Sexually transmitted viral infections: epidemiology and treatment

Human papillomavirus, herpes simplex virus, and both hepatitis A and B are some of the most common sexually transmitted infections (STI) worldwide. They are preventable, but unlike bacterial STIs the person may harbor the virus in her or his body for life with periodic recurrences of active infection. Viral STIs have long-term health consequences, some of which are serious and life threatening. Nurses not only care for individuals who have a viral STI but also can provide education for prevention.     

Sexually transmitted infections and women’s sexual and reproductive health

Sexually transmitted infections (STIs) are widespread globally and result in a large burden of sexual and reproductive health consequences that disproportionately affect women, including pregnancy complications, cancer, infertility, and enhanced HIV transmission. A new WHO publication, available online, outlines key points of action and new and future technologies for global STI prevention and control. Highlights from the WHO publication are described in the present article.     

Sexually transmitted infection is associated with increased risk of preterm birth in South Carolina women insured by Medicaid

Objective.?We investigated the association between diagnosed maternal sexually transmitted infections (STIs) and very preterm or late preterm birth in 108,346 South Carolina women receiving medical care purchased by Medicaid from 1996 through 2002, and delivering singleton infants.

Methods.?ICD9 codes in South Carolina Medicaid data were used to identify maternal infections. Gestational age was obtained from birth certificates.

Results.?Trichomoniasis, gonorrhea, and/or Chlamydia/non-gonococcal urethritis (NGU) were diagnosed in 4,208 women. Preterm birth occurred in just over 9% of pregnancies. Women diagnosed with one of the infections in the first 7 months of pregnancy were significantly more likely to deliver very preterm infants (adjusted HR?=?1.73, p?<?0.0001). Women with infection in the first 8 months were significantly more likely to deliver between 33 and 36 weeks (adjusted HR?=?1.39, p?<?0.0001). Of the three infections, Chlamydia/NGU was most strongly associated with preterm birth and infections occurring later in pregnancy (months 6, 7, and 8).

Conclusion.?STIs appear to be preventable risk factors for very and late preterm birth.     

Non-HIV sexually transmitted infections

Sexually transmitted infections (STIs) is a term variably applied to a variety of clinical scenarios caused by or associated with sexually transmissible infectious agents.The infectious potential is the reason they are grouped and considered differently as diagnosis and management of the individual is a starting, not an endpoint. For some e.g. Neisseria gonorrhoea, the association with sexual behaviour is intrinsic to effective management, for others e.g. Candida albicans, sexual transmissibility is of little consequence.All infectious conditions have a range of clinical presentations, challenging clinicians to think beyond the individual to the population and address the identification and management of the larger asymptomatic pool outside. Then there are the issues of sensitivity about sexual health and behaviour.Embarrassment, fear or stigma of STIs can limit appropriate presentation or discussion, preventing or delaying diagnosis and hampering management. In this article we will focus on common bacterial STIs and practical issues for their management. Viral STIs will not be discussed in detail.     

Sexual behavior and knowledge of sexually transmitted infections among university students in Sao Paulo, Brazil

Objective

To investigate the sexual behavior and knowledge about sexually transmitted infections (STIs) among undergraduate students in Sao Paulo, Brazil.

Methods

Self-reported questionnaires were used.

Results

Most of the 447 students in the study were single (97.3%), in their first year of university (87.7%), and the mean ages were 20.4 years (males) and 19.8 years (females). Vaginal intercourse was practiced by 69.7% of males and 48.4% of females, oral sex by 64.5% of males and 43.7% of females, and anal sex by 18.4% of males and 14.1% of females. Use of a condom during vaginal sex was practiced by 80.4% of males and 74.8% of females and during anal sex by 47.8% of males and 30.0% of females. Knowledge of transmission of STIs was greater than 90% for HIV, syphilis, genital herpes, and gonorrhea; 63%-76% for HPV and genital warts; 30%-34% for Trichomonas and only 16% for Chlamydia. Only 25%-34% knew that HIV was transmitted by breastfeeding; 56%-60% knew that HIV was transmitted by anal sex.

Conclusion

Many students engage in high-risk sexual behavior with multiple partners and use condoms inconsistently. Knowledge of the acquisition and modes of sexual and vertical transmission of HIV are strikingly deficient.     

Condom use among married women at risk for sexually transmitted infections and HIV in rural China

Objective

To assess factors associated with condom use among married women in rural China, and provide evidence for implementing education strategies to prevent sexually transmitted infections and HIV.

Methods

A total of 737 sexually active married rural women who were aged between 18 and 49 years and had heard of AIDS were selected by cluster sampling and interviewed in 8 villages of Anhui province, China.

Results

The rate of condom use was only 5.4%.There were no significant differences in sexual behavior and condom use between married women whose husbands were away as migrant workers and the wives of nonmigrant men, except in knowledge of free condom sources. Significant factors associated with condom use included age, level of education, knowledge about condoms, training about condoms, sources of condoms, and husbands' attitude toward condoms.

Conclusions

More educational interventions are needed to increase condom knowledge and promotion, especially among less educated women and married women left behind by migrant husbands.     

Sexually transmitted infections in adolescent women

Adolescent women possess physiologic and, frequently, behavioral characteristics that place them at an increased risk for contracting sexually transmitted infections. Diagnosis and prompt treatment of sexually transmitted infections is of paramount importance for an adolescent's future fertility and prevention of transmission to future partners. Diagnosis and treatment is often hindered by lack of symptoms, concern for screening and treatment confidentiality, and lack of knowledge about community medical resources.     

性传播疾病病原体在急性盆腔炎发病中的作用

目的 研究性传播疾病病原体在急性盆腔炎发病中的作用。方法 对130例急性盆腔炎患者的宫颈分泌物采用分离培养法进行细菌培养及性传播疾病系列检查。结果 130例急性盆腔炎患者中,有55例培养出性传播疾病病原体,其中淋病奈瑟菌检出率为6．9％（9／130）,约半数病例混有解脲支原体、沙眼衣原体及白色念珠菌感染;沙眼衣原体检出率为4．6％（6／130）,均为混合感染（淋病奈瑟菌、解脲支原体及厌氧菌）;解脲支原体检出率为37．7％（49／130）,三分之一病例存在混合感染。结论 性传播疾病病原体可为急性盆腔炎的发病因素,但也可能仅在急性盆腔炎发病中起协同作用。     

Role of gender in sexual behaviours and response to education in sexually transmitted infections in 17-year-old adolescents

Objective

to investigate gender differences in high school students with respect to sexual risk behaviours, and their perceptions of the effect of an educational programme on sexually transmitted infections (STIs). In addition, this study aimed to investigate differences between students in programmes preparing for university compared with vocational programmes.

Participants, setting and design

second-year high school adolescents from two communities in south-west Sweden were invited to participate in the study, and completed a questionnaire on sexual experience, sexual risk behaviours and the impact of the educational programme on STIs.

Findings

males took less responsibility for STI prevention than females. Furthermore, males perceived themselves to be less influenced by the STI education than females. Females had more experience of same-sex sexuality than males.

Conclusions and implications for practice

males take less responsibility for STI prevention than females. When planning STI education, it is important to consider gender, traditions and various learning styles. If STI education fails to reach males, the prevalence of these infections will continue to increase.     

Prevalence of sexually transmitted infections in pregnant urban Aboriginal and Torres Strait Islander women in northern Australia

OBJECTIVE: To assess the prevalence of sexually transmitted infections (STI) in a cohort of pregnant urban Indigenous women and association of STI with preterm birth, low birthweight birth and perinatal mortality. DESIGN: Prospective intervention program in a cohort of women attending Townsville Aboriginal and Islander Health Services (TAIHS) for shared antenatal care between 1 January 2000 and 31 December 2003 incorporating routine screening for chlamydia, gonorrhoea, trichomoniasis, hepatitis B and syphilis. SETTING: Townsville is a provincial urban centre with a regional Indigenous population of over 16 000. PARTICIPANTS: Four hundred and fifty-six pregnant women who were screened for bacterial STI and other viral infections. MAIN OUTCOME MEASURES: Prevalence of STI, associated risk factors and perinatal outcomes. RESULTS: Of the 456 women, 403 (88.4%) were screened for chlamydia, gonorrhoea and trichomonas and 432 (94.7%) were screened for syphilis. A total of 92 cases of STI (20.2%, 95% CI 16.5-23.9) were detected, with 21 concurrent infection(s). The overall prevalence of chlamydia was 14.4%, gonorrhoea 6.1%, trichomoniasis 7.2% and infectious syphilis 2.5%. Predictors for STI were young age, harmful/hazardous alcohol use and unwanted pregnancy. Low birthweight and perinatal death were significantly associated with the presence of STI and infectious syphilis during pregnancy. CONCLUSION: The prevalence of STI among pregnant women in this urban Indigenous community is high, suggesting that screening for STI should be included in all antenatal care protocols for Indigenous women in Australia. Strategies to reach the whole Indigenous community of child-bearing age, especially those aged less than 25 years, are needed to improve perinatal outcome.     

Factors Associated with Contraceptive Use Differ between Younger and Older African-American Female Adolescents

Study ObjectiveTo examine differences in factors associated with contraceptive use between younger and older adolescent age groups, which has not previously been well described.DesignAge group-specific analyses were performed on cross-sectional survey data to identify factors associated with any contraceptive use at last sex among younger (14- to 16-year-old) and older (17- to 19-year-old) sexually active African American female adolescents; interaction analyses were used to assess whether these associations differed by age.SettingAdolescent reproductive health clinic in Atlanta, Georgia.ParticipantsSexually active African American female adolescents 14-19 years of age.InterventionsNo intervention tested; cross-sectional design.Main Outcome MeasureSelf-reported contraceptive use during most recent vaginal sex with a male partner.ResultsThe prevalence of contraceptive use at last sex was identical in both groups; however, factors associated with contraceptive use differed according to age. The only factor associated with contraceptive use in both age groups was involvement in decisions about sexual health in the most recent relationship. Associations between factors and contraceptive use significantly differed according to age. History of sexually transmitted infection, age difference with partner, discussion of condoms with partner, and concurrent partners were important factors among younger adolescents; worry about pregnancy and discussion of birth control with partner were important among older adolescents.ConclusionFactors associated with contraceptive use at last sex differ according to adolescent age; this should be considered when designing counseling and interventions for teens, as well as research.     

Sexually transmitted infections and contraceptives: selective issues

It is important to examine the successful completed research and use it to move forward in practice to halt the almost 50% unintended pregnancy rate in the United States and the continued worldwide epidemic of HIV and other STIs. A significant development has been the evidence supporting the IUD as a valuable contraceptive option available to many women, including women who are HIV infected, with no increased risks of infertility or PID. Evidence exists that OCPs may increase chlamydial infection acquisition and cervicitis, but it is unlikely that OCP use is associated with PID. The lack of female-controlled dual method protection remains a void, but with the introduction of products such as FemCap and Reality condom and the continuing progress of microbicides and spermicides, the future is brighter. Clearly research into the interactions of STIs and contraceptives must continue to discern how best to approach a resolution to these public health concerns that affect women and the global population.     

Intimate partner violence and sexually transmitted disease symptoms in a national sample of married Bangladeshi women.

OBJECTIVES: To assess associations of intimate partner violence (IPV) with women's sexually transmitted disease (STD) symptoms, and to clarify biological and behavioral mechanisms underpinning heightened STD rates among abused women. METHODS: A cross-sectional investigation of married couples (n=2865) sampled via the Bangladesh Demographic Health Survey. RESULTS: Over one third (38%) of married Bangladeshi women experienced physical or sexual IPV in the 12 months preceding the survey. Victimization was bivariately associated with vaginal irritation/discharge, pelvic pain during intercourse, genital sores/ulcers, and vaginal discharge with odor (OR 1.39-2.09). IPV demonstrated an independent effect on vaginal irritation with discharge (adjusted OR 1.34) and vaginal discharge with odor (adjusted OR 2.08) after accounting for STD exposure (i.e., husbands' recent STD). CONCLUSIONS: IPV elevates married Bangladeshi women's STD symptoms beyond the risk represented by husbands' STD alone, suggesting that high rates of STD among abusive men and the context of violence itself both relate to abused women's STD risk.