SEXUALLY-TRANSMITTED DISEASES: AN AGE-OLD PROBLEM
Sexually transmitted diseases, now renamed Sexually Transmitted Infections, have been a problem for centuries. The pre-eminent Sexually Transmitted Disease (STD), Syphilis, took the life, or the intellectual capability, of many prominent citizens as far back as records can be obtained. It’s still around, but is somewhat less of a problem than gonorrhea, chlamydia, and herpes, but still causes a dilemma.
During the early stages of the COVID-19 pandemic, the CDC reported a decline in cases of STD’s presumably due to “pandemic-related disruptions in care and several other factors: public health staff being diverted to work on COVID-19, insurance lapses, lab supply shortages, and telemedicine services that may not have logged cases in national databases.” If you were to ask me, I would think, yes, there were pandemic-related issues, but they were the reduction of promiscuous and indiscriminate sexual activity caused by the closure of venues from which such liaisons originate, and not the ridiculous reasons given by the CDC.
Since the pandemic hysteria has waned, the CDC is now reporting a ”dramatic resurgence” of cases of STD’s. Between 2019 and 2020, the following stats were recorded:
GONORRHEA cases increased by 10%
SYPHILIS, primary and secondary, increased by 7%
CHLAMYDIA increased by 13%
CONGENITAL SYPHILIS increased by 15% (explanation below)
STD’s have hounded medical professionals for decades, especially since the 60’s sexual revolution and the introduction of oral contraceptives, ie. birth control pills. Sexual intercourse, and it’s many varieties, have become a cultural norm as exemplified by the enormous popularity of the series “Sex and the City.” Other such examples are numerous.
What follows next is a brief definition and explanation of the many types of STD’s which are now more specifically named STI’s, Sexually Transmitted Infections. The new name differentiates them from other disorders of the genitals that are not infectious in their origin but may still be sexually induced.
GONORRHEA: a bacterial infection that can infect multiple areas of the body based on the
sexual proclivities of the individuals. Those areas are:
Urethritis—the classic penile infection causing a discharge (pus) from the urethra
Epididymitis—painful infection of a glandular appendage in the scrotum
Pharyngitis—throat infection caused by oral sexual activity
Cervicitis—infection of the female uterine cervix located in the vagina
Conjunctivitis—uncommon eye infection caused by hand transmission genitals-to-eyes
Pelvic Inflammatory Disease (PID)—infection of uterus, tubes, ovaries spread from
cervical infection
CHLAMYDIA: a bacterial infection similar in distribution to gonorrhea
Non-Gonococcal Urethritis—similar to classic urethritis, but discharge is clearer and
not pus-like
Epididymitis—similar to gonococcal infection, tends to be less severe but longer-lasting
Pharyngitis, Conjunctivitis, Vaginitis—infections of areas similar to, but less severe
than Gonorrhea
Pelvic Inflammatory Disease (PID)—infection of female reproductive organs that
causes vaginal discomfort, painful intercourse
TRICHOMONIASIS: a parasitic organism that causes an odorous vaginal discharge
HERPES SIMPLEX VIRUS: a viral infection of the genitals
Herpes simplex virus Type I—common cause of cold sores and fever blisters
Herpes simplex virus Type II—cause of penile and labial (vaginal) ulcerations
HUMAN PAPILLOMA VIRUS: a virus that causes genital and anal warts
Genital and Anal Warts—papillomatous lesions spread by skin-to-skin contact
Cervical Cancer—virus causes inflammation of uterine cervix which, if untreated,
progresses to cancer of the cervix
BACTERIAL VAGINOSIS: vaginal infection caused by several different bacteria, primarily
Gardnerella vaginalis; symptoms-odorous vaginal discharge
SYPHILIS: spirochetal infection caused by Treponema pallidum
Primary Syphilis—penile, vaginal (labial) ulceration called a “chancre” heals very slowly
Secondary Syphilis—after chancre appears or heals, diffuse spotted red rash develops,
rash also involves palms of hands, soles of feet
Latent Syphilis—period between second and third phases, no obvious symptoms
Tertiary Syphilis—occurs in untreated cases, disease involves multiple organ systems
Neurosyphilis—chronic syphilitic infection invades brain and nervous system
Ocular Syphilis—chronic infection invades visual system
Otosyphilis—chronic infection invades the hearing system
Congenital Syphilis—infection transferred to fetus in the uterus of an infected mother,
infant acquires multiple severe deformities
HIV (Human Immunodeficiency Virus): viral infection that invades the immune system
AIDS (Acquired Immunodeficiency Syndrome)—result of HIV where patients cannot
fight infections
Stages—Seroconversion, asymptomatic, symptomatic, and late stage HIV
(This is a blog unto itself)
HEPATITIS A, B, C: viral diseases of the liver
A—“infectious” hepatitis, acquired from contaminated food, water, bodily fluids
B—“serum” hepatitis, acquired through IV drug use, contaminated blood sexual contact
C—acquired through IV drug use, sexual contact A and B have chronic liver disease
implications
Pediculosis pubis —pubic lice
Lymphogranuloma venereum—bacterial infection of anus, rectum
Chancroid—bacterial infection causing genital ulcers
Mycoplasma genitalium—bacterium that causes urethritis, cervicitis
In practice, I didn’t see many cases of some STD’s. My patient population wasn’t dominated by a lot of people who partied and had substance abuse problems or wild, promiscuous lifestyles. If they had STD’s, they sought treatment elsewhere. Thus, in 40 years I saw only one case of primary syphilis, one case of tertiary syphilis, no cases of HIV, a half dozen or so patients with non-gonococcal urethritis, 15-20 cases of gonorrhea, 8-10 cases of pubic lice, and hundreds of patients with Chlamydia, bacterial vaginosis, HPV, trichomoniasis, or Herpes simplex virus. HPV is one cause of abnormal PAP smears, and in the first thirty years, in my office, abnormal PAPS were a weekly occurrence. HPV was not identified as the cause of cervical cancer until 1983 and wasn’t a preventable disease until 2006 when HPV vaccine, Gardasil, was released. I saw a lot of HPV cases, but didn’t recognize it as such.
The point of all this was my practice probably was on the low end of the “bell-shaped curve” where STD cases are recorded. Ninety percent of the STD cases I saw were while in my training years, 1965-1974. I’m not naive enough to think my patients didn’t have STD’s because I know they did. They just didn’t want me to know it.
This blog post gives you an overview of sexually transmitted infections. Nationwide the number of cases has continued to increase which is a regrettable statistic that reflects negatively on the moral integrity of American society. Our country is swirling badly. We need a reawakening, a reset, and a leader who can appeal to all factions. I hope that person exists.
References: Practice Guidelines. “Sexually Transmitted Infections: Updated Guideline from the CDC” JAMA 2022 May;105(5):553-557.
News from the Centers for Disease Control and Prevention “Resurgence of Sexually Transmitted Diseases in the U.S.” JAMA 2022 May 24/31;327(20):1951.
Tuddenham S, Hamill MM, Ghanem KG. Diagnosis and Treatment of Sexually Transmitted Infections: A Review JAMA2022 Jan 11;327(2):161-170.
Dalby J, Stoner BP. Sexually Transmitted Infections: Updates from 2021 CDC Guidelines, Am Fam Phys. 2022 May;105(5):514-520.
Hazra A, Collison ME, Davis AM. CDC Sexually Transmitted Infections Treatment Guidelines, 2021. JAMA 2022 March 1;327(9):870-871.
