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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = Sexually transmitted disease | | | Name = Sexually transmitted disease |
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| | MeshID = D012749 | | | MeshID = D012749 |
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| {{SI}} | | {{Sexually transmitted disease}} |
| {{CMG}} | | {{CMG}} |
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| ==Overview complete== | | ==[[Sexually transmitted disease overview|Overview]]== |
| A '''sexually transmitted disease''' ('''STD'''), [[Wiktionary:A.K.A.|a.k.a.]] '''Venereal disease''' ('''VD'''), is an illness that has a significant probability of transmission between [[human]]s or animals by means of [[sexual contact]], including [[sexual intercourse|vaginal intercourse]], [[oral sex]], and [[anal sex]]. Increasingly, the term '''sexually transmitted infection''' ('''STI''') is used, as it has a broader range of meaning; a person may be ''infected'', and may potentially infect others, without showing signs of ''disease''. Some STIs can also be transmitted via the needles used in [[Intravenous drug use (recreational)|IV drug use]], as well as through [[childbirth]] or [[breastfeeding]]. Sexually transmitted infections have been well known for hundreds of years.
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| == Classification and terminology ==
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| Until the 1990s, such afflictions were commonly known as ''venereal diseases'': ''Veneris'' is the [[Latin]] genitive (possessive) form of the name [[Venus (mythology)|Venus]], the Roman goddess of love. ''Social disease'' was another euphemism. [[Public health]] officials originally introduced the term ''sexually transmitted infection'', which clinicians are increasingly using alongside the term ''sexually transmitted disease'' in order to distinguish it from the former. According to [http://www.etharc.org http://www.etharc.org], "Sometimes the terms STI and STD are used interchangeably. This can be confusing and not always accurate, so it helps first to understand the difference between infection and disease. Infection simply means that a [[germ]] — [[virus]], [[bacteria]], or [[parasite]] — that can cause disease or sickness is present inside a person’s body. An infected person does not necessarily have any symptoms or signs that the virus or bacteria is actually hurting his or her body; they do not necessarily feel sick. A disease means that the infection is actually causing the infected person to feel sick, or to notice something is wrong. For this reason, the term STI — which refers to infection with any germ that can cause an STD, even if the infected person has no symptoms — is a much broader term than STD.''"
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| The distinction being made, however, is closer to that between a ''colonization'' and an ''infection'', rather than between an ''infection'' and a ''disease''.
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| Specifically, the term STD refers only to [[infection]]s that are causing [[symptom]]s. Because most of the time people do not know that they are infected with an STD until they start showing symptoms of [[disease]], most people use the term STD, even though the term STI is also appropriate in many cases.
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| Moreover, the term ''sexually transmissible disease'' is sometimes used since it is less restrictive in consideration of other factors or means of transmission. For instance, [[meningitis]] is transmissible by means of sexual contact but is not labeled as an STI because sexual contact is not the primary [[Vector (biology)|vector]] for the [[pathogen]]s that cause meningitis. This discrepancy is addressed by the probability of infection by means ''other than sexual contact''. In general, an STI is an infection that has a negligible probability of transmission by means other than sexual contact, but has a realistic means of transmission by sexual contact (more sophisticated means — [[blood transfusion]], sharing of [[hypodermic needle]]s —are not taken into account). Thus, one may presume that, if a person is infected with an STI, e.g., [[chlamydia]], [[gonorrhea]], [[genital herpes]], it was transmitted to him/her by means of sexual contact.
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| The English language has short words for two of the most common: "pox" ([[syphilis]]) and "the clap" ([[gonorrhea]]).
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| == Pathology ==
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| Many STIs are (more easily) transmitted through the [[mucous membrane]]s of the [[penis]], [[vulva]], and (less often){{Fact|date=December 2007}} the [[mouth]]. The visible membrane covering the [[glans|head of the penis]] is a mucous membrane, though it produces no [[mucus]] (similar to the [[lip]]s of the mouth). Mucous membranes differ from [[skin]] in that they allow certain pathogens into the body.
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| This is one reason that the probability of transmitting many infections is far higher from sex than by more casual means of transmission, such as non-sexual contact—touching, hugging, shaking hands—but it is not the only reason. Although [[mucous membrane]]s exist in the mouth as in the genitals, many STIs seem to be easier to transmit through [[oral sex]] than through deep kissing. According to this chart [http://www.tinynibbles.com/safesexchart.html], many infections that are easily transmitted from the mouth to the genitals or from the genitals to the mouth, are much harder to transmit from one mouth to another. With [[HIV]], [[genital]] fluids happen to contain much more of the [[pathogen]] than [[saliva]]. Some infections labeled as STIs can be transmitted by direct [[skin]] contact. [[Herpes simplex]] and [[HPV]] are both examples. [[KSHV]], on the other hand, may be transmitted by deep-kissing but also when saliva is used as a sexual lubricant, which is common among gay men engaging in anal intercourse.
| | ==[[Sexually transmitted disease classification|Classification]]== |
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| Depending on the STD, a person may still be able to spread the infection if no signs of disease are present. For example, a person is much more likely to spread [[herpes]] infection when [[blister]]s are present (STD) than when they are absent (STI). However, a person can spread [[HIV]] infection (STI) at any time, even if he/she has not developed symptoms of [[AIDS]] (STD).
| | ==[[Sexually transmitted disease historical perspective|Historical Perspective]]== |
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| ''All'' [[human sexual behavior|sexual behaviors]] that involve contact with another person or the bodily fluids of another person should be considered to contain some risk of transmission of sexually transmitted diseases. Most attention has focused on controlling [[HIV]], which causes [[AIDS]], but each STD presents a different situation.
| | ==[[Sexually transmitted disease pathophysiology|Pathophysiology]]== |
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| As may be noted from the name, sexually transmitted diseases are ''transmitted'' from one person to another by certain sexual activities rather than being actually ''caused by'' those sexual activities. [[Bacterium|Bacteria]], [[fungi]], [[protozoa]] or [[virus]]es are still the causative agents. It is not possible to catch any sexually transmitted disease from a sexual activity with a person who is not carrying a disease; conversely, a person who has an STD got it from contact (sexual or otherwise) with someone who had it, or his/her bodily fluids. Some STDs such as HIV can be transmitted from mother to child either during pregnancy or breastfeeding.
| | ==[[Sexually transmitted disease epidemiology and demographics|Epidemiology & Demographics]]== |
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| Although the likelihood of transmitting various diseases by various sexual activities varies a great deal, in general, all sexual activities between two (or more) people should be considered as being a two-way route for the transmission of STDs, i.e., "giving" or "receiving" are both risky.
| | ==[[Sexually transmitted disease epidemiology and demographics|Risk Factors]]== |
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| Healthcare professionals suggest [[safer sex]], such as the use of [[condoms]], as the most reliable way of decreasing the risk of contracting sexually transmitted diseases during sexual activity, but safer sex should by no means be considered an absolute safeguard. The transfer of and exposure to bodily fluids, such as [[blood transfusion]]s and other blood products, sharing injection [[Intravenous therapy|needles]], needle-stick injuries (when medical staff are inadvertently jabbed or pricked with needles during medical procedures), sharing [[tattoo]] needles, and childbirth are other avenues of transmission. These different means put certain groups, such as doctors, [[haemophilia]]cs and drug users, particularly at risk.
| | ==[[Sexually transmitted disease screening|Screening]]== |
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| Recent [[epidemiology|epidemiological]] studies have investigated the networks that are defined by sexual relationships between individuals, and discovered that the properties of [[sexual network]]s are crucial to the spread of sexually transmitted diseases. In particular, [[assortative mixing]] between people with large numbers of sexual partners seems to be an important factor.
| | ==[[Sexually transmitted disease causes|Causes]]== |
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| It is possible to be an [[symptom|asymptomatic]] carrier of sexually transmitted diseases. In particular, sexually transmitted diseases in women often cause the serious condition of [[pelvic inflammatory disease]].
| | ==[[Sexually transmitted disease differential diagnosis|Differentiating Sexually transmitted disease from other Diseases]]== |
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| == Prevalence == | | ==[[Sexually transmitted disease natural history|Natural History, Complications & Prognosis]]== |
| STD incidence rates remain high in most of the world, despite diagnostic and therapeutic advances that can rapidly render patients with many STDs noninfectious and cure most. In many cultures, changing sexual mores and oral contraceptive use have eliminated traditional sexual restraints, especially for women, and both physicians and patients have difficulty dealing openly and candidly with sexual issues. Funding to control STDs is almost uniformly inadequate. Additionally, worldwide dissemination of drug-resistant bacteria (eg, penicillin-resistant gonococci) reflects misuse of antibiotics and spread of resistant clones by mobile populations. The effect of travel is most dramatically illustrated by the rapid spread of the AIDS virus (HIV-1) from Africa to Europe and the Americas in the late 1970s.<ref name=AMN>{{cite journal | author = Mary-Ann Shafer, Anna-Barbara Moscicki | title = [http://www.health.am/sex/more/sexually_transmitted_infections/ Sexually Transmitted Infections], 2006. | journal = | volume = | issue = | pages = 1-8 | year = 2006}}</ref>
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| Commonly reported prevalences of STIs among sexually active adolescent girls both with and without lower genital tract symptoms include [[chlamydia]] trachomatis (10 to 25%), Neisseria gonorrhoeae (3 to 18%), syphilis (0 to 3%), Trichomonas vaginalis (8 to 16%), and herpes simplex virus (2 to 12%).{{Fact|date=February 2007}} Among adolescent boys with no symptoms of urethritis, isolation rates include C. trachomatis (9 to 11%) and N. gonorrhoeae (2 to 3%).{{Fact|date=February 2007}}
| | ==Diagnosis== |
| | [[Sexually transmitted disease history and symptoms|History & Symptoms]] | [[Sexually transmitted disease physical examination|Physical Examination]] | [[Sexually transmitted disease staging|Staging]] | [[Sexually transmitted disease laboratory tests|Lab Tests]] | [[Sexually transmitted disease electrocardiogram|Electrocardiogram]] | [[Sexually transmitted disease chest x ray|Chest X Ray]] | [[Sexually transmitted disease CT|CT]] | [[Sexually transmitted disease MRI|MRI]] | [[Sexually transmitted disease echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Sexually transmitted disease other imaging findings|Other Imaging Findings]] | [[Sexually transmitted disease other diagnostic studies|Other Diagnostic Studies]] |
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| As early as 1996, [[WHO]] estimated that more than 1 million people were being infected daily. About 60% of these infections occur in young people <25 years of age, and of these 30% are <20 years. Between the ages of 14 and 19, STDs occur more frequently in girls than boys by a ratio of nearly 2:1; this equalizes by age 20.
| | ==Treatment== |
| | [[Sexually transmitted disease medical therapy|Medical Therapy]] | [[Sexually transmitted disease surgery|Surgery]] | [[Sexually transmitted disease primary prevention|Primary Prevention]] | [[Sexually transmitted disease secondary prevention|Secondary Prevention]] |
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| == Prevention == | | ==Related Chapters== |
| The most effective way to prevent sexual transmission of STIs is to avoid ''contact'' of body parts or fluids which can lead to transfer, not necessarily any ''sexual activity'' with an infected partner. (No contact equals no risk, not all sexual activities involve contact, like cybersex, masturbation from a distance, etc) ''Abstinence is one method of avoiding contact''. Ideally, both partners should get tested for STIs before initiating sexual contact, ''or if a partner engaged in contact with someone else'', but even then, certain STIs, particularly certain persistent viruses like HPV, may be impossible to detect with current medical procedures as they may be [[asymptomatic]].
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| Prevention is also key in addressing viral STIs such as HIV & herpes, as they are currently incurable. Many diseases that establish permanent infections can so occupy the immune system that other diseases become more easily transmitted.
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| The [[Innate immune system]] led by [[defensins]] against HIV can prevent transmission of HIV when viral counts are very low, but if busy with other viruses or overwhelmed, HIV can establish itself. Certain viral STI's also greatly increase the risk of death for HIV infected patients.
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| === Condoms ===
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| [[Condoms]] only provide protection '''when used properly as a barrier''' and to and from the area that it covers. ''Uncovered areas are still susceptible to many STD's''. In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin, thus ''properly shielding the insertive penis with a properly worn condom from the vagina and anus effectively stops HIV transmission''. An infected fluid to broken skin borne direct transmission of HIV would not be considered "sexually transmitted", but can still theoretically occur during sexual contact, this can be avoided simply by not engaging in sexual contact when having open bleeding wounds. However, other STI's, usually persistent viral ones like Herpes and HPV, invade skin and mucous membranes, so a condom in that case may do little to stop transmission.
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| Condoms are designed, tested, and manufactured to never fail if used properly. There has not been one documented case of an HIV transmission due to an improperly manufactured condom. However, there have been cases of condom recall, as in a case in South Africa.<ref>[http://www.cnn.com/2007/WORLD/africa/10/24/condom.recall.ap/index.html]</ref>
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| Proper usage entails:
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| *Not putting the condom on too tight at the end, and leaving 1.5 cm (3/4 inch) room at the tip for [[ejaculate]]. Putting the condom on snug can and often does lead to failure.
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| *Wearing a condom too loose can defeat the barrier.
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| *Avoiding inverting, spilling a condom once worn, whether it has ejaculate in it or not, even for a second.
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| *Avoiding condoms made of substances other than latex or polyurethane, as they don't protect against HIV.
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| *Avoiding the use of oil based lubricants (or anything with oil in it) with latex condoms, as oil can eat holes into them.
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| Not following the five guidelines above perpetuates the common misconception that condoms aren't tested or designed properly.
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| In order to best protect oneself and the partner from STI's, the old condom and its contents should be assumed to be still infectious. Therefore the old condom must be properly disposed off. A new condom should be used for each act of intercourse, as multiple usage increases the chance of breakage, defeating the primary purpose as a barrier. Defeated barrier equals potential transmission.
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| == Testing ==
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| {{main|STD testing}}
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| == Treatment ==
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| [[Image:SheMayLookCleanBut.jpg|thumb|right|280px|American poster propaganda targeted at [[World War II]] soldiers and sailors appealed to their patriotism in urging them to protect themselves. The text at the bottom of the poster reads, "You can't beat the Axis if you get VD." Images of women were used to catch the eye on many VD posters.]]
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| [[Image:Stdspain.jpg|thumb|right|280px|[[Spanish Civil War]] poster, produced by the Republican government, saying "Avoid venereal diseases ... As dangerous as enemy bullets"]]
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| Prior to the invention of modern medicines, sexually transmitted diseases were generally incurable, and treatment was limited to treating the symptoms of the disease. The first voluntary hospital for venereal diseases was founded in 1746 at [[London Lock Hospital]].<ref name="AIM-Albert">Archives in London and the M25 area ([http://www.aim25.ac.uk/index.stm AIM25]) [http://www.aim25.ac.uk/cgi-bin/search2?coll_id=859&inst_id=9 London Lock Hospital records]</ref>
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| The first effective treatment for a sexually transmitted disease was [[Arsphenamine|salvarsan]], a treatment for syphilis. With the discovery of [[antibiotic]]s, a large number of sexually transmitted diseases became easily curable, and this, combined with effective public health campaigns against STDs, led to a public perception during the 1960s and 1970s that they have ceased to be a serious medical threat.
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| During this period, the importance of [[contact tracing]] in treating STIs was recognized. By tracing the sexual partners of infected individuals, testing them for infection, treating the infected and tracing their contacts in turn, STI clinics could be very effective at suppressing infections in the general population.
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| In the 1980s, first [[genital herpes]] and then [[AIDS]] emerged into the public consciousness as sexually transmitted diseases that could not be cured by modern medicine. AIDS in particular has a long asymptomatic period — during which time [[HIV]] (the human immunodeficiency virus, which causes AIDS) can replicate and the disease can be transmitted to others — followed by a symptomatic period, which leads rapidly to death unless treated. Recognition that AIDS threatened a global [[pandemic]] led to public information campaigns and the development of treatments that allow AIDS to be managed by suppressing the replication of HIV for as long as possible. Contact tracing continues to be an important measure, even when diseases are incurable, as it helps to contain infection.
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| [http://std-gov.org/stds/treatment.htm Current STD Treatment (Cure)]
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| == Types and their pathogenic causes ==
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| Most of the diseases on this list are most commonly transmitted sexually. Some are commonly transmitted in other ways as well; for example, [[HIV/AIDS]] is also commonly transmitted through the sharing of infected needles by drug users, while [[SARS]], which can be spread through casual contact such as coughing and sneezing, is very often not associated with sexual activity.
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| === Bacterial ===
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| *[[Chancroid]] (''[[Haemophilus ducreyi]]'')
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| *[[Donovanosis]] (''[[Granuloma inguinale]]'' or ''[[Calymmatobacterium granulomatis]]'')
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| *[[Gonorrhea]] (''[[Neisseria gonorrhoeae]]'')
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| *[[Lymphogranuloma venereum]] (LGV) (''[[Chlamydia trachomatis]]'' serotypes L<sub>1</sub>, L<sub>2</sub>, L<sub>3</sub>. See [[Chlamydia]])
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| *[[Non-gonococcal urethritis]] (NGU) (''[[Ureaplasma urealyticum]]'' or ''[[Mycoplasma hominis]]'')
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| * [[Staphylococcus aureus]], [[MRSA]].<ref name="CDI2007">{{cite journal |author=Cook H, Furuya E, Larson E, Vasquez G, Lowy F |title=Heterosexual transmission of community-associated methicillin-resistant Staphylococcus aureus |journal=Clin Infect Dis |volume=44 |issue=3 |pages=410-3 |year=2007 |id=PMID 17205449 | url=http://www.journals.uchicago.edu/cgi-bin/resolve?CID40836}}</ref>
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| *[[Syphilis]] (''[[Treponema pallidum]]'')
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| === Fungal ===
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| *[[Jock Itch]]
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| *[[Yeast Infection]]
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| === Viral ===
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| *[[Cytomegalovirus]] (CMV) through skin to skin contact, saliva, not only sexually.
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| *[[Hepatitis B]]. <br />(Note: [[Hepatitis A]] and [[Hepatitis E]] are transmitted via the [[fæcal-oral route]], not sexually; [[Hepatitis C]] is rarely sexually transmittable,<!--
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| --><ref name=Workowski>{{cite journal | author = Workowski K, Berman S | title = [http://www.cdc.gov/mmwr/PDF/rr/rr5511.pdf Sexually transmitted diseases treatment guidelines], 2006. | journal = MMWR Recomm Rep | volume = 55 | issue = RR-11 | pages = 1-94 | year = 2006 | id = PMID 16888612}}</ref><!--
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| -->and the route of transmission of [[Hepatitis D]] is uncertain, but may include sexual transmission.<ref>{{cite journal | author = Wu J, Chen C, Sheen I, Lee S, Tzeng H, Choo K | title = Evidence of transmission of hepatitis D virus to spouses from sequence analysis of the viral genome. | journal = Hepatology | volume = 22 | issue = 6 | pages = 1656-60 | year = 1995 | id = PMID 7489970}}</ref> <ref>{{cite journal | author = Farci P | title = Delta hepatitis: an update. | journal = J Hepatol | volume = 39 Suppl 1 | issue = | pages = S212-9 | year = | id = PMID 14708706}}</ref> <ref>{{cite journal | author = Shukla N, Poles M | title = Hepatitis B virus infection: co-infection with hepatitis C virus, hepatitis D virus, and human immunodeficiency virus. | journal = Clin Liver Dis | volume = 8 | issue = 2 | pages = 445-60, viii | year = 2004 | id = PMID 15481349}}</ref>)
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| *[[Herpes simplex]]
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| **[[Herpes simplex virus]] implicated in [[Alzheimer's disease]].<ref>[http://abc.net.au/news/stories/2007/11/03/2080862.htm?section=world]</ref>
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| *[[Human Immunodeficiency Virus]] ([[HIV]]/[[AIDS]])
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| *[[Human papillomavirus]] (HPV)
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| **Certain strains of HPV cause [[genital warts]]
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| **Certain strains of HPV cause cervical dysplasias which can lead to [[cervical cancer]], [[penis cancer]], [[anal cancer]], [[oral cancer]], [[head and neck cancer]].
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| *[[Marburg virus]] and [[Ebola]], as any contact can spread it, sexual transmission has been documented.
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| *[[Molluscum contagiosum|Molluscum]] (MC)
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| *[[Mononucleosis]] is spread through saliva, can occur during sex.
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| *[[Kaposi's sarcoma-associated herpesvirus]] ([[KSHV]]/HHV8)
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| **The cause of [[Kaposi's sarcoma]]
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| === Parasites ===
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| *[[Pubic lice]], colloquially known as "crabs" (''[[Phthirius pubis]]'')
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| *[[Scabies]] (''[[Sarcoptes scabiei]]'')
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| === Protozoal ===
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| *[[Trichomoniasis]] (''[[Trichomonas vaginalis]]'')
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| ===Sexually transmitted enteric Infections ===
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| Various bacterial ([[Shigella]], [[Campylobacter]], or [[Salmonella]]), viral ([[Hepatitis A]]), or parasitic ([[Giardia]] or [[amoeba]]) pathogens are transmitted by sexual practices that promote anal-oral contamination. Sharing sex toys without washing or multiple partnered [[barebacking]] can promote anal-anal contamination. Although the bacterial pathogens may coexist with or cause [[proctitis]], they usually produce symptoms (diarrhoea, fever, bloating, nausea, and abdominal pain) suggesting disease more proximal in the GI tract.
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| === Sexually transmitted oral infections ===
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| Common [[colds]], [[influenza]], [[Staphylococcus aureus]], [[E.Coli]] and the yeast [[Candida albicans]] can all be transmitted through the oral route.
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| == See also ==
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| *[[Microbicide]] | | *[[Microbicide]] |
| *[[Reproductive health]] | | *[[Reproductive health]] |
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| *[[Zoophilia and health]] Health aspects of sexual acts with animals | | *[[Zoophilia and health]] Health aspects of sexual acts with animals |
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| == References == | | ==Resources== |
| {{Reflist|2}}
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| == External links ==
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| *[http://www.soc.ucsb.edu/sexinfo/?article=stds&refid=032menu SexInfo's STD's A to Z] at [[University of California, Santa Barbara]] | | *[http://www.soc.ucsb.edu/sexinfo/?article=stds&refid=032menu SexInfo's STD's A to Z] at [[University of California, Santa Barbara]] |
| *[http://www.dermnet.com/moduleIndex.cfm?moduleID=16 STD photo library] at [[New Zealand Dermatological Society|Dermnet]] | | *[http://www.dermnet.com/moduleIndex.cfm?moduleID=16 STD photo library] at [[New Zealand Dermatological Society|Dermnet]] |
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| [[zh:性病]] | | [[zh:性病]] |
| {{jb1}}
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| | [[Category:Disease]] |
| | [[Category:Infectious disease]] |
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| [[Category:Sexual health]] | | [[Category:Sexual health]] |
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