Sexually Transmitted Diseases

 Sexually Transmitted Diseases, STDs are passed on through intimate sexual contact. Sexually transmitted diseases can be passed on during vaginal, anal and oral sex, as well as through genital contact with an infected partner.

Causes of sexually transmitted diseases

Chancroid (Haemophilus ducreyi)

The causative agent of this sexually transmitted diseases is Haemophilus ducreyi

Symptoms and signs

• Painful, soft and tender genital ulcer
• Vesiculo-pustule on perineum, vagina or cervix
• Heavy, foul contagious discharge
• Ulcers may appear in clusters
• Oedema and fluctuation(inguinal buboes)
• Kissing ulcers may develop(on opposite surfaces of the labia)
• Painful urination(women)
• Pain during intercourse

Investigations

    Ito test

Treatment

• Medicines
• Drainage of large lymph node swellings

Chlamydia (Chlamydia trachomatis)

Causative agent

Chlamydia trachomatis

Symptoms and signs

Male

• Burning micturition
• Dysuria
• Redness, swelling, burning, itching around the opening of the penis
• Discharge from the penis( milky-white, grey, or yellow)

Female

• Recurrent urethritis
• Yellowish vaginal discharge with/out a foul odour
• Bleeding between periods and after intercourse
• Dyspareunia
• Pain in the lower abdomen

Rectal infection

• Itching
• Bleeding
• Painful defecation
• Mucus-like discharge

Investigations

• Tissue culture
• Micro Immuno-fluorescence

Treatment

• Medicines
• Sexual partners should be treated too.

Gonorrhoea (Neisseria gonorrhoea)

Causative agent

Neisseria gonorrhoea

Symptoms and signs

Male

• White, yellow or green thick discharge from the tip of the penis
• Inflammation of the testicles & prostate gland
• Irritation or discharge from the anus
• Urethral itch
• Burning micturition
• Dysuria

Female

• Urethritis
• Dysuria
• Low backache
• Lower abdominal discomfort
• Tubo-ovarian abscess
•  Pyosalpinx
• Pelvic abscess
• Periuretheral abscess
• Yellow purulent discharge (urethral orifice)
• Skeinitis
• Bartholinitis
• Vulvitis
• Vaginitis
• Cervicitis
• Cystitis
• Mild trigonitis

Proctitis

• Rectal discharge
• Painful defecation
• Rectal bleeding

Gonococcal arthritis (upper limb may be involved)

Gonococcal septicaemia

Chronic Gonorrhoea

• Fixed retroversion of the uterus
• Thick appendages
• Menstrual irregularities (menorrhagia, polymenorrhoea)
• Dyspareunia
• Infertility
• Backache
• Low-grade fever
• Chronic hydrosalpinx

Investigations

• Smears of urethral and cervical discharge
• Culture of discharge
• Gonococcal complement fixation test
• Fluorescent tests

Treatment

• Ayurvedic Medicines are effective in almost all sexually transmitted diseases.
• Drainage of pus

1. Bartholin abscess
2. Skene’s abscess
3. Periuretheral abscess

• Pelvic diathermy(pelvic adhesions)
• Surgery (chronic gonorrhoea)
• Sexual partners should be treated too.

Granuloma inguinale

Granuloma Inguinale (Donovanosis) is a chronic ulcerative granulomatous disease that develops in the vulva, perineum and inguinal regions. After contracting the infection it may take from 1 week to 3 months for any signs and symptoms to appear.

Causative agent

Calymmatobacterium granulomatis

Symptoms and signs

Nodular type

It consists of ulcerated, painless soft lumps that are typically beefy red in colour and tend to bleed easily.

Hypertrophic or verrucous type

It consists of large dry warty masses that resemble genital warts.

Necrotic type

It presents as dry ulcers that evolve into scarred areas.

Chronic case

• Bleeding
• Inguinal swelling(bubo)
• Local lymph nodes may enlarge and become abscesses or ulcers

Investigations

• Punch biopsy of the lesion
• Culture of tissue sample

Treatment

 Medicines

Complications

• Heart failure.
• Permanent swelling and scarring
• Pneumonia
• Widespread destruction of the genitals

Lymphogranuloma venereum (Chlamydia)

Causative agent

 Chlamydia trachomatis

Symptoms and signs

• Vesiculopustular eruptions on external genitalia (male and female)
• Ulceration of inguinal nodes and of vulva
• B/L inguinal bubo(hard, cutaneous, reddish blue induration)
• Severe pain restricted movements
• Painful defecation
• Bleeding per rectum
• Tenesmus
• Rectal strictures
• Vaginal stenosis

 Investigations    

• Frei’s test
• Complement fixation
• Micro Immuno-fluorescence

Treatment

• Warm compresses
• Medicines
• Surgery

1. Dilatation of anal strictures
2. Colostomy
3. Vulvectomy
4. Drainage of pus

Syphilis (Treponema pallidum)

Causative agent

It is one of the most common sexually transmitted diseases. The causative agent is Treponema pallidum

Symptoms and signs

Primary stage

• Chancres appear 21 days after sexual contact with an infected person; On the vulva, cervix (female); On penis(male)
• The primary lesion is circular, indurated with an eroded base
• Marked oedema of the surrounding tissues
• Superficial inguinal lymphadenopathy

Secondary stage

• Generalized skin eruptions
• Fever
• Papulo-squamous lesions
• Flat, warty-looking growths (vulva –female and around the anus -both sexes)
• White patches on the tongue or roof of the mouth.
• Patchy hair loss.
• Lesions may form large plaques and are highly infectious

Latent and tertiary stages

• Paralysis
• Tabes dorsalis
• Aortic incompetence
• Insanity
• Gummatous lesion of skin/mucous membrane (rarely seen on genitalia)

Investigations

• Immune-flouroscent technique
• Fluorescent treponemal antibody absorption test(FTA)
• VDRL
• Complement fixation(Wassermann)
• Spinal fluid test (neurosyphilis)

Treatment

Early syphilis

Ayurvedic Medicines

Late syphilis

Usually, damage done to body organs cannot be reversed.

Genital herpes (herpes simplex virus)

Causes

• Herpes simplex virus type 2 (HSV-II)
• Herpes simplex virus type 1 (HSV-I)

Symptoms and signs

• Decreased appetite
• Fever
•  Malaise
• Muscle aches in the lower back, buttocks, thighs, or knees
• Blisters—

1. small, painful blisters filled with clear or straw-coloured fluid.
2. Female-on labia, vagina, cervix, around the anus, thighs or buttocks
3. Male- on the penis, scrotum, around the anus, thighs or buttocks

Can also occur on the tongue, mouth, eyes, gums, lips, fingers, and other parts of the body

• Tingling, burning, itching, pain at the site before the appearance of blisters
• Painful, shallow ulcers after blisters break. These ulcers eventually crust over and slowly heal over 7 – 14 days or more
• Enlarged and tender inguinal  lymph nodes
• Dysuria
• Incomplete voiding(female)

Investigations

• Culture of fluid from a blister or open sore
• PCR (performed on fluid from a blister)
• Blood tests for Antibody levels to the herpes virus.

Treatment

1. Medication cures genital herpes.
2. Self-care

• Do not wear nylon or other synthetic pantyhose, underwear, or pants. Instead, wear loose-fitting cotton garments
• Gentle cleansing with soap and water is recommended.
• Taking warm baths may relieve the pain (afterwards, keep the blisters dry)

Complications

• Dysplasia
• Carcinoma –in-situ (In vulva and cervix)

Genital warts (human papillomavirus virus)

Genital warts (condyloma acuminatum) are flesh-coloured or greyish bumps caused by the human papillomavirus, or HPV that occur in the genital area. They can be big or small, flat or raised, and solitary or clustered.

Causes

• Poor hygiene
• Presence of other venereal diseases
• Pregnancy
• Moist condition

Symptoms and signs

• Male—lesions on the scrotum or penis
• Female lesions on the cervix, vagina, vulva, near or inside the anus and urethra.
• Red, pink or grey-coloured cauliflower-shaped lesions. These bumps may grow in large clusters and expand into huge masses very rapidly.
• Increase in vaginal fluid excretion.
• Pain and bleeding during and after sexual intercourse.
• Tiny papules on the shaft of the penis
• Discomfort and itching in the affected areas.
• Burning sensation in the genital and anal region.

Investigations

• Aceto-whitening
• Colposcopy
• Pap smear
• Biopsy

 Treatment

• Cryotherapy
• Electro-cautery
• Laser treatment
• Surgery( to remove warts)
• Medication

Hepatitis B and D (hepatitis viruses)

Hepatitis D only occurs in people who are also infected with the hepatitis B virus. 

HIV/AIDS (Human immunodeficiency virus)

AIDS (acquired immunodeficiency syndrome) is the final and most serious stage of HIV(human immunodeficiency virus) disease, which causes severe damage to the immune system. HIV is a retrovirus infecting T-helper cells bearing the CD4 receptors. The body can make more CD4 cells, but eventually, HIV reduces the number of CD4 cells to such an extent that the immune system stops working.

Types

• Primary HIV
• Early HIV
• Advanced HIV

Causes

• Diseases—The following diseases progress to HIV if left untreated/partially treated

1. Chlamydia
2. Genital herpes
3. Gonorrhoea
4. Hepatitis
5. HPV
6. Tuberculosis

• Transmission By– 

1. sexual contact
2. sharing needles
3. infected mothers to their newborns (during pregnancy, delivery
   or breastfeeding)
4. accidental exposure(needle stick injuries)

Symptoms and signs

• Primary HIV infection

1. Fever
2. Fatigue
3. Sore throat
4. Tiredness
5. Joint pain
6. Muscle pain
7. Swollen glands (nodes)
8. Diffuse maculopapular rash

• Late Stage HIV

1. Fever of above 37c (100f) that lasts a number of weeks
2. Blurred vision
3. Dry cough
4. Night sweats
5. Persistent diarrhoea
6. Persistent tiredness
7. Shortness of breath
8. Swollen glands that last for more than three months
9. Unexplained weight loss
10. White spots on your tongue or mouth

Investigations

1. CD4 Cell Count

This is less than 200 cells/ mm³

2. Viral load

It directly measures the amount of virus in the blood. Those people with high viral loads are more likely to experience a decline in CD4 cells and progression of disease than those with lower viral loads.

Treatment

Ayurveda Immunotherapy(strictly under Ayurveda expert guidance) is the right approach for sexually transmitted diseases.

 Complications

• Chronic incurable systemic infections
• Malignancies
• Neurological diseases
• Wasting
• Malnutrition
• Multisystem failure
• Death

Prevention

1. Do not use injected drugs.
2. Do not share needles or syringes(If IV’s are used at all)
3. Prevention Of Transmission From Mother To Child
4. Promotion Of Safe Sex
5. Screening Blood  Donors
6. Trials Of HIV Vaccines

Molluscum contagiosum (poxvirus)

Causative agent

DNA poxvirus is called the Molluscum contagiosum virus (MCV).

Causes

It spread by

• Direct contact with a lesion.
• Contact with contaminated objects(towels, clothing, toys)
• Sexual contact.

Symptoms and signs

• Small, painless, discrete, flesh-coloured umbilicated papules on the external genitalia or perineum
• Papule has a dimple in the centre (containing thick gelatinous material)
• Papules may occur in lines (crops), where scratching is done.    
• Never occur on palms and soles
• Lesions on genitals, abdomen, and inner thigh (adults)

 Investigations

Skin biopsy

Treatment

• Surgery

1. Scraping
2. de-coring
3. freezing
4. electrosurgery.

• Medications used to remove warts                 

Trichomoniasis (Trichomonas vaginalis)

Causative agent

Trichomonas vaginalis

Symptoms and signs

Female

• Vaginal discharge (green-yellow or frothy; unpleasant or fishy smell)
• Pruritus vulvae
• Dyspareunia
• Small, dark red spots (petechiae) on the cervix.
• Dysuria
• Oedema

Male

• Discharge from the penis
• Dysuria
• Increased frequency of urine

Investigations

• Protozoan can be identified on a wet mount of vaginal discharge.
• PH test-The pH(vagina)is likely to exceed 5.0.

Treatment

Medicines

Jock itch (Tenia cruris)

Jock itch (Tenia cruris) is a fungal infection of the skin in the groin. The warm, moist environment is the perfect place for the fungus to grow.

Symptoms and signs

• Itchy enlarged area of redness in a skin fold.
• Raised red plaques rash with sharp borders.
• The border may exhibit tiny pimples or pustules with a red and dry centre.
• The skin of the tip of the penis may be involved
• Female- vaginal itching and white, thick, cottage cheese-like discharge.

Investigations

• Examination of skin with a Wood’s lamp
• Skin scrapings
• Fungal cultures
• RBS
• Full blood count

Treatment

• Topical creams or ointments
• Medicines

Yeast infections (Candida albicans)

The causative yeast Candida albicans lives in the mouth, digestive (gastrointestinal) tract, and vagina, along with many kinds of harmless bacteria, without causing any issues.

Causes

• Weak immunity
• Undue use of antibiotics
• Exposure to cancer drugs or corticosteroids
• Diabetes

Signs and symptoms

Thrush (oral yeast infection) –

• Mouth lining, tongue, and/or angles of the mouth are red, cracked, or have white patches
• Soreness or no symptoms.

Skin (cutaneous) –

• Small-to-large patches of red, moist, raw skin usually develop in body creases( under the breasts, belly, or groin)
• The skin may itch or be painful.
• Pustules may appear around the edges of the red areas.

Vaginitis

• Vaginal itch, pain, or burning
• Cottage-cheese-like discharge
• Dyspareunia
• Dysuria
• Oedema

Esophagitis

• Dysphagia
• Pain behind the breastbone.

Investigations

• Culture of the discharge
• CT-scan
• MRI-brain

Treatment

Medicines

Pubic lice(Pediculosis pubis)

Pubic lice (crabs) are tiny insects that normally reside in pubic hair, underarm hair and, occasionally, in eyelashes and eyebrows. These can also be transmitted through sexual contact, so are clubbed in sexually transmitted diseases.

Symptoms and signs

• Itching (worse at night) and burning of the pubic area.
• Itching may spread to other moist areas of the body (armpit)
• Intense or prolonged scratching

Investigations

Lice eggs, or “nits,” may be found attached to hair in the pubic area, when seen under a microscope.

Treatment

Completely treated with Medicines

Scabies( Sarcoptes scabiei)

Scabies is a contagious skin condition where the main symptom is intense itching. It is caused by tiny mites called Sarcoptes scabiei, which burrow into the skin. The mites deposit their eggs, forming a burrow that looks like a pencil mark. Eggs mature in 21 days. The itchy rash is an allergic response to the mite. These are included in sexually transmitted diseases.

Causes

Causative agents are Sarcoptes scabiei mites.

This condition is spread by

• Direct contact with infected people
• By sharing towels, clothing or bedding.
• Spreads rapidly under crowded conditions

1. Nursing homes
2. Hospitals
3. Institutions
4. Childcare facilities.

Symptoms and signs

General

• Intense itching, especially at night and over most of the body.
• Sores on the body
• Scaling and redness
• Small, rounded lumps (often on the penis and scrotum)
• Pimple-like irritations, burrows, or rash on the skin; typically found on the

1. Breasts
2. Buttocks
3. Elbows
4. Knees
5. Penis
6. Shoulder blades.
7. Webbing between the fingers
8. Wrists

Infants

• Irritations on the palms of the hands and soles of the feet.
• Scabies of the face and scalp are more common

Investigations

• Examination under the microscope of skin scrapings
• Skin biopsy

Treatment

Self-Care

• Wash all clothing, towels, and bed linens
• Use hot water.
• Use the dryer at high heat rather than air drying.
• Cut nails, and clean under them thoroughly to remove any mites or eggs that may be present.
• Thoroughly vacuum rugs, furniture, bedding, and car interior and throw the vacuum-cleaner bag away when finished.
• Avoid scratching.

Medical

• Medicines
• Lotion or cream
• All household members, sexual partners, and other close contacts should be treated at the same time regardless of whether or not they have symptoms
• Keep away from the person with scabies unless fully treated.

Complications

• Crusted scabies
• Impetigo

Prevention

• All Sexually transmitted diseases can be prevented by protected sexual contact (devices like condoms)
• Practice a monogamous relationship (both sexual partners are each other’s, only sexual partners).
• Learn the symptoms of Sexually transmitted diseases.
• Avoid sexual contact during the course of treatment.
• Avoid douching. It removes the natural barrier to Sexually transmitted diseases in the vagina 
• Vaccines against HPV and hepatitis B are available and effective.