Pharmacotherapy/Treatment Of Sexually Transmitted Infections (STIs)

 Sexually transmitted infections (STIs) arre infections contracted through unprotected sex or close sexual contact with an infected person. They are sometimes called sexually transmitted disease (STDs) or venereal disease. Most of these infections are not contracted only through unprotected sex or close contact with infected persons.

Read Also: Difference between STI and STD

STI can affect any part of the body and not only the genital. In some cases, symptoms do not occur in the genital. It is just a means of transmission.

Statistics Of Sexually Transmitted Infections (STIs)

According to WHO in 2016, 376 million people were reported to be infected with one form of STI around the world. That is more than a million new infections recorded everyday. Majority of these infections are among people between the age of 15 and 24 years old.

Trichomonas had an infection rate of 156 million. That is more than the 127 million cases recorded for chlamydia, 87 million by gonorrhea and 1.3 million by syphilis.

Worldwide, 240 million people are living with chronic HBV, 500 million with genital herpes with 300 million living with HPV.

Cause

STI are caused by small organisms. They are viruses, bacteria and parasites. According to the world health organisation (WHO), there are about 30 different organisms responsible for different types of STI. However, eight calls for greater concerns. Four of which are curable with drugs. Those four are syphilis, gonorrhea, chlamydia and trichomonas.

The other four don't currently have any cure. There are drugs for management. These four include hepatitis B virus (HBV), herpes simplex virus (HSV), human immunodeficiency virus (HIV), and human papilloma virus (HPV).

Some STI do not affect a growing fetus. But that cannot be said of HIV, syphilis, chlamydia and gonorrhoea as they can cause birth defects or even death.

Symptoms

Different STI have different incubation periods. For example, HIV incubation can be up to 2 years or beyond. And asymptomatic patients can be infective even before they start exhibiting symptoms.

Sexually Transmitted Infections, STI

Symptoms of a particular STI may differ between genders. Some STI in male may lead to pain during urination and will be asymptomatic in females. That is the reason some people with infection doubt where they got it from when their partner is perfectly normal. They may start suspecting innocent people. The following are some symptoms;

1. Canker sores (painless red sores), soft, flesh-coloured warts, bumps or rashes on or around the penis, testicles, vagina, anus, buttocks, thighs and even in some cases mouth (throat)

2. Pain or discomfort during urination and in female during sex

3. Unusual discharge or bleeding from the penis or vagina

4. Itching in or around the vagina for females

5. Eye inflammation

6. A scaly rash in the palms of the hands or soles of the feet

7. Dark urine, loose, light-colored stools and yellow eye and skin

8. Fever

9. Body ache

10. Fatigue

11. Night sweat

12. Weight loss

13. Swollen glands

Complications Of STI

1. Infertility

2. Still birth or birth defects especially syphilis

3. Organ damage

4. Heart disease

5. Cervical Cancer by HPV

6. Pelvic inflammatory disease (PID) from gonorrhoea and chlamydia

7. Arthritis

8. Death

Risk

1. STI like herpes and syphilis increase the risk of contracting HIV more than three fold.

2. Unsafe sexual behaviour

3. Sharing sharp objects

5. Blood transfusion

Mode Of Transmission

Because the infection is in the blood, most can be contracted through blood transfusion, sharing of needles, using the same clippers with an infected person, fluid contact with skin and kissing (syphilis and herpes), etc. Mother to child transmission is also possible.

Diagnosis

1. Blood test

2. Urine test

3. Vagina, penis or sore swab

4. Pelvic or physical examination

Pap smear is no confirmatory test of any type of STI. It is only used to check for cervical cancer which is one of the complications of chlamydia. If cervical cancer is positive, it gives clues on what next test to do which is a test for chlamydia.

Also, there are a couple of rapid home test kits available. Most of them are not accurate. However, WHO and the Center for Disease Control (CDC) have approved a couple of some. These rapid home test kits are fast and give some level of privacy.

Pharmacotherapy/Treatment Of STI

Chlamydia, gonorrhoea, syphilis and trichomonas are curable with drugs. HSV and HIV can be modulated with drugs but no cure. HBV has drugs to fight the virus and prevent liver damage. There are vaccines for HBV and HPV.

HIV/AIDS

Treatment of HIV involve the use of combination therapy. It is called highly active antiretroviral therapy (HAART). One or two drug from one class of antiretroviral is combined with one or two from another for synergistic effect.

Nucleoside Reverse Transcriptase Inhibitors: abacavir, didanosine (ddl), lamivudine (3TC), stavudine (d4T), zalcitabine (ddC), zidovudine (ZDV)

Protease Inhibitors: indinavir, nelfinavir, ritonavir, saquinavir, lopinavir plus ritonavir

Non Nucleoside Reverse Transcriptase Inhibitors: delavirdine, efavirenz, nevirapine

Chlamydia

Antibiotics: azithromycin, azithromycin, doxycycline

Gonorrhea

Antibiotics: ceftriaxone, cefixime, ciprofloxacin, ofloxacin

Gonorrhea and chlamydia can occur together, in which case both have to be treated together. A regimen of ceftriaxone plus doxycycline or azithromycin is recommended.

Pelvic Inflammatory Disease (PID): is a complication of some bacteria STI. Choice of treatment are;

Antibiotics: Typically, two antibiotics are prescribed. Cefotetan or cefoxitin plus doxycycline, clindamycin plus gentamicin, ofloxacin plus metronidazole

Human Papillomavirus (HPV)

Topical Preparations (creams and solutions that the  patient applies directly to the affected area): imiquimod, podophyllin, podofilox, fluorouracil (5-FU), trichloroacetic acid (TCA), interferon

Genital Herpes

Antivirals: acyclovir, famciclovir, valacyclovir

Syphilis

Antibiotics: penicillin—doxycycline or tetracycline only if allergic to penicillin

Read Also: HIV rapid home test kit

There are preventive measures. They include abstinence, faithfulness to an STI non infected person and the proper use of condoms. Condoms prevent most STI but not against herpes, warts and syphilis. Dental dams are not very popular in Nigeria but they have been claimed to help prevent STI.

Some risky behaviour exposes people to STI. For example, douching kills good bacterias in the vagina. This exposes the vagina to infection that might otherwise be resisted by the hood bacteria acting as immune defence. Drugs and alcohol abuse is another behaviour responsible for exposure to STI.

Pre-exposure prophylaxis (PrEP) is the use of drugs to prevent developing a disease when one is exposed to it. For example, PrEP is given to a person who recently had unprotected sex with an HIV infected. The choice of drugs depends on so many factors.