Sexually Transmitted Diseases
(STDs) In Women
Medical Author: Carolyn Janet
Crandall, MD, FACP
Medical Editor: William C. Shiel
Jr., MD, FACP, FACR
Medical Revising Author:
Melissa Conrad Stöppler, MD
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Unprotected Sex Between HIV-Infected Partners: What's the Harm?
Medical Author: Eric S. Daar, M.D.
Medical Editor: Jay W. Marks, M.D.
 At least once a week, I am asked by one of my HIV-infected patients whether they need to continue to practice safe sex if they are in a monogamous (one mate only) relationship with an HIV-infected partner. Put another way, since both partners already have HIV, what's the harm of unprotected sex? Actually, this is not an easy question to answer fully. My belief, however, is that the best approach is to provide as much information as possible; emphasizing what is known versus what is uncertain. Such a complete disclosure is the only way I can remain credible while allowing the patient to make a fully informed decision.
My response to this question generally begins by telling the patient what is known about the risks of unsafe (unprotected) sex between HIV-infected partners. First of all, we know that in this situation, the spread of other
sexually transmitted diseases (STDs), such as gonorrhea, chlamydia,
syphilis, and
herpes remains a risk, as usual. What's more, these so-called traditional STDs are well known to be associated with serious complications.
Both gonorrhea and chlamydia initially can cause infections of the urethra (urethritis) and anus, or rectum (proctitis). Subsequently, these infections can progress to serious complications in these areas and even spread to other parts of the body. In addition, in women,
gonorrhea and
chlamydia are associated with increased risks of infertility and ectopic pregnancy, which at times can be life-threatening. (An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus; for example, in the tubes.)
Top Searched STDs in Women Terms:
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What are sexually transmitted diseases (STDs)?
Sexually transmitted diseases (STDs) are infections that can be
transferred from one person to another through any type of sexual contact. STDs
are sometimes referred to as sexually transmitted infections (STIs) since they
involve the transmission of a disease-causing organism from one person to
another during sexual activity. It is important to realize that sexual contact
includes more than just sexual intercourse (vaginal and anal). Sexual contact
includes kissing, oral-genital contact, and the use of sexual "toys," such as
vibrators. STDs probably have been around for thousands of years, but the most
dangerous of these conditions, the
acquired immunodeficiency syndrome (AIDS), has only been recognized since
1984.
Many STDs are treatable, but effective cures are lacking
for others, such as HIV, HPV, and hepatitis B and C. Even gonorrhea, once easily
cured, has become resistant to many of the older traditional antibiotics. Many
STDs can be present in, and spread by, people who do not have any symptoms of
the condition and have not yet been diagnosed with an STD. Therefore, public awareness and education about these infections and
the methods of preventing them is important.
There really is no such thing as "safe" sex. The only truly effective way to
prevent STDs is abstinence.
Sex in the context of a monogamous relationship wherein neither party is
infected with a STD also is considered "safe." Most people think that kissing is
a safe activity. Unfortunately, syphilis, herpes, and other infections can be
contracted through this relatively simple and apparently harmless act. All other
forms of sexual contact carry some risk.
Condoms are commonly thought
to protect against STDs. Condoms are useful in decreasing the spread of certain
infections, such as chlamydia and gonorrhea; however, they do not fully protect
against other infections such as genital herpes, genital warts, syphilis, and
AIDS. Prevention of the spread of STDs is dependent upon the counseling of
at-risk individuals and the early diagnosis and treatment of infections.
Gonorrhea
What is gonorrhea?
Gonorrhea is a bacterial infection caused by the organism Neisseria
gonorrheae that is transmitted by sexual contact. Gonorrhea is one of the
oldest known sexually transmitted diseases. It is estimated that over one
million women are currently infected with gonorrhea. Among women who are
infected, 25-40% also will be infected with chlamydia, another type of bacteria
that causes another STD. (Chlamydia infection is discussed later in this
article.)
Contrary to popular belief, gonorrhea cannot be
transmitted from toilet seats or door handles. The bacterium that causes
gonorrhea requires very specific conditions for growth and reproduction. It cannot live outside the body for more than a few seconds or
minutes, nor can it live on the skin of the hands, arms, or legs. It survives
only on moist surfaces within the body and is found most commonly in the
vagina, and, more commonly, the
cervix. (The cervix is the end of the
uterus that protrudes into the vagina.) It can also live in the tube (urethra)
through which urine drains from the
bladder. Gonorrhea can even exist in the back of the throat (from
oral-genital contact) and in the
rectum.
Symptoms of gonorrhea
Over 50% of infected women have no symptoms, especially in the early
stages of the infection. Symptoms of gonorrhea include burning or frequent
urination, a yellowish vaginal
discharge, redness and swelling of the genitals, and a burning or itching of
the vaginal area. If untreated, gonorrhea can lead to a severe pelvic infection
with inflammation of the Fallopian tubes and ovaries. Gonorrheal infection of
the Fallopian tubes can lead to a serious, painful infection of the
pelvis known as pelvic
inflammatory disease or PID.
PID occurs in 10-40% of women with gonorrheal infection of the uterine cervix.
Symptoms of pelvic infection include fever, pelvic cramping,
abdominal pain, or pain
with intercourse. Pelvic infection can lead to difficulty in becoming pregnant
or even sterility.
Occasionally, if the infection is severe enough, a localized area of infection
and pus (an abscess) forms, and major surgery may be necessary and even lifesaving.
Gonorrhea infection in people with conditions causing serious abnormal immune
function, such as AIDS, can also be more serious.
Diagnosis of gonorrhea
Testing for gonorrhea is done by swabbing the infected site (rectum, throat,
cervix) and identifying the bacteria in the laboratory through culturing of the
material from the swab (growing the bacteria) in the laboratory. The culture is
positive when the gonorrhea bacteria are found to be growing on a culture plate.
Sometimes the test does not show bacteria because of sampling errors (the
sampled area does not contain bacteria) or other technical difficulties, even
when the woman has an infection. Newer tests to diagnose gonorrhea involve the
use of DNA probes or
amplification techniques (for example, polymerase chain reaction, or
PCR) to identify the genetic material of the bacteria. These tests are more
expensive than cultures but typically yield more rapid results.
Treatment of gonorrhea
In the past, the treatment of uncomplicated gonorrhea was fairly simple. A
single injection of penicillin
cured almost every infected person. Unfortunately, there are new strains of
gonorrhea that have become resistant to various antibiotics, including
penicillin, and are therefore more difficult to treat. Fortunately, gonorrhea
can still be treated by other injectable or oral medications. Gonorrheal
infections that infect the cervix, rectum, urethra, or throat are usually
treated with one 400 mg oral dose of cefixime or an intramuscular injection of
125 mg of ceftriaxone. Alternative
antibiotic
regimens include: cefpodoxime, one 400 mg oral dose; ciprofloxacin, one 500 mg
oral dose; ofloxacin, one 400 mg oral dose; levofloxacin, one oral 250 mg dose;
and levofloxacin, one 250 mg oral dose. An intramuscular injection of 2 g of
spectinomycin is also an alternative treatment in nonpregnant patients, but this
treatment is not effective for throat infections caused by gonorrhea.
Because some developing bacterial strains are resistant
to certain antibiotics, ceftriaxone is the recommended treatment for all
patients in Hawaii and California and for persons who acquired the infection in
certain parts of the world. Treatment should always include medication that will
treat chlamydia (such as azithromycin or doxycycline) as well as gonorrhea, because gonorrhea and chlamydia commonly
exist together in the same person. The sexual partners of women who have had
either gonorrhea or chlamydia must receive treatment for both infections since
their partners may be infected as well. Treating the partners also prevents
reinfection of the woman.
Women suffering from PID require more
aggressive treatment that is effective against the bacteria that cause gonorrhea
as well as against other organisms. These women often require
intravenous
administration of antibiotics. Recommended treatment regimens for PID include:
- Cefotetan: 2 g intravenously every 12 hours (or cefoxitin 2 g every six
hours), plus 100 mg doxycycline intravenously or orally every 12 hours until
improvement, then 100 mg doxycycline orally twice per day until 14 days have
been completed.
- Clindamycin: 900 mg intravenously every 8 hours, plus one 2 mg per kilogram
of body weight intravenous dose of gentamycin followed by 1.5 mg of gentamycin
per kilogram body weight every eight hours, then 100 mg doxycycline orally twice
per day until 14 days have been completed.
Acceptable alternative regimens for treatment of PID are:
- Ofloxacin: 400 mg intravenously every 12 hours or 500 mg of levofloxacin
intravenously once per day, plus 500 mg of metronidazole intravenously every
eight hours until improvement, then 100 mg of doxycycline orally twice per
day until 14 days have been completed.
- Ampicillin/sulbactam: 3 g intravenously every six hours, plus 100 mg of
doxycycline orally or intravenously every 12 hours until improvement, then 100
mg of doxycycline orally twice per day until 14 days have been completed.
Sometimes oral antibiotic regimens are used to treat PID. Oral antibiotics
used to treat PID include:
- Ofloxacin: 400 mg twice per day for 14 days.
- Levofloxacin: 500 mg once daily, plus 500 mg of metronidazole twice daily
for 14 days.
- Cefoxitin: one 2 g dose, along with 100 mg of doxycycline twice per day for
14 days.
It is important to note that doxycycline, one of the recommended drugs for
treatment of PID, is not recommended for use in pregnant women.
Gonorrhea is one of the easier STDs to prevent because the bacterium that
causes the infection can survive only under certain conditions. The use of
condoms protects against gonorrhea infection. Since the organism can live in the
throat, condoms should be used during oral-genital contact as well.
Next: Chlamydia »
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Last Editorial Review: 7/10/2006
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