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Sexually Transmitted Diseases

Sexually Transmitted Diseases

STD stands for Sexually Transmitted Diseases . These are diseases transmitted from one person to another by sexual intercourse. STD is not a synonym for HIV as there are many other types of infections as well transmitted this way like Herpes, Human Papilloma Virus, Syphilis, Chlamydia, Gonorrhoea, 
 
HIV- It stands for Human Immunodeficiency Virus . It causes destruction of immune cells called T cells or CD4 cells . As a result, body finds it harder to fight infections and develops a problem called AIDS. It is characterised by one or more types of commonly found infections with uncommon difficulty in treatment due to poor immunity and one or more types of cancer 
 
Some facts about HIV- 
 
1- In India, about one lac cases are detected HIV positive each year 
2- About 22 lac people are living with HIV in India
3- Being HIV positive doesn’t mean you have AIDS . It may take many years ( up to 10-12 years) depending on your age ,fitness level and life style. 
4- There are about 2.2 million people with AIDS in India and 1 lac new cases add to it every year
5- Having sex with a HIV positive person doesn’t guarantee HIV transmission. It depends on the type of sex ( anal sex has maximum chance , vaginal sex has good chance and oral sex is also risky ) , the stage of HIV in the person ( Those having high viral load not on ARV treatment are more dangerous but those on antiviral drugs pose lesser danger) and your own immunity. Overall, there is 1 in 100 chance of transmission by vaginal sex . 
 
Transmission of Virus- 
 
It can be transmitted by sexual intercourse, oral sex , sharing a needle or during delivery from mother to child . If the Virus comes in contact with mucous membrane ( present in mouth, vagina, anus ) or body fluids are exchanged, HIV is transmitted. It is not transmitted by handshake, sharing food, air or cough, sharing utensils or toilet seat or bed or social kissing or caressing.Deep kissing may result in abrasions so not safe. Saliva , tears or sweat not mixed with Blood of HIV positive person can’t transmit the virus nor the mosquito, ticks or other insects can’t transmit it either. 
 
What happens once it is transmitted - 
HIV virus starts multiplying and damage the CD4 cells . Body responds by producing antibodies which initially can kill the virus . These antibodies are detected in a lab to detect the presence of virus 
 
Window period - for a particular test is the time taken between acquiring the virus and getting detected by that particular test . It can vary from 7-10 days in Viral Load PCR test to 2-3 weeks in combined RNA and DNA PCR test to 3 weeks in Classical Antibody test . The earliest is 7-10 days of infection and all cases are expected to be diagnosed by 6 weeks . If one has negative result after 3 months of possible exposure- It can be assumed that HIV infection has not taken place 
 
HIV testing results are conveyed only to the person so complete secrecy is practiced . 
 
There is a lot of psychological issues involved . There is extreme anxiety, guilt, loss of sleep and fear of transmitting HIV to the spouse . So a negative result is a big relief . You can have sex with your spouse with protection. Some times people repeatedly get themselves tested despite negative results . It is not needed. 
 
Treatment- There is no cure but disease can be controlled with antiviral drugs. Most people will have a mean duration of 11 years after diagnosis if ART is taken . 
 
HIV positive individuals and Pregnancy- 
You can have HIV negative baby despite being HIV positive . If both mother and father have HIV, taking ART to reduce viral load to negligible level will minimise the chances of transmission to baby. If the mother is HIV negative, the main question becomes- How to conceive 
 
 
Herpes Simplex Virus ( HSV) 
 
• The herpes simplex virus, or herpes, is categorized into 2 types: herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).
• HSV-1 is mainly transmitted by oral-to-oral contact to cause oral herpes (which can include symptoms known as “cold sores”), but can also cause genital herpes.
• HSV-2 is a sexually transmitted infection that causes genital herpes.
• Both HSV-1 and HSV-2 infections are lifelong.
• An estimated 3.7 billion people under age 50 (67%) have HSV-1 infection globally.
• An estimated 417 million people aged 15-49 (11%) worldwide have HSV-2 infection.
• Most oral and genital herpes infections are asymptomatic.
• Symptoms of herpes include painful blisters or ulcers at the site of infection.
• Herpes infections are most contagious when symptoms are present but can still be transmitted to others in the absence of symptoms.
• Infection with HSV-2 increases the risk of acquiring and transmitting HIV infection.
 
HSV-1 and 2
 
HSV-1 is a highly contagious infection, which is common and endemic throughout the world. Most HSV-1 infections are acquired during childhood, and infection is lifelong. The vast majority of HSV-1 infections are oral herpes (infections in or around the mouth, sometimes called orolabial, oral-labial or oral-facial herpes), but a proportion of HSV-1 infections are genital herpes (infections in the genital or anal area).
 
In 2012, an estimated 3.7 billion people under the age of 50 ,had HSV-1 infection. Estimated prevalence of the infection was highest in Africa (87%) and lowest in the Americas (40-50%).
 
With respect to genital HSV-1 infection, 140 million people aged 15-49-years were estimated to have genital HSV-1 infection worldwide in 2012, but prevalence varied substantially by region. Most genital HSV-1 infections are estimated to occur in the Americas, Europe and Western Pacific, where HSV-1 continues to be acquired well into adulthood. In other regions, for example in Africa, most HSV-1 infections are acquired in childhood, before the age of sexual debut.
Signs and symptoms.
 
Oral herpes infection is mostly asymptomatic, and the majority of people with HSV-1 infection are unaware they are infected. Symptoms of oral herpes include painful blisters or open sores called ulcers in or around the mouth. Sores on the lips are commonly referred to as “cold sores.” Infected persons will often experience a tingling, itching or burning sensation around their mouth, before the appearance of sores. After initial infection, the blisters or ulcers can periodically recur. The frequency of recurrences varies from person to person.
 
Genital herpes caused by HSV-1 can be asymptomatic or can have mild symptoms that go unrecognized. When symptoms do occur, genital herpes is characterised by 1 or more genital or anal blisters or ulcers. After an initial genital herpes episode, which may be severe, symptoms may recur, but genital herpes caused by HSV-1 often does not recur frequently.
 
Transmission
HSV-1 is mainly transmitted by oral-to-oral contact to cause oral herpes infection, via contact with the HSV-1 virus in sores, saliva, and surfaces in or around the mouth. However, HSV-1 can also be transmitted to the genital area through oral-genital contact to cause genital herpes.
 
HSV-1 can be transmitted from oral or skin surfaces that appear normal and when there are no symptoms present. However, the greatest risk of transmission is when there are active sores.
 
Individuals who already have HSV-1 oral herpes infection are unlikely to be subsequently infected with HSV-1 in the genital area.
 
In rare circumstances, HSV-1 infection can be transmitted from a mother with genital HSV-1 infection to her infant during delivery.
 
Possible complications
Severe disease
In immunocompromised people, such as those with advanced HIV infection, HSV-1 can have more severe symptoms and more frequent recurrences. Rarely, HSV-1 infection can also lead to more severe complications such as encephalitis or keratitis (eye infection).
 
Neonatal herpes
Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.
 
Psychosocial impact
Recurrent symptoms of oral herpes may be uncomfortable and can lead to some social stigma and psychological distress. With genital herpes, these factors can have an important impact on quality of life and sexual relationships. However, in time, most people with either kind of herpes adjust to living with the infection.
 
Treatment
Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, are the most effective medications available for people infected with HSV. These can help to reduce the severity and frequency of symptoms, but cannot cure the infection.