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Sexually Transmitted Disease

Alternate Names

  • STD
  • venereal disease
  • VD
  • Syphilis ulcer
  • Genital warts in males
  • Gonorrhea in females
  • Gonorrhea in males

Definition

Sexually transmitted disease, or STD, refers to any disease caused by a sexually transmitted infection (STI). STIs are transmitted from one person to another during sexual contact.

What is going on in the body?

Infections and diseases are passed from one person to another in many ways. The common cold virus (or the common cold), for example, could be caught during sexual activity. However, the cold virus is not considered an STI and the cold not considered a STD because sex is not the primary way a cold virus or a cold is transferred from one person to another.
Sexual activity refers to contact between the genitals of one partner and the genitals, anus, eyes, mouth, or throat of the partner.
An STD may be transmitted by bacteria, a virus, or a parasite. These microorganisms can enter the body and infect the skin and mucous linings of the vagina, rectum, urethra, cervix, eyes, mouth, and throat. STDs can be spread by heterosexual or homosexual relations.

Risks

What are the causes and risks of the disease?

The organisms that cause sexually transmitted diseases are passed from one partner to another during sexual intercourse. Any other intimate contact of the genitals, mouth, rectal area, or the sharing of sexual toys can also transmit the organism from one individual to another.
The most common STDs are caused by:
  • gonorrhea, caused by thebacterium. This condition primarily causes pain and a fluid discharge in the affected area.
  • chlamydia, caused by thebacterium. This STD may also cause pain and a fluid discharge in the affected area.
  • syphilis, caused by thebacterium. Untreated syphilis causes a painless skin rash and many other effects, including heart and brain damage.
  • AIDS, caused by the human immunodeficiency virus, or HIV. This condition slowly destroys the immune system, which results in serious infections and, possibly, death.
  • genital herpes, caused by the herpes simplex virus. This STD results in a painful skin rash and sores on the area of contact that can return from time to time.
  • hepatitis B, caused by the hepatitis B virus, which can cause serious liver disease and liver cancer
  • trichomonas, caused by theparasite. This condition causes a discharge from the vagina in women.
  • pubic lice, commonly referred to as crabs, which are caused by a parasite. This STD causes itching, which may be severe.
  • human papilloma virus or HPV, which causes genital warts, cervical cancer and cancer of the anus and rectum
Other STDs are less common.
Having multiple sex partners, having sex as an adolescent and not using condoms increases the risk of STDs. Having sex with those more likely to have STDs, such as prostitutes, also increases the risk. Open lesions or sores on the skin or inside the mouth increase the likelihood of catching an STD when skin-to-skin exposure takes place during sexual activity. Oral or anal sexual practices can expose a person to a greater load of organisms.

Prevention

What can be done to prevent the disease?

According to the Centers for Disease Control and Prevention (CDC), "The surest way to avoid transmission of sexually transmitted disease is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected."
For those who choose any other form of sexual activity that will increase their risk for STDs, correct and consistent use of the male latex condom can reduce the risk of transmitting some STDs.
However, no protective method is 100 percent effective, and condom use cannot guarantee absolute protection against any STD Furthermore, condoms lubricated with spermicides are no more effective than other lubricated condoms in protecting against the transmission of HIV and other STDs.
In order to achieve the protective effect of condoms, they must be used correctly and consistently. Incorrect use can lead to condom slippage or breakage, thus diminishing their protective effect. Inconsistent use, e.g., failure to use condoms with every act of intercourse, can lead to STD transmission because transmission can occur with a single act of intercourse or other sexual activity.
The "ABC Strategy" has been promoted to prevent STDs like AIDS:
  • Abstain from sexual activity
  • Be faithful for life to one partner
  • Condoms and other protections should be used for nonmonogamous sex
The use of male condoms or female condoms reduces, but does not eliminate, the risk of catching some STDs. And, for some forms of STDs, there is no evidence that condoms reduce the risk of disease.
Other forms of birth control, such as oral contraceptives or a diaphragm, do not provide protection from STDs. Epidemics of STDs exist in most parts of the world.

Diagnosed

How is the disease diagnosed?

Diagnosis of sexually transmitted disease begins with a history and physical exam. Further tests will be performed depending on the STD suspected.
A culture may be done to diagnose some STDs, including chlamydia and gonorrhea. Culture is a method used to grow organisms in the lab, which helps providers identify the particular infection. A specimen of tissue, such as a sample of liquid discharge, is put in a special material to help the organism grow. The organism can then be identified a few days later under a microscope. Newer tests can diagnose certain STDs, such as chlamydia, within minutes. Previously, test results were not available for a day or two.
With STDs such as trichomonas or syphilis, the organism can be seen in a sample of discharge with a microscope.
HIV, hepatitis B, and certain other STDs require a blood test to make the diagnosis.
Pubic lice can be seen as tiny bugs in the pubic hair, usually with a microscope or magnifying glass.
The appearance of lesions on the skin is enough to make a diagnosis and begin treatment for genital herpes, human papilloma virus, and syphilis.

Long Term Effects

What are the long-term effects of the disease?

Long-term effects vary depending on the type and severity of the sexually transmitted disease, as well as the effectiveness of the treatment.
  • Trichomonas and pubic lice have few or no long-term effects other than continued symptoms.
  • Chlamydia infections and human papilloma virus infections increase a woman's risk of cervical dysplasia and cervical cancer.
  • HIV can result in AIDS and death.
  • Chlamydia and gonorrhea can cause infertility in women.
  • Hepatitis B can cause permanent liver damage, liver cancer, and death.
  • Syphilis can cause permanent brain and heart damage.

Other Risks

What are the risks to others?

All sexually transmitted diseases are contagious. Those who have an STD should not have sexual contact with another person until they receive treatment or until the infection has cleared. All STDs can be transmitted to babies while they are in the uterus or during delivery. Effects of STD infection on babies depend on the disease transmitted and effectiveness of treatment. Effects can include localized infections, congenital abnormalities, or even death.

Treatments

What are the treatments for the disease?

Chlamydia, gonorrhea, trichomonas, pubic lice, and syphilis can be cured with antibiotics. Genital herpes, hepatitis B, and HIV cannot be cured, but they often can be treated with medications to lessen symptoms and damage to the body. Genital warts from human papilloma virus can be removed, but the warts may come back. All sexual partners need to be informed, tested, and treated, if necessary.

Side Effects

What are the side effects of the treatments?

Antibiotics may cause allergic reactions, stomach upset, and rash. The methods used to destroy genital warts may irritate or damage nearby healthy skin.

After Treatment

What happens after treatment for the disease?

Many sexually transmitted diseases can be cured completely. It is important to notify and treat all sexual partners to prevent spreading of the STD. If a partner is not treated, the affected person may catch the STD again.
Some long-term effects of STDs, such as infertility from chlamydia or gonorrhea, may not be reversed by treatment. Other STDs, such as HIV or hepatitis B, may get worse over time with or without treatment.

Monitor

How is the disease monitored?

Some STDs need no monitoring after treatment. Others, such as HIV and hepatitis B, need frequent blood tests to monitor the effects of the disease on the body. Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

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