Sexually transmitted diseases or sexually transmitted infections (STD or STI) are a great threat to society. Sexually infectious diseases are a major cause for serious health implications and hazardous menace including infertility, ectopic pregnancy, cancer and severe psychological and physical consequences for men and women and children and communities as a whole, across every part of the world and crossing all the social boundaries.
The United Nations has declared December 1 each year as World AIDS Day (WAD) to serve as a reminder of the global struggle to end HIV related stigma and opportunity to honour those who have lost and rallying to commit towards a day where HIV is no longer a public threat.
Specialised Venereologist of the sexual clinic of the Anuradhapura Teaching Hospital Dr. Thilani Rathnayaka told the Sunday Observer that the world commemorated its 35th WAD on December 1, under the theme ‘’Let communities lead’’ to showcase the solidarity with those affected by HIV and medical professionals and health care staff fighting to eradicate the menace. Dr. Thilani said that Sri Lanka is endeavouring and working hard to end AIDS by 2030 with communities leading which is the concept of the United Nations.
Every year in Sri Lanka, over 6,000 males and females are treated for different types of STIs of which genital herpes has been reported in the highest numbers. Gonorrhea, Syphilis, genital warts are other common sexually infectious diseases are reported from all parts of the country.
Reported cases
According to the National STD/AIDs control program, last year 1,753 cases of genital herpes, 1,741 cases of genital warts, 666 cases of syphilis and 301 cases of gonorrhea were reported. There could be many unreported cases and the patients treated at private sector hospitals were not taken into account. Gonorrhoea and syphilis are known to the world from very early stages of human civilisation and are still reported in large numbers in various countries.
It is estimated through surveys that around 4,000 persons are living with HIV in the country. Last year, 607 new HIV infections were reported. It shows that more males are infected related to homosexual transmission giving a female to male ratio of 1:7 which indicates masculinisation of the HIV epidemic during the past two decades. Around 648 AIDS related deaths were reported in the country and 95 children acquired infection from their infected mothers since the first such case was reported in 1986.
Many types of viruses, bacteria and parasites are sexually transmissible through different types of sexual acts: unprotected vaginal sex, oral sex and anal sex. Eight pathogens are linked to the greatest incidence of STIs and of these, four types are curable: syphilis, gonorrhoea, chlamydia and trichomoniasis. The other four incurable viral infections are hepatitis – 13, herpes simplex virus (HSV), HIV and human papillomavirus (HPV).
According to Dr. Thilani, regarding transmission and sexual behaviour, unprotected sex is the main mode of transmission for STIs and the risk of sexual transmission of STIs varies in accordance with the type of sex partners. According to findings related to HIV transmission, anal sex is considered the highest risk act which has five percent risk of transmission compared to vaginal sex which has 0.1 percent.
Illicit drug use
Venerologist Dr. Thilani said the other associated factors such as commercial sex, sex under intoxication and illicit drugs increase the risk of STI transmission. Particularly, under the influence of various drugs, the ability to make correct decisions impaired and more likely to have engaged in unprotected sex and casual sex.
A new trend of illicit drug use reported as chem sex is commonly practised among MSMs, and Bi sexual groups in most Western societies where three specific illicit drugs called’’ chem drugs’’ are used during sex acts. These drugs are increasing sexual feelings and desire for an elongated period. It has been found that the risk of STI and HIV transmission is known to be very high among the ‘’chem sex users because of long sessions of unprotected anal sex with multiple male partners.
Complicated gonorrhoea and chlamydia infections can permanently damage the reproductive system making male and female partners infertile. Damage to the fallopian tube is a reason for having an ectopic pregnancy or implantation outside the womb with chlamydia infection. Both infections can lead to chronic pelvic infection and chronic prostate infection which make patients suffer with long term pelvic pain and some ending up with sexual dysfunctions. Herpes is a lifelong infection which causes patients to suffer with recurrent painful sores.
‘’Many STIs are associated with adverse birth outcomes with mother to child transmission. Syphilis is a common reason for repeated miscarriages, stillbirths and congenital syphilis with stigmata. Neonatal herpes is rare but linked to high mortality and morbidity in newborns which can end up with permanent brain damage. Neonatal conjunctivitis and blindness are serious outcomes of gonococcal and chlamydia infections transmitted from infected mothers at the time of labour.
STIs are also a cause for cancers. HPV infection is the primary cause for cervical cancer which is the fourth common cancer in women. HPV is also associated with anal cancer in men particularly men who have sex with other men. Worldwide, 296 million people live with hepatitis B which is responsible for 296 million deaths from cirrhosis and Carcinoma, Dr. Thilani said.
Asymptomatic cases
Wide ranges of clinical presentations are described for STIs. Significant numbers of STIs are asymptomatic or have no symptom and can be easily missed. For example, a high percentage of women with gonococcal and chlamydia are asymptomatic. Sometimes syphilis and HIV infections also have long latency periods which can go up to an average of eight years without any symptoms.
According to Dr. Thilani, STI presentation techniques are described under two categories as biological interventions and behavioural interventions. Behaviour change to reduce the number of sexual partners and limit sexual relationship to one faithful partner are proven strategies for STI prevention. Correct and consistent use of condoms is an effective method for STI prevention and can prevent HIV transmission by almost 98 percent. Dr. Thilani said that there are many novel interventions for HIV infection and many have shown significant positive results in research. For example, male circumcision has shown to reduce HIV acquisition by 60 percent among men and WHO recommend as adoption for high HIV prevalence settings.
Two vaccines known to prevent STIs are Hepatitis B Vaccine and HPV vaccine. Hepatitis – B Vaccine in three doses is recommended for all sexual contacts of acute hepatitis – B infection M.S.M., drug users and HIV positive persons to prevent new infections. HPV vaccine has proven to prevent 90 percent cervical cancer and girls between the age of 9 – 12 are eligible for vaccination and proven to prevent both cervical cancer and genital warts caused by H.P.V.
Stigma and discrimination are attached to HIV and STIs resulting in a negative impact for prevention and control of HIV/STIs.
Stigma is a considerable barrier to achieve targets in HIV testing among key population groups such as MSM, TG and Female Sex workers (FSW) Stigma discourages risk people coming for country’s 41 sex clinics for condoms and screening at government sector, Dr. Thilani said.
