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Sexually Transmitted Disease (STD) or Sexually Transmitted Infections (STI)

What is Sexually Transmitted Disease (STD)?

Sexually Transmitted Diseases are a group of bacterial, viral or fungal infections which are transmitted via sexual activity and they may cause many embarrassing moments and can be fatal in some cases. Another term for Sexually Transmitted Diseases (STD) is Sexually Transmitted Infections (STI). STD are very common with the changes in social habits and activity, therefore accurate diagnosis and finding out the problem is important.

How do I know if I have Sexually Transmitted Disease (STD)?

Symptoms for Sexually Transmitted Disease (STD) varies from one person to another; there are some instances that some people are totally oblivious to the symptoms of Sexually Transmitted Disease (STD).

Everyone expects to see pus discharge, itching or ulcers at their private parts when they are infected with Sexually Transmitted Disease (STD). Nevertheless, you can have Sexually Transmitted Disease (STD) without any symptoms. It is important to anticipate the possibilities of sexually transmitted infections based on an individual’s sexual risk.

What increases my risk of acquiring Sexually Transmitted Disease (STD)?

Before one determines their risk, they have to ask themselves about their own sexual practices. Different sexual practices and sexual preferences can influence the risk of Sexually Transmitted Disease (STD) for example sex without condoms or sex workers.

Many people have a misconception about condoms. In my clinic, I have done a survey regarding the assumption can condoms total prevent Sexually Transmitted Disease (STD) and based on my survey about 80% of my patients agree that condoms can totally prevent Sexually Transmitted Disease (STD). This assumption is untrue. Most Sexually Transmitted Disease (STD) are transmitted via contact, namely sex. Condomless sex is of course going to increase possibility of acquiring Sexually Transmitted Disease (STD) directly with possible infection. Condoms just act as a barrier but failure of condom can occur throughout the entire process of using condom. Steps and processes of condom usage can range from donning the condom, removal of condoms and hygiene practices after sex. A slight mistake in the steps required can cause the condom to lose its integrity against Sexually Transmitted Disease (STD). This is the tip of the iceberg in determining your risk of contracting Sexually Transmitted Disease (STD).

Engaging with sex workers as opposed to a random hook-up or an acquaintance may increase risk of Sexually Transmitted Disease (STD). I do not mean to be stereotypic but logically sex workers deal with many clients and some of their clients may carry some Sexually Transmitted Infections (STI). The more often sex is performed, then the higher the possibility of acquiring some sexually transmitted infection (STI). I have also come across some sex workers who told me that if they have clients who “last too long” because the condom reduces the man’s sensitivity to stimulation therefore prolonging the sexual service before ejaculation. In such cases the sex worker may remove the condom and attempt to make their clients ejaculate faster in order to finish the service faster. Needless to say a random hook-up or having sex with an acquaintance does not mean that they are cleaner or have lesser risk as compared to a sex worker. It may be vice versa because most sexually active men or women may have never done or do not test themselves frequently for possible Sexually Transmitted Disease (STD), therefore they may be carriers of infection without them knowing. Sex workers on the other hand get themselves tested 1 to 2 months once.

The highest risk of acquiring Sexually Transmitted Disease (STD) is not based on whether they are sex workers, random hook-ups or acquaintances. The highest risk of acquiring Sexually Transmitted Disease (STD) is when people are unaware, oblivious, ignorant and assume that they do not have Sexually Transmitted Disease (STD).

What are the types of Sexually Transmitted Disease (STD)?

There are many types of infections which cannot be discussed here as they are extensive and impossible to cover in this article. I would advise that you should discuss with your doctor who is trained in the arts of Sexually Transmitted Disease (STD).

So let me classify the groups of STDs available and which are commonly found.

How to test for Sexually Transmitted Disease (STD)?

Testing and diagnosis is not difficult but deciding on the best time, appropriate testing, treatment and method to collect sample makes testing and diagnosis of STD difficult. Simply withdrawing blood or sending urine for testing is the easy part. The art which a STD doctor practices is to determine the best time to take the sample, where to take the sample, how to take the sample and why the sample is required. I have patients whose tests were negative while they were having symptoms. It is possible to be symptomatic but that does not mean you have to be positive on the lab test. Read this particular blog I Have Symptoms But The Doctor Says My Test Are Negative this is a story based on true occurrence.

The art of testing and deciding on which tests are useful in detecting specific Sexually Transmitted Disease (STD) will determine a full-proof plan in patient care and treatment. A STD doctor has to anticipate the possible infection they are up against to ensure that you get the good efficacy.

First you need to understand the specific bacteria’s or virus’ mode of transmission. If you do not understand the mode of transmission of the bacteria or virus; then you will not understand the proper test required.

Most of my patients always ask for a comprehensive Sexually Transmitted Disease (STD) test and they assume that a blood sample is enough to test for all sorts of Sexually Transmitted Disease (STD). It has been a norm that most clinics and also laboratories to have test packages for HIV, Hepatitis A, Hepatitis B, Syphilis, gonorrhea and chlamydia in a blood sample. I will agree to do a blood test for HIV, Hepatitis A, Hepatitis B and Syphilis, however I disagree for gonorrhea and chlamydia testing through blood because gonorrhea and chlamydia is not found in the blood unless we are dealing with sepsis.

HIV, Hepatitis B, Hepatitis C, Hepatitis D and Hepatitis E is transmitted via blood whereas

Hepatitis A is infective via fecal-oral route and it can show up finally in the blood therefore these infections can be detected via withdrawing of blood.

Syphilis on the other hand is different. Syphilis is infective via skin to skin contact and blood contact however the end point is that syphilis will still turn up in the blood. Syphilis is caused by a spirochetes bacteria called Treponema Pallidum which has flagella (fins) around the bacteria; these fins makes the bacteria mobile and able to swim through the skin. The initial form of syphilis is called primary syphilis which can result in ulcers at the private parts and during this phase it is possible that syphilis is still not found in the blood yet. The best way to test for syphilis during the earliest part of the infection is to get a swab sample of the ulcer to pick up the bacteria from the skin and view under a dark field microscope.

Your doctor must also understand the life cycle and also the incubation period of the bacteria and virus. If you are tested to be negative you need to know that if you have tested yourself during the incubation period, then you may probably need to retest again later. What is Incubation Period? Incubation period is a time frame when the bacteria or virus has infected the person but still does not elicit any symptoms and cannot be tested as the virus or bacteria is just too low to be detected.

Other infections like gonorrhea, chlamydia, mycoplasma, ureaplasma, trichomonas, Human Papilloma Virus and Herpes should be tested via swab test with proper technique in order to obtain the best sample and result. If you do not get proper samples then the results may mislead your doctor and patient.

What happens if your test turns out to be negative despite having symptoms? You may have a false negative test if the sample is taken incorrectly or testing errors. Usually we will retest again if indicated to be sure. In my clinic retesting may be free if the criteria indicate an error. This is my additional bonus of coming to me!

What are the treatment recommendations for STD?

There many things taken into consideration when initiating treatment for STD:

1. Type of medication. There are multiple studies done regarding treatments which are specific to each type of STDs. Some medications fair poorly and some do better than others. Take for example Syphilis: Penicillin Benzathine G 2.4MU has shown that it is more superior than Rocephine and Doxycycline. In a certain group of my patient who cannot tolerate Penicillin due to allergies therefore, I may be forced to still use Rocephine or other drugs instead of Penicillin. Once I had a patient who had allergies to an unknown antibiotic. In this case I had to do an antibiotic allergy test before the injection. This allergy test was life-saving because the high dose of Penicillin would have put him into a state of anaphylaxis and ultimately would have killed him. With this allergy test I evoked a small allergic response which was localized to only his skin. As a result, I decided to give him Rocephine as the treatment of choice. It is my duty to ensure that I decide on the best antibiotic for you after taking into account possible side effects and allergies. In another scenario is you can see many clinics giving out Ciprofloxacin which is alarming. Ciprofloxacin is a fluorquinolone group of antibiotics which in a few studies has cautioned its usage as it tends to cause antibiotic resistance. I usually avoid giving Ciprofloxacin to my patients as the I have had a few experiences with it. There are a few factors which determines treatment choices:

2. Dose of medication. In my practice I have come across patient who are underdosed causing lack of clinical improvement and overdosed cause mild to severe symptoms. Your doctor needs to understand basics of pharmacology like timing to initiate treatment and understand the clearance of the drug in the body. When taking your medication always remember the rule about medication dosing, “fast acting mean short acting” or “slow acting means long acting”. This means that drugs which requires frequent dosing may act fast but does not last long in the body or vice versa. Take for example Clarithromycin IR 250mg (IR showing Immediate Release) which is taken twice a day as compared to Clarithromycin MR 500mg (MR showing Moderate Release) which is taken daily. The Clarithromycin IR 500mg starts acting within 2 hours and the Clarithromycin MR 500mg requires about 6 to 10hrs to start acting. In my experience with Clarithromycin IR 250mg effect and resolution of symptoms occurs fast as compared to Clarithromycin MR 500mg but Clarithromycin MR is easier to consume as it is once a day. If you have pus discharge, you would naturally want to have quick resolution therefore I would choose Clarithromycin IR 250mg over Clarithromycin MR 500mg. It does not mean that the Clarithromycin IR 250mg is superior over the Clarithromycin MR 500mg as both has the same end point of total cure but the resolution of pus discharge may be faster in the normal Clarithromycin IR 250mg. There was a comparative study that both the Clarithromycin IR and MR also has rather similar curative rates however based on my experience Clarithromycin IR may be faster in the resolution of initially symptoms.

3. Duration of treatment make a world of difference in terms of efficacy. There are many recommendations about the duration of treatment and they are constantly updated. Duration of treatment depends on:

a. Type of Bacteria. Some bacteria have structures which are susceptible to certain antibiotics therefore your doctor needs to think hard before initiating treatment. Mycobacteria Tuberculosis is a slow growing bacteria and many people never experience any symptoms until many months later. Mycobacteria Tuberculosis can grow to about 32,768 bacteriae in a month as compared to E Coli which is 68,719,476,636 bacteriae in a day. The course of treatment for Mycobacteria Tuberculosis is about 6 months whereas E. Coli will be about 5 to 10 days. It does not make much sense right? The amount of E. Coli is much more than Mycobacteria Tuberculosis but Mycobacteria Tuberculosis requires longer duration of antibiotics. A longer treatment is required for Mycobacteria Tuberculosis because antibiotics work only when the bacteria are actively dividing (replicating), and Mycobacteria Tuberculosis can rest (dormant) without growing for long periods. This treatment is necessary to keep the latent TB infection from developing into active disease.

b. Bacteria Resistance. Resistance is seen as natures law of survival of the fittest. A study was conducted on E. Coli to investigate the rate of E. Coli gaining resistance. The bacteria is placed on a dish with nutrient agar at opposite sides of the dish. A quadrant from periphery to central is draw up and each quadrant is saturated with different types of antibiotics from the lowest to the strongest strength. The bacteria is studied to determine the rate of the bacteria gaining resistance against antibiotics.

c. Location of infection. Based on the location of infection, the duration of antibiotics may differ. Usually brain infections may require 14 to 21 days of antibiotics as compared to urinary infections which, may require 7 to 14 days course. It also the duration will be based on the type of antibiotics used.

What to do if my STD becomes drug resistant?

Sometimes STD bacteria, virus and fungus becomes resistant to treatment, then we need a contingency plan to ensure you are properly treated with the right drugs, right dose, right duration, right route and right timing. I have had multiple situations with bacteria, virus and fungal resistance; most of them require a lot of patience and anticipation in terms of more specific treatment and testing to ensure that my patient gets the optimum result. Testing like cultures usually can help to detect which are the most suitable antibiotics but it is impossible detect every type of pathogen, therefore you can only discuss with your doctor who is well versed with STD.

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