By Dr James Koh Kwee Choy
Senior Lecturer & Infectious Diseases Specialist, Clinical School Seremban
Many misconceptions abound regarding sexually-transmitted diseases. Here is what you really to know to STIs:
1) STIs are caused by bacteria, viruses or protozoans.
Truth. Commonly known STIs caused by bacteria are Syphilis (Treponema pallidum), Gonorrhoea (Neisseria gonorrhoeae), and Chlamydia (Chlamydia trachomatis). Viral causes of STIs include Herpes simplex virus type 1 and 2, which cause oral and genital ulcers; Hepatitis A, B and C; Human papilloma virus (HPV) which causes genital warts and the Human Immunodeficiency Virus (HIV). Trichomoniasis is an example of an STI caused by the protozoan Trichomonas vaginalis.
However, some medical practitioners also consider phthiriasis pubis, or infestation with pubic lice (Pthirus pubis) or commonly known as ‘crabs’ as a form of sexually transmitted disease. Similarly, scabies, an itchy skin condition caused by mites (Sarcoptes scabiei) can be transmitted through close contact during sexual intercourse.
2) Although they are called sexually-transmitted infections, STIs can also be transmitted through other means.
Truth. Although most of the pathogens in STIs are indeed transmitted sexually, non-sexual transmission are known to occur. For example, genital warts, hepatitis B and C may be transmitted from an infected mother to the newborn during childbirth. Molluscum contangiosum, a skin condition caused by the poxvirus may be transmitted via close contact.
3) The condom is the only proven way to prevent STIs.
Myth. Consistent and correct use of the male condom is one of the means of preventing STIs but the amount of protection provided by condom use for the prevention of STIs is difficult to establish. A review by the National Institutes of Health in 2000 could only conclusively determined that condom use prevented HIV transmission in both men and women during vaginal intercourse and prevented gonorrhoea in men.1 However, since then many studies have shown significant reduction in transmission of various STIs such as genital herpes, HPV, syphilis, and chlamydia through the use of condom with the caveat that the infected areas are covered or protected by the condom.
In addition, condoms lubricated with spermicides have been shown to be no more superior to ordinary condom in preventing HIV and other STIs and may in fact increase the risk of HIV acquisition.2,3
The ‘take-home’ message regarding condom use is this: There is no such thing as ‘safe sex’, only ‘safer sex’. While the use of condom during sexual intercourse is probably the best method in preventing transmission of STIs when used correctly, it is not infallible. The only sure way of preventing STIs is abstinence from sexual intercourse.
Fortunately, some STIs, like HPV and Hepatitis B, can be prevented through vaccinations.
4) Some STIs never manifest themselves until many years later.
Truth. While most STIs would manifest in signs and symptoms fairly soon after exposure, some STIs remain dormant for many years before an infected person becomes visibly sick. Most notable of these is HIV infection where an infected person may not demonstrate any symptoms for many years before succumbing to opportunistic infections due to a weakened immunity. During this ‘incubation period’, an HIV-infected person appears to be in good health and is at risk of transmitting the infection to others.
5) Circumcision can prevent STIs such as HIV/AIDS.
Myth. Although many studies have demonstrated the beneficial effect of male circumcision in preventing STI acquisition, particularly for HIV infection, the beneficial effect is limited only to reduction in female-to-male HIV transmission. 4,5 The same benefit has not been demonstrated for male-to-female transmission and among men-who-have-sex-with-men (MSM). Circumcision has also been shown to reduce risk of viral STIs including HSV-2 and HPV but not of gonorrhoea or chlamydia.6
6) Monogamy does not protect against STIs.
Truth. Being faithful sexually to one’s partner does not guarantee against STIs acquisition unless the partner is also monogamous. If the partner is not monogamous, he or she may act as a conduit for the transmission of STIs from his/her other possibly infected partner or partners. If a partner’s monogamous status cannot be determined, it may be prudent to use condom while engaging in sexual intercourse.
7) Some STIs can last for a lifetime.
Truth. While most STIs are curable with appropriate antibiotics, some STIs are rather recalcitrant to treatment and tend to persist in a person for life. Other than HIV which has no cure and no preventive vaccine available yet, HPV, which causes genital warts and HSV 1 and HSV 2 which cause painful oral and genital ulcerations tend to recur even after ‘successful’ therapy. Thankfully, there is now an effective vaccine available against HPV.
8) STIs that are left untreated can spread to the other parts of the body and have serious consequences.
Truth. STIs, when left untreated may lead to grave complications and even death. For instance, untreated gonorrhoea may result in pelvic inflammatory disease in females which in turn may lead to complications such as tuboovarian abscess, chronic pelvic pain, infertility and ectopic pregnancy.
Untreated primary syphilis may progress to secondary and tertiary syphilis with neurological and cardiovascular complications, higher risk of HIV infection acquisition and increased risk of passing the infection to a newborn child. HIV, when left untreated will slowly ravage a person’s immunity over many years resulting in the person succumbing to an opportunistic infection due to severely weakened immunity.
9) Once diagnosed with an STI, your partner must also be tested and treated.
Truth. Getting your partner or partners to get tested and treated is the logical next step after you have been diagnosed with an STI. An untreated infected partner may unknowingly infect others or may even re-infect you with the same STI even though you have been treated.
10)Most STIs are easy to treat and will resolve by itself after some time.
Myth. Without appropriate antibiotics, most STIs do not spontaneously resolve. The only way to be certain is to seek medical help from a qualified medical practitioner. It is highly unadvisable to attempt to self-medicate or to ignore the problem.
1. National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Service. Workshop summary: scientific evidence for sexually transmitted diseases (STD) prevention. Herndon, VA: 2000.
2. Nonoxynol-9 spermicide for prevention of vaginally acquired HIV and other sexually transmitted infections: systematic review and meta-analysis of randomised controlled trials including more than 5000 women. Wilkinson D, Tholandi M, Ramjee G, et al. Lancet Infect Dis. 2002;2(10):613.
3. Randomised controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future. Wetmore CM, Manhart LE, Wasserheit JN. Epidemiol Rev. 2010;32(1):121.
4. HIV and male circumcision – a systematic review with assessment of the quality of studies. Siegfried N, Muller M, Deeks J, et al. Lancet Infect Dis. 20905;5(3):165.
5. Male circumcision as an HIV prevention strategy in sub-Saharan Africa: sociolegal barriers. Gostin LO, Hankins CA. JAMA. 2008;300(21):2539.
6. Male circumcision for the prevention of HSV-2 and HPV infections and syphilis. Tobian AA, Serwadda D Quinn TC, et al. N Engl J Med. 2009;360(13):1298.