Sexually Transmitted Diseases in Women

Sexually transmitted diseases (STDs) are among the most common infectious diseases in the United States today. More than 20 STDs have been identified and they affect an estimated 19 million men and women in this country each year. The annual treatment cost of STDs in the United States is estimated to be more than $14 billion.

How do STDs affect women?

Health problems caused by STDs tend to be more severe and more frequent for women than for men, in part because for women there are often no visible symptoms, so they do not seek care until serious problems have developed.

Some STDs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which is a cause of both infertility and ectopic (tubal) pregnancy. Ectopic pregnancy can be fatal. STDs in women also may be associated with cervical cancer. Human papillomavirus infection (HPV) can cause genital warts and cervical and other genital cancers. STDs can be passed from a mother to her baby before, during or immediately after birth. Some of these new-born infections can be cured easily, but others may cause a baby to be permanently disabled or even die.

What are the most common types of STDs?

Chlamydial Infection

This infection is the most common of all bacterial STDs, with an estimated 2.8 million new cases occurring each year. Chlamydial infection may cause an abnormal vaginal discharge and burning during urination. In women, untreated chlamydial infection may lead to pelvic inflammatory disease (PID), one of the most common causes of ectopic pregnancy and infertility in women. Many people with chlamydial infection, however, have few or no symptoms of infection; it often goes undiagnosed and untreated. Once diagnosed with chlamydial infection, a person can be treated with an antibiotic.

Genital Herpes

Genital herpes affects at least 45 million Americans ages 12 and older. Approximately 500,000 new cases of this incurable viral infection develop annually. Herpes infections are caused by the herpes simplex viruses type 1 and type 2. Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender sores that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter. The virus remains in the body for life and the lesions may recur from time to time. Severe or frequently recurrent genital herpes is treated with one of several antiviral drugs that are available by prescription. These drugs help control the symptoms, but do not eliminate the herpes virus from the body. Suppressive antiviral therapy can be used to prevent recurrences and perhaps transmission. Women who acquire genital herpes can transmit the virus to their babies during delivery. Untreated HSV infection in new-borns can result in mental retardation and death.

Genital Warts 

Genital warts (also called venereal warts or condylomata acuminata) are caused by the human papillomavirus, a virus related to the one that causes common skin warts. Certain high-risk types of HPV can cause cervical cancer and other genital cancers, but these are different from the types that cause genital warts. Genital warts usually first appear as small, hard painless bumps in the vaginal area or around the anus. If untreated, they may grow and develop a fleshy, cauliflower-like appearance. There is a very low risk that a pregnant woman with genital warts can pass HPV to her baby. In the rare cases where HPV is passed, the baby could develop warts in the throat or voice box. Genital warts infect between 500,000 to 1 million Americans each year. They are usually removed by freezing, burning or laser treatment. If the warts are very large, they can be removed by surgery. If they recur, they may be treated with injections of a type of interferon. Although treatments may get rid of warts, they do not get rid of HPV, which can still be passed on to sex partners.

Gonorrhea

Gonorrhea is the second most commonly reported infectious disease in the United States. The CDC estimates that more than 700,000 persons in this country get new gonorrheal infections each year; only about half of these infections are reported to the CDC. Most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The most common symptoms of gonorrhea are a vaginal discharge or vaginal bleeding between periods. Untreated cases can lead to serious complications, including PID, ectopic pregnancy and infertility. Historically, penicillin has been used to treat gonorrhea, but in the last decade resistance to penicillin has emerged. New antibiotics or combinations of drugs must be used to treat these resistant strains.

Syphilis 

While the rate of primary and secondary (P&S) syphilis – the most infectious stages of the disease – reached an all-time low in 2000, it has increased dramatically in recent years. Between 2004 and 2005, the number of reported P&S syphilis cases in the United States increased from 7,980 to 8,724. The overall increase in syphilis cases was driven primarily by increases among males. However, troubling trends also were seen among females, as the rate of reported cases among females increased for the first time in more than 10 years. Syphilis is easily curable in its early stages. The initial symptom is a chancre, a painless open sore that usually appears around or in the vagina. If untreated, it can lead to serious long-term complications, including problems of the heart and central nervous system, organ damage and even death. Congenital syphilis can cause stillbirth, death soon after birth, and physical deformity and neurological complications in children who survive. The full course of the disease can take years. Penicillin remains the most effective drug in the treatment of syphilis.

Other STDs

Other diseases that may be sexually transmitted include human immunodeficiency virus (HIV), trichomoniasis, bacterial vaginosis, cytomegalovirus infections and pubic lice (crabs). STDs in pregnant women are associated with a number of adverse outcomes, including spontaneous abortion and infection in the new-born. Low birth weight and prematurity appear to be associated with STDs, including chlamydial infection and trichomoniasis. Congenital or perinatal infection (infection that occurs around the time of birth) occurs in 30 percent to 70 percent of infants born to infected mothers, and complications may include pneumonia, eye infections, and permanent neurologic damage.

What can you do to prevent STDs?

The best way to prevent STDs is to avoid sexual contact with others. If you decide to be sexually active, there are things that you can do to reduce your risk of developing an STD:

Have a mutually monogamous sexual relationship with an uninfected partner.

Use condoms correctly every time you have sex. The use of latex or polyurethane condoms during vaginal intercourse, when used consistently and correctly, can reduce the risk of transmission of STDs.

Delay having sexual relations as long as possible. The younger people are when having sex for the first time, the more susceptible they become to developing an STD. The risk of acquiring an STD also increases with the number of partners over a lifetime.

Source: http://www.idph.state.il.us/about/womenshealth/factsheets/std.htm

NUCLEIC-ACID AMPLIFICATION TESTS

NUCLEIC-ACID AMPLIFICATION TESTS

Nucleic-acid amplification tests, also known as NATs or NAATs, are used to identify small amounts of DNA or RNA in test samples. When it comes to STD testing, there are NATs available that can detect a variety of different STDs. In fact, most urine tests for STDs are performed using nucleic-acid amplification tests.

MECHANISM

A NAT uses a series of repeated chemical reactions to make numerous copies of the DNA or RNA that doctors are trying to detect. These reactions amplify the signal of the nucleic acids in the test sample so that they are easier to identify. It's much simpler to find 10,000 copies of a gene than 10. 

once the amount of DNA or RNA has been increased in the sample using PCR or LCR, more conventional tests are used to detect it. These tests usually involve some form of nucleic acid hybridization. In those tests, the sample is probed with an artificially produced complementary strand of DNA or RNA that has been labelled in some way that makes it easy to detect. It may help to picture it as a glow in the dark tag that only sticks to one very specific piece of identifying information.

STD TESTING

Nucleic-acid amplification tests are incredibly useful for STD testing. They allow doctors to detect an STD pathogen even when only a very small number of organisms are present. It is this sort of technology that has made it possible to do urine testing for STDs that were previously only detectable by swab.

Furthermore, since nucleic-acid amplification tests are incredibly sensitive to even small amounts of viral DNA, they are very important for screening the blood supply. These tests make it possible to detect tiny amounts of HIV and other blood-borne pathogens that might otherwise be missed.

There are also non-amplified nucleic acid tests available for certain STDs, such as gonorrhea and chlamydia. Non-amplified nucleic acid hybridization tests are more likely to be used when large amounts of bacterial or viral DNA (or RNA) would be expected to be present, such as in a urethral swab or in a bacterial culture sample. In such circumstances, no amplification is necessary. In these samples, if DNA or RNA is present, it should be present in detectable amounts.

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STD 2018: Scientific Sessions

Session 1: Types of STDs

Sexually transmitted diseases (STDs) are infectious diseases that are transmitted from a person to another through sexual contact or blood of an infected person. The pathogens such as bacteria, virus, fungi, protozoa are responsible for the disease transmission. Bacterial STDs are Syphilis, Gonorrhoea, Chlamydia, Chancroid. Viral STDs include HIV/AIDS, Human papillomavirus, Hepatitis, Genital Herpes. Trichomoniasis is a STD caused by parasitic protozoan. Candidiasis is considered to be an fungal STD which is spread by fungus Candida albicans. Most of the sexually transmitted diseases such as viral STDs have no cure but the disease can be controlled with proper treatment while bacterial, fungal and protozoan STDs can be cured with antifungals and antibiotics.

• Bacterial STDs
• Viral STDs
• Protozoan STDs
• Fungal STDs

Session 2: Evolution of STDs

The evolution of the STD pathogens are caused by the selective pressures of the host-immune response, modern drugs, vaccines or by microbial competition. Through evolutionary phase, a pathogen can become more or less virulent. The phylogeny, epidemiology and origin studies on sexually transmitted diseases provides valuable data on the genetic transition traits in both host and pathogen. The evolutionary study of the disease-causing pathogen provides the disease transmission and diversity among the human population. The clinical epidemiologyand phylogenetic study paves way for new insights for the development of drugs and therapies against the multiple drug resistance.

• Origin
• Phylogenetics
• Epidemiology
• Diversity

Session 3: Immunopathogenesis

The immune system helps in elimination of the invading microbial pathogens in the body through a series of defense mechanism. The innate immune response of the body provides first line of defense against the pathogens which is fast and non-specific response while adaptive immune response is specific and slow. The study of immunopathogenesis allows us to explore the disease transmission process, pathogen-host interactions, immune defense against the STD pathogens. This allows us to understand the pathological condition and progression of the disease and also the genetic factors influencing the immune defense against STD transmission. The genetic factors influence can be used for the development of gene therapies that triggers immune reaction against the disease-causing pathogens in the body.

• Disease Transmission
• Pathogen-Host Interaction
• Innate Immune Response
• Adaptive Immune Response
• Genetic Factors

Session 4: Treatment Strategies

Antibiotics are used for treating the STDs caused by bacteria and protozoa. The bacterial STDs can be cured if the infection is properly diagnosed and treated. Several antibiotic resistant strains of pathogens have developed which pose a serious threat for health of the STD affected individuals. For viral STDs, there are no complete cure but progression of the disease can be controlled by antiretroviral therapies which use multiple antiretroviral drugs to decrease the disease proliferation and reduce other opportunistic infections. Gene therapy involves gene editing approaches which can provide a better and safer alternative to other existing drugs. Novel and emerging treatment strategies can provide a solution for the increasing drug resistance in the pathogens.

• Antibiotic Therapy
• Antiretroviral Combination Therapy
• Immunotherapy
• Gene Therapy

Session 5: STDs Prevention

Sexually Transmitted Diseases are transmitted from a person to another through sexual contact or blood transfusions from an infected person or needle sharing, or from mother to infant during pregnancy, labor and breastfeeding. STDs can be prevented through vaccination, screening and through promoting safer sexual behaviour, early health-care seeking behaviour, prevention and care activities. Pregnant women affected with STD must take proper treatment to prevent the vertical transmission of STD. Most STDs cannot be cured and leads to infertility, birth defects in infants, co-infections, opportunistic infections and many other health issues.

• Effective Healthcare Systems
• Vaccination
• Preconception Care
• Prenatal Care

Session 6: Advanced Diagnostic Tools

Diagnosis of STDs are done by serological assays, amplification techniques, immunological diagnosis attains accurate result of the diagnosis. Point-of-care test enables rapid screening of Syphilis and allows treatment without delay. Nucleic acid amplification tests monitor the infection trends and helps in the adaptation of treatment protocols. Drug-resistance test provides the provisions for identifying drug resistance in the STDswhich aids in overcoming the resistance and provide a better treatment. Further improvements in the diagnosis method can help in rapid and cost-effective method for screening of the STDs.

• Nucleic acid Tests
• Serological Assays
• Amplification Techniques
• Immunological Diagnosis
• Drug-Resistance Testing
• Point- of-Care Test

Session 7: Drug Development and Research

Drug development and research is the development and invention of new drugs and improvement of existing drugs. Continuous progress in drug development and research field is necessary for invention of new drugs and drug targets for STDs. Identification of the drug target is the basis of the drug development process, this can be done through various computational approaches. Gene editing technology such as CRISPR seeks to eliminate the latent as well active HIV infection in the human which would be more effective in the treatment of AIDS. Various viral inhibitors such as entry inhibitors, maturation inhibitors are designed to inhibit the replication of the virus inside the host cell.

• New Drugs and Drug Targets
• Integrase Inhibitors
• Entry Inhibitors
• Maturation Inhibitors
• Gene Editing

Session 8: Vaccines Development

A highly effective method for controlling infectious diseases is vaccination, it helps in prevention of high risk health issues. Prophylactic vaccines are those used for prevention while therapeutic vaccines are used for treatment of the specific disease. Sexually transmitted diseases are spread by pathogens such as bacteria, virus, fungi and protozoa. Many viral STDs doesn't have cure hence preventing the infection through vaccination is a best method. Vaccines are developed for Hepatitis and Human Papillomavirus (HPV) infection and for HIV and Herpes virus vaccines are being developed. Vaccination is the primary solution for eradication of sexually transmitted diseases in human.

• Pre-Exposure Prophylaxis
• Post-Exposure Prophylaxis
• Therapeutic Vaccines
• Advancements in Vaccine Technology
• HIV and Genital herpes Vaccine Development

Session 9: Nanotechnology in HIV Treatment

Nanotechnology is the science and engineering of structures that are 1–100 nm in size. Nanomedicine is a branch of medicine which is employed in preventive, diagnostic and therapeutic purposes. Using nanoparticles, effective timely release of drugs to the infected areas/organs are possible which improves specificity of drug action. HIV/AIDS patients face a major problem where the virus resides in latent reservoirs makes it hard to reach for drugs. Nanoparticles has the ability to travel through the body with less interruption which aids in effective release of drugs at HIV virus reservoirs at the specific target. Therapeutic nanoparticles have higher specificity for the drug targets which enhances the treatment efficiency and better cure for the affected individual.

• Drug Delivery System
• Drug Nanosuspension
• Therapeutic Nanomaterials
• Nanoparticle Based Vaccines

Session 10: Phytochemicals in STDs Treatment

Plants contain a wide range of substances that are used for treating chronic as well as acute infectious diseases. Many modern drugs in use have been developed from the medicinal plants which has been used by indigenous people. Phytochemicals are chemicals secreted by plants that have disease preventive properties that is used by the plants to protect itself from diseases. Antimicrobial activity of the plant sources can act as a better drug for the strains that has developed multiple drug resistance to antibiotics. Many bacterial STDs can be combated using phytochemicals produced by the medicinal plants. Pharmacological effects of the bio active compounds in the plants must be explored to produce a cure for the multiple drug resistant bacterial STDs.

• Antimicrobial Effect of Phytochemicals
• Phytoconstituents and its Effects on STDs
• Novel Therapeutic Drugs
• Multi-Drug Resistance and Phytochemical Drugs

Session 11: Drug Resistance and Mutation

The infectious pathogens mutate under certain circumstances to overcome the pressure inflicted upon them. Such organisms develop resistance to the drug in use. This proves to be a major problem in the treatment of sexually transmitted diseases. Human immunodeficiency virus has developed resistance to the antiretroviral drug provided. Hence combination antiretroviral therapies are used for treating AIDS which involves using two or more antiretroviral drugs together. Several bacterial species has also developed resistance to the antibiotics provided for the treatment. The mutation of the pathogens has led to development of drug resistance against many antibiotics and antiretroviral drugs.

• Nucleoside Reverse Transcriptase Inhibitors Resistance
• Non-Nucleoside Reverse Transcriptase Inhibitors Resistance
• Protease Inhibitors Resistance
• Antibiotic Resistance
• Antiviral Drug Resistance

Session 12: STDs and Cancer

Sexually transmitted diseases increases the risk of being affected by cancer. Among the STDs which lead to cancer, human papillomavirus infection is found to cause cervical cancer in women and penile cancer in men. It is also responsible for the development of oropharyngeal cancer in both sexes. Untreated STDs has a higher risk for leading to development of cancer. The progression of cancer in people affected by STD must be analyzed to understand the causative agents of the cancer.

• Oropharyngeal Cancer
• Cervical Cancer
• Penile Cancer
• Prostate Cancer

Session 13: Co-Infection of STDs

Gonorrhoea, chlamydia and trichomoniasis cause immune reactions which leads to inflammation that can easily be infected with HIV. Co-infection is a condition where a person actively infected with STD is infected with another STD. when a STI infected individual is prone to another infection due to immune compromise they are less able to mount a protective response against sexually transmitted pathogens. Treating co-infected individuals can be challenging and the treatment methods must be analyzed and modified to their needs.

• HIV and Gonorrhea
• HIV and Hepatitis
• HIV and Kidney disease
• HIV and Tuberculosis

Session 14: Infertility and Birth Defects

When an STD infection is left untreated in women, it may be lead to pelvic inflammatory disease (PID). Being affected by pelvic inflammatory disease may lead to infertility or ectopic pregnancy in pregnant women. When the mother is infected by STD, the fetus or new born is mostly infected. STDs during pregnancy can lead to miscarriage, birth defects including blindness, deafness, bone deformities, and intellectual disability, stillbirth, premature birth. In males, reduced fertility or infertility is most common side effect of the disease.

• Ectopic Pregnancy
• Premature Birth
• Neonatal Sepsis
• Neurological Defects

Session 15: Vertical STD Transmission

Vertical STD transmission is the process of transfer of STD from a mother to infant perinatally or postnatally. During delivery, when the baby passes through the infected canal, it can contract the STDs such as chlamydia, gonorrhoea, genital herpes from the infected mother. Syphilis and HIV can be contracted from the mother during fetus development. Postnatal transmission of the disease is possible through breastfeeding the baby. Vertical STD transmission poses serious threat to the health of the baby.

• Perinatal Transmission
• Postnatal Transmission
• Prevention of STD Transmission
• Pregnancy Care and Treatment

Session 16: Paediatric STDs

Sexually Transmitted Diseases are an important cause of morbidity in paediatric patients. The transmission occurs via transplacental, intrapartum, and postpartum exposure. When an infant contracts STD from mother, it can affect the skin, eyes, mouth, central nervous system, and can also lead to organ failure. With treatment, the chances of transmitting HIV from mother to infant is low. Proper awareness, treatment and diagnosis is needed to prevent the transmission of STDs among young people.

• Clinical Manifestation
• Early Diagnosis
• Risk Factors
• Preventive Measures

Session 17: Multimorbidities and complications

Multi-morbidities is the presence of two or more chronic diseases at the same time. Super infection or re-infection is the condition where a person with HIV infection acquires infection with the sub-type of HIV. Re-infection affects the treatment which can deteriorate the health of the affected individual. The STDs affected individual suffers from other social and emotional complications which may also have adverse effects in the health of the individual. Multiple morbidities associated with the disease causes more damage to the health as the immune system would be compromised by the STD.

• Opportunistic Infection
• Superinfection/Reinfection
• Behavioral Complications
• Social Complications

Session 18: Public Awareness and Knowledge of STDs

Educational and awareness programs must be conducted to improve the public knowledge about the sexually transmitted diseases. People affected by sexually transmitted diseases have dramatically increased, millions of people are affected by the disease due to lack of awareness. Public must be aware about the impact of STDs on the lives of the affected people and the importance of preventing, screening and treating STDs. Poor knowledge about the STDs lead to increased health issues such as ectopic pregnancies, infertility and other complications. STDs are a major health issue that affects mostly young people, not only in developing countries but in developed countries also.

• Impact of STDs
• STD Screening
• Risk Awareness
• Prevention Education
• Community Awareness

 

Julius Wagner-Jauregg's Nobel Prize for Syphilis Treatment

In 1927, Austrian psychiatrist Julius Wagner-Jauregg received the Nobel Prize in Medicine for curing some patients with brain damage from syphilis by infecting them with malaria (Yale J Biol Med, June, 2013;86(2):245–254).  He got the idea of causing very high fevers to cure syphilis after he saw a woman apparently cured of schizophrenia when she suffered a very high fever and terrible rash on her skin caused by erysipelas, an infection with streptococcal bacteria.  

Ten to thirty years after a person is infected with syphilis, the spirochete bacteria can invade the brain to damage a person's thought process, behavior, mood and ability to reason.   Wagner-Jauregg was correct in treating psychiatric disease with biological methods, but because he was a Nazi, he has not been recognized as a groundbreaker for medical treatments for mental disease.  

Who was Julius Wagner-Jauregg? 

Julius Wagner-Jauregg (7 March 1857 – 27 September 1940) was an Austrian physician, who won the Nobel Prize in Physiology or Medicine in 1927 and is the only psychiatrist to have done so. His Nobel award was "for his discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica". Wagner-Jauregg was a scientist whose scientific studies showed that:

• iodine deficiency causes cretinism (lack of growth in childhood),

• giving iodine can cure an enlarged thyroid, and 

• giving a patient malaria could treat the brain damage caused by syphilis.  

Scientists later learned that a prolonged, high fever does not cure non-syphilitic schizophrenia, even if it can kill the germ that causes syphilis.  

The Nobel Prize-Winning Experiment

In 1917, Wagner-Jauregg injected blood from a German soldier infected with malaria into nine of his patients who were suffering from paresis, schizophrenic-like brain damage caused by syphilis. After 7-12 days of very high fevers, the patients were given quinine to treat the malaria and Neosalvarsan to treat syphilis.  One died, two were sent to insane asylums, and six improved dramatically. 

However, four of these six later suffered further brain damage, but two recovered completely (Psychiatrike. 2013;24(3):208-12).  Subsequent studies showed that about 50 percent of patients responded to this fever treatment and improved enough to be released from insane asylums. Of those released from the asylum, 50 percent had no recurrence, but about 15 percent died from complications of malaria (Science. 2013;342(6159):686). 

Temperatures above 105.8 F (41 Celsius) for at least six hours can kill the bacterium that causes syphilis. However, the brain can be permanently damaged by temperatures that high for that long. 

On the Road to a Cure for Syphilis

Approximately five to ten percent of all psychiatric admissions before 1945 were due to syphilis of the brain, which affected predominantly middle-class males to cause dementia, psychosis, paralysis and death.   Paul Ehrlich, another Nobel Prize winner, discovered Salvarsan to treat syphilis and also used methylene blue to treat malaria.  In the 1950s, derivatives of methylene blue called phenothiazines were found by the French company Rhone Poulenc to treat mental disorders.  That was followed by chlorpromazine and other drugs to treat mental disorders.  

Prior to Wagner-Jauregg’s reports of treating schizophrenia from syphilis with malaria, doctors had no effective treatment for that disease. Giving patients malaria was just about the only treatment that allowed some insane asylum patients to return to their normal lives (Am J Psychiatry. 1946;02:577-582).  It allowed psychiatry to become an accepted medical specialty because it showed that schizophrenia at last had a treatable cause, killing the bacterium that causes syphilis.  

In 1928, Alexander Fleming noted that mold could prevent the bacterium Staphylococcus from growing in a petri dish. In 1939, Howard Florey and Ernst Chain extracted and purified penicillin and all three were awarded the Nobel Prize in Medicine. Today all cases of syphilis can be cured as long as an infected person is diagnosed and treated properly and early enough.   

Syphilis Symptoms

Syphilis is transmitted during vaginal, anal or oral sex with an infected person.  An unborn child can get it from an infected mother.  You do not get syphilis from doorknobs, toilet seats, swimming pools, clothing, bathtubs, or silverware. 

Primary Syphilis: From 10 to 90 days after sex with an infected partner, a person usually develops a painless single skin ulcer called a chancre in the genitals, anus or mouth.  It usually goes away after a week or two with no treatment whatever.  Many infected people develop no chancre at all and have no other symptoms. 

Secondary Syphilis: Two to eight weeks after being infected, a person may develop a non-itchy rash, usually reddish-brown spots on the bottoms of the feet and on the palms of the hands.  Other symptoms can include a sore throat, fever, swollen lymph glands, headaches, fatigue, muscle aches, warts on the genitals, loss of appetite and joint pain. If you are treated properly with antibiotics, you should be cured.  However, if you do not receive treatment, you can suffer tertiary syphilis with permanent incurable damage.  

Tertiary Syphilis: Ten, twenty or more years later, the bacterium can grow in and destroy any part of the body. It can cause blindness, dementia, schizophrenia, paralysis, loss of feeling, arthritis, ruptured blood vessels and liver damage.  

 

Source: http://www.drmirkin.com/histories-and-mysteries/julius-wagnerjaureggs-nobel-prize-for-syphilis-treatment.html

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