Prevention of Sexually Transmissible Infections

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By. Dr. Luis Medina

Sexually Transmissible Infections (STI), also known as venereal diseases are a group of infectious medical conditions that are transmitted from person to person through contact that occurs almost exclusively during intercourse, including vaginal sex, anal and oral sex. However, they can be transmitted by using contaminated or blood contact syringes, and some of them can be transmitted during pregnancy or childbirth, from mother to child.

The incidence rates of STD remain high in most of the world, despite diagnostic and therapeutic advances. In many cultures, changing sexual morals and oral contraceptive use have eliminated traditional sexual restraints, especially for women, and both health professionals and patients have difficulty dealing openly and candidly with sexual problems.

In 1996, WHO estimated that over one million people are infected daily venereal disease. About 60% of these infections occur in children under 25 years and 30% of these are under 20 years. An estimated 340 million new cases of syphilis, gonorrhea, chlamydia and trichomoniasis occurred throughout the world in 1999.

Over 2 million primoinfecciones currently presented annually HIV and STD 400 million in total, leading to the medical world to direct their efforts towards finding effective prevention of these diseases and reliable methods.

Failure STD treatment can lead to long-term infertility, ectopic pregnancy and chronic pelvic pain in up to 20% of cases, and spontaneous abortions, premature birth and congenital infections in pregnancy more for immunosuppression in patients AIDS, reasons for preventing STDs should be considered a priority for primary care medicine.

To prevent STDs, it is essential to know its existence, the means of transmission, opt for safe sexual behavior, either abstain from sexual contact, or have only couple practice safe sex, if you have symptoms, go early to the healthcare. It is also essential to avoid sharing needles (for substance abuse, for example).

It is vital for the prevention of these infections to identify high-risk individuals. Are considered at high risk for STDs to the following individuals:

• People with new sexual partners.
• multiple sex partners.
• History of previous STDs.
• Use of illicit drugs.
• Contact with sex workers.
• Sexual partners of people infected with HIV (serodiscordant couples) individuals.
• Men who have sex with men.
• High-risk sexual behaviors and condom disuse.

What strategies exist for prevention of STDs?

Different vaccines have been developed for some of these. For example for hepatitis A, which is recommended for men who have sex with men, intravenous drug users and those with chronic liver disease. The Hepatitis B vaccine recommended for all adults, especially those high-risk patients, antibody titers should be measured in the blood of the vaccine at least once a month to the proper value, and efficiency.

HPV vaccine was also developed, there are two classes currently Cervarix protects against types 16 and 18 (which cause 70% of cervical cancers) and the quadrivalent called Gardesil (6, 11, 16 and 18) in addition to providing protection for serotypes that produce the highest rates of genital warts. However, despite intense efforts to find an effective HIV vaccine no studies to support the use of one of the prototypes that have been developed to prevent infection.

Condom use is a preventive strategy that has been associated with significantly reduced risk of transmission of HIV, chlamydia, gonorrhea, herpes and HPV.

Circumcision has proven useful in reducing infections herpes, HPV and HIV.

Prevention of HIV infection

Preventing HIV infection is a topic that has been working hard, two routes have been devised for this virus prophylaxis, postexposure prophylaxis is pre-exposure and over which major advances have been made.

In Gladstones US Institute working group of Dr. Robert Grant has tested a drug, consisting of two antiretrovirals commonly used in the clinic under the tradename Truvada (Tenofovir-Emtricitabine). Reduced risk of HIV between 44-90% by taking one tablet daily plus the awareness of individuals participating in the study to reduce potential risk behaviors and especially the use of condoms was obtained.

The only contraindication that seems to have it in patients with chronic kidney disease or those in their creatinine levels are above normal, to be elucidated their impact on pregnant women well and should be maintained until the risk factors persist. However, it is not yet known exactly the minimum dosage required to maintain the prophylactic effect of the drug to provide the patient a more convenient dosing regimen and not represent an undue hardship to unnecessary patient (currently one month of treatment for a patient would be estimated around $ 1425).

At the beginning of the investigation evaluated the ability of a drug to be as effective for the prevention of infection in patients with HIV were to promote increased sexual risk behavior but found that this is not so.

There are still details to explore in relation to this new way of prophylaxis but you can not deny that is encouraging news for the world that, if passed in its entirety, represent a potential shift in strategy to tackle the global epidemic of HIV.