Evaluate the spread and control of these sexually transmitted infections.

1. Give 10 examples and Name and Evaluate the spread and control of these sexually transmitted infections.

2. Identify risk factors and outline appropriate client education needed in common sexually transmitted infections.

3. Describe how contraceptives can play a role in the prevention of sexually transmitted infections.

4. Analyze the physiologic and psychological aspects of sexually transmitted infections.

5. Outline the nursing management needed for women with sexually transmitted infections.

 

Important information

  • Every day, more than 1 million STIs, mostly asymptomatic, are contracted around the world.
  • An estimated 374 million people worldwide contract one of the four treatable STIs each year: chlamydia, gonorrhea, syphilis, and trichomoniasis.
  • It is estimated that more than 500 million people between the ages of 15 and 49 years have herpes simplex genital infection (HSV or herpes)
  • More than 311 000 deaths from cervical cancer are linked to human papillomavirus (HPV) infection each year.
  • In 2016, an estimated 1 million pregnant women had syphilis, leading to over 350 000 unfavorable delivery outcomes.
  • STIs can raise the risk of HIV and have a direct influence on sexual and reproductive health through stigma, infertility, malignancies, and pregnancy difficulties.
  • Drug resistance poses a serious challenge to efforts to lower the incidence of STIs globally.

Overview

Sexual contact, including vaginal, anal, and oral sex, is known to transmit more than 30 different bacteria, viruses, and parasites. During pregnancy, childbirth, and breastfeeding, some STIs can also be passed from mother to kid. The highest prevalence of STIs is associated with eight infections. Of them, syphilis, gonorrhea, chlamydia, and trichomoniasis are currently treatable. The remaining 4 viral diseases—HIV, hepatitis B, herpes simplex virus (HSV), and human papillomavirus—are all fatal.

There is also a resurgence of neglected STIs like lymphogranuloma venereum, as well as new outbreaks of sexually transmitted diseases including monkeypox, Shigella sonnei, Neisseria meningitidis, Ebola, and Zika. These signal growing difficulties in providing effective services for the prevention and control of STIs.

Problem scope

STIs have a significant influence on sexual and reproductive health.

Each day, more than 1 million STIs are contracted. According to WHO estimates, there will be 374 million new cases of one of the four STIs in 2020: chlamydia (129 million cases), gonorrhoea (82 million cases), syphilis (7.1 million cases), and trichomoniasis (156 million). In 2016, it was projected that more than 490 million people had genital herpes, and 300 million women had HPV infections, which are the main causes of cervical cancer and anal cancer in males who have sex with men. In the world, 296 million people are thought to have chronic hepatitis B. (2)

STIs can have negative effects that go beyond the symptoms of the infection.

  • The risk of contracting HIV can be increased by STIs such herpes, gonorrhea, and syphilis.
  • STIs can be transmitted from mother to child leading to risks of stillbirth, neonatal death, low birth weight, preterm, sepsis, newborn conjunctivitis, and congenital abnormalities.
  • HPV infection is a risk factor for cervical as well as other forms of cancer.
  • In 2019, an estimated 820 000 people died from hepatitis B, primarily from cirrhosis and hepatocellular cancer. STIs including gonorrhoea and chlamydia are significant contributors to female infertility and pelvic inflammatory illness.

STI prevention

One of the best ways to protect against STIs, including HIV, is to use condoms appropriately and regularly. However, whereas condoms are quite effective, they do not provide protection against STIs that result in extra-genital ulcers (i.e., syphilis or genital herpes). Condoms ought to be used throughout all anal and vaginal sex, wherever possible.

For two viral STIs, hepatitis B and HPV, safe and very effective vaccinations are available. Significant strides in STI prevention have been made thanks to these vaccinations. The HPV vaccination had been incorporated into routine immunization programs by the end of 2020 in 111 countries, predominantly high- and middle-income nations. In order to completely eradicate cervical cancer as a public health issue worldwide, high coverage targets for HPV vaccine, precancerous lesion detection and treatment, and cancer care must be met by 2030 and then sustained at this high level for decades. (1)

The development of vaccinations against genital herpes and HIV is progressing, and several vaccine candidates are currently in the early stages of clinical trials. The likelihood that the meningitis vaccination (MenB) offers some degree of cross-protection against gonorrhea is growing. It is necessary to conduct more study on the chlamydia, gonorrhea, syphilis, and trichomoniasis vaccines.

Microbicides, partner treatment, and adult elective medical male circumcision are further biological therapies used in preventing some STIs. Trials are still being conducted to determine the advantages of STI pre- and post-exposure prophylaxis and their possible safety when compared to antibiotic resistance (AMR).

Diagnosis of STIs

With STIs, symptoms may not always be identifiable. Furthermore, blood, urine, or anatomical samples are used in laboratory tests. At least one STI can reside in three anatomical locations. Sex and sexual risk influence these disparities. Due to these variations, STI diagnoses are frequently overlooked and patients are routinely treated for two or more STIs.

In high-income nations, accurate STI diagnostic tests (using molecular technology) are frequently employed. These are especially helpful for asymptomatic infection diagnosis. However, for chlamydia and gonorrhea, this technology is unavailable in low- and middle-income (LMIC) nations. Even in nations where testing is offered, it is sometimes costly and not readily available. Additionally, it frequently takes a long time to acquire findings. Follow-up may be hindered as a result, and care or therapy may be lacking. (3)

In contrast, affordable, quick testing for HIV, hepatitis B, and syphilis are readily available. Many locations with minimal resources use the rapid syphilis test and the rapid dual HIV/syphilis test.

Other quick tests are being developed and could help in STI detection and treatment, particularly in places with low resources.

STI treatment

Effective treatment for STIs is available:

  • With current single-dose antibiotic regimens, three bacterial STIs—chlamydia, gonorrhea, and syphilis—and one parasitic STI—trichomoniasis—are typically curable.
  • The most effective treatments for HIV and herpes are antivirals, which can alter the course of the disease but do not have the ability to treat it.
  • Antivirals can aid in the treatment of hepatitis B by decreasing liver damage and battling the infection.

The number of available treatments has decreased while AMR of STIs, particularly gonorrhea, has climbed substantially in recent years. High rates of resistance to numerous antibiotics, including quinolone, azithromycin, and extended-spectrum cephalosporins, a last-resort treatment, have been detected by the Gonococcal AMR Surveillance Programme (GASP). (1)

 

Even though it is less common, AMR for other STIs like Mycoplasma genitalium does exist.

 

STI case management

LMICs rely on detecting predictable, easily recognizable indications and symptoms to direct treatment. This strategy, known as “syndromic management,” frequently makes use of clinical algorithms and enables medical professionals to identify specific infections based on symptoms (such as vaginal/urethral discharge, anogenital ulcers, etc.). Syndromic care is straightforward, ensures quick, same-day treatment, and spares patients with symptoms from costly or inaccessible diagnostic tests. As the majority of STIs are asymptomatic, this strategy leads to overtreatment and missed treatment opportunities.

The WHO recommends improving syndromic management by progressively integrating laboratory tests to facilitate diagnosis. It is advised to treat STIs based on laboratory results in environments where high-quality molecular assays are accessible. Additionally, STI screening methods are crucial for those who are more likely to contract the disease, such as sex workers, men who have sex with males, adolescents in particular situations, and pregnant women.

Treatment of sexual partners is a crucial part of STI case management since it can stop the spread of the infection and prevent it from happening again.

Controlling the spread

Behavioral Change

Despite significant efforts to pinpoint straightforward interventions that can cut down on unsafe sexual behavior, behavior modification remains a difficult task.

Information, education, and counseling can help people detect the signs of STIs more easily, which will enhance the possibility that they will get medical attention and persuade a sexual partner to do the same. Unfortunately, there are still impediments to a wider and more effective use of these therapies, including a lack of public knowledge, a lack of training among health professionals, and a persistent, pervasive stigma around STIs.

 

Health services for STI detection and treatment are still insufficient.

Numerous issues confront STI screening and therapy patients. These include a lack of resources, stigma, poor service quality, and frequent out-of-pocket costs.

 

Many of the populations with the greatest incidence of STIs, including sex workers, men who have sex with men, injecting drug users, prisoners, migratory populations, and teenagers in high-HIV burden nations, lack access to adequate and welcoming medical care.

STI services are frequently underfunded and neglected in many settings. Due to these issues, testing for asymptomatic infections is difficult to do, there is a lack of educated workers, the laboratory’s capacity is constrained, and there aren’t enough supplies of the necessary medications.

The Global Health Sector Strategy on HIV, Hepatitis and Sexually Transmitted Infections, 2022-2030 serves as the current framework and guides WHO efforts. In this regard, WHO:

  • establishes global goals, benchmarks, and standards for STI screening, diagnosis, and care;
  • supports the assessment of the STI burden on the economy and the improvement of STI surveillance;
  • monitoring gonorrhea AMR worldwide;
  • leads the development of the STI research agenda globally, including the creation of diagnostic tools, STI vaccines, and new gonorrhoea and syphilis medications.

The WHO also assists nations to:

  • conceive of and implement national strategic plans;
  • establish a supportive atmosphere that enables people to talk about STIs, switch to safer sexual habits, and get treatment;
  • intensify primary prevention
  • to further integrate STI services within primary healthcare services;
  • expand the availability of high quality STI care and one that is focused on the needs of the patient;
  • promote the use of point-of-care tests;
  • improve and scale up health interventions for impact, such as syphilis screening in priority groups, hepatitis B and HPV vaccination;
  • increase the ability to track STI trends;
  • track AMR in gonorrhoea and take appropriate action.

References

 

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018 Nov;68(6):394-424. Epub 2018 Sep 12. Erratum in: CA Cancer J Clin. 2020 Jul;70(4):313.
  2. James C, Harfouche M, Welton NJ, et al. Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bull World Health Organ. 2020;98(5):315-329.
  3. Unemo M, Lahra MM, Escher M, Eremin S, Cole MJ, Galarza P, Ndowa F, Martin I, Dillon JR, Galas M, Ramon-Pardo P, Weinstock H, Wi T. WHO global antimicrobial resistance surveillance (GASP/GLASS) for Neisseria gonorrhoeae 2017-2018: a retrospective observational study. Lancet Microbe 2021; 2: e627–36