February 2018 is the National Condom week awareness in The Gambia

Tuesday, January 30, 2018

National Condom Week is usually celebrated the same week as Valentine’s Day

What do we know about sexually transmitted infections (STIs), Prevention, Symptoms, Diagnose, Treatments

National Condom Week  is one of the leading sexual health campaigns organized is organized with the aim of educating young adults about safer sex, to raise awareness of the risks involved with having sex and to reinforce the fact that using a condom is the only way to protect against both unwanted pregnancies and sexually transmitted diseases.

National Condom Week focuses on delivering the safer sex message to young adults through sexual health professionals, both in family planning and genitourinary medicine clinics.

World Health Organization Key facts

More than 1 million sexually transmitted infections (STIs) are acquired every day worldwide.

Each year, there are an estimated 357 million new infections with 1 of 4 STIs: chlamydia, gonorrhea, syphilis and trichomonas’s.

More than 500 million people are estimated to have genital infection with herpes simplex virus (HSV).

More than 290 million women have a human papillomavirus (HPV) infection1.

The majority of STIs have no symptoms or only mild symptoms that may not be recognized as an STI.

STIs such as HSV type 2 and syphilis can increase the risk of HIV acquisition.

Over 900 000 pregnant women were infected with syphilis resulting in approximately 350 000 adverse birth outcomes including stillbirth in 20122.

In some cases, STIs can have serious reproductive health consequences beyond the immediate impact of the infection itself (e.g., infertility or mother-to-child transmission)

Drug resistance, especially for gonorrhea, is a major threat to reducing the impact of STIs worldwide.

What are sexually transmitted infections and how are they transmitted More than 30 different bacteria, viruses and parasites are known to be transmitted through sexual contact. Eight of these pathogens are linked to the greatest incidence of sexually transmitted disease. Of these 8 infections, 4 are currently curable: syphilis, gonorrhea, chlamydia and trichomonas’s. The other 4 are viral infections and are incurable: hepatitis B, herpes simplex virus (HSV or herpes), HIV, and human papillomavirus (HPV). Symptoms or disease due to the incurable viral infections can be reduced or modified through treatment.

STIs are spread predominantly by sexual contact, including vaginal, anal and oral sex. Some STIs can also be spread through non-sexual means such as via blood or blood products. Many STIs - including chlamydia, gonorrhoea, primarily hepatitis B, HIV, and syphilis - can also be transmitted from mother to child during pregnancy and childbirth.

A person can have an STI without having obvious symptoms of disease. Common symptoms of STIs include vaginal discharge, urethral discharge or burning in men, genital ulcers, and abdominal pain.

Scope of the problem

STIs have a profound impact on sexual and reproductive health worldwide.

More than 1 million STIs are acquired every day. Each year, there are estimated 357 million new infections with 1 of 4 STIs: chlamydia (131 million), gonorrhea (78 million), syphilis (5.6 million) and trichomonas’s (143 million). More than 500 million people are living with genital HSV (herpes) infection. At any point in time, more than 290 million women have an HPV infection, one of the most common STIs.

STIs can have serious consequences beyond the immediate impact of the infection itself.

· STIs like herpes and syphilis can increase the risk of HIV acquisition three-fold or more.

· Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low-birth-weight and prematurity, sepsis, pneumonia, neonatal conjunctivitis, and congenital deformities. Over 900 000 pregnant women were infected with syphilis resulting in approximately 350 000 adverse birth outcomes including stillbirth in 20122.

· HPV infection causes 528 000 cases of cervical cancer and 266 000 cervical cancer deaths each year.

· STIs such as gonorrhea and chlamydia are major causes of pelvic inflammatory disease (PID) and infertility in women.

Prevention of STIs

Counselling and behavioral approaches

Counselling and behavioral interventions offer primary prevention against STIs (including HIV), as well as against unintended pregnancies. These include:

· comprehensive sexuality education, STI and HIV pre- and post-test counselling;

· safer sex/risk-reduction counselling, condom promotion;

·  interventions targeted at key populations, such as sex workers, men who have sex with men and people who inject drugs; and

· Education and counselling tailored to the needs of adolescents.

In addition, counselling can improve people’s ability to recognize the symptoms of STIs and increase the likelihood they will seek care or encourage a sexual partner to do so. Unfortunately, lack of public awareness, lack of training of health workers, and long-standing, widespread stigma around STIs remain barriers to greater and more effective use of these interventions.

Barrier methods

When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Female condoms are effective and safe, but are not used as widely by national programmers as male condoms.

Diagnosis of STIs

Accurate diagnostic tests for STIs are widely used in high-income countries. These are especially useful for the diagnosis of asymptomatic infections. However, in low- and middle-income countries, diagnostic tests are largely unavailable. Where testing is available, it is often expensive and geographically inaccessible; and patients often need to wait a long time (or need to return) to receive results. As a result, follow up can be impeded and care or treatment can be incomplete.

The only inexpensive, rapid tests currently available for STIs are for syphilis and HIV. The syphilis test is already in use in some resource-limited settings. The test is accurate, can provide results in 15 to 20 minutes, and is easy to use with minimal training. Rapid syphilis tests have been shown to increase the number of pregnant women tested for syphilis. However, increased efforts are still needed in most low- and middle-income countries to ensure that all pregnant women receive a syphilis test.

Several rapid tests for other STIs are under development and have the potential to improve STI diagnosis and treatment, especially in resource-limited settings.

Treatment of STIs

Effective treatment is currently available for several STIs.

· Three bacterial STIs (chlamydia, gonorrhoea and syphilis) and one parasitic STI (trichomonas’s) are generally curable with existing, effective single-dose regimens of antibiotics.

· For herpes and HIV, the most effective medications available are antivirals that can modulate the course of the disease, though they cannot cure the disease.

· For hepatitis B, immune system modulators (interferon) and antiviral medications can help to fight the virus and slow damage to the liver.

Resistance of STIs - in particular gonorrhoea - to antibiotics has increased rapidly in recent years and has reduced treatment options. The emergence of decreased susceptibility of gonorrhoea to the “last line” treatment option (oral and injectable cephalosporins) together with antimicrobial resistance already shown to penicillin, sulphonamides, tetracycline, quinolones and macrolides make gonorrhoea a multidrug-resistant organism. Antimicrobial resistance for other STIs, though less common, also exists, making prevention and prompt treatment critical.

Low- and middle-income countries rely on identifying consistent, easily recognizable signs and symptoms to guide treatment, without the use of laboratory tests. This is called syndromic management. This approach, which often relies on clinical algorithms, allows health workers to diagnose a specific infection on the basis of observed syndromes (e.g., vaginal discharge, urethral discharge, genital ulcers, and abdominal pain).

Syndromic management is simple, assures rapid, same-day treatment, and avoids expensive or unavailable diagnostic tests. However, this approach misses infections that do not demonstrate any syndromes - the majority of STIs globally.

Vaccines and other biomedical interventions

Safe and highly effective vaccines are available for 2 STIs: hepatitis B and HPV. These vaccines have represented major advances in STI prevention. The vaccine against hepatitis B is included in infant immunization programmers in 93% of countries and has already prevented an estimated 1.3 million deaths from chronic liver disease and cancer.

HPV vaccine is available as part of routine immunization programmers in 65 countries, most of them high- and middle-income. HPV vaccination could prevent the deaths of more than 4 million women over the next decade in low- and middle-income countries, where most cases of cervical cancer occur, if 70% vaccination coverage can be achieved.

Research to develop vaccines against herpes and HIV is advanced, with several vaccine candidates in early clinical development. Research into vaccines for chlamydia, gonorrhoea, syphilis and trichomonas’s is in earlier stages of development.

Other biomedical interventions to prevent some STIs include adult male circumcision and microbicides.

· Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60% and provides some protection against other STIs, such as herpes and HPV.

· Tenofovir gel, when used as a vaginal microbicide, has had mixed results in terms of the ability to prevent HIV acquisition, but has shown some effectiveness against HSV-2.

WHO response

WHO develops global norms and standards for STI treatment and prevention, strengthens systems for surveillance and monitoring, including those for drug-resistant gonorrhoea, and leads the setting of the global research agenda on STIs.

Our work is currently guided by the “Global health sector strategy on sexually transmitted infections, 2016 -2021, adopted by the World Health Assembly in 2016 and the 2015 United Nations Global Strategy for Women’s, Children’s and Adolescents’ Health, which highlight the need for a comprehensive, integrated package of essential interventions, including information and services for the prevention of HIV and other sexually transmitted infections. The Sixty-ninth World Health Assembly adopted 3 global health sector strategies for the period 2016-2021 on HIV, viral hepatitis and sexually transmitted infections (STIs).

You can reduce your chances of exposure to STIs in several ways: • Have sex with a partner who has been tested for an STI, and who only has sex with you. The more partners you have, the more likely you are to be exposed to an STI. • Having sex without a condom is one of the greatest causes of contracting STIs. It is vital that you use a condom at all times when having sexual intercourse. •

Previous infections with one or more STIs make it easier for a new STI to develop in your body. You and your partner can also re-infect one another with an STI if you do not get yourselves tested and treated regularly. • Always use sterile or new needles, and do not share drug-using equipment. Most STIs can be cured if diagnosed and treated early. All of them can be prevented, however, through responsible sexual behaviour.

Condoms and STIs Most experts believe that the risk of getting HIV & AIDS and other STIs can be greatly reduced if a condom is used properly. Consistent and correct use of male latex condoms can reduce (though not eliminate) the risk of STI transmission, and provide maximum protective support. Inconsistent use can lead to STI acquisition, because transmission can occur with a single act of intercourse with an infected partner. However, there’s no absolute guarantee even when you use a condom. Sexual health

For further information visit EFSTH, government Health centers throughout the country, number of NGO and Private Clinics, email to azadehhassanmd10@gmail.com and text only week days from 3-6 pm to Dr Azadeh 002207774469/3774469.

Author DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in Obstetrics & Gynaecology, Clinical Director of Medicare Health services.

Author: Dr Azadeh
Source: Picture: Dr Azadeh