S exual practices in today’s modern liberated society with its permissive culture has led to a leap in all types of sexually transmitted diseases and infections ( STD) and (STI) due to risky behaviour on the part of those engaging in sexual activity. Many of these diseases if untreated or detected too late can lead to HIV/AIDs. While the number of such diseases in Sri Lanka are lower than in other countries in the region due to vigilance and careful monitoring plus education on the part of our health officials, the prevailing rates in the country are a matter of concern to all health officials battling to bring down the number to zero level.
The fact that young persons are among those most vulnerable to sexual diseases is an added worry considering that the permissive cultures they live in could tempt them into unprotected sex at an early stage resulting in unwanted health impacts.
Consultant Venereologist Dr. G. Weerasinghe from the National STD/AIDS Control Program, tells the Sunday Observer how such diseases could be avoided, detected and about new treatment technologies currently available for patients.
Excerpts …
Q. Sexual practices in today’s modern liberated world has according to recent studies led to a leap in Sexually Transmitted Diseases ( STDs). Yet many persons afflicted by an STD are unaware they carry the infection. For our readers’ benefit tell us what STD means .
A. STDs are those diseases which develop in the genital areas (predominantly, but not exclusively) of a person as a result of an infection acquired through sex between two persons. But sometimes these infections (STIs) can be transmitted through infected blood (syphilis, HIV) or from mother to child (HIV, gonorrhoea, chlamydia)
Q. What are the most common STDs and Sexually Transmitted Infections( STI) currently prevailing in Sri Lanka and what are their symptoms?
A. Syphilis, oro-genital herpes infection causes genital ulcer diseases gonorrhoea, chlamydia infections, urethral discharges among men, trochomoniasis, gonorrhoea, chlamydia, vaginal discharges. Other common STDs include genital warts.
Untreated gonorrhoea or chlamydia infections in the cervix also cause pelvic inflammatory disease. Untreated gonorrhoea or chlamydia infections in the urethra cause scrotal swelling. Untreated gonorrhoea or chlamydia infections in the cervix cause neo-natal eye discharges.
Q. How are they transmitted?
A. Usually, they are transmitted through sex between an infected person and a healthy person. A healthy person usually acquires the infection from an infected person, though some of these infections are transmitted via other modes also.
There is no age limit for a person to acquire an STI, but they are common among men and women in the sexually active age group.
Q. Symptoms? How long do they take to manifest themselves?
A. Some symptoms which need attention of a doctor are as follows:
Genital ulcers,
Urethral discharge
Vaginal discharge
Swelling of genitals
Pain of genitals or lower abdomen
Unusual lumps or bumps in the
genital area
Redness of the genital area
Difficult or painful passing of urine
Time to manifest these symptoms or incubation period varies from infection to infection. But generally, it could be from 1 to 21 days except for a few infections such as genital warts, HIV/AIDS.
Q. If one gets an STD is he/she likely to be more at risk of becoming a victim of STD again? How soon?
A. Acquiring STD once does not mean that the person is likely to acquire them again. But what we need to understand is that if the STD was acquired as a result of risky behaviour such as having sex with many partners / having sex with many partners without using condoms and they continue with those behaviours, then they are liable to acquire STDs again.
How soon they acquire STDs again depends on the continuation of those behaviours.
Q. Are STDs reversible if detected/ treated early?
A. There are certain STDs which are 100% curable and others controllable. What is important is, once we have any risky sexual exposure, to have sexual health check-up soon.
Q. Health impacts of STDs?
A. Basically, STDs themselves are serious health issues. They cause inflammation in genitals, surrounding areas and sometimes on the other parts of the body. They cause a lot of discomfort such as discharge, ulcers, pain, swelling, difficulty in passing urine, etc. depending on the STD the person has been affected with.
Q. How serious are they? Can you die of an STD like gonorrhoea or chlamydia?
A. They are serious enough to prevent the person from attending to work for few days at least. Certain STDs compel persons to adjust their sexual activities so that their future partners do not acquire them. STDs, if not treated, can cause complications which would be serious enough to have severe impacts such as sub-fertility or infertility. Both men and women could be affected with those complications. If a woman in the reproductive age develops tubal pregnancy due to a complication of ascended infection with gonorrhoea or chlamydia she could face a life threatening situation.
Q. Gender wise which segment of the population is most at risk of STD ? Males or females? Why?
A. Men and women are equally affected with STIs. Women can have STDs without their knowledge at times or they come to know about them later compared to men.
Q. It is said that growing youth populations living in permissive cultures tend to engage in sex earlier. Does this mean that young adolescents and teenagers are more at risk of contracting sexually transmitted infections than older persons?
A.Young persons are naturally more active in sex compared to older persons, therefore, a possibility exists for younger people to acquire STDs compared to older people.
Q. As children develop, an important phase is the pubertal stage. As this stage both sexes signify hormonal changes that produce natural sexual urges which could lead to young people engaging in active sex without a real understanding about the fallout. What action has been taken to provide them correct information that would prevent unwanted results when they engage in sex, especially, adolescents?
A. The school curricula contain chapters in the text books related to age-appropriate material on these issues. The NSACP also works to raise awareness on these issues among schoolchildren.
Q. Approximately, how many patients do we have now?
A. Around fifteen thousand (15,000) new STIs are diagnosed in the STD clinics and it is estimated that 60,000 to 200,000 STIs occur annually in the country. Among the reported cases to STD clinics viral STIs are slightly increasing in the age group below 25 years while bacterial ones are decreasing.
Q. Can a pregnant woman with an STD like gonorrhoea or syphilis or chlamydia transmit the infection to her baby while in the womb or at delivery?
A.Yes, some of these diseases can be transmitted from mother to child. Syphilis is one such disease. Sri Lanka has a very successful program to prevent mother to child transmission of syphilis during pregnancy. What is important for us to know is that mothers should undergo the testing for syphilis during pregnancy and also refrain from any risky sexual behaviour during that period.
Gonorrhoea and chlamydia both could be transmitted to the child during delivery causing infections in both or one eye. The child will develop within days discharges from one or both eyes requiring immediate medical attention.
Q What about HIV?
A. HIV could also be transmitted from mother to child. But that has been eliminated in Sri Lanka. We encourage mothers to request and undergo HIV test during pregnancy, so, in-case they are infected, it can be treated easily and prevent transmission to child.
Q. Protective sexual practices such as personal hygiene and genital hygiene like washing the penis or vagina after sex lowers the risk of STD. Do you agree?
A. Hygiene is a good practice but would not offer much protection from STIs. The only effective practice is to use condoms whenever you have sex with more than one partner.
Q. What about condoms?
A. It is a proven fact that condom use is the only effective preventive measure to avoid STIs, whenever people have sex with more than one faithful partner.
Q. Myths /prejudices preventing persons with suspected STDs seeking treatment?
A. The public has an unnecessary fear about seeking help from STD clinics. They must get rid of this fear as all staff in STD clinics in government clinics are very approachable and trained and respect the confidentiality of the clients.
Q. Recent interventions by the Health Ministry to prevent and treat STDs in Sri Lanka, e.g. screening of high risk pregnant women as in some countries?
A. All pregnant women are screened for syphilis and HIV and they happen voluntarily. Almost 100% of them undergo these tests.
Q. Your message to the public?.
A.The best practice towards protection of sexual health is to limit sex to one faithful partner. If a person has sex with more than one partner it is advisable to use condoms. If one engages in unprotected sexual activity with a partner, he /she should undergo sexual health check-up.
Finally, according to new data it appears more HIV cases are detected among men having sex with men. These persons are vulnerable to HIV infection and should use condoms when having sex with other men.