Category Archives: Sexual Health

Chlamydia and Gonorrhea

Gonorrhea Quick Facts

Posted on by dnaserver

What is gonorrhea?
Gonorrhea is a common sexually transmitted disease (STD) that is spread through sexual contact with the penis, vagina, mouth, or anus of an infected individual. Gonorrhea can also be transmitted from a mother with an untreated cervical infection to her newborn during childbirth (1).

What causes gonorrhea?
Gonorrhea is caused by infection with the bacterium Neisseria gonorrhoeae.

What are the symptoms of gonorrhea?
Males may exhibit symptoms of a gonorrheal infection; however, most infected females remain asymptomatic, with an estimated 85-90% of infected males showing symptoms and only ~20% of infected females (2) If symptoms occur, it’s usually 1-3 weeks after exposure. Symptoms can include:

  • Abnormal vaginal discharge
  • Bleeding between periods and/or after sexual intercourse
  • Increased urinary frequency
  • Dysuria – painful urination
  • Pain during sexual intercourse
  • Abdominal and/or pelvic pain
  • Urethral discharge
  • Testicular pain
  • Burning or itching in the urethra

Gonorrhea can also affect the rectum, resulting in rectal pain, discharge, and bleeding (3), and the throat, which may cause a sore throat (4).

Who is at risk of gonorrhea?
Any sexually active individual is at risk of gonorrheal infection, with an increased risk among younger individuals. Gonorrhea is a common STD in the United States with 583,405 cases reported to the CDC in 2018 (5).

How is gonorrhea diagnosed?
Modern nucleic acid amplification testing (NAAT) provides the most sensitivity and specificity for a gonorrheal diagnosis. These can be performed on vaginal swabs (either clinician- or patient-collected) or urine.

How is gonorrhea treated?
Dual antibiotic treatment was previously recommended for gonorrhea infections due to antimicrobial resistance (6). However, due to other health concerns, now only ceftriaxone is recommended for treating gonorrhea in the United States (7). Repeat gonorrheal infections from sexual contact with an infected partner are common, increasing the risk of serious reproductive health complications. Antibiotics do not repair any permanent damage done by the disease (6).

References:
1. Sexually Transmitted Disease Surveillance, 2018. CDC. October 2019.
2. Gonorrhea Gonococcal Infection (clap, drip). New York State Department of Health. November 2006.
3. Klein EJ, et al. (1977). Anorectal gonococcal infection. Ann Intern Med, 86 (3), 340-346.
4. Wiesner PJ, et al. (1973). Clinical Spectrum of Pharyngeal Gonococcal Infection. N Engl J Med, 288 (4), 181-185.
5. Sexually transmitted Disease Surveillance 2018, Gonorrhea. CDC October 2019.
6. Workowski KA & Bolan GA (2015) Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep, 64 (RR-03), 1-137.
7. Gonococcal Infections Among Adolescents and Adults. Sexually Transmitted Infections Treatment Guidelines, 2021. (Reviewed July 2021).CDC.

Sexual Health

How common are STDs?

Posted on by dnaserver

Sexually transmitted diseases (STDs) can also be known as sexually transmitted infections (STIs). They are infections that are usually spread from person to person during vaginal, anal, and oral sex.

Many STDs are quite common with the CDC estimating there were 26 million new STDs in 2018 in the United States, with almost half of new STDs among youth aged 15 – 24 years (1).

The most common STDs are chlamydia, gonorrhea, trichomoniasis, and syphilis. Other STDs that we also offer at-home testing for are hepatitis B, hepatitis C, and HIV.

Chlamydia
Chlamydia is caused by infection with the bacterium Chlamydia trachomatis.

Over 1.7 million cases of chlamydia were reported to the CDC in 2018, with an increase to over 1.8 million reported cases in 2019. However, actual annual chlamydia cases are estimated to be closer to 2.86 million (1).

50-60% of new chlamydia infections occur in individuals aged between 15 and 24 years. Reported chlamydia rates are approximately two times higher in females compared to males (2). The prevalence of chlamydia varies between racial and ethnic groups, with significantly higher rates among blacks compared to whites (2).

Chlamydia is easily treated with oral antibiotics (3).

Gonorrhea
Gonorrhea is caused by infection with the bacterium Neisseria gonorrhoeae.

There were 583,405 cases of gonorrhea reported to the CDC in 2018, and 616,392 reported cases in 2019 (1).

50-60% of new gonorrhea infections occur in individuals aged between 15 and 24 years. Reported gonorrhea rates are higher in males than females (2). The prevalence of gonorrhea varies between racial and ethnic groups, with significantly higher rates among blacks compared to whites (2).

Dual antibiotic treatment was previously recommended for gonorrhea infections due to antimicrobial resistance (3). However, due to other health concerns, now only ceftriaxone is recommended for treating gonorrhea in the United States (4).

Trichomoniasis
Trichomoniasis is caused by infection with a protozoan parasite called Trichomonas vaginalis.

As of 2018, there are an estimated 2.6 million individuals with trichomoniasis in the United States (1).

Trichomoniasis prevalence is significantly higher among African American females (9.6-13%), compared to Hispanic (1.4%) and non-Hispanic white females (0.8-1.8%) (5).

Prescription antibiotics are an effective treatment for trichomoniasis (3).

Syphilis
Syphilis is caused by the bacterium Treponema pallidum subspecies pallidum. It has been called “The Great Pretender”, as symptoms can resemble other diseases. If syphilis is untreated it can cause serious health complications.

In 2018, there were 115,045 new syphilis cases reported in the United States. In 2019, this increased to 129,813 reported cases of all stages of syphilis, including 38,992 cases of primary and secondary syphilis, which are the most infectious stages of the disease. In 2019, there were 1,870 reported cases of congenital syphilis (when the fetus acquires syphilis before birth) (1).

Primary, secondary, and early latent stage syphilis (infection within 2 years) is treated with a single intramuscular dose of Benzathine penicillin G. Late latent stage syphilis (more than 2 years after original infection) requires three intramuscular doses of Benzathine penicillin G at weekly intervals (3).

Hepatitis B
Hepatitis refers to inflammation and damage to the liver. The most common causes of hepatitis are three viruses known as hepatitis A, B, and C. The hepatitis B virus is a major global health problem that can cause both acute (short-term) and chronic (long-term) diseases.

Hepatitis B is most prevalent in the western Pacific region and in Africa, where at least 6% of the adult population is infected. In the United States, a total of 3,322 cases of acute hepatitis B were reported to CDC in 2018, but actual estimates were closer to 21,600 (6).

There are no specific treatments for an acute hepatitis B infection with most adults not showing any symptoms and not progressing to chronic infection (7). Medications are available for chronic hepatitis B, but only 10% to 40% of individuals with chronic hepatitis B will require treatment. These medications suppress the replication of the virus, thereby slowing the progression of cirrhosis and reducing the risk of liver cancer, but they generally do not cure an infection, so must continue for life (7).

Prevention is the best option to avoid hepatitis B, as a very effective and safe vaccine is available (7).

Hepatitis C
Hepatitis refers to inflammation and damage to the liver. The most common causes of hepatitis are three viruses known as hepatitis A, B, and C. The hepatitis C virus causes acute (short-term) infections in some individuals, but in most individuals, the virus remains in the body causing serious chronic (long-term) infection.

In 2018, there were 3,621 new cases of hepatitis C reported to the CDC. However, actual estimates are closer to 50,300 new cases during 2018 (8). During 2013-2016, there were an estimated 2.4 million individuals in the United States with chronic hepatitis C (9). In 2018, there were 15,713 US death certificates with HCV recorded as an underlying or contributing cause of death (7), but actual numbers are estimated to be considerably higher (10).

Hepatitis C is treated with antiviral medications to eliminate the virus from the body. Newly developed “direct-acting” antivirals have improved treatment considerably with fewer side effects and shorter treatment periods. Nowadays, over 90% of individuals infected with hepatitis C can be cured with 8-12 weeks of oral therapy (11).

HIV
Human immunodeficiency virus (HIV) is a sexually transmitted infection, which occurs by contact or transfer of blood, semen, pre-ejaculate, and vaginal fluids. There are two types of HIV. HIV-1 is the virus that was initially discovered. It is more virulent and infective than HIV-2 and is associated with most of the HIV infections around the world. HIV-2 is not transmitted as easily and is predominantly confined to infections in West Africa (12).

An estimated 38 million individuals worldwide were living with HIV at the end of 2019 (12). In the United States, there were an estimated 1.2 million individuals living with HIV, with approximately 14% being unaware of their HIV status.

Although there is no cure for HIV, effective antiretroviral therapy (ART) ensures that infected individuals can live relatively normal lives and prevents the transmission of HIV.

References:
1.Sexually Transmitted Infections Prevalence, Incidence, and Cost Estimates in the United States. CDC Jan 25 2021
2. Sexually Transmitted Disease Surveillance, 2018. CDC
3. Workowski KA & Bolan GA (2015) Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep, 64 (RR-03), 1-137.
4. Gonococcal Infections Among Adolescents and Adults. Sexually Transmitted Infections Treatment Guidelines, 2021. (Reviewed July 2021).CDC.
5. Trichomoniasis Statistics. CDC Feb 27 2020.
6. Viral hepatitis surveillance—United States, 2017. CDC
7. Hepatitis B, World Health Organization. July 2020
8. Viral Hepatitis Surveillance Report 2018 — Hepatitis C. CDC. August 2020
9. Hofmeister MG, et al. (2019) Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013-2016. Hepatology, 69 (3), 1020-1031.
10. Mahajan R, et al. (2014) Mortality among persons in care with hepatitis C virus infection: The Chronic Hepatitis Cohort Study (CHeCS), 2006-2010. Clin Infect Dis, 58 (8), 1055-1061.
11. Initial Treatment of Adults with HCV Infection. August 2020
12. HIV/AIDS. World Health Organization.

Trichomoniasis

What are the symptoms of trichomoniasis?

Posted on by dnaserver

Trichomoniasis is a common sexually transmitted disease (STD) caused by infection with a protozoan parasite called Trichomonas vaginalis. Trichomoniasis is often referred to as “trich”. It is transmitted through sexual contact with the penis or vagina of an infected individual (1).

Approximately 70% of individuals infected with trichomoniasis remain asymptomatic, meaning they don’t experience any symptoms of the infection (2). However, asymptomatic individuals can still pass the infection on to any sexual partners.

The severity of symptoms can vary significantly, ranging from just mild irritation to severe inflammation.

The onset of symptoms also varies, with some individuals showing symptoms 5 to 28 days post-exposure, while symptoms occur in others much later, or symptoms may disappear then reappear (2).

Symptoms in males can include:

  • Itching or irritation inside the penis
  • Painful burning sensation after urination or ejaculation
  • Increased urination
  • Abnormal discharge from the penis

Symptoms in females can include:

  • Itching or irritation of the vagina
  • Painful and more frequent urination
  • Endocervical bleeding
  • Abnormal vaginal discharge with an unpleasant odor

Trichomoniasis infections can cause discomfort during sexual intercourse, and are associated with an increased risk of contracting other STDs, including a two to three-fold increased risk of HIV (2).

Trichomoniasis during pregnancy also increases the risk of premature rupture of membranes, preterm delivery, and low birth weight (3), and is associated with an increased risk of the transmission of HIV from an HIV-positive mother to her child (4).

References
1. Soper D (2004). “Trichomoniasis: under control or undercontrolled?” Am J Obstet Gynecol. 190(1), 281-90.
2. Trichomoniasis Fact Sheet. CDC. Feb 2020. 
3. 2015 Sexually Transmitted Diseases Treatment Guidelines, Trichomoniasis. CDC. June, 2015. 
4. Gumbo FZ, et al. (2010) Risk factors of HIV vertical transmission in a cohort of women under a PMTCT program at three peri-urban clinics in a resource-poor setting. J Perinatol. 67(2), 717-723. 

Sexual Health

Are STDs and STIs the same thing?

Posted on by dnaserver

Infections that are usually spread from person to person during vaginal, anal, and oral sex can be referred to as sexually transmitted diseases (STDs) or sexually transmitted infections (STIs). Although the two terms are often used interchangeably, they do actually have slightly different meanings.

STDs is the term that many people are more familiar with, as it has been used for a lot longer to describe diseases spread through sexual contact. However, more recently there has been increased use of the term STI. This is for two reasons – to improve accuracy and to reduce stigma.

Why is the term STI more accurate?
According to the American Sexual Health Association, the term “disease” refers to a medical problem with obvious signs and symptoms (1). However, many people can be infected with an STI, but not show any symptoms whatsoever (although can still transmit the infection). So, are they really suffering from a “disease”?

As soon as a sexually transmitted bacteria or virus first enters the body and begins multiplying, it is correct to say an “infection” has occurred. But there is usually no initial impact on the normal functioning of the body so no signs of a “disease”.

In many cases, the infection can then progress to a disease, but this doesn’t occur for all STIs. For example, for chlamydia, only an estimated 10% of infected males show symptoms and 5-30% of infected females (2).

For other STIs, it may take months before any symptoms develop. For example, the average time of onset for hepatitis B symptoms is three months after exposure to the virus (3).

The stigma associated with “disease”
STIs were originally referred to as venereal diseases until this term was replaced with the more commonly used STD. Both terms include the word “disease” and both terms can make people shudder! However, using the term “infection” tends to sound less serious to many people; hence STI is not associated with as much negativity.

Reducing the stigma associated with STIs is essential, as it is important that people feel comfortable getting tested and treated for STIs. STIs are very common with an estimated 26 million new STIs in 2018 in the United States, with almost half of new STIs among youth aged 15 – 24 years (4). A lot of infected people do not show any symptoms and are unaware that they have an STI, but can still pass the infection to others. Without treatment, STIs can lead to serious health complications. However, most STIs are easy to test for and can be effectively treated.

References
1. STDs A to Z. American Sexual Health Association.
2. Farley TA, Cohen DA, & Elkins W (2003). Asymptomatic sexually transmitted diseases: the case for screening. Prev Med, 36 (4), 502-509.
3. Hepatitis B Questions and Answers for the Public. CDC. July 28 2020. 
4. Sexually Transmitted Infections Prevalence, Incidence, and Cost Estimates in the United States. CDC. Jan 25 2021. 

HIV

What are the symptoms of HIV?

Posted on by editor

Human immunodeficiency virus (HIV) is a sexually transmitted disease, with three typical stages of infection – acute infection, chronic infection, and acquired immunodeficiency syndrome (AIDS). Symptoms differ depending on the stage of infection.

Acute HIV Infection
The initial phase of acute HIV infection is when HIV is most infectious (1), even though many individuals are unaware that they have contracted HIV, as they do not display any symptoms, or only experience mild symptoms. Other people experience more serious symptoms within 2-4 weeks after infection, which can last for just a few days or for several weeks (2, 3). Symptoms can include:

  • High fever
  • Sore throat
  • Swollen lymph nodes
  • Skin rashes
  • Diarrhea
  • Mouth ulcers
  • Muscle aches
  • Persistent coughing
  • Chills
  • Night sweats

Chronic HIV Infection
The second stage of HIV infection can also be known as clinical latency or asymptomatic HIV infection. The virus is still multiplying during this stage, but only at very low levels, and many individuals do not show any symptoms. However, without HIV treatment, individuals in this stage can still transmit HIV (2).

AIDS
HIV targets cells of the immune system reducing the ability to fight other infections and eventually progressing to AIDS (stage 3 of HIV infection) in untreated individuals (2). The symptoms of AIDS include:

  • Rapid weight loss
  • Extreme fatigue
  • Pneumonia
  • Skin discoloration
  • Memory loss
  • Depression
  • Increased susceptibility to other infections such as tuberculosis, severe bacterial infections, and certain cancers

How quickly does an HIV infection progress?
HIV progression can vary widely. Typically untreated HIV infections progress to AIDS in 8-10 years, but it can be shorter or longer for some people. Most of those with untreated AIDS only survive about three years, or less depending on opportunistic infections and cancers.

Nowadays, effective HIV medications, called antiretroviral therapy (ART), are available treat HIV. Although these medications do not cure the disease, they reduce the replication of HIV in the blood to an undetectable level. This enables infected individuals to live relatively normal lives and prevents the transmission of HIV (1).

References
1. HIV/AIDS. World Health Organization.
2. Symptoms of HIV. Clinical Info HIV.gov. July 2020.
3. HIV Basics: About HIV. CDC. November 2020. 

Posted in HIV
HIV

A brief history of HIV

Posted on by editor

Chimpanzees as the source of HIV-1
Human immunodeficiency virus (HIV) shares many similarities with Simian immunodeficiency virus (SIV), which is a virus that attacks the immune systems of monkeys and apes. Researchers discovered a strain of SIV, called SIVcpz, in a chimpanzee that is almost identical to HIV-1 in humans (1). It is believed that this virus was spread to humans through hunting of the chimpanzees, where the virus was transmitted during consumption of the chimpanzee or the chimpanzee blood getting into wounds on the hunter (2). The much less common HIV-2 was transmitted from sooty mangabey monkeys in likely the same hunter scenario (3).

African origins of HIV
Although the earliest verified HIV case is from a blood sample collected in 1959, there were numerous earlier clusters of deaths from opportunistic infections, which are a now known to be ‘AIDS-defining’ patterns (2). Retrospective analyses of the 1959 blood sample have allowed scientists to create a ‘family-tree’ ancestry of HIV, from which it has been concluded that the first transmission of SIV to humans (and the subsequent small changes to become HIV) occurred around 1920 in what is now Kinshasa in the Democratic Republic of Congo (4).

Around the time that HIV began to spread, Kinshasa had a growing sex trade and was also a transport hub, enabling to virus to spread around the country and further into Africa (5).

Spread around the world
In the 1960s, many Haitian professionals who had been working in DR Congo returned to Haiti, unwittingly bringing HIV with them (5). Around this time, HIV is believed to have also spread to other regions of the world. People often think of the HIV epidemic starting in the 1980s, but by this point, HIV had likely already spread to five continents (North America, South America, Europe, Africa, and Australia), infecting between 100,000 and 300,000 people (6, 7).

HIV in the US in the early 1980s
In June 1981, there was a report of Pneumocystis carinii pneumonia (PCP) in previously healthy, homosexual men in LA (8). This was the first official report of what became known as the AIDS epidemic. At the same time, an unusually aggressive cancer named Kaposi’s Sarcoma was reported in groups of men in New York and California (9).

The original names given to this infectious disease were related to the word ‘gay’ due to the cases occurring in homosexual males. However, soon cases were reported in other populations, including heroin users and hemophiliacs. By September 1982, the spreading epidemic was officially called acquired immunodeficiency syndrome (AIDS) (10).

Discovery of the cause of AIDS
In May 1983, researchers at the Pasteur Institute in France reported the discovery of a new retrovirus called Lymphadenopathy-Associated Virus (or LAV) that could be the cause of AIDS (11). Scientists working at the USA National Cancer Institute isolated the same virus and called it HTLV-III. LAV and HTLV-III were later acknowledged to be the same, and renamed HIV (12).

First testing for HIV
The first commercial blood test to detect HIV was an ELISA licensed by the FDA in March 1985. This enabled HIV screening of blood donations at the blood banks. In 1987, a more specific western blot test kit was approved for detecting HIV antibodies. A testing kit became available to healthcare providers in 1992, and the first rapid HIV test in 2002 (7).

How quickly was the epidemic growing?
By the end of 1985, AIDS had been reported in every region of the world, with 20,303 reported cases in total. This nearly doubled to 38,401 reported cases by the end of 1986, and 71,751 reported cases by the end of 1987. By December 1990, there were already over 100,000 AIDS cases in the US and over 307,000 AIDS cases reported worldwide. However, actual numbers were predicted to be closer to a million, and an estimated 8-10 million people were living with HIV worldwide.

Despite the approval of effective HIV treatments, the numbers kept escalating. By December 1996, an estimated 23 million people around the world were living with HIV, 30 million by 1997, and 33 million by 1999. In 1999, the WHO announced that AIDS was the most common cause of death in Africa, and the fourth biggest cause of death worldwide, with an estimated 14 million AIDS deaths having occurred by this point. AIDS-related deaths reached a peak in 2005, and by 2013, the death rate had fallen by 30% (7).

HIV drugs
In March 1987, the FDA approved the first antiretroviral drug, zidovudine (AZT), as treatment for HIV. However, it wasn’t until the approval of highly reactive antiretroviral treatment (HAART) in 1995 that there was such a noticeable decrease (60-80% decline) in AIDS-related deaths, and this was only in those countries that could afford it (13). In the early 2000s, antiretroviral drug prices were reduced for developing countries and a global fund was created to reduce the spread of HIV (7). By 2017, more than half the global population affected by HIV was receiving effective HIV treatment, which prevents the development of AIDS and the transmission of HIV if viral load is undetectable (14).

References
1. Gao F, et al. (1999). Origin of HIV-1 in the chimpanzee Pan troglodytes troglodytes. Nature, 397 (6718), 436-441.
2. Sharp PM & Hahn BH (2011). Origins of HIV and the AIDS pandemic. Cold Spring Harb Perspect Med. 1 (1), a006841.
3. Chen Z, et al. (1997). Human Immunodeficiency Virus Type 2 (HIV-2) Seroprelavence and Characterization of a Distinct HIV-2 Genetic Subtype from the Natural Range of Simian Immunodeficiency Virus-Infected Sooty Mangebeys. J Virol. 71 (5), 3953-3960.
4. Faria NR, et al. (2014). The early spread and epidemic ignition of HIV-1 in human populations. Science, 346 (6205), 56-61.
5. Origin of HIV & AIDS. Avert. 30 Oct, 2019.
6. Mann JM (1989). AIDS: A worldwide pandemic. Current Topics in AIDS Volume 2, edited by Gottlieb MS, et al. John Wiley & Sons.
7. History of HIV & AIDS Overview. Avert. 10 Oct, 2019.
8. Epidemiologic Notes and Reports (June 1981). Pneumocystis Pneumonia – Los Angeles. MMWR. 30 (21). 1-3. 
9. CDC (1981). Kaposi’s Sarcoma and Pneumocystis Pneumonia among Homosexual Men- New York City and California. MMWR, 30 (25), 305-308.
10. HIV and AIDS Timeline. CDC. 21 Oct 2020. 
11. Barré-Sinoussi F, et al. (1983). Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science, 220 (4599), 868-871.
12. Marx JL (1984). Strong new candidate for AIDS agent. Science, 224 (4648), 475-477.
13. James JS (1995). Saquinavir (Invirase): first protease inhibitor approved – reimbursement, information hotline numbers. AIDS Treatment News, 22 (237), 1-2.
14. UNAIDS (2017). Ending AIDS: Progress towards 90-90-90. [pdf]

Posted in HIV
Hepatitis

Who is the most at risk for hepatitis C?

Posted on by editor

The most common way that hepatitis C is transmitted is through sharing needles. Other potential sources of infection include at birth (~6% of infants of infected mothers), sexual intercourse (rare but more common in men who have sex with men), healthcare exposures, blood transfusions and organ transplants (now very uncommon), unregulated tattoos or body piercings, and sharing personal items that have been contact with infected blood (e.g. glucose monitors, razors) (1).

Those who have an increased risk of hepatitis C include:

  • HIV-positive individuals
  • Current or former injectable drug users
  • Individuals on hemodialysis or who have other selected medical conditions
  • Recipients of blood or organ donations prior to July 1992
  • Recipients of clotting factors before 1987
  • Individuals who received blood from a donor who later tested positive for hepatitis C
  • Health care personnel who may be exposed to blood from infected individuals
  • Children born to hepatitis C-positive mothers

Testing recommendations
The CDC recommends universal hepatitis C screening at least once in a lifetime for all adults and for all pregnant women during each pregnancy, except in populations where the prevalence of hepatitis C is less than 0.1%. Testing should occur in HIV-positive individuals, anyone who has ever injected drugs, individuals with abnormal liver tests and/or liver disease, and in anyone who received donated blood or organs before July 1992 or clotting factor concentrates before 1987. Anyone who has been potentially exposed to the blood of an infected individual should get tested. Regular testing is recommended for individuals who currently use injectable drugs or are on hemodialysis (2).

Cirrhosis associated with hepatitis C
When an individual is infected with hepatitis C their immune system produces specific antibodies against the hepatitis C virus. The presence of these hepatitis C antibodies is consistent with both current and past infections. Up to 50% of individuals who test positive for antibodies to hepatitis C no longer have an active infection (3), which indicates that they have spontaneously cleared the virus after an acute (short-term) infection.

However, more than half of infected individuals develop a chronic (long-term) infection, which can be due to viral changes that evade the immune response (4). Furthermore, 5-25% of all individuals infected with hepatitis C will develop cirrhosis within 10-20 years post-exposure. This is associated with an increased risk of hepatocellular carcinoma and hepatic decompensation.

These factors increase the risk of cirrhosis associated with hepatitis C:

  • Male gender
  • Over 50 years of age
  • Increased alcohol consumption
  • Fatty liver disease
  • Hepatitis B or HIV coinfection
  • Receiving immunosuppressive therapy

References
1. Viral Hepatitis – Q&As from the Public. (2020, July). CDC.
2. Testing Recommendations for Hepatitis C Virus Infection. (2020, July). CDC.
3. Seo S, et al. (2020). Prevalence of Spontaneous Clearance of Hepatitis C Virus Infection Doubled From 1998 to 2017. Clin Gastroenterol Hepatol, 18 (2), 511-513.
4. Thomas DL, & Seeff LB. (2005). Natural history of hepatitis C. Clin Liver Dis, 9 (3), 383-398.

Syphilis

What health complications can occur due to an untreated syphilis infection?

Posted on by editor

Syphilis is a sexually transmitted disease caused by the bacterium Treponema pallidum subspecies pallidum. It has been called “The Great Pretender”, as symptoms can resemble other diseases. If syphilis is untreated it can cause serious health complications. There are distinct stages of a syphilis infection, known as primary, secondary, latent, and tertiary.

Primary stage
A skin lesion, called a chancre, is the first sign of a syphilis infection. Chancres appear at the location where syphilis entered the body anytime from 10-90 days after infection, with an average onset of 21 days post-infection (1). Chancres last for three to six weeks and heal whether or not treatment is received. Individuals in this stage are very infectious. If untreated, the infection progresses to the secondary stage (2).

Secondary stage
Skin rashes and/or lesions in the mouth, vagina, or anus occur during the secondary stage of infection. These may appear when the primary chancre is healing or several weeks after it has healed. Additional symptoms in the secondary stage can include fever, sore throat, hair loss, weight loss, swollen lymph glands, headaches, muscle aches, and fatigue. Individuals in this stage are infectious. Like the primary symptoms, secondary symptoms will also disappear whether or not treatment is received. However, the syphilis infection will progress to the latent stage if adequate treatment does not occur (2).

Latent stage
There are no visible signs or symptoms of syphilis during the latent (hidden) stage. However, syphilis-causing bacteria (T. pallidum) are still present. The latent stage can last for many years, with 15-40% of untreated individuals developing tertiary syphilis (3). Individuals in the early latent stage (less than 1-2 years after the original infection) may be infectious, but individuals in the late latent stage are generally not infectious.

Tertiary stage
In rare cases, the latent stage progresses to a potentially fatal tertiary stage. This can occur 10-30 years or more after acquiring a syphilis infection. Multiple different organ systems can be affected including the brain, nerves, eyes, heart, liver, bones, and joints. The associated symptoms vary depending on the affected body parts. Individuals with tertiary syphilis are not infectious (1).

Gummatous syphilis or later benign syphilis can occur in the tertiary stage. It is characterized by soft, tumor-like balls of inflammation, which typically affect the skin, bone, and liver. Cardiovascular syphilis is a relatively common complication of tertiary syphilis, where the heart tissue is affected (1).

Neurosyphilis and ocular syphilis
At any stage of infection, T. pallidum can invade the nervous system causing neurosyphilis, or the eyes causing ocular syphilis. Neurosyphilis symptoms can include headaches, paralysis, dementia, sensory deficits, and altered behavior. Ocular syphilis can cause vision changes, decreased visual acuity, and blindness (2). 

Congenital syphilis
Syphilis during pregnancy is associated with miscarriage, stillbirth, or infant death shortly after delivery in up to 40% of cases. Congenital syphilis occurs when an infected pregnant woman passes syphilis to her baby during pregnancy. If an infected infant is not treated immediately, serious health complications can occur, including enlargement of the liver and spleen, rashes, fever, neurosyphilis, lung inflammation (4), developmental delays, seizures, and other fatal complications (5).

References
1. Kent ME & Romanelli F (2008). Reexamining syphilis: an update on epidemiology, clinical manifestations, and management. Ann Pharmacother, 42 (2), 226-236.
2. Syphilis – CDC Fact Sheet (Detailed). (2017, January).
3. Peeling RW, et al. (2017). Syphilis. Nat Rev Dis Primers, 3 (17073).
4. Woods CR. (2009). Congenital syphilis-persisting pestilence. Pediatr Infect Dis J , 28 (6), 536-537.
5. Sexually Transmitted Diseases Treatment Guidelines, 2015. (2015). MMWR, 64 (RR-3).

Chlamydia and Gonorrhea

Chlamydia Quick Facts

Posted on by editor

What is chlamydia?
Chlamydia is a common sexually transmitted disease (STD) that is spread through sexual contact with the penis, vagina, mouth, or anus of an infected individual. Chlamydia can also be transmitted from a mother with an untreated cervical infection to her newborn during childbirth (1).

What causes chlamydia?
Chlamydia is caused by infection with the obligate intracellular bacterium Chlamydia trachomatis.

What are the symptoms of chlamydia?
Most individuals infected with chlamydia remain asymptomatic. If symptoms occur, it’s usually 1-3 weeks after exposure. Symptoms can include:

  • Abnormal vaginal discharge
  • Bleeding between periods and/or after sexual intercourse
  • Increased urinary frequency
  • Dysuria – painful urination
  • Pain during sexual intercourse
  • Abdominal and/or pelvic pain
  • Urethral discharge
  • Testicular pain
  • Burning or itching in the urethra

Chlamydia can also affect the rectum, resulting in rectal pain, discharge, and bleeding (2), and the eyes, resulting in chlamydial conjunctivitis (red, watery, painful eyes) (3). 

Who is at risk of chlamydia?
Any sexually active individual is at risk of chlamydial infection, with an increased risk among younger individuals. Chlamydia is one of the most prevalent STDs in the United States, with annual chlamydia cases estimated to be around 2.86 million (4). 

How is chlamydia diagnosed?
Modern nucleic acid amplification testing (NAAT) provides the most sensitivity and specificity for a chlamydia diagnosis. These can be performed on vaginal swabs (either clinician- or patient-collected) or urine.

How is chlamydia treated?
Chlamydia is easily cured with antibiotics. However, repeat chlamydial infections from sexual contact with an infected partner are common, increasing the risk of serious reproductive health complications. Antibiotics do not repair any permanent damage done by the disease (5).

References
1. Sexually Transmitted Disease Surveillance, 2018. CDC. [Online]. October 2019. 
2. Quinn TC, et al. (1981). Chlamydia trachomatis Proctitis. N Engl J Med, 305 (4), 195-200.
3. Kalayoglu MV (2002). Ocular chlamydial infections: pathogenesis and emerging treatment strategies. Curr Drug Targets Infect Disord, 2 (1), 85-91.
4. Satterwhite CL et al. (2013). Sexually transmitted infections among US women and men: prevalence and incidence estimates. Sex Trans Dis, 40 (3), 187-193.
5. Workowski KA & Bolan GA (2015) Sexually Transmitted Diseases Treatment Guidelines, 2015. MMWR Recomm Rep, 64 (RR-03), 1-137.

Syphilis

Is there a cure for syphilis?

Posted on by editor

Syphilis a sexually transmitted disease caused by the bacterium Treponema pallidum subspecies pallidum. It is primarily transmitted during sexual contact or during pregnancy from an infected mother to her infant. It has been called “The Great Pretender”, as symptoms can resemble other diseases. If syphilis is untreated it can cause serious health complications.

Penicillin G is the preferred drug for treating individuals in all stages of syphilis. Although treatment cures the disease and prevents disease progression, it does not repair any tissue damage that has already occurred, and does not prevent reinfection at a later date (1). There is currently no effective vaccine available for syphilis (2).

Treatments in the primary and secondary stages
The primary stage of syphilis is generally characterized by the appearance of one or more skin lesions (chancres) at the location where syphilis entered the body. This can appear anytime from 10-90 days after infection, with an average onset of 21 days post-infection. Skin rashes mark the secondary stage of syphilis, which may appear as the primary chancre is healing or several weeks later (3).

Individuals with either primary or secondary stage syphilis are treated with a single intramuscular dose of Benzathine penicillin G. Adults receive 2.4 million units, while infants and children receive 50,000 units/kg (up to 2.4 million units). These individuals should also be tested for HIV, and retested in three months in areas with a high prevalence of HIV. Clinical and serologic evaluations should be conducted at six and twelve months after treatment (1).

Treatments during the latent and tertiary stages
There are no visible signs or symptoms of syphilis during the latent (hidden) stage. However, syphilis-causing bacteria (Treponema pallidum subspecies pallidum) are still present. In the early latent phase (less than one to two years after original infection), transmission can still occur as up to 25% of individuals can develop a recurrent secondary infection (4). In rare cases, the latent stage progresses to a potentially fatal tertiary stage. This can occur 10-30 years or more after acquiring a syphilis infection.

The recommended treatment in the early latent stage is the same as for the primary and secondary stages – a single intramuscular dose of Benzathine penicillin G. Individuals with late latent syphilis, or latent syphilis of unknown duration, or tertiary stage syphilis should be treated with three intramuscular doses of Benzathine penicillin G at one-week intervals. Adults receive 2.4 million units per dose, while infants and children receive 50,000 units/kg per dose (up to 2.4 million units per dose) (1).

Treatments during pregnancy
Penicillin G is the only known effective treatment for preventing the transmission of syphilis from an infected pregnant mother to her baby. The penicillin dosage depends on the stage of syphilis and pregnancy. Any infected woman with a penicillin allergy should be desensitized and treated as normal with penicillin, as there are no proven alternative treatments for syphilis during pregnancy (1).

Treatments for neurosyphilis and ocular syphilis
At any stage of infection, Treponema pallidum subspecies pallidum can invade the nervous system causing neurosyphilis, or the eyes causing ocular syphilis. The recommended regimen for individuals with these complications is with Acqueous crystalline penicillin G for 10-14 days. This can be administered as 3-4 million IV units every four hours, or by continuous infusion (1).

Treatment complications
The Jarisch-Herxheimer reaction is a complication that can occur within the first 24 hours of any syphilis treatment. When penicillin kills the harmful syphilis-causing bacteria, toxic bacterial products are released. Some individuals develop a systemic inflammatory reaction to these toxins in the bloodstream, resulting in symptoms including fever, chills, rigor, hypotension, headaches, muscle pain, hyperventilation, and anxiety (5). This reaction is more common in individuals with early syphilis. It may also induce early labor or cause fetal distress in pregnant women (1).

References
1. 2015 STD Treatment Guidelines Syphilis. CDC. (2015, June 4). 
2. Sexually Transmitted Diseases Treatment Guidelines, 2015. (2015). MMWR, 64 (RR-3).
3. Kent ME & Romanelli F (2008). Reexamining syphilis: an update on epidemiology, clinical manifestations, and management. Ann Pharmacother, 42 (2), 226-236.
4. O’Byrne P & MacPherson P (2019). Syphilis. BMJ, 365 (4159).
5. Belum GR, et al. (2013). The Jarisch-Herxheimer reaction: revisited. Travel Med Infect Dis, 11 (4), 231-237.