Sexually transmitted infections (STIs)
There were an estimated 86 million new cases of four curable sexually transmitted infections (STIs) (chlamydia, gonorrhoea, syphilis, and trichomoniasis) in the Region in 2020. STIs can have serious reproductive health consequences, including infertility, mother-to-child transmission, adverse birth outcomes including stillbirths and newborn deaths, increased risk of HIV acquisition, and cancer.
STIs are spread predominantly by sexual contact, including vaginal, anal and oral sex. Some STIs can also be spread through non-sexual means, such as via blood or blood products, as well as from mother to child during pregnancy and childbirth. Common symptoms of STIs include vaginal discharge, urethral discharge or burning in men, genital ulcers, and abdominal pain. The majority of STIs have no symptoms..
Of the 8 most common STIs, 4 are currently curable: syphilis, gonorrhoea, chlamydia and trichomoniasis. The other 4 infections are caused by viruses and cannot be cured: hepatitis B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV). Symptoms or disease due to these viral infections can be reduced or modified through treatment.
When used correctly and consistently, condoms are one of the most effective methods of protection against STIs and HIV. Early diagnosis of STIs, among people with or without symptoms, offers the best opportunity for effective medical treatment and support, and for preventing further transmission.
Vaccines can protect against hepatitis B and HPV. Worldwide, cervical cancer is the fourth most frequent cancer in women and nearly all cases of cervical cancer can be attributed to HPV infection. Chronic hepatitis B is a leading cause of liver cancer.
HIV, hepatitis B and syphilis can be transmitted from infected mothers to their infants, causing significant morbidity and mortality. However, transmission of these infections can be prevented by simple and effective interventions, including the prevention of new infections among people of reproductive age, prevention of unintended pregnancies, antenatal screening, treatment of infected pregnant women, follow-up and vaccination of infants born to infected mothers.
A person can have an STI without having obvious symptoms of disease. When present, common symptoms of STIs include: abnormal vaginal discharge, urethral discharge, genital ulcers and lumps, and lower abdominal pain.
Symptoms of specific STIs are:
Gonorrhoea and chlamydial infection
These STIs cause cervicitis in women, urethritis in men and extra-genital infections, including rectal and oropharyngeal manifestations. Common symptoms include vaginal or penile discharge and burning with urination. Infants of infected mothers can contract neonatal conjunctivitis (red eyes) due to exposure to the STIs during vaginal delivery. Rectal and pharyngeal infections can be asymptomatic.
Syphilis
Syphilis is often asymptomatic, when symptoms occur, primary syphilis presents as a solitary, painless ulcer. Secondary syphilis may manifest as generalized lesions affecting skin, mucous membranes and lymph-node including a classic rash on the palms of the hands and soles of the feet. Latent syphilis is asymptomatic and characterized by positive syphilis serology.
Trichomoniasis
The predominant symptoms include abnormal vaginal discharge with redness of the vulva, itching and painful intercourse.
Genital herpes simplex virus (HSV)
HSV most commonly presents as painful sores, vesicles or ulcerations on the external genitalia and mouth. Symptomatic genital HSV is a lifelong condition that can be characterized by frequent symptomatic recurrences.
Human T-lymphotropic virus type 1 (HTLV-1)
Generally asymptomatic, the chronic form of HTLV-1 can cause severe disease, including adult T-cell leukaemia/lymphoma (ATL) and a progressive nervous system condition known as HTLV-1-associated myelopathy or tropical spastic paraparesis (HAM/TSP).
Effective treatment is currently available for several STIs.
Three bacterial STIs (chlamydia, gonorrhoea and syphilis) and one parasitic STI (trichomoniasis) are usually curable with existing, effective single-dose or multiple-dose regimens of antibiotics.
For viral STIs (HIV, HSV and HTLV-1), the most effective medications available are antivirals or anti-cancer drugs (in the case of HTLV-1), that can modulate the course of the diseases, though they cannot cure these three diseases.
Antimicrobial resistance (AMR) to antibiotics used to treat STIs, in particular gonorrhoea, has increased rapidly in recent years and has reduced successful treatment outcomes. Results from the current Gonococcal AMR Surveillance Programme (GASP) show trends of high rates of quinolone resistance, increasing azithromycin resistance and emerging resistance of extended-spectrum cephalosporins.
The emergence of decreased susceptibility of gonorrhoea to extended-spectrum cephalosporins, together with established high-levels of resistance to penicillins, sulphonamides, tetracyclines, quinolones and macrolides make gonorrhoea a multidrug-resistant organism. AMR for other STIs, though less common, also exists, making prevention and prompt treatment critical.
To adequately treat STIs it is important to take the appropriate antimicrobials, with the correct dose and duration for the specific STI to ensure adequate treatment or cure, and to prevent the development of antimicrobial resistance.
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