, and the National Institute of Diabetes and Digestive and Kidney Diseases.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.