Sexually transmitted infections can affect the lower and upper genital tract to cause significant disease and disability. Prevention is better than cure and condoms should be used at all times with new sexual partners. It should be remembered that symptoms attributable to sexually acquired infections do not become apparent for many months or years after exposure and that the current sexual partner may not necessarily be the source of the infection that the patient has acquired. The most commonly encountered sexually transmitted infections in our community are:
- Chlamydia trachomatis
- Gardnerella vaginalis
- Human papilloma virus
- Herpes simplex virus
Chlamydia trachomatis is a bacterial infection which is acquired through sexual intercourse with a partner who harbours this organism within the genitourinary tract and is one of the most common sexually transmitted infections in our community. In the female, vaginal infection with Chlamydia is often asymptomatic, so that regular screening should be carried out in patients who have had multiple sexual partners. Upper genital tract infection with Chlamydia when undetected and untreated, can cause tubal damage, infertility, ectopic pregnancy and in the long term, pelvic inflammatory disease and chronic pelvic pain. The diagnosis of Chlamydia infection can be established by taking a swab from the cervix for polymerase chain reaction (PCR) which has a very high sensitivity for detecting this microorganism. An early morning urine sample sent for PCR can be taken from both the male and female patients to diagnose Chlamydia infection. Treatment of Chlamydial infection of the genital tract is with Doxycycline 100mg daily for 28 days with the sexual partner being treated at the same time.
Gardnerella vaginalis is another microorganism that often involves the lower genital tract in association with other anaerobic bacteria to produce an overgrowth of these organisms to cause a vaginal discharge which is a grey, watery discharge with a characteristic fishy odour particularly after sexual intercourse. This is most often a sexually transmitted infection with the male partner having no symptoms. The diagnosis may be suspected by the finding of a characteristic discharge and is confirmed by taking a vaginal swab to culture the organism. A routine cervical smear may reveal the characteristic ‘clue cells’ which are indicative of the presence of Gardnerella vaginalis. Treatment with Metronidazole 400mg x3 / day for 7 days is usually effective in clearing the infection but the sexual partner must also be treated at the same time.
Human papilloma virus
The Human papilloma virus (HPV) is a sexually transmitted infection which is often asymptomatic but can cause genital warts in both the male and female patient. In the female it can affect the lower genital tract and is detected through an abnormal cervical smear. The human papilloma virus can be associated with precancerous changes on the cervix which if untreated can progress to a more serious lesion. Most young girls receive the HPV vaccine at 16 years of age which affords some protection against this infection. There is no treatment for this infection but the use of condoms will protect the female from being infected. Regular Pap smears every 12 – 24 months are also important in detecting abnormalities on the cervix caused by HPV.
Herpes simplex virus
There are 2 types of Herpes simplex virus (HSV) with genital herpes being caused by HSV type 1 in 15% and HSV type 2 in 85%. Genital herpes is a sexually transmitted disease and the use of condoms will protect the female. The primary genital infection with HSV results in multiple painful blisters on the vulva, thereafter, recurrent lesions can recur at regular intervals. Treatment with antiviral agents will limit the extent and severity of the initial episode and long term antiviral prophylaxis may be necessary to prevent recurrence.