Sexually Transmitted Disease
The incidence of sexually transmitted diseases (STDs) in the United States
is higher than any other country, with approximately 15 million new cases
diagnosed each year. It is estimated that approximately two-thirds of
these cases are represented by two diseases: trichomoniasis and human
papilloma virus (HPV). Furthermore, an estimated 65 million people are
living with an incurable STD. Sexually transmitted diseases include those
produced by fungal, bacterial, and viral pathogens, as well as parasitic
infection with pubic lice (commonly called 'crabs') and scabies (caused
by mites). These diseases may produce symptoms ranging from mild to severe,
and may result in simply a minor nuisance, or potentially be life-threatening
if left untreated.
The incidence of STD's among people with intellectual disabilities is
not well-documented. However, it should be assumed that people with intellectual
disabilities who are sexually active are at similar risk as the general
population. Furthermore, individuals with intellectual disabilities experience
an increased risk of sexual abuse. Such abuse may expose them to sexually-transmitted
pathogens, even when they are not voluntarily sexually active. Considering
these factors, it is important to screen all women, including those with
intellectual disabilities, for sexually transmitted disease during routine
gynecological exams.
It is important that primary care providers be aware of the issues surrounding
sexuality and sexual expression in persons with intellectual disabilities.
See the Sexuality Education and Sexuality and Self-Determination resource
documents for more information.
Some frequently encountered sexually transmitted diseases and their symptoms
are outlined below. Symptoms for males are not included. This list is
not exhaustive.
Chlamydia trachomatis is the most frequently
reported bacterial STD in the United States. Infection with Chlamydia
may potentially damage a woman's reproductive organs. Infection may be
silent without significant symptoms; therefore, complications may occur
before the problem is recognized. Symptoms, when present, include abnormal
vaginal discharge, painful urination, lower abdominal pain, low back pain,
nausea, fever, painful intercourse, and/or menstrual spotting. Chlamydia
infections may spread to the throat or rectum. Chlamydia causes pelvic
inflammatory disease in approximately 40% of women infected. Annual screening
for all sexually active women is recommended. Chlamydia is easily treated
with antibiotics such as a single dose of Azithromycin or a one week course
of doxycycline. Sexual partners must also receive treatment in order to
prevent re-infection.
Gonorrhea is a sexually transmitted disease caused by
the bacterium Neisseria Gonorrhoeae. Gonorrhea reproduces easily
in warm, moist, locations, including the vagina, rectum, cervix, uterus,
fallopian tubes, urethra, mouth, throat, and eyes. Untreated gonorrhea
may even spread to the blood or joints. Gonorrhea is very common in the
United States. The Center for Disease Control estimates that approximately
700,000 new cases are diagnosed each year. Symptoms may be very mild or
absent. When present, symptoms may include painful urination, increased
vaginal discharge, and/or menstrual spotting. Oral infection may present
as a sore throat. Gonorrhea is a common cause of pelvic inflammatory disease
(PID) in women. PID typically presents with symptoms such as chronic lower
abdominal pain, fever, internal abscesses, and scarring of the fallopian
tubes. Gonorrhea is treated with a variety of antibiotics. Sexual partners
should be identified and treated in order to prevent both patient re-infection
and further spread of the disease within the community.
Genital Herpes is caused by the herpes simplex viruses
type 1 (HSV-1) and type 2 (HSV-2), with the type 2 being responsible for
the majority. Infection may be silent or may present with blisters in
the genital and/or rectal area. Blisters typically progress to tender
ulcers that may take up to four weeks to heal. Outbreaks may become chronic,
with subsequent episodes typically becoming less severe. According to
the CDC, approximately one out of four women has been infected with HSV-2.
Herpes can be contracted by the infant during vaginal delivery where it
may induce potentially fatal infection without intervention. There is
no known cure for herpes; however, antiviral medications may help to prevent
or shorten outbreaks only during the time the medication is being taken.
Women should be educated about herpes infections, particularly concerning
disease transmission. Latex condoms are not completely effective in preventing
herpes infection as not all potentially affected areas are covered.
Genital HPV infection is a sexually transmitted disease
caused by human papillomavirus (HPV). The CDC estimates that 20 million
Americans are currently infected with HPV, with approximately 6.2 million
new cases diagnosed annually. There are over 100 strains of HPV, with
approximately 30 of these being sexually transmitted. HPV infection affects
the female genital area including the vulva, anus, vaginal lining, cervix,
and rectum. There is no medical 'cure' for HPV infection; however, most
HPV infections produce little or no symptoms and clear up on their own.
A few of the viruses are designated 'high-risk' types and have been implicated
in abnormal Pap smears. Ten high risk types of HPV have been linked most
significantly to the development of cervical cancer. Chronic, persistent
infection with 'high-risk' HPV is the number one risk factor for cervical
cancer. Genital warts are a manifestation of 'low-risk' HPV.
HIV (human immunodeficiency virus) is probably the most
feared of all sexually transmitted diseases due to both to the severity
of symptoms and terminal nature of disease progression. Infection with
HIV causes Acquired Immune Deficiency Syndrome (AIDS). HIV is spread through
contact with blood and/or body fluids, including sexual fluids and breast
milk. HIV produces symptoms which reflect the individual's increased susceptibility
to a variety of secondary infections. The inability to 'fight off' infection
is in effect the eventual cause of death in persons experiencing full-blown
AIDS. A person may test positive for HIV without experiencing AIDS. There
is no known cure for HIV infection at the current time, although progress
has been made in ameliorating the symptoms and slowing disease progression.
Women should be educated in ways to protect themselves from HIV infection
(as well as STDs in general) as part of routine gynecological care.
Syphilis is a sexually transmitted disease (STD) caused
by the bacterium Treponema pallidum. It is often difficult to
diagnose syphilis infections as the symptoms may mimic many other conditions.
The disease presents in one of three stages. The primary stage is marked
by the appearance of one or more chancre sores. The sore occurs at the
location where the bacterium entered the body. Although the sores are
typically painless and resolved in 3-6 weeks, the infection will progress
to the secondary stage if left untreated. In the secondary stage
of syphilis infection, the individual typically develops a rough, non-pruritic,
red or brown skin rash and lesions of the mucosa. The patient may also
experience fever, swollen lymph glands, sore throat, patchy hair loss,
headaches, weight loss, muscle aches, and fatigue. This secondary
stage will also resolve without treatment; however, without treatment
the disease will progress to the latent stage. This final stage
is characterized by progression to a chronic, systemic course which eventually
results in ataxia, paralysis, parasthesia, blindness, and dementia. A
single IM injection of penicillin will easily cure syphilis in individuals
who have had the infection for less than one year. Recurrent doses of
antibiotics are necessary to clear up more advanced stages of the disease.
Sexual partners should also be identified and treated in order to prevent
further spread within the community.
Trichomoniasis results from infection with a single-celled
protozoan parasite, trichomonas vaginalis. Trichomoniasis infections
are the most commonly occurring curable STD in young sexually active women.
As with many STDs, trichomoniasis infection may be present even in the
absence of symptoms. When symptoms are present they include frothy, yellow-green,
offensive vaginal discharge, painful intercourse and urination, and itching
and irritation of the genital area. Pelvic examination may reveal small
red ulcerations on the vaginal walls and/or cervix. Trichomoniasis is
usually successfully treated by prescribing metronidazole. Sexual partners
should also be identified and treated. Infected individuals should abstain
from intercourse until medication is completed and symptoms resolve.
Cates,
W., Jr. (1999). Estimates of the incidence and prevalence of sexually
transmitted diseases in the United States. Sexual Transmission of
Disease, 4, S2-7.
Feder,
A. (2006). Management of STIs in women. Primary Health Care, 16,
31-32.
Division of STD Prevention (DSTDP), Centers for Disease Control and Prevention
Fact Sheets. Retrieved online 7/31/06 from http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm
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