Sexually Transmitted Infections: Causes, Symptoms, and Treatment
Sexually transmitted infections (STIs) remain a crucial public health issue for the U.S. Being on the rise, STIs undermine the nation’s well-being in diverse ways and cause long-term consequences if left untreated, and the existence of asymptomatic STI cases poses a challenge to their timely detection. This essay discusses the key epidemiological, symptom-related, and treatment-related facts for chlamydia infection, syphilis, herpes simplex virus-2, hepatitis B virus, and trichomoniasis and reflects on infection prevention and the stigma surrounding these conditions.
Caused by Chlamydia trachomatis, chlamydia is among the most common STIs globally. The infection is asymptomatic in 70-90% of cases (Centers for Disease Control and Prevention [CDC], 2021a). Depending on the infected region, chlamydia causes various objective signs, including frequent urination, pus in the urine, cervical excitation, bleeding from the rectum, or intermenstrual bleeding (CDC, 2021a). Common subjective symptoms are painful urination and scrotal, rectal, or vaginal pain. Regarding prevalence among U.S. citizens older than fifteen, the number of chlamydia cases exceeded 2.4 million in 2018 (CDC, 2021c). First-line treatment for the infection is one-week antibiotic therapy with doxycycline, and azithromycin/levofloxacin therapies are also used (CDC, 2021a). Regarding prognosis, timely therapy combined with temporary abstinence from sex is highly effective. If treatment regimens are followed, the STI’s symptoms usually disappear within two weeks (CDC, 2021a). Patients receiving no treatment can develop diseases of the fallopian tubes, inflammation of the liver’s peritoneal coating, and inflammatory arthritis and have higher risks of giving premature birth (CDC, 2021a). Finally, infection prevention strategies range from complete abstinence from sexual activities to the appropriate use of male/female condoms during any type of intercourse.
Syphilis is another widespread STI causing serious health deficiencies if left untreated. Objective signs pointing to it vary depending on its stage, with round sores in the infected region being typical for primary infection. Severe mucosal sores, red rashes on the extremities, receding hair, and lymph node inflammation are observed in patients with stage two of the infection (CDC, 2021d). Subjective symptoms are mostly non-existent during stage one since the primary sores are painless. The next stage may involve exhaustion, throat pain, headaches, muscle soreness, and increased body temperature (CDC, 2021d). As of CDC’s (2021c) estimates for 2018, the prevalence of syphilis among Americans aged fourteen and older was 156 thousand cases, making it the seventh most common venereal infection. Syphilis is treated with slow-onset antibiotics, such as benzathine benzylpenicillin, administered through the intramuscular route. Concerning prognostic predictions, antibiotics effectively prevent the condition’s further progression, but organ damages remain irreversible (CDC, 2021c). Untreated syphilis is potentially fatal, which highlights the importance of early diagnosis. Some avoidance-related recommendations are the correct use of barrier protection and abstinence from unprotected sex, especially male-to-male homosexual contacts or sex with many different partners.
Herpes Simplex Virus of the Second Type (HSV2)
Being increasingly common in the U.S., HSV2 has enormous influences on the quality of life. During the organism’s first encounter with HSV2, the possible symptoms and signs include tiny blisters near the affected regions that start to cause pain after breaking and are typically present in genital, rectal, or buccal areas (CDC, 2021b). Subsequent encounters with the virus are marked with different subjective and objective manifestations, such as pain in the lower part of the body that precedes new lesions’ formation (CDC, 2021b). As per CDC (2021c), the prevalence of HSV2 exceeded 18.6 million cases in 2018, making it the second most common STI affecting Americans older than fifteen. The situation with treatments is not reassuring since no strategies to remove the virus are available. Nevertheless, symptomatic pharmaceutical treatments are available, with acyclovir and famciclovir as popular ones (CDC, 2021b). In terms of prognosis, the infection always persists for the patient’s lifetime, but daily everyday pharmacological interventions are effective in shortening the STI’s outbreaks or even postponing them (CDC, 2021b). To avoid the infection, individuals should use barrier contraception and ensure that their partners have no HSV2 histories.
Hepatitis B Virus (HBV)
HBV is a common infection transmitted by both sexual activities and high-risk drug injection practices. Less than 50% of infected adults develop any manifestations (CDC, 2020). Some common symptoms and signs are increases in body temperature, exhaustion, emesis, and an abnormally decreased appetite (CDC, 2020). Other observable physiological changes are urine color abnormalities and yellowish eyes and skin (CDC, 2020). As of 2018, HBV’s prevalence among U.S. adults was 4.3%, with non-Hispanic Asians and foreign-born citizens as the most exposed demographic categories (Kruszon-Moran et al., 2020). HBV’s impacts on the body are systemic and diverse, so treatment strategies incorporate antiviral therapies with entecavir or other drugs, interferon-based immunomodulatory therapies, or transplantation treatments if liver damage is serious enough (CDC, 2020). Concerning the outcomes, timely and adequate treatment usually promotes full recovery, but some infected adult patients develop chronic disease (CDC, 2020). To avoid HBV, one can choose between three single-antigen vaccines approved in the U.S. (CDC, 2020). The other methods are standard lifestyle and condom use STI prevention recommendations.
Parasitic STI: Trichomoniasis
Trichomonas vaginalis, a one-celled parasite, causes another common protozoan STI called trichomoniasis. This STI is typically asymptomatic, but both women and men can experience specific symptoms and signs affecting the genitourinary system (Rein, 2020). For female patients, such manifestations include abnormal yellow/green discharge from the vagina that can be foamy and with a foul odor, genital irritation, and painful urination (Rein, 2020). In men, the STI causes irritation or abnormal discharge from the urethra, as well as post-urination and post-ejaculation burning (Rein, 2020). In terms of prevalence, trichomoniasis is the third most widespread infection; in 2018, the total number of cases in the U.S. exceeded 2.6 million (CDC, 2021c). The key treatment option is pharmacotherapy with nitroimidazole antibiotics taken orally, with higher doses for patients infected with HIV. As for prognosis, trichomoniasis is relatively easy to address, and timely treatment with metronidazole promotes full recovery in most patients (Rein, 2020). Although non-sexual transmission of trichomoniasis is sometimes possible, the key infection avoidance measures are condom use and refraining from sex with partners having the abovementioned manifestations.
Barriers to STI Prevention and Timely Treatment
Despite being profoundly different etiologically and symptomatically, all five conditions discussed above have common features in terms of biases against their carriers. The commonly known risk factors for viral, bacterial, and parasitic STIs are lifestyle-related, which might cause initial negative assumptions about those contracting such infections. Some of these factors are high-risk sexual behaviors, including contact with multiple sex partners, having new partners regularly, promiscuity in marriage, insufficient sexual hygiene, or a limited understanding of protective techniques (Benta et al., 2020). Individuals contracting STIs can be automatically assumed to have engaged in morally condemned practices, and it fuels self-stigmatization and a sense of guilt in those seeking treatment or professional advice (Benta et al., 2020). The shame of being diagnosed with an STI persists today in spite of awareness-raising campaigns targeted at the general population and extensive ethics training for healthcare professionals providing STI-related services (Benta et al., 2020). With that in mind, the psychological aspect of awareness and provider-patient interaction should be emphasized.
STI stigma’s implications for the current public health situation are quite pronounced. Cross-sectional survey research on U.S. adults suggests that having the signs of an STI, regardless of the likely diagnosis, is not always seen as a reason to seek treatment (Benta et al., 2020). Particularly, compared to their older counterparts, those aged between 18 and 21 are less likely to seek medical attention right after noticing any worrying changes affecting the genitourinary system (Benta et al., 2020). Rather than seeking recommendations from healthcare professionals, more than 55% of U.S. adults would prefer to use online resources to get information regarding STI prevention and resolve their sensitive issues (Benta et al., 2020). Young people’s ongoing embarrassment with having overly personal health promotion questions creates a situation in which common STIs, including HSV-2, syphilis, chlamydia, HBV, and trichomoniasis, remain unreported (Benta et al., 2020; CDC, 2021c). Considering untreated STIs’ devastating health effects, the issue still requires close attention at the national level.
In summary, viral, bacterial, and parasitic STIs are dissimilar in terms of physiological manifestations, treatment methods, and possible complications. Infection avoidance measures suitable for these conditions are typically based on giving up high-risk sexual practices, but in rare cases, such as HBV, vaccines are also available. All five reviewed infections remain relatively common in the U.S. and are still surrounded by the social stigma that contributes to disease transmission even more.
Benta, L., Khan, S., Khan, S., Madanat, S., Sewchand, R., & Minakova, V. (2020). Correlation between STD-related social stigma and STD/STI screening among young adults in the United States. Saint James School of Medicine. Web.
Centers for Disease Control and Prevention. (2020). Hepatitis B questions and answers for health professionals. Web.
Centers for Disease Control and Prevention. (2021a). Chlamydia – CDC fact sheet (detailed). Web.
Centers for Disease Control and Prevention. (2021b). Genital herpes – CDC fact sheet (detailed). Web.
Centers for Disease Control and Prevention. (2021c). Sexually transmitted infections: Prevalence, incidence, and cost estimates in the United States. Web.
Centers for Disease Control and Prevention. (2021d). Syphilis – CDC fact sheet (detailed). Web.
Kruszon-Moran, D., Paulose-Ram, R., Martin, C. B., Barker, L. K., & McQuillan, G. (2020). Prevalence and trends in hepatitis B virus infection in the United States, 2015–2018. NCHS Data Brief, 361, 1-6. Web.
Rein, M. F. (2020). Trichomoniasis. In E. T. Ryan et al. (Eds.), Hunter’s tropical medicine and emerging infectious diseases (10th ed., pp. 731-733). Elsevier.