How many types of sexually transmitted infections are there? The first signs and symptoms of sexually transmitted diseases in women (STDs, STIs). Risk factors for developing genital warts

The term “venereal diseases”, widely used in Soviet times in relation to syphilis and gonorrhea, is gradually being replaced by a more correct one - diseases (infections) that are predominantly sexually transmitted.

This is explained by the fact that many of these diseases are also transmitted through parenteral and vertical routes (that is, through blood, untreated instruments, from mother to fetus, and so on).

Eight sexually transmitted disease agents are the most common and are associated with the majority of diagnosed sexually transmitted infections. STDs are contracted primarily during sex (vaginal, anal, oral).

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1. Basic facts about STDs

1 More than 1 million new cases of sexually transmitted diseases are recorded every day worldwide.
2 Every year, there are 357 million new cases of 1 of 4 sexually transmitted infections worldwide: chlamydia, gonorrhea, syphilis and trichomoniasis.
3 According to WHO estimates, about half a billion people in the world are infected with the genital herpes virus.
4 More than 290 million women are infected with papillomaviruses.
5 Most STDs are not accompanied by severe symptoms and are asymptomatic.
6 Some pathogens of sexually transmitted infections (herpes virus type 2, syphilis) can increase the likelihood of transmission of the human immunodeficiency virus (HIV).
7 In addition to the negative impact on the body and the triggering of a chronic infectious and inflammatory process, sexually transmitted diseases can cause serious reproductive dysfunction.

Table 1 - The most common pathogens of STDs

2. Bacterial STIs

2.1. Chlamydia

– a disease caused by chlamydia Ch. trachomatis serovars D-K. Chlamydia is one of the most common STIs. Most often, the infection is diagnosed in young patients (15-24 years old).

In women, chlamydia is more often asymptomatic (80% of patients do not worry about anything). Only half of men infected with chlamydia may experience symptoms from the genitals and urinary system.

The most typical symptoms that accompany chlamydial infection: pain, pain in the urethra when urinating, the appearance of mucous or purulent yellow discharge from the urethra (in women, from the vagina).

2.2. Gonorrhea

– a venereal disease caused by Neisser gonococci and accompanied by damage to the genital organs, rectum, and in some cases the posterior wall of the pharynx.

In men, the disease is accompanied by a burning sensation in the urethra during urination, the appearance of white, yellowish or green discharge from the urethral canal (often the secretion is collected overnight and its maximum amount is released before the first urination), swelling and tenderness of the testicles.

Some men have asymptomatic gonorrhea. Most women infected with N. gonorrhea do not complain about their health. Symptoms in women may include pain, burning in the urethra during urination, the appearance of discharge, and bleeding between menstruation.

Infection of the rectum occurs during unprotected anal sex and is accompanied by itching, burning, pain in the anus, and the appearance of discharge and blood from the rectum.

2.3. Mycoplasmosis

Not all mycoplasmas are pathogenic. At the moment, only infection requires mandatory treatment, as it is often the cause of non-gonococcal urethritis, vaginitis, cervicitis, and PID.

M. hominis, Ureaplasma urealyticum, Ureaplasma parvum are found in healthy men and women, however, in the presence of predisposing factors, they can cause genitourinary diseases.

2.4. Chancroid

Chancroid (caused by Haemophilus ducreyi) is an endemic disease recorded primarily in Africa, the Caribbean, and South-West Asia. For European countries, only periodic outbreaks (imported cases) are typical.

The disease is accompanied by the appearance of painful ulcers on the genitals and enlarged regional lymph nodes. Infection with H. ducreyi increases the likelihood of human immunodeficiency virus transmission.

Figure 1 - In the area of the penis, at the base of the head, early chancroid is detected. In the right groin area there is regional enlargement of the inguinal lymph nodes.

2.5. Granuloma inguinale

Inguinal granuloma (synonym - donovanosis, causative agent - Calymmatobacterium granulomatis) is a chronic bacterial infection that usually affects the skin and mucous membranes in the groin and genital area.

Nodular compactions appear on the skin and mucous membranes, which then ulcerate. The ulcers may gradually grow larger.

Inguinal granuloma is rare in temperate climates and is most common in southern countries. Africa, Australia, South. America. Most often the disease is diagnosed in patients 20-40 years old.

Figure 2 - Inguinal granuloma.

2.6. Granuloma venereum

– damage to the inguinal lymph nodes, developing as a result of infection with serovars L1 – L3 of Chlamydia trachomatis. The disease is endemic to countries in Africa, Southeast Asia, India, South. America. Over the past 10 years, there has been an increase in incidence in the North. America, Europe.

The patient is concerned about ulcerative defects on the skin of the genitals, which are then supplemented by enlarged lymph nodes in the groin area and an increase in body temperature. Patients may also experience ulcerations of the rectum, which leads to pain in the anus, perineum, and the appearance of discharge and blood from the anus.

2.7. Syphilis

– a highly contagious (infectious) venereal disease, which is characterized by a staged course. In the early stages, chancre forms in the genital area, oropharynx, etc. The ulcer closes over time.

After a short period of time, a rash appears on the patient’s body, which is not accompanied by itching. The rash can appear on the palms, soles and then spread to any part of the body.

If treatment is untimely in the later stages, irreversible damage to internal organs, including the nervous system, occurs.

Figure 3 – The figure in the upper left corner shows the causative agent of syphilis. In the lower left corner there is a chancre (ulcer), which forms at the first stage of the disease. In the right half there is a type of rash characteristic of secondary syphilis.

3. Trichomoniasis

– a protozoal STI, in which the tissues of the vagina and urethra are involved in inflammation. Every year, 174 million new cases of trichomoniasis are reported worldwide.

Only 1/3 of infected patients have any signs of trichomoniasis: burning, itching in the vagina, urethra, foul-smelling yellow-green discharge from the genital tract, pain when urinating. In men, the listed symptoms may be accompanied by complaints of pain and swelling of the scrotum.

4. Candidiasis

– an infectious disease caused by yeast fungi of the genus Candida. There are more than 20 species of Candida fungi that can cause infection, but the most common cause of candidiasis is Candida albicans.

The disease is not an STD, but is quite often transmitted through unprotected sex.

Normally, candida lives in the intestines, on the skin and mucous membranes of a healthy person and does not cause diseases. With concomitant chronic diseases, inadequate antibacterial therapy, immunodeficiency, unprotected sexual contact with a patient, fungal colonies grow and local inflammation develops.

Vaginal candidiasis is accompanied by a feeling of itching, burning in the vulva and vagina, pain, discomfort during sex, the appearance of pain during urination, and the appearance of a white, cheesy discharge from the genital tract.

In men, candida often causes balanitis and balanoposthitis (itching, redness, peeling of the foreskin and glans penis).

5. Viral sexually transmitted infections

5.1. Genital herpes

Genital herpes (HSV, HSV type 2) is one of the most common STDs. Most often, genital herpes develops as a result of infection with herpes simplex virus type 2. Most patients are unaware that they have an infection.

The virus is transmitted during unprotected sexual contact, regardless of the presence of symptoms in the carrier. After entering the body, the virus migrates along the nerve endings and can remain in a “dormant” state for a long time.

When the patient’s immune system is weakened, the virus migrates back to the skin and symptoms of genital herpes develop: redness of the genital skin, the appearance of small blisters filled with clear liquid.

Such blisters burst and a superficial ulcer forms, which heals within a few days. The rash is painful and may be accompanied by increased body temperature and enlarged inguinal lymph nodes.

Figure 4 - Rashes with genital herpes.

5.2. Papillomaviruses

Genital papillomas (HPV, HPV, human papillomavirus infection) are a disease accompanied by the formation of growths (papillomas) on the skin of the genital organs. Throughout life, almost all people become infected with one of the subtypes of the human papillomavirus.

Infection with HPV types 6 and 11 is not always accompanied by the appearance of papillomas. Papillomas occur more often in women than in men.

They are small skin growths on a thin stalk, often skin-colored and soft in consistency. Some subtypes of the virus (16, 18, 31, 33, 45, 52, etc.) can lead to the development of cervical cancer. Vaccines against HPV have been developed.

Figure 5 - Genital papillomas.

5.3. Hepatitis B

Hepatitis B (HBV, HBV) is a viral liver infection, accompanied by inflammation, death of hepatocytes, and the development of fibrosis. In addition to sexual contact, the hepatitis B virus can be transmitted through blood transfusion, hemodialysis, from mother to fetus, through accidental injections with infected syringe needles (usually among medical staff, drug addicts), through tattooing, piercing using poorly sterilized materials.

The disease can occur in an acute form, accompanied by varying degrees of liver dysfunction (from mild to severe, including acute liver failure), the development of jaundice of the skin, general weakness, darkening of urine, nausea, and vomiting.

In chronic hepatitis B, the liver tissue undergoes fibrosis. The infection increases the risk of developing liver cancer.

5.4. HIV infection

– a retrovirus that is transmitted sexually, parenterally (when the blood of an infected patient enters the recipient’s blood) and vertically (from mother to fetus) by routes. After entering the human body, the virus primarily affects lymphocytes, leading to a decrease in their number and weakened immunity.

Currently, when lifelong antiretroviral therapy is prescribed, the multiplication of the virus can be suspended, thereby maintaining the patient’s normal immune status.

If treatment is not started in a timely manner or therapy is abandoned, the level of lymphocytes decreases significantly, and the likelihood of developing opportunistic diseases (infections that are extremely rarely recorded in people without impaired immune status) increases.

6. Main symptoms of STDs

In men	Among women
	Pain, cutting in the urethra during urination
Itching in the head, urethra	Itching in the vagina, urethra
Increased urination	Increased urination

	Enlarged inguinal lymph nodes

	Pain in the rectum, discharge from the anus
	Vaginal bleeding between periods

	Painful and unpleasant sensations during sex

Table 2 - Main symptoms of diseases transmitted primarily through sexual contact

7. Diagnostics

1 If the symptoms described above appear, there is a suspicion of an STD, or casual unprotected sex, it is recommended to consult a urologist or venereologist; the woman is also recommended to consult a gynecologist. After the initial examination, the patient is sent for a series of examinations that help identify sexually transmitted infections and prescribe adequate treatment.
2 Initial examination by a doctor. In men, the scrotum, penis, head of the penis, and, if necessary, the rectum are examined. The gynecologist performs an external examination of the genital organs, examination of the vagina and cervix with mirrors.
3 During the initial examination, a smear may be taken from the urethra and vagina, followed by staining with dyes and microscopy.
4 Sowing a smear on nutrient media to cultivate the pathogen and determine its sensitivity to antibacterial drugs.
5 Sending smear material from the urethra/vagina for molecular genetic diagnostics (determination of the DNA of the main pathogens of STDs using PCR).
6 To identify some STDs (hepatitis B and C, HIV, syphilis, etc.), venous blood is taken and sent for serodiagnosis (enzyme-linked immunosorbent assay to determine antibodies to the causative agent of the disease), PCR diagnostics.

Figure 6 – Sample results of determining the DNA of pathological microorganisms in a smear from the urethra using the PCR method (DNA of the main pathogens was not detected in the scraping from the urethra).

8. Most common complications

Due to the fact that most cases of STDs are asymptomatic in the early stages, patients often consult a doctor late. The most common complications of sexually transmitted diseases are:

1 Chronic pelvic pain syndrome.
2 Complications of pregnancy (miscarriages, premature births, intrauterine growth restriction syndrome, infection of the newborn - pneumonia, conjunctivitis, etc.).
3 Conjunctivitis (inflammation of the outer layer of the eye).
4 Arthritis (inflammation of the joints).
5 Female and male infertility.

In men	Among women
Pain, cutting in the urethra during urination	Pain, cutting in the urethra during urination
Itching in the head, urethra	Itching in the vagina, urethra
Increased urination	Increased urination
The appearance of discharge from the urethral canal (mucous, yellowish, green)	The appearance of vaginal discharge
Enlarged inguinal lymph nodes	Enlarged inguinal lymph nodes
Swelling, pain in the scrotum, inflammation of the testicles	Vaginal bleeding between periods
Pain in the rectum, discharge from the anus	Pain in the rectum, discharge from the anus
The appearance of ulcers on the genitals	Vaginal bleeding between periods
Redness of the head of the penis, the appearance of plaque on the head	Chronic pain in the lower abdomen
Painful and unpleasant sensations during sex	Painful and unpleasant sensations during sex

STIs or sexually transmitted infections are the general name for infectious pathologies, the main route of infection for which is sexual contact with an infected person. There is also the abbreviation STD - sexually transmitted diseases.

Testing for STIs is a complex of clinical and laboratory research methods aimed at making an accurate diagnosis and choosing an effective treatment method.

As a rule, the research complex is compiled individually and includes both standard diagnostic methods (OAC, OAM) and specialized studies (ELISA, PCR). In addition, most clinics offer a comprehensive examination for STIs, which will include a package of necessary studies for a complete assessment of the entire microflora of the genital organs. What kind of STI testing will be performed depends on the patient's clinical and medical history.

All patients are subject to an initial examination by a doctor - urologist or gynecologist. As a rule, the present clinical manifestations and data from the anamnesis (information about sexual contacts, diseases of sexual partners) allow the specialist to establish a previous diagnosis and determine what tests for STIs are necessary to confirm or refute this diagnosis. All laboratory diagnostic methods can be divided into two groups: general or standard and specialized.

General research. This includes those diagnostic methods that are performed on all patients, regardless of what pathology they present to the hospital with. For STIs, a complete blood count (CBC) and a complete urinalysis (UCA) are informative.

Complete blood count - CBC. The first laboratory diagnostic method performed on all patients. As a rule, it makes it possible to establish the presence of inflammatory changes in the body, but does not indicate the exact etiology of the pathological process. The results of the CBC for STIs can reveal neutrophilic leukocytosis (increased number of neutrophil leukocytes), lymphocytosis (increased number of lymphocytes), a shift in the leukocyte formula to the left, and an increase in ESR (erythrocyte sedimentation rate).

To obtain reliable results, at least 20 hours before taking blood for OAC, it is necessary to avoid drinking alcoholic beverages, using tobacco products and taking medications. Also, for 8-12 hours before blood sampling, you need to fast and limit physical activity.

General urine analysis - OAM. Always included in the initial examination for STIs. With it, it is possible to establish a violation of the transparency of urine, its color, the presence of pathological impurities or acidity (pH). As a rule, if there are pathological changes in the urine, a decision is made to conduct specialized research methods aimed at verifying the diagnosis of STIs.

Research aimed at verifying STIs. Carrying out such studies makes it possible to establish an accurate diagnosis and begin specific therapy aimed at a particular infectious agent. The most effective methods for diagnosing STIs include enzyme-linked immunosorbent assay (ELISA), polymerase chain reaction (PCR) and STI smear.

During pregnancy, a woman must undergo a series of examinations aimed at identifying possible pathologies that could potentially threaten the child.

These include the following studies:

Blood test for TORCH infection. These include toxoplasmosis, rubella, herpes virus and CMV (cytomegalovirus). ELISA is used.
- Wasserman's reaction. Necessary for detecting syphilis.
Blood tests for HIV infection, hepatitis C and B. ELISA and PCR are used.
Comprehensive examination for STIs. This examination for STIs is carried out using the PCR or ELISA method.

As a rule, the attending physician writes a referral for testing, indicating the laboratory where this can be done. This can be either the medical institution itself or a private laboratory. If a person personally wishes to undergo an examination, he can contact any private laboratory. However, when is the best time to get tested for STIs, it is still better to check with a specialist, as otherwise you may get false results.

Preparation for research most often involves fasting for 8-12 hours before taking the test, giving up bad habits 24 hours before taking the material, and limiting physical and psycho-emotional stress. However, not all diagnostic methods require such measures. The exact preparation rules depend on what tests are taken for STIs in each individual clinical case.

Smear test for STIs: preparation rules and methods

A smear for STIs is a test that involves taking material for bacterial and microscopic examination. This test for STIs is more accessible than PCR, but it takes more time and is less sensitive and informative.

Preparation for taking a genital smear:

At least 7 days before sampling, you must stop taking all medications, primarily vaginal suppositories or sprays.
Avoid sexual intercourse 2-3 days before the test.
In the evening before the procedure, perform hygiene procedures with warm water. There is no need to do this in the morning.
It is recommended not to urinate 2-3 hours before taking materials.
In women, it is recommended to take a smear in the first days after the end of the menstrual cycle or immediately before the start of menstruation.

Method of collecting material from women. First of all, the doctor examines the genital organs. After this, the material is collected using a sterile brush or tampon from the side wall of the upper third of the vagina. In some cases, samples may also be taken from the cervix and urethra.

In men. Materials for examination are collected using a sterile probe or a special swab. They are inserted into the urethra (urethra) to a depth of 3 cm, which may cause discomfort or pain to the patient. Also, several hours after the collection, slight pain, a feeling of discomfort and burning in the area of the head of the penis may persist. In certain situations, doctors recommend immediately before the procedure to perform a transrectal massage (through the rectum) of the prostate or wipe it with a probe.

As a result of microscopic examination, it is possible to determine the presence of a particular pathogen in the taken material. As a rule, this will become possible already during the development of the clinical picture of the disease, while during the incubation period, the study in most cases will be uninformative.

Bacterial inoculation involves inoculation on various nutrient media specific for various infectious agents. This examination for STIs allows you to accurately determine the species of the microorganism, but it takes a fairly long period of time.

Advantages of these methods:

Availability. As a rule, such testing for STIs is carried out by all laboratories, both private and public, at a relatively inexpensive cost.
Credibility. Almost always, they are accurate and allow an accurate diagnosis.

Flaws:

Information content. These tests make it possible to identify pathogens only if they are present on the mucous membranes of the genital organs. This usually occurs with advanced clinical symptoms. During the incubation period they may be false negative.
Ready dates. Bacterial seeding in most cases takes from 5 days to several weeks.

PCR for STIs: specialized examination for STIs using the PCR method and its nuances

Polymerase chain reaction or PCR is a molecular test that allows you to identify infectious agents even in the smallest quantities by identifying their DNA molecules. PCR for STIs is the most accurate diagnostic method at the present time.

Examination for STIs using the PCR method, if all the rules for its implementation are followed, gives 100% accuracy of results, even during the incubation period, when there are no clinical manifestations of the disease yet. However, false positive and false negative results are possible. They are usually associated with errors in the laboratory: contamination of the material being studied, incorrect collection and examination of tissues, etc.

To conduct a PCR test for STIs, you must first check with your doctor about what specific material is needed for the test. This is explained by the fact that for different diseases it is necessary to take different biological materials. For example, in order to conduct an examination for STIs, discharge from the genital organs is required, and to diagnose HIV and hepatitis C, blood from a vein is required. Preparation for the analysis and the technique for collecting material are similar to those for a smear for STIs. Testing for STIs using the PCR method usually takes from 1 to 2 days, which allows it to be used as a rapid test for STDs. The interpretation of PCR results for STIs should only be done by a doctor.

However, only two research results are possible:

Positive. This means that STD pathogens have been detected and their species has been determined.
Negative. No infectious agent DNA was detected.

The advantages of the PCR method include:

Versatility. PCR allows you to determine the presence of any infectious agent, regardless of its type.
Sensitivity. PCR makes it possible to diagnose infection even in the presence of only 1 DNA molecule of the pathogen.
Efficiency. The results of the study can be obtained after a few days.
Information content. Since PCR determines the presence of the agent, it can detect diseases even in the incubation period.

Flaws:

High cost of research. This is explained by the fact that high-precision equipment is used during the procedure.
Possibility of obtaining false results. If the rules of the technique are not followed, there is a very high risk of obtaining false positive results, since PCR is capable of detecting an infection that has entered the material after it has been taken from the patient.

More than one million cases of sexually transmitted infections (STIs) occur every day (1, 2).
An estimated 376 million new infections occur each year with one of the four STIs—chlamydia, gonorrhea, syphilis, or trichomoniasis (1, 2).
It is estimated that more than 500 million people have genital herpes, caused by the herpes simplex virus (HSV) (3).
More than 290 million women have human papillomavirus (HPV) infection (1).
Most STIs are asymptomatic or cause only minor symptoms, which can result in the STI going undetected.
STIs such as HSV type 2 and syphilis may increase your risk of acquiring HIV infection.
In 2016, 998,000 pregnant women were infected with syphilis, resulting in more than 200,000 stillbirths and neonatal deaths (5).
In some cases, STIs can have serious consequences for reproductive health beyond the immediate impact of the infection itself (for example, infertility or mother-to-child transmission).
The Gonococcal Antimicrobial Resistance Surveillance Program has identified high rates of quinolone resistance, increasing resistance to azithromycin, and emerging resistance to extended-spectrum cephalosporins. Drug resistance, particularly in gonorrhea, poses a serious threat to efforts to reduce the burden of STIs worldwide.

STIs are transmitted primarily through sexual contact, including vaginal, anal and oral sex. In addition, a number of STIs are transmitted non-sexually, for example through blood or blood products. Many STIs, including chlamydia, gonorrhea and mainly hepatitis B, HIV and syphilis, can also be transmitted from mother to child during pregnancy and childbirth.

STIs can occur without obvious symptoms of the disease. Common symptoms of STIs include vaginal discharge, urethral discharge or a burning sensation when urinating in men, genital sores, and abdominal pain.

Scale of the problem

STIs have a profound negative impact on sexual and reproductive health throughout the world.

More than one million cases of STIs occur every day. WHO estimates that in 2016, there were 376 million cases of infection with one of the four STIs—chlamydia (127 million), gonorrhea (87 million), syphilis (6.3 million) or trichomoniasis (156 million). More than 500 million people live with genital HSV infection (genital herpes), and about 300 million women are infected with HPV, the leading cause of cervical cancer. An estimated 240 million people worldwide live with chronic hepatitis B. HPV and hepatitis B virus infections can be prevented through vaccination.

STIs can have serious consequences beyond the immediate impact of the infection itself.

STIs such as herpes and syphilis can increase your risk of contracting HIV by three or more times.
Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low birth weight and prematurity, sepsis, pneumonia, neonatal conjunctivitis, and congenital anomalies. An estimated 1 million pregnant women were infected with syphilis in 2016, resulting in approximately 350,000 adverse birth outcomes, including 200,000 stillbirths and neonatal deaths (5).
HPV infection is responsible for 570,000 cases of cervical cancer and more than 300,000 deaths from cervical cancer each year (6).
STIs such as gonorrhea and chlamydia are the main causes of pelvic inflammatory disease and infertility in women.

STI prevention

Counseling and behavior change approaches

Counseling and behavior change interventions are tools for the primary prevention of STIs (including HIV) as well as the prevention of unwanted pregnancies. They cover in particular:

Comprehensive sexuality education, STI and HIV counseling before and after testing;
Safer sex/risk reduction counselling, promotion of condom use;
Interventions targeting key and vulnerable populations such as adolescents, sex workers, men who have sex with men and people who inject drugs;
Education and counseling tailored to the needs of adolescents.

In addition, counseling can increase people's ability to recognize STI symptoms and the likelihood that they will seek care or recommend that their sexual partners do so. Unfortunately, public ignorance, lack of appropriate training among health care workers, and persistent and widespread stigmatization of all things STI-related continue to hinder the wider and more effective use of these interventions.

Barrier methods

If used correctly and systematically, condoms are one of the most effective methods of protection against STIs, including HIV. Female condoms are effective and safe, but are not used in national programs as widely as male condoms.

Diagnosis of STIs

Accurate diagnostic tests for STIs are widely used in high-income countries. They are of particular interest for the diagnosis of asymptomatic infections. However, the availability of diagnostic tests in low- and middle-income countries remains very low. In countries where tests are available, they are often too expensive and not available locally; However, patients often have to wait too long for results (or return to the diagnostic facility for them). As a result, follow-up is difficult and medical care or treatment is not fully provided.

Currently, the only inexpensive rapid tests for STIs are tests for syphilis and HIV. A rapid test for syphilis is already used in some resource-limited countries. A rapid parallel test for HIV/syphilis is also available today, which involves taking just one blood sample from a finger prick and using a simple test cartridge. This test is reliable, provides results in 15-20 minutes and can be used with minimal preparation. Thanks to the advent of rapid tests for syphilis, diagnostic rates for pregnant women have increased. However, more efforts are still needed to ensure that all pregnant women are tested for syphilis in most low- and middle-income countries.

A number of rapid tests for other STIs are being developed to improve the diagnosis and treatment of STIs, especially in countries with limited resources.

STI treatment

There are now effective treatments for some STIs.

In recent years, the resistance of STIs, particularly gonorrhea, to antibiotics has been rapidly increasing, narrowing the range of treatment options. The Gonococcal AMR Surveillance Program (GASP) has identified high rates of quinolone resistance, increasing resistance to azithromycin, and emerging resistance to extended-spectrum cephalosporins, the last-line drugs. The emergence of reduced sensitivity of the gonorrhea pathogen to extended-spectrum cephalosporins, along with the already existing resistance to penicillins, sulfonamides, tetracyclines, quinolones and macrolides, places gonococcus among microorganisms with multidrug resistance. Antimicrobial resistance of other STIs also occurs, although it remains less common, making STI prevention and prompt treatment critical (7).

Management of patients with STIs

In low- and middle-income countries, treatment is based on identifying persistent, easily recognized signs and symptoms without laboratory testing. This approach is called syndromic. Syndrome-by-syndrome therapy, often based on clinical algorithms, allows health care providers to diagnose a specific infection based on observed syndromes (such as vaginal discharge, urethral discharge, genital ulcers, abdominal pain).

Syndromic therapy is a simple technique that provides rapid same-day treatment and eliminates the need for costly or difficult-to-access diagnostic testing for symptomatic patients. However, with this approach, there may be cases of unnecessary treatment being prescribed, as well as infections being missed, since most STIs occur without symptoms. Thus, it is extremely important that syndrome-specific therapy be accompanied by screening.

To prevent the spread of infection and prevent relapses, an important component of treatment work with patients with STIs is the treatment of their sexual partners.

Vaccines and other biomedical interventions

There are safe and highly effective vaccines against two STIs—hepatitis B and human papillomavirus (HPV). Their appearance was a great achievement in the field of STI prevention. In 95% of countries, hepatitis B vaccine is included in the childhood immunization schedule, preventing millions of deaths from chronic liver disease and liver cancer each year.

As of October 2018, HPV vaccination is included in the vaccination schedule in 85 countries, most of which are classified as high- and middle-income countries. Achieving high rates (>80%) of HPV vaccination coverage among young women (aged 11 to 15 years) would prevent millions of deaths over the next decade among women in low- and middle-income countries, where cervical cancer incidence is highest. .

Work on obtaining vaccines against herpes and HIV is close to completion, and a number of candidate vaccines are already in the first stages of clinical trials. Work on vaccines against chlamydia, gonorrhea, syphilis and trichomoniasis is still in the earlier stages.

Other biomedical interventions to prevent some STIs include adult male circumcision and the use of microbiocides.

Male circumcision reduces the risk of HIV infection among heterosexual men by approximately 60% and provides some protection against other STIs such as herpes and HPV.
The use of tenofovir gel as a vaginal microbiocide has had mixed results in preventing HIV acquisition but has shown some effectiveness against HSV-2.

Current measures to curb the spread of STIs are not enough

Changing behavior is challenging

Despite significant efforts to identify simple interventions that can reduce risky sexual behavior, behavior change remains challenging. Research has identified the need to target carefully defined populations, conduct extensive consultation with identified target populations, and involve them in the design, implementation, and evaluation of interventions.

STI screening and treatment services remain underdeveloped

People seeking STI screening and treatment services face many challenges. These challenges include limited resources, stigma, poor quality of services and low or no follow-up of intimate partners.

In many countries, STI services are provided separately and are not integrated into primary health care, family planning and other routine health care services.
In many settings, screening for asymptomatic infections is often not possible due to a lack of trained personnel, laboratory capacity and appropriate medications.
Marginalized populations with the highest rates of STIs, such as sex workers, men who have sex with men, people who inject drugs, prisoners, mobile populations and adolescents, often lack access to adequate sexual health services.

WHO activities

WHO develops global norms and standards for the treatment and prevention of STIs, strengthens surveillance and monitoring systems, including for drug-resistant gonorrhea, and leads the process of shaping the global research agenda on STIs.

Our activities are currently guided by the Global Health Sector Strategy on Sexually Transmitted Infections 2016–2021(8) , adopted by the World Health Assembly in 2016, and the Global Strategy for Women, Children and Adolescents’ Health (9), adopted by the United Nations in 2015, which emphasize the need to provide a comprehensive, integrated package of essential interventions, including information and services for the prevention of HIV and other sexually transmitted infections. The Sixty-ninth World Health Assembly adopted three global health sector strategies for the period 2016–2021. for HIV, viral hepatitis and sexually transmitted infections (STIs).

WHO works with countries to address the following:

Scaling up effective STI services, including:

management of patients with STIs and counseling on issues related to STIs;
testing for syphilis and its treatment, especially among pregnant women;
vaccination against hepatitis B and HPV;
screening for STIs in populations at high risk of STIs;

Promote the implementation of strategies to improve the effectiveness of STI prevention, including:

integrating STI services into existing health systems;
promoting sexual health;
measuring STI burden;
monitoring and responding to antimicrobial resistance of STIs;

Support the development of new STI prevention tools, such as:

point-of-care tests for STI diagnosis;
new drugs against gonorrhea;
vaccines and other biomedical interventions against STIs.

Sexually transmitted infections (STIs) are a whole group of diseases that have a negative impact on the genitourinary, reproductive and other systems of the body. The danger is posed by pathogenic microorganisms that can be transmitted from a sick person to a healthy person during sex, through blood and, in very rare cases, through everyday contact.

Types of sexually transmitted infections

There are 20 main types of sexually transmitted infections, and all of them pose health risks. Very often, the patient does not even realize that he is infected, since such diseases have a hidden incubation period, during which no symptoms are detected. This situation leads to the transition of the initial stage of the disease to chronic.

All infectious diseases are divided into three types according to the type of pathogen:

Ailments caused by microbes - syphilis, gonorrhea, chancroid, inguinal lymphogranulomatosis.
Diseases caused by protozoan microorganisms, the most common of which is trichomoniasis.
Viral lesions - HIV, hepatitis, herpes, cytomegaly.

Each disease has its own symptoms and methods of infection:

Syphilis. It is transmitted both sexually and domestically, through blood, saliva and seminal fluid; placental infection of the child from the mother is possible. The main symptoms are skin rashes, ulcers, myalgia, headache, an increase in leukocytes and a decrease in hemoglobin. Read about testing for syphilis.
Chancroid (soft chancroid). Infection occurs only during sexual contact. The disease is characterized by the development of purulent processes that involve the nearest lymph nodes. External signs are non-healing ulcers with serous contents and swelling around the circumference. The lesion covers the prepuce area in men and the labia in women. With unconventional types of sex, damage to the oral cavity and anus is possible.
Trichomoniasis. Infection occurs during sexual intercourse, less often during household contacts. In women, the disease manifests itself in the form of hyperemia and itching of the vaginal mucous tissues, discharge mixed with foam and an unpleasant odor. In men, this is difficult, painful urination, frequent false urge to go to the toilet.
Gonorrhea. The infection is transmitted during sex, through the patient's personal objects, and when the baby passes through the birth canal. In men, the main symptoms are inflammation of the urethral canal, pain when urinating, and purulent discharge. If the pathogen penetrates the prostate gland, erection may decrease. Gonorrhea in women is manifested by copious discharge of pus, pain and burning when urinating. Read more about gonococcal infection (gonorrhea).
. It is distinguished by the latent nature of its occurrence and, in fact, has no external manifestations. The main symptoms appear only when the form is advanced and are expressed in pain, itching of the genital organs in a woman, and the same symptoms in a man during urination. The routes of infection are sexual contact, the use of linen and hygiene items of a sick person, transmission from mother to child during pregnancy and childbirth.
Candidiasis. It has typical manifestations in the form of inflammation of the mucous membranes of the genitals and mouth, severe itching, and intense cheesy discharge. The infection can develop as a result of sexual intercourse, with prolonged use of antibiotics.
Human papillomavirus. The infection typically enters the body through sexual and domestic means. External signs are genital warts and warts on the mucous tissues of the reproductive organs and anus. Some varieties are especially dangerous - they lead to breast and cervical cancer in women.
Ureaplasmosis. It is transmitted to the baby during childbirth, through sexual contact. Pronounced signs are often absent; in men, the infection provokes the development of prostatitis with typical symptoms - pain, stinging, difficulty urinating.
Cytomegalovirus. Infectious agents penetrate tissues through sperm, female, and vaginal secretions and are capable of infecting a child during fetal development. There are generally no symptoms.
Inguinal lymphogranulomatosis. Spread occurs through sexual contact. In men, the head of the penis is affected; in women, the labia and vagina are affected. Blisters and ulcers appear at the sites of infection. As the pathology develops, the cervical, inguinal and submandibular lymph nodes enlarge.
Gardnerellosis. It is transmitted through unprotected sexual intercourse, although in some cases the virus can be introduced through household means. Since the pathogen actively suppresses the vital activity of lactobacilli, a person may experience digestive problems and disruption of normal bowel movements.
Mycoplasmosis. It is more common in women during unprotected sex, causing kidney dysfunction, inflammation of the urethra and vagina.
Hepatitis (B and C). The infection has different routes of entry - through blood, saliva, semen, and breast milk. Symptoms of infection may be loss of appetite, fatigue, pain in the liver, aching joints, dark urine, and attacks of nausea.
. A common, practically incurable disease, transmitted both sexually and through household methods. Due to the fact that the pathogen not only has the ability to penetrate human DNA, it penetrates into the nerve fibers of the spine, where it remains, becoming inaccessible to interferons and antibodies of the immune system. While in a latent state, the virus is activated at any sign of a decrease in the body's defenses. The rashes are localized on the lips, mucous membrane of the cheeks, eyes, in the genital area, and on the genitalia in women and men. The rashes disappear, most often, after 20-30 days.
Human immunodeficiency virus (HIV). Routes of infection - through blood, sexual intercourse (see more details about). Symptoms of infection during the acute phase are high fever, chills, joint and muscle pain, enlarged lymph nodes, rash, intestinal upset, vomiting, headache. The disease may not progress for some time, continuing to destroy the immune system, after which the patient’s well-being deteriorates.
AIDS. A serious sexually transmitted disease. The main routes of transmission are oral and anal sexual intercourse. Immunodeficiency syndrome has the following primary symptoms - high fever, general weakness, increased sweating, regular headaches, myalgia. Signs of intoxication often appear - nausea, vomiting, difficulty breathing.
Pediculosis pubis. The peculiarity of the disease is that it is transmitted not only sexually, but also through underwear and bed linen. Characteristic symptoms are severe itching, hyperemia of the skin in the scalp area.
Molluscum contagiosum. In addition to sexual relations, the disease is transmitted through underwear, bed linen, household items, when applying a tattoo, through microtrauma during close contacts. The skin disease is expressed in the form of rounded papules - nodules, which increase in size over time and merge with each other, forming a large affected surface.
Athlete's foot (groin fungus). Routes of infection are intimate intimacy, close household contacts, introduction of infection through cosmetics and personal hygiene items. A typical sign of the disease is severe itching, rashes in the form of pink papules in the scrotum, penis in men, in the armpits, genitals, buttocks, inside the knee and under the breasts in women.
Scabies. The introduction of scabies mites occurs through prolonged contact, including during coitus, when the patient’s skin comes into contact with healthy epidermis. The main manifestations are intense itching, which becomes unbearable in the evening and at night, when the activity of the pathogen increases. Localization of rashes - genitals, lumbar region, buttocks, chest, feet, inner thighs, armpits.

Sometimes damage is observed by several types of pathogens at once. This situation is typical for people who are promiscuous in their intimate relationships or who are addicted to drugs or alcohol. The lack of reliable contraceptives and weak immunity increases the risk of infection.

In this video, a venereologist talks in detail about the types of sexually transmitted infections, how they affect organs, what their symptoms are and how to effectively fight them.

And these are just the most common infections caused by various pathogenic microorganisms. Each case will require an individual approach to treatment and medications effective for a specific pathogen.

Causes of infection

The cause of the development of sexually transmitted infections is the penetration of pathogenic viruses, bacteria, protozoan single-celled organisms, and fungi into the body.

Basic prerequisites:

Lack of quality contraceptives.
Casual sexual relations with unfamiliar partners.
Insufficient personal hygiene.
Blood donation and transfusions in case of accidents, operations, transplantations.
Lack of timely treatment of infection before conception and during pregnancy.

However, there are always factors that contribute to infection. And, first of all, this is a weakened immune system for various reasons. Alcohol abuse, an unbalanced diet that is poor in essential vitamins, mineral compounds and trace elements, constant stressful situations, and physical overload lead to the fact that the immune system cannot cope with the pathology on its own.

Sexual infections lead not only to poor health, but also to serious consequences - infertility, impotence, and death.

Diagnostics

To make an accurate diagnosis, laboratory tests and the use of medical equipment are required. But any visit to a doctor begins with collecting anamnesis and examining the patient. Today there are so many varieties of pathogens that bacterial culture and smear examination are clearly not enough to obtain a reliable result.

Diagnosis in men is carried out using the following methods:

Polymerase chain reaction (PCR) is a highly informative examination method that makes it possible to identify the type of pathogen by its DNA in biomaterial from the secretion of the prostate gland, urethra, sperm and blood. The method also allows you to select the right antibiotic for a given virus. For examination, material is taken from the patient's urethral canal.
Enzyme-linked immunosorbent assay (ELISA) is a method by which antibodies to specific infectious organisms can be found using a blood test.
Immunofluorescence is a laboratory blood test that provides maximum information about the protective forces of the male body, autoimmune disorders, endocrine system failures, and hematopoietic pathologies.

To examine women, in addition to PCR and bacteriological culture, the following is carried out:

serological blood test to recognize antigens;
histological examination of tissues of the uterine cavity and cervical canal;
clinical blood test for hemoglobin content, level of erythrocytes and leukocytes.

These methods are basic, but other diagnostic procedures are used if necessary. Research allows us to select adequate, comprehensive treatment.

Complex treatment

Treatment of infectious diseases is individual for each patient and is comprehensive. In addition, patients are registered with a venereological institution until complete recovery. The course is prescribed to both the patient and his partner.

Treatment of sexually transmitted infections in men and women involves abstinence from sexual relations and the use of a complex of medications:

antibacterial agents in the form of tablets and injections;
analgesics and antispasmodics for painful urination, headaches, muscle, and lumbar pain;
anti-inflammatory drugs to relieve swelling, irritation, hyperemia of the skin and mucous membranes;
if necessary, antifungal medications;
vitamins and immunomodulators to improve immunity;
medications for external use in the form of ointments, creams for rashes and ulcers.

The most effective antibiotics against pathogenic bacteria and viruses are:

Penicillins – Ampicillin, Amoxicillin.
Nitroimidazole – Trichopolum, Metronidazole.
Aminoglycosides – Neomycin, Spectinomycin.
Macrolides – Clarithromycin, Erythromycin.
Fluoroquinolones – Ofloxacin.
Tetracyclines – Doxycycline, Tetracycline.

Medicines are selected individually, as they can cause an allergic reaction. Antibiotics are used for no more than 2-7 days in a row as directed by a doctor. For more information about antibiotics that are used in the fight against sexually transmitted infections -.

Separately, it is worth mentioning the treatment of human papillomavirus infection. This is a lifelong disease and you can only suppress its manifestation. Read more about this.

Among other things, for genital infections, rectal/vaginal suppositories are prescribed in combination with other drugs that help relieve inflammation, reduce pain and swelling. These include:

antimicrobial suppositories Betadine, which stop inflammation;
for trichomoniasis, the antibacterial drug Metronidazole is effective;
Pimafucin is a highly effective vaginal suppository for women with antifungal action.

Among the immunostimulating agents used during general therapy are drugs such as Cycloferon, Genferon. For women, douching is prescribed, and for men - baths with a solution of potassium permanganate, Chlorhexidine.

In this video, a venereologist talks in detail about the treatment of sexually transmitted infections. Which drugs are better, how to properly build a treatment system.

In severe conditions, inpatient treatment under constant supervision is indicated. In the early stages of the disease, the patient can be treated at home as directed by a specialist, following the regimen of taking the necessary medications, and sometimes even bed rest.

Preventive measures

In order to prevent infection, the following rules should be followed:

use of condoms and contraceptives in women;
periodic examination by a gynecologist and urologist;
if necessary, undergo vaccinations;
maintaining intimate hygiene;
use of antiseptic solutions if infection is suspected within several hours after sexual intercourse;