Sexually Transmitted Infections: Problems for Life

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by WeirdBoy
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Sexually Transmitted Infections: Problems for Life

A sexually transmitted disease (STD), also known as sexually transmitted infection (STI) or venereal disease (VD), is an illness that has a significant probability of transmission between humans or animals by means of human sexual behavior, including vaginal intercourse, oral sex, and anal sex. While in the past, these illnesses have mostly been referred to as STDs or VD, in recent years the term sexually transmitted infection (STI) has been preferred, as it has abroader range of meaning; a person may be infected, and may potentially infect others, without showing signs of disease. Some STIs can also be transmitted via the use of IV drug needles after its use by an infected person, as well as through childbirth or breastfeeding.Sexually transmitted infections have been well known for hundreds of years.

Case Study 1: Preventing HIV/AIDS and Sexually Transmitted Infections in ThailandGeographic area: ThailandHealth condition: Between 1989 and 1990, the proportion of direct sex workers in Thailand infected with HIV tripled, from 3.5 percent to 9.3 percent and a year later reached 21.6 percent. Over the same period, the proportion of male conscripts already infected with HIV when tested on entry to the army at age 21 rose sixfold, from 0.5 percent in 1989 to 3 percent in 1991.Global importance of the health condition today: HIV/AIDS is one of the greatest threats to human health worldwide, with an estimated 38.6 million people infected with the virus in 2005. The vast majority of people with HIV are in sub-Saharan Africa, where life expectancy today is just 47 years; without AIDS, it is estimated that life expectancy would be 15 years longer. The number of children who have lost a parent to AIDS is now estimated at 20 million. Intervention or program: In 1991, the National AIDS Committee led by Thailand’s prime minister implemented the “100 percent condom program,” in which all sex workers in sex establishments were required to use condoms with clients. Health officials provided boxes of condoms free of charge, and local police held meetings with sex establishment owners and sex workers, despite the illegality of prostitution. Men seeking treatment for sexually transmitted infections (STIs) were asked to name the sex establishmentthey had used, and health officials would then visit the establishment to provide more information.Cost and cost-effectiveness: Total government expenditure on the national AIDS program remained steady at approximately $375 million from 1998 to 2001, with the majority spent on treatment and care (65 percent); this investment represents 1.9 percent of the nation’s overall health budget.Impact: Condom use in sex work nationwide increased from 14 percent in early 1989 to more than 90 percent by June 1992. An estimated 200,000 new infections were averted between 1993 and 2000. The number of new STI cases fell from 200,000 in 1989 to 15,000 in 2001; the rate of new HIV infections fell fivefold between 1991 and 1995.

Case Study 3: Sexually transmitted infections on the rise in S'poreSexually transmitted infections (STIs), other than HIV, are on the rise inSingapore, with a 10.6% increase in recent three years.Singapore citizens accounted for about 62% of the number of infections.This was a written answer from the Minister of Health, Mr Khaw Boon Wan, inresponse to a question posed by MP for Sembawang GRC, Ms Ellen Lee Geck Hoon,as to how many cases of sexually transmitted diseases other than HIV (such asgenital warts, herpes, venereal disease, gonorrhea etc) were seen in the clinics,public and private hospitals in past years.The number of STIs increased fromabout 11,000 in 2006 to 12,300 in 2008. The three main STIs are gonorrhoea,non-gonococcal urethritis (NGU) and syphilis.Based on statistics from STI Control Clinic, one-third of the attendances were newcases, with two-thirds as follow-up cases, but there was no breakdown of thecases seen at private clinics.70% of the cases were young adults, in their 20s or 30s. For cases below 20, twothirdswere female. For those older than 20, two-thirds were male.Sexually transmitted infections (STIs) are notifiable in Singapore. To protectpatients' confidentiality, STI notifications need not include personal particulars. Apatient who consults several doctors will chalk up several notifications. Repeatvisits to the same doctor for the same STI will however require only onenotification by the doctor.Those aged between 10 and 39 years accounted for the largest increases in STInotification rates. For those in their 20s and 30s, the rate per 100,000 populationhas increased by 67%, from 270 in 2000 to 451 in 2008.But for those below 20, the rate is especially alarming, having more than doubledfrom 61 per 100,000 population in 2000 to 133 in 2008.The overall rate of notifications per 100,000 population has remained quite stable,increasing only marginally from 250 in 2006 to 254 in 2008. However, while therates have been relatively stable over the past 3 years, they are at a higher levelthan before. The overall rate of notifications per 100,000 population has increasedabout 1 1/2 times from 155 in 2000 to 254 in 2008.The Ministry of Health has worked with several organisations to put in place severalprogrammes to address the rising trend of STIs among youths.The topic on STIs is included in the science syllabus and Ministry of Education hasmade it mandatory for schools to implement sexuality education. Health PromotionBoard (HPB) conducts regular programmes for parents in work places, schools andcommunity venues offering them information and tips on how to broach anddiscuss sexuality issues, including STIs, with their children. The safe sex messagesin HPB?s educational campaigns for HIV also apply to the prevention of STIs ingeneral.

Case Study 2:According to the Health Protection Agency’s Communicable Disease Surveillance Centre, there were 708,083 new diagnoses of STIs in genitourinary medicine (GUM) clinics in England, Wales and Northern Ireland in 2003 - a 4% increase on 2002. The data also indicated that young people are disproportionately affected with STIs. For example, 79% of new diagnoses of chlamydia infection in women occurred in those under the age of 24 and 55% of new diagnoses in men were among those aged 16-24 years old.There is also evidence that young people are particularly ill-informed about sexually transmitted infections and how to protect against them. In a survey in 1999, a quarter of 14-15 year olds said they thought the pill protected against STIs while less than one third of 16-24 year olds had heard of chlamydia.Sexual activity surveys have found that the age at which the majority of young people first have heterosexual sexual sex is 16. Indeed, almost 30% of young men and almost 26% of young women report having had intercourse before their 16th birthday. By the age of 20 the vast majority of young people today will have had sex.

Sexually Transmitted Infections:Problems For Life

Ways to Reduce Your RiskChoose ABSTINENCE:•Complete abstinence from all sexual activity is the only 100% effective way to eliminate your risk of STIsSTIs.Choose SAFER SEX:•Practice less risky forms of sexual activity that dondon’’t include direct genital contact or the exchange of fluids.Choose SOBER SEX ––without alcohol or drugs.• Use latex protection (condoms, oral barriers) at all times.• Have fewer partners ––a single mutually monogamous partner who has been tested is best.• Consider vaccination against hepatitis A/B and HPV.• Talk to your healthcare provider about STI testing

PreventionPrevention is key in addressing incurable STIs, such as HIV & herpes.The most effective way to prevent sexual transmission of STIs is to avoid contact of body parts or fluids which can lead to transfer with an infected partner. No contact minimizes risk. Not all sexual activities involve contact: cybersex, phonesex or masturbation from a distance are methods of avoiding contact. Proper use of condoms reduces contact and risk.Ideally, both partners should get tested for STIs before initiating sexual contact, or before resuming contact if a partner engaged in contact with someone else. Many infections are not detectable immediately after exposure, so enough time must be allowed between possible exposures and testing for the tests to be accurate. Certain STIs, particularly certain persistent viruses like HPV, may be impossible to detect with current medical procedures.Many diseases that establish permanent infections can so occupy the immune system that other diseases become more easily transmitted. The innate immune system led by defensins against HIV can prevent transmission of HIV when viral counts are very low, but if busy with other viruses or overwhelmed, HIV can establish itself. Certain viral STI's also greatly increase the risk of death for HIV infected patients.VaccinesVaccines are available that protect against some viral STIs, such as Hepatitis B and some types of HPV. Vaccination before initiation of sexual contact is advised to assure maximal protection.CondomsCondoms only provide protection when used properly as a barrier, and only to and from the area that it covers. Uncovered areas are still susceptible to many STDs. In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin, thus properly shielding the insertive penis with a properly worn condom from the vagina and anus effectively stops HIV transmission. An infected fluid to broken skin borne direct transmission of HIV would not be considered "sexually transmitted", but can still theoretically occur during sexual contact, this can be avoided simply by not engaging in sexual contact when having open bleeding wounds. Other STDs, even viral infections, can be prevented with the use of latex condoms as a barrier. Some microorganisms and viruses are small enough to pass through the pores in natural skin condoms, but are still too large to pass through latex condoms.

Link to InfertilityBecause males infected with STIs usually seek treatment in order to stop painful symptoms, their incidence of STI-related infertility is less than for women. However, men are not "off the hook" here: approximately half a million yearly develop epididymitis (inflammation of the testicular tubes) from an STI, which can result in decreased fertility or sterility. Females more typically are not aware of the existence of their STI, therefore do not receive prompt treatment. This often results in pelvic inflammatory disease (PID), a leading cause of tubal-factor infertility, which is one of the most common types of infertility. Tubal-factor infertility refers to any dysfunction of the fallopian tubes, such as adhesions, scar tissue, or any other blockage of the tubes. Such blockage makes it impossible for the sperm and egg to meet in a natural, unassisted manner. In-vitro fertilization (IVF) was first invented specifically as a treatment for tubal-factor infertility. While it can be successful, IVF to treat infertility is very costly, both financially and emotionally

Long-term impact for HerpesThere is no cure for Herpes, but frequency and severity of infections can be partially managed with medication. By themselves, HSV-1 and HSV-2 are generally not considered a serious health risk. However, in very rare cases, the Herpes Simplex Virus can cause serious illness. Infected pregnant women can pass the virus to infants during birth, causing lesions and possibly life-threatening infections of the central nervous system of the baby. In a very small number of cases HSV can cause meningitis or encephalitis (inflammation of the brain), and herpes infection of the eye can cause scarring of the cornea and even blindness.Because Herpes can cause sores on the penis or inside the vagina, it also increases the risk of transmission of HIV, the virus that causes AIDS.

Each year, at least 340 million new infections other than HIV are transmitted through unprotected sex worldwide. The control and treatment of STIs is both a public health imperative and an important intervention for the prevention of HIV. Despite the ample evidence for the link between STIs and HIV, STI control is badly neglected in much of the world. Treatment facilities are often inadequate and unwelcoming, and stigma makes people reluctant to acknowledge symptoms or seek treatment.


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