Sexually Transmitted Infections (STIs)

 Sexually Transmitted Infections (STIs)

Ακώνης Δ., Βασιλάκη Ρεϊζ Κ.Μ., Κανακούδης Γ., Μιχαλόπυλος Β.Ε, Μεϊχανετζίδου Ε.

 

Sexually transmitted infections (STIs) or sexually transmitted diseases (STDs) refer to illnesses or infections transmitted from person to person through sexual behavior. STIs represent a significant global public health challenge, with both social and economic implications. From a medical standpoint, they can cause serious reproductive health issues, while also leading to social stigma, placing a substantial burden on healthcare systems, and affecting people's overall quality of life.

STIs involve a wide variety of pathogenic microorganisms, each with unique characteristics, modes of transmission, and clinical manifestations.

Bacterial STIs, such as gonorrhea and chlamydia, are notorious for their silent nature and tendency to cause asymptomatic infections, particularly in women. These infections can result in severe complications like pelvic inflammatory disease, infertility, and ectopic pregnancy. Gonorrhea, in particular, has shown alarming rates of antimicrobial resistance, posing a major treatment challenge. Syphilis progresses in stages if left untreated and, although rare in the age of antibiotics, may lead to devastating cardiovascular and neurological complications.

Viral STIs, including genital herpes, human papillomavirus (HPV), and HIV/AIDS, exert a significant global health burden with morbidity and mortality impacts. HPV, the most common viral STI worldwide, includes a wide range of genotypes and causes genital warts. Some HPV strains are oncogenic and predispose individuals to cervical, anal, and oropharyngeal cancers.

HIV/AIDS not only compromises the immune system, leading to opportunistic infections and malignancies, but also perpetuates social and economic inequalities, worsening disease burden among marginalized populations. Additionally, hepatitis B (HBV) and hepatitis C (HCV) viruses can be transmitted through sexual contact. HBV infection may lead to long-term complications and liver damage if left untreated, while chronic HCV infection is a leading cause of liver cirrhosis, liver failure, and hepatocellular carcinoma globally.

Parasitic STIs, though less common than bacterial and viral ones, also pose health risks. Trichomoniasis can cause vaginal discharge, itching, and discomfort, and increases the risk of acquiring and transmitting HIV.

STIs are often asymptomatic and may go undiagnosed. In such cases, infected individuals may not seek testing or medical care, continuing to spread the infection unknowingly. Even without symptoms, STIs can still cause harm and be transmissible. If symptoms do appear, they may include unusual genital discharge, sores or warts, painful or frequent urination, genital itching or redness, abnormal vaginal odor, anal itching, pain or bleeding, abdominal pain, or fever.

The global prevalence of STIs is alarmingly high. According to the World Health Organization (WHO), over one million STI cases are diagnosed daily worldwide. Annually, an estimated 374 million people are infected with one of the four main curable STIs: chlamydia, trichomoniasis, gonorrhea, and syphilis, or with HPV. In 2016, more than 490 million people were living with genital herpes, and approximately 300 million women had an HPV infection, which is linked to over 311,000 cervical cancer deaths each year. HIV, the virus that causes AIDS, remains a major global health crisis, affecting over 38 million people worldwide. Notably, in 2022, 254 million people were living with hepatitis B.

Risk factors for all STIs include frequent partner changes, young age, smoking, and drug use. Young people aged 15–24 are particularly vulnerable, accounting for a large proportion of new infections globally, especially with chlamydia and gonorrhea. Women, especially in resource-limited settings, face increased risks due to biological factors, gender-based violence, and limited participation in decisions about their sexual health. In Western countries, young women specifically have nearly double the rates of chlamydia and gonorrhea compared to women of all ages. Greece ranks high in STIs such as chlamydia, trichomoniasis, and syphilis.

The best preventive measure is public education on the benefits of condom use. Condoms not only prevent unwanted pregnancies but also effectively block STI transmission when used correctly and consistently. However, while highly effective, condoms do not fully protect against STIs that cause lesions outside the genital area (e.g., syphilis or genital herpes). Additional prevention strategies include STI testing, reducing the number of sexual partners, and practicing mutual monogamy.

Some STIs, such as hepatitis B and HPV, can be prevented through vaccination. Ideally, these vaccines should be administered before a person becomes sexually active, and are recommended for both girls and boys. Increasing HPV vaccination rates would greatly aid in STI prevention.

Sexually active individuals should regularly consult healthcare providers regarding STI risk and follow advice about screening. Some STIs can be diagnosed during a physical examination or through specific STI tests, such as microscopic analysis of genital lesions or fluids, or blood tests.

Regular screening enables early diagnosis and, when combined with appropriate treatment and responsible partner choices, plays a crucial role in individual health and prevention by limiting further transmission. Treatment typically involves consistent use of antiviral or antibacterial medications, aiming to reduce symptom severity, transmission, and speed up recovery. Patients should refrain from sexual contact until treatment is completed and inform their recent sexual partners. It's essential to recognize that treatment is vital, as untreated STIs can cause severe health issues.

In conclusion, implementing global public education programs, counseling on high-risk behaviors, promoting safer practices, and reshaping perceptions about responsible sexual behavior—with a focus on social responsibility rather than personal gratification—are the key strategies for controlling STI spread and protecting public health.