January is the month to talk about Sexually Transmitted Infections
Sexually transmitted infections (STIs) are a rising problem worldwide, threatening the physical, mental, reproductive and sexual health of women everywhere.
Women are more vulnerable to STIs than men, and OBGYNs have a critical role to play in supporting informed, safe and responsible sexual health.
The problem and the scale
Today, 37 million people live with HIV, more than 500 million are estimated to carry herpes simplex virus (HSV), and 300 million women have a human papillomavirus (HPV) infection, and every day:
- more than 1 million people acquire an STI
- over 30,000 people are affected by syphilis
- 250,000 people are infected by chlamydia
- 170,000 people are diagnosed with gonorrhoea
There are more than 30 different infectious agents responsible for STIs, including bacteria (Chlamydia, Gonorrhoea and Syphilis infections), viruses (Herpes, the Human Papillomavirus, the Human Immunodeficiency Virus (HIV) and the hepatitis A, B and C), protozoa (Trichomonas) and parasites (pubic lice).
Vulnerable groups: women and adolescents
Each year, 1 in 20 young people catches a sexually transmitted bacterial infection, and adolescent women are the most vulnerable.
STIs carry a profound range of risks for women’s health and fertility. Left untreated, Chlamydia and Gonorrhoea can cause pelvic inflammatory disease (PID) which may permanently damage the fallopian tubes, leading to infertility and an increased risk of ectopic pregnancy.
Women are more vulnerable to STIs than men, as the delicate mucous membrane covering the vagina allows viruses and bacteria to pass through more easily than the thick skin of the penis. Adolescents are also susceptible as their genital tissues, still immature, are more receptive to infections.
The Human Papilloma Virus Infection (HPV)
There are more than 200 types of HPV, and it has been estimated that 3 in 4 women will come into contact with the virus at some time during their lifetime. Transmission occurs through micro-lesions in the skin or the mucosa, particularly through sexual activities, but not necessarily by penetrative genital contact.
While low-risk HPV infections, like HP 6 and 11, may resolve on their own and cause no clinical problems, high-risk HPV, like HPV 16 and 18, may lead to pre-invasive lesions. Left untreated, these may persist and progress to cancer: HPV infections cause 1,500 new cases of cervical cancer every day.
Vaccination and screening is an essential priority for FIGO with our Global Declaration on Cervical Cancer Elimination and our work alongside the World Health Organization in the Working Group on Increased Access to Screening and Treatment.
Screening, diagnosis and treatment
Early diagnosis is essential to ensure the correct treatment is prescribed and administered as soon as possible. This means vaccination, testing, and prevention of reinfection through correct use of prophylaxis.
The three bacterial STIs (chlamydia, gonorrhoea and syphilis) and the most common parasitic STI, Trichomoniasis, can usually be cured by single-dose antibiotic regimens. For herpes and HIV, the most effective medications are antivirals which are able to modulate the course of the infection, while for hepatitis B, immune system modulators and antiviral medications can help to fight the virus and slow down liver damage.
STI resistance to antibiotics, in particular in cases of gonorrhoea, has rapidly increased in recent years and reduced treatment options, making prevention even more vital.
Vaccines are a safe and effective way to prevent some STIs. The HPV vaccination protects against nine types of Papilloma Virus and reduces the risk of condyloma and pre-cancerous lesions, which, if left untreated, may persist and progress to cancer in both men and women (cervix, anus, vagina, penis, vulva, oropharynx, oral cavity). Vaccination against hepatitis B can also prevent serious consequences of this infection.
Most STIs are asymptomatic, especially in early stages, so it is important to be proactive about testing, even if you have no symptoms. A blood test or swab can often diagnose infections that, if promptly treated, can be cured. Others, such as HIV, require repeat testing or partner testing and treatment, and it is essential to visit a trained counsellor or healthcare provider to ensure the appropriate course of action.
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