General Pathology

Sexually Transmitted Infections (STIs) can readily spread through mucous membranes. These delicate linings are found in areas such as the penis, vulva, rectum, and urinary tract. Depending on the specific infection, transmission can also occur, though less commonly, through the mouth, throat, respiratory system, and eyes.

Mucous membranes are distinct from regular skin. They are more permeable, allowing certain disease-causing organisms to enter the body more easily. Even tiny breaks or cuts in the skin, which may be microscopic, can also serve as entry points for pathogens. The penis shaft is particularly vulnerable to infection due to friction during sexual intercourse.

The primary sources of STI transmission, listed from most to least common, are sexual fluids (like semen and vaginal fluids), saliva, and direct contact with mucosal or skin surfaces (especially the penis). Infections can also be transmitted, though less frequently, through feces, urine, and sweat.

It’s important to note that some conditions classified as STIs can spread through simple skin-to-skin contact. Examples of these include herpes simplex virus (HSV), pubic lice, and human papillomavirus (HPV).

Risk Factors for Acquiring STDs

1. Unprotected Sex: Engaging in vaginal, anal, or oral sex without using a condom correctly and consistently significantly elevates the risk of STI acquisition.

2. Multiple Partners: Having sexual relations with numerous individuals increases the likelihood of exposure to sexually transmitted infections.

3. Pre-existing STIs: Being already infected with one STI makes a person more susceptible to contracting additional STIs. For instance, infections like herpes, syphilis, gonorrhea, or chlamydia increase the risk of HIV acquisition.

4. Forced Sexual Contact: Acts of sexual violence, such as rape or sexual assault, not only cause trauma but also expose victims to a higher risk of bacterial and viral infections due to forced penetration.

5. Alcohol Misuse: Excessive alcohol consumption can impair judgment, leading individuals to engage in riskier sexual behaviors they might otherwise avoid.

6. Substance Abuse and Shared Needles: Sharing needles for drug injection is a major route for transmitting severe infections like HIV, Hepatitis B, and Hepatitis C. While primarily spread through blood contact, these infections can also be transmitted sexually.

7. Adolescent Stage: The transition from childhood to adulthood is often characterized by experimentation and increased risk-taking, making adolescents more vulnerable to engaging in unsafe sexual practices and acquiring STIs.

8. Political Unrest: In regions experiencing political instability, where sexual violence and forced sexual relationships may be more prevalent, there is a heightened risk of STI transmission.

9. Mother-to-Child Transmission (Vertical Transmission): STIs like HIV, gonorrhea, chlamydia, and syphilis can be passed from a pregnant mother to her child during pregnancy or childbirth.

General Control and Prevention of STIs

• Abstinence: Choosing to abstain from sexual activity is the most reliable way to prevent STI transmission.

• Consistent Condom Use: Using condoms properly and every time during sexual intercourse significantly reduces the risk of STI transmission.

• Limit Alcohol and Drug Use: Reducing or avoiding excessive alcohol and drug use can improve judgment and decrease the likelihood of engaging in risky sexual behaviors.

• Vaccination: Vaccination before sexual debut is an effective preventive measure for certain STIs, including HPV and Hepatitis B.

• Mutual Monogamy and Open Communication: Being in a mutually faithful relationship with one partner and having honest conversations about sexual health promotes safer sexual practices.

• Life Skills Education: Providing young people and those becoming sexually active with comprehensive life skills education helps them understand the risks of early sexual activity and make informed choices.

• Safe Male Circumcision: Male circumcision has been linked to a lower risk of HIV acquisition from women and can help prevent the spread of genital HPV and genital herpes.

Complications of STIs

STIs can lead to a range of complications, including:

• Miscarriage

• Premature birth of a baby

• Fetal death during pregnancy (Intrauterine death)

• Stillbirth

• Congenital syphilis (syphilis passed from mother to baby)

• Recurring sores in the genital area

• Pain, redness, and swelling in the scrotum

• Inability to conceive (Infertility)

• Chronic pelvic pain

• Hair loss

• Eye infections

• Pelvic Inflammatory Disease (PID) – an infection of the female reproductive organs

• Joint inflammation (Arthritis)

• Relationship breakdown (Divorce)

STIs and Pregnancy

STIs during pregnancy can increase the risk of various complications for the mother:

• Ectopic pregnancy (pregnancy outside the uterus)

• Preterm birth

• Spontaneous abortion (Miscarriage)

• Premature rupture of membranes (water breaking early)

• Infection of the uterus after childbirth (Puerperal sepsis)

• Postpartum infection (infection after delivery)

And pose risks to the infant, including:

• Stillbirth

• Low birth weight

• Eye infection in newborns (Conjunctivitis)

• Blindness

• Infection present at birth (Congenital infection)

• Lung infection (Pneumonia)

• Blood infection in newborns (Neonatal sepsis)

• Birth defects (Congenital abnormalities)

Prevention Strategy

• Advocacy: Promote awareness and support for STI prevention efforts.

• Abstinence and Behavior Change Communication (BCC): Encourage abstinence and use communication strategies to promote safer sexual behaviors.

• Safe Sex Practices – Condom Use: Promote consistent and correct condom use.

• Counselling and Partner Management: Offer counselling, and ensure prompt testing and treatment of sexual partners.

• Health Education: Provide comprehensive education about STIs.

• Vaccination: Administer vaccines against preventable viral STIs like Hepatitis B and HPV.

• Responsible Antibiotic Use: Use antibiotics judiciously to prevent antibiotic resistance.

• Hygiene Practices: Maintain good personal hygiene, including genital and hand washing.

Take Home Question

• What personal steps will you take to help stop the spread of STIs?

In Daily Practice:

• Inquire about STI risk factors with patients.

• Encourage abstinence, especially among young individuals.

• Promote and educate about safer sex practices.

• Support behaviors that reduce STI risk.

• Screen individuals who are not showing symptoms based on local STI prevalence and patient demographics.

• Administer all recommended STI vaccines.

In the Community:

• Participate in disease surveillance and reporting.

• Support public health decisions that are based on scientific evidence.

• Educate young people about practicing safe sexual behaviors.