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Sexual Transmitted Disease

Intoduction

What is Sexually Transmitted Infections (STI’s)?

Sexually transmitted infections (STI’s) are passed on through intimate sexual contact. STI’s include chlamydia, syphilis, and gonorrhoea. They can be passed on during vaginal, anal and oral sexual intercourse, as well as through genital contact with an infected partner.

In Malaysia, STI’s have been rising continually and there is an increase in positive diagnoses of chlamydia, genital warts, and herpes.

To some extent, the increase in the number of diagnosed cases of STI’s is due to a greater awareness of the problem, more reliable diagnostic techniques, and an increase in the number of health clinics carrying out the tests. However, by far the highest increase in STI’s has been among the 16 to 24 years age group.

Signs & Symptoms

You should visit your GP or local health clinic if you experience itching, swelling or redness around the vagina or penis, unusual discharge from the vagina or penis, or pain in the lower abdomen.

Most conditions vary in their symptoms but the most common are listed below:

Chlamydia

In women, genital chlamydial infection often does not cause any symptoms. However, there may be non-specific symptoms such as cystitis, a change in the vaginal discharge, or mild lower abdominal pain. Men with chlamydia commonly experience a urethral discharge from the penis, and may have inflammation of the tube leading from the bladder to the tip of the penis (urethritis), or of the tube leading from the testes to the penis (epidymitis). This discomfort may then disappear but the infection can still be passed on to a sexual partner.

Genital warts

Many people who get the virus that leads to genital warts do not show any recognisable symptoms, and this is why the infection can go undiagnosed for a long time. However, if symptoms are present, they may include small white spots or lumps that are hidden inside the vagina or anus

Genital herpes

Like genital warts, genital herpes is a condition that often presents no symptoms and can remain undiagnosed for long periods of time. Symptoms may show in the form of flu-like symptoms, itchiness, burning or tingling around the genitals, small, fluid-filled blisters that burst to leave sores, and pain when passing urine.

Gonorrhoea

Gonorrhoea is an infection that is found in both sexes and can affect the genitals, anus, rectum and throat. About half of all women infected with gonorrhoea, and over 90% of men experience symptoms, including thin, watery discharge from the vagina or tip of the penis that can appear yellow or green, with pain when urinating.

Syphilis

The symptoms of syphilis usually begin with a small sore on the penis or vagina. Up to six months after the initial symptoms occur, you may experience flu-like symptoms, such as aches and shivering and rashes elsewhere.

HIV

Many people do not develop any symptoms when they first become infected with HIV. Some people, however, get a flu-like illness within three to six weeks after exposure to the virus. The only way to know if you are HIV-positive is to have a test. Over time, infection with HIV weakens the immune system leading to difficulty in fighting off certain infections.

Non-specific urethritis

Non-specific urethritis is an STI that affects men. It causes discomfort of the urethra (the tube that leads from the bladder to the tip of the penis, along which urine is passed), or urethral discharge.

Trichomoniasis

Trichomoniasis is an infection of the genitals that is caused by the bacterium trichomonas vaginalis (TV). This condition often has no symptoms, but symptoms may include a yellow or green discharge from the vagina with soreness. Men usually act as carriers and do not show symptoms.

Pubic lice

Symptoms of pubic lice include itchy skin, and you may notice black powder (lice droppings) in your underwear and white eggs in your undergarments.

Scabies

Scabies can occur anywhere on the body, but sometimes the signs are hard to see. Symptoms can appear weeks after first contact and include itching (especially at night), a rash, and tiny spots.

Thrush (Candidiasis)

Symptoms of thrush include intense itching around your penis or vagina, with a thick, white discharge, and the appearance of tiny white spots around the genitals.

What is the causes of STI’s?

Sexually transmitted infections (STI’s) are passed from person to person during intimate sexual contact. You can catch STI’s through:

  • having unprotected vaginal sex,
  • having unprotected anal sex,
  • having unprotected oral sex, or
  • having genital contact with an infected partner.

The risk of contracting infections such as gonorrhoea and syphilis through oral sex is much greater than the risk of contracting HIV. However, recent studies suggest that the potential risk of HIV through oral sex is higher than previously estimated.

The Diagnosis of STI?

Most sexually transmitted infections (STI’s) are initially diagnosed on presentation of the symptoms, and then formally through blood, urine and other tests. The results of an STI’s test are completely confidential.

The GPs or local health clinics commonly used a swab test which involved taking a sample of secretion from the vagina or penis using a piece of absorbent material attached to a rod, such as a cotton bud. The sample is then sent to a laboratory for examination.

In some cases, such as pubic lice, STI’s testing is not necessary because the symptoms are conclusive. Other STI’s are difficult to diagnose as they present few or no recognisable symptoms. For example, chlamydia sometimes presents no symptoms, and often goes undetected unless it leads to complications, such as pelvic inflammatory disease (PID), ectopic pregnancy or infertility.

The Complications

Pelvic inflammatory disease (PID), ectopic pregnancy or infertility.

The Treatment

Most sexually transmitted diseases (STI’s) can be treated using a single dose or a course of antibiotics. These include chlamydia, gonorrhoea (although some strains are now showing signs of resistance to antibiotics), syphilis and urinary tract infections.

Antiviral drugs may be used to relieve the symptoms of genital herpes, but infection by the virus cannot be cured. Genital warts can be treated although they do eventually heal and disappear without treatment. Many people choose to have genital warts removed by a doctor, for cosmetic reasons. Caustic agents or liquid nitrogen are used to burn them away, or freeze them.

As STIs are easily passed on through sexual contact, if you have a positive diagnosis, it is important that your current and past sexual partners are notified and treated, in order to reduce the risk of spreading and re-infection. Your local health GUM clinic may be able to provide help by notifying them.

Below is a basic summary of the treatments that are used to treat the main STI’s. Most of these STI’s are also covered as separate health encyclopaedia topics which provide more detailed information and advice.

  • Chlamydia is easily treated with antibiotics, either using a single dose, or a course for a couple of weeks.
  • Trichomonas vaginalis (TV) is easily treated with a course of antibiotic tablets.Early treatment for gonorrhoea involves a single dose of antibiotics. If complications occur further treatment will be needed.
  • Non-specific urethritis (NSU) is easily treated with antibiotics, although damage to the urethra take time to heal.
  • The virus for genital herpes remains in the body as there is no treatment that gets rid of it completely. Antiviral drugs may be used to relieve the symptoms.  Self-help measures can reduce symptoms, or prevent outbreaks. For example, avoiding stress, resting, stopping smoking, cutting- down on drinking, and avoiding direct sunlight.
  • Pubic lice are easily treated. Special shampoos, creams or lotions are used to kill the lice and their eggs.
  • Scabies is easily treated. A special lotion is applied all over the body and is washed off 24 hours later and repeated twice or three times. While there is no cure for AIDS, drugs can be used to suppress the HIV virus and preserve the immune system for as long as possible. AIDS-related illnesses that arise can also be treated, and advice from specialists such as dieticians, physiotherapists, counsellors, and support groups is also available.
  • Syphilis can be easily treated during the early stages using a course of antibiotics for two weeks. It can also be treated during later stages of infection, but any damage to the heart or nervous system may be irreversible.
  • Thrush (Candidiasis) is easily treated using pessaries (tablets that are inserted into the vagina), cream or tablets. Creams are usually used to treat men who have thrush.
  • Genital warts are easily treated by either painting them with a medicated liquid, or freezing them with a spray. However, some people need a number of treatments, and if the warts return, further treatment will be required.

Preventions

Practising safe sex is the most effective way of preventing sexually transmitted infections (STI’s). The male condom is the most effective method of preventing STI’s. However, you can never be 100% sure that a prospective sexual partner does not have an STI’s, and the more sexual partners that you have, the higher the risk of contracting an STI’s. Therefore, if you have a new partner, it is a good idea for you both to be tested for STI’s before having sexual intercourse.

If you have any of the symptoms mentioned earlier, and you think that you may have an STI’s, you should visit your local health clinic for assessment and investigation. You should also ensure that your partner is aware of the various STI’s and their consequences, and if necessary, encourage them to get tested.

Support Group

Majlis AIDS Malaysia

Last reviewed : 26 April 2012
Writer : Dr. Hj. Mohd Hatta M.Tarmizi
Reviewer : Datin Dr. Asmah Johar