Sexually Transmitted Infections

Sexually Transmitted Infections

Sexually Transmitted Infections (STI) is the name now used to describe a group of infections previously referred to as venereal diseases (VD) or sexually transmitted diseases (STD). Primarily affecting the genital organs of the body, the organisms or germs causing these diseases are transmitted through "skin to skin" contact, ie, sexual intercourse or other intimate physical contact. Traditionally, only syphilis and gonorrhea were regarded as significant sexually transmitted infections, but it is now recognized that at least 20 different infections may be communicated this way, many exclusively, others only occasionally. The most common sexually transmitted infections in Canada include urethritis and cervicitis caused by either Chlamydia trachomatis or Neisseria gonorrhoeae, nongonococcal urethrits, mucopururlent cervicitis, syphilis, genital herpes, certain types of vaginal infections, human papilloma virus (HPV) infections including genital warts and infestations of pubic lice (also known as "crabs") and scabies.

Each STI is caused by a specific germ or organism. Although different in nature, most organisms can only survive in the environment of the areas of the body lined with mucous tissue, eg, the mouth, urethra, rectum or the vagina. Warmth and moisture must be present as well, to allow the organisms to multiply and produce an infection. Most germs rapidly die when removed from this environment; subsequently, they can only be transmitted when there is direct contact between an uninfected susceptible tissue and an infected one. The most common sites of infection are the cervix and vagina in women and the urethra in the male. In certain circumstances or as a result of some sexual practices, the throat, rectum and conjunctiva (eye) can also be infected.

STIs can affect anyone, regardless of age, sex, race or socioeconomic background. However, the highest incidence is among sexually active individuals from their middle teens to late twenties.

The symptoms and signs of sexually transmitted infections usually appear in or around the genital area. However, it is not uncommon to have a STI without noticing any symptoms. This is more common in women when symptoms of infection are often hidden and go unnoticed.

Although each infection produces a particular symptom, the same symptom may occur with different infections and may resemble symptoms produced by nonsexually transmitted infections. In a sexually active person a discharge of pus from the urinary opening, vagina or rectum, burning pain on urination, the appearance of blisters, growths or sores on or around the genital organs, or itching of the genital or pubic areas may signal infection. Depending upon the disease, this can lead to the development of serious complications of the reproductive organs such as pelvic inflammatory disease (PID), tubal (or ectopic) pregnancy, sterility and chronic pelvic pain. Unborn infants or infants born to mothers with untreated infection can be severely affected by STIs.

Most sexually transmitted infections can be detected and differentiated by laboratory testing using either swabs or blood tests. With the exception of genital herpes and genital warts (HPV), which are caused by viruses, STIs can be cured with appropriate antibiotics. However, this therapy, while curing the infection, may not reverse damage that has already occurred. Having a STI does not provide immunity against future infection should re-exposure occur.

The best protection against STIs is consistent safer sex and limiting the number of sexual partners. The only currently available vaccination against these infections is for HPV. Vaccination can provide protection against some HPV infections including those causing genital warts and some types of cervical cancer.

The real incidence of STIs in Canada can be attributed both to biological and social factors. Bacteria have the ability to become ANTIBIOTIC RESISTANT and in many cases asymptomatic infections prevent early detection. Although changes in attitudes towards acceptance of more permissive sexual behaviour have favoured the increase of opportunities for disease transmission, this openness has not been accompanied by similar attitudes toward diseases that may be acquired through sexual activity. This stigma attached to STIs results in widespread ignorance and fear and interferes with both medical and public recognition of the problems.

Each province has jurisdictional authority to establish public-health programs for the control of the notifiable STIs. Most programs make provisions for diagnostic and treatment centres for statistical data collection and for the promotion of education programs for the medical community and the public.

The concern about STI is international, and research is being conducted worldwide to gain a better understanding of the infections and the organisms causing them, to examine and identify patterns of incidence within given populations, to develop and explore the potential of new therapies, and to devise preventative measures such as vaccines. Canadian scientists are involved in many of the research studies both in Canada and internationally. Continued surveillance is essential to determine changes in the patterns of STI incidence, to apply new knowledge and technology, and to be alert to the emergence of new diseases, eg, lymphogranuloma venereum.

The existence of disease undermines the physical and emotional health and productivity of a nation. Sexually transmitted infections can only be controlled through the combined efforts of government, health-care professionals and the Canadian public.