9.2 Prevention and treatment of STIs

Sexually transmitted infections (STIs) pose significant health risks, but prevention and treatment options are available. Regular testing, barrier methods, and vaccines can reduce transmission. Early detection allows for prompt treatment, preventing complications and further spread.

Treatment options vary depending on the type of STI. Bacterial infections like chlamydia and gonorrhea can be cured with antibiotics. Viral STIs like herpes and HIV are managed with antiviral medications. Proper treatment not only improves individual health but also helps control the spread of infections.

Importance of STI Testing

Regular Testing for Early Detection and Treatment

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• Regular STI testing and screening is crucial for early detection and treatment of infections, preventing complications and the spread of STIs to sexual partners
• Early treatment can prevent long-term health consequences (infertility, chronic pain, certain cancers)
• Prompt treatment also reduces the risk of transmitting the infection to sexual partners
• Many STIs can be easily cured with antibiotics if detected early (chlamydia, gonorrhea, syphilis)

Asymptomatic Infections and Unknowing Transmission

• Asymptomatic infections are common with many STIs, meaning individuals may be unaware they are infected and can unknowingly transmit the infection to others
• Chlamydia and gonorrhea often present with no symptoms, especially in women
• Asymptomatic individuals can still experience complications and spread the infection to partners
• Regular testing helps identify asymptomatic infections and prevent further transmission

High-Risk Populations and Recommended Testing Frequency

• Certain populations, such as sexually active individuals under 25, men who have sex with men, and those with multiple sexual partners, are at higher risk and should be tested more frequently
• Routine screening for STIs, particularly chlamydia and gonorrhea, is recommended for all sexually active women under 25 and those with risk factors
• Men who have sex with men should be tested annually for HIV, syphilis, chlamydia, and gonorrhea
• Individuals with multiple sexual partners or engaging in high-risk behaviors should be tested more often (every 3-6 months)

STI Testing During Pregnancy

• Pregnant women should be tested for STIs, as untreated infections can lead to serious complications for both the mother and the baby
• Untreated STIs during pregnancy can cause preterm labor, low birth weight, and congenital infections
• Routine prenatal care includes screening for HIV, syphilis, hepatitis B, and chlamydia
• Timely treatment of STIs during pregnancy can prevent adverse outcomes for the mother and child

Reducing STI Risk

Barrier Methods and Consistent Use

• Consistent and correct use of barrier methods, such as male and female condoms, during sexual activity can significantly reduce the risk of contracting STIs
• Condoms provide a physical barrier, preventing the exchange of bodily fluids and direct contact with infectious areas
• Consistent use means using a condom every time during sexual activity, from start to finish
• Correct use involves properly putting on the condom, ensuring it does not break or slip off during intercourse

Sexual Partners and Mutual Monogamy

• Limiting the number of sexual partners and engaging in mutual monogamy with an uninfected partner decreases the likelihood of exposure to STIs
• Having fewer sexual partners reduces the chances of encountering someone with an STI
• Mutual monogamy involves being sexually exclusive with one uninfected partner who is also monogamous
• Open communication about sexual history and STI testing is essential for maintaining a mutually monogamous relationship

Abstinence and Risk Reduction Strategies

• Abstinence from sexual activity is the only 100% effective method for preventing the transmission of STIs
• Engaging in non-penetrative sexual activities (outercourse) carries a lower risk of STI transmission compared to penetrative sex
• Regular STI testing and open communication with sexual partners about STI status and testing history can help inform decision-making and reduce risk
• Avoiding sexual contact with individuals who have active STI symptoms or known infections can prevent transmission

Circumcision and STI Risk Reduction

• Circumcision has been shown to reduce the risk of HIV transmission from women to men, but does not provide complete protection against STIs
• Circumcised men have a lower risk of acquiring HIV from heterosexual intercourse compared to uncircumcised men
• Circumcision also reduces the risk of other STIs, such as HPV and genital herpes
• However, circumcision does not eliminate the risk of STIs, and other preventive measures should still be used

Vaccines for STI Prevention

HPV Vaccine

• The HPV vaccine protects against the most common strains of HPV that cause cervical, anal, and oropharyngeal cancers, as well as genital warts
• The vaccine is most effective when administered prior to sexual activity and exposure to the virus, typically in adolescence
• Two HPV vaccines are available: Gardasil (protects against 9 strains) and Cervarix (protects against 2 strains)
• The vaccine is administered in a series of shots over a 6-month period

Hepatitis B Vaccine

• The HBV vaccine provides protection against hepatitis B infection, which can lead to chronic liver disease and liver cancer
• Hepatitis B is transmitted through blood, semen, and other bodily fluids, and can be passed from mother to child during childbirth
• The HBV vaccine is typically given as a series of 3-4 shots over a 6-month period
• Vaccination is recommended for all infants, children, and adults at risk of HBV infection

Limitations of STI Vaccines

• While these vaccines are highly effective in preventing infection with the targeted viruses, they do not provide protection against other STIs
• There are currently no vaccines available for other common STIs, such as chlamydia, gonorrhea, herpes, or HIV
• Vaccination should be used in conjunction with other preventive measures, such as condom use and regular STI testing

STI Treatment Options

Bacterial STIs and Antibiotic Treatment

• Bacterial STIs, such as chlamydia, gonorrhea, and syphilis, are typically treated with antibiotics, which can effectively cure the infection when taken as prescribed
• Chlamydia is usually treated with a single dose of azithromycin or a week-long course of doxycycline
• Gonorrhea treatment involves a single injection of ceftriaxone and oral azithromycin to prevent antibiotic resistance
• Syphilis treatment depends on the stage of infection, but typically includes injections of penicillin G benzathine

Viral STIs and Management Strategies

• Viral STIs, like herpes and HIV, cannot be cured, but antiviral medications can help manage symptoms and reduce the risk of transmission to sexual partners
• Herpes outbreaks can be managed with antiviral drugs, such as acyclovir or valacyclovir, which reduce the severity and duration of symptoms
• Suppressive therapy with daily antiviral medication can reduce the frequency of herpes outbreaks and lower the risk of transmission
• Antiretroviral therapy (ART) is used to treat HIV infection, suppressing viral replication and preventing the progression to AIDS
• ART involves taking a combination of medications daily to maintain low viral loads and preserve immune function

Treatment for Other STIs

• Trichomoniasis, caused by a parasitic protozoan, is treated with antiprotozoal medications, such as metronidazole or tinidazole
• A single dose of oral medication is usually sufficient to cure trichomoniasis
• Treatment for human papillomavirus (HPV) is directed at managing the symptoms of genital warts or precancerous lesions, as there is no cure for the viral infection itself
• Genital warts can be removed through cryotherapy, laser therapy, or topical medications
• Pubic lice and scabies, which are caused by parasitic insects and mites, respectively, are treated with topical insecticides or oral medications
• Permethrin cream or lotion is commonly used to treat pubic lice and scabies, applied to the affected areas and washed off after several hours