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Chart: Common Reproductive Tract Infections

A concise description of 11 common reproductive tract infections, including bacterial and viral sexually transmitted diseases, is given. Contraceptive considerations are summarized. The infections are AIDS(HIV), bacterial vaginosis, candidiasis, chancroid, chlamydia, gonorrhea, herpes, human papilloma, hepatitis B, syphilis and trichomoniasis.

Network: Winter 1997, Vol. 17, No. 2

Vaginal Infections
Contraceptive considerations
  • Since some cases are transmitted sexually, consistent and correct use of latex condoms may provide protection.
  • Women with vaginal infections should be successfully treated before they use IUDs.
 Bacterial Vaginosis  Trichomoniasis  Candidiasis
Worldwide, the most common vaginal infections are bacterial vaginosis, caused by anaerobic bacteria including Gardnerella vaginalis; trichomoniasis, a protozoan infection caused by Trichomonas vaginalis; and candidiasis (thrush), a fungal infection caused by Candida albicans.

Bacterial vaginosis symptoms may include a bad smelling vaginal discharge, although a large number of infected women do not have (or recognize) symptoms. Trichomoniasis may result in foamy, yellowish vaginal discharge, itching or discomfort. Candidiasis may show as a thick, white discharge with itching and swelling. Symptoms alone are unreliable predictors of the specific vaginal organisms.

Treatment -- All are treatable with antibiotics or other drugs.
Bacterial STDs
Contraceptive considerations
  • When used consistently and correctly, latex condoms give substantial protection.
  • Spermicides and diaphragms protect against gonorrhea and chlamydia.
  • Female condom and cervical cap may protect against some STDs, but have not been adequately studied.
  • No STD protection occurs from non-barrier methods, including hormonal contraceptives (the pill, DMPA and Norplant), intrauterine devices (IUDs), sterilization or natural family planning methods.
  • Hormonal contraceptives may be associated with increased risk of chlamydia, but decreased risk of symptomatic pelvic inflammatory disease (PID).
  • Women with bacterial vaginal and cervical infections should be successfully treated before they use IUDs.
Chancroid
Chlamydia
Gonorrhea
Syphilis
Chancroid is caused by the bacterium Haemophilus ducreyi, and is transmitted sexually. Chancroid is a common cause of genital ulcers in tropical areas. Chlamydial infection is caused by Chlamydia trachomatis, and is transmitted sexually. The bacteria can infect urethra, cervix, or eyes. In women, chlamydia can lead to sterility, pregnancy complications or can infect infants during delivery. Gonorrhea is caused by Neisseria gonorrhoeae, and is transmitted sexually. The bacteria can infect genitals, throat, eyes or rectum. In men and women, gonorrhea can lead to sterility. Women can infect their infants during delivery. Syphilis is caused by the bacterium Treponema pallidum, and is transmitted sexually or from contaminated blood. Mothers can pass the disease to infants during pregnancy.
Symptoms -- Sores develop that are painful and tender when touched. Glands in the area of infection typically are swollen. Genital or oral areas are the most common infection sites. Symptoms -- Most people are infected without having symptoms (asymptomatic). A sparse, clear discharge from the urethra, redness and irritation are common symptoms. Without treatment, an infection may last years. Symptoms -- Some people may be infected without having symptoms (asymptomatic). In men, a yellow discharge from the urethra, painful urination and blood in urine may result. Symptoms among women include redness on the cervix, vaginal discharge and pelvic pain. Symptoms -- Sores develop, initially at the places where bacteria entered the body such as genital or oral areas, and later bacteria enter the blood stream. Flu-like symptoms (fever and swollen glands), rash, and bumps on genitals are among symptoms from this spread. Heart disease, neurological damage and other complications can result if untreated.
Treatment -- Can be cured with antibiotics. The presence of bacterial STDs increases the risk of HIV transmission.
Viral STDs
Contraceptive considerations
  • When used consistently and correctly, latex male condoms give substantial protection. Other barrier methods (female condom, spermicides, sponge and diaphragm) have not been adequately studied.
  • No STD protection occurs from other methods, including hormonal contraceptives (the pill, DMPA and Norplant), intrauterine devices (IUDs), sterilization or natural family planning methods.
AIDS (HIV)
Herpes Simplex (HSV)
Human Papilloma (HPV)
Hepatitis B (HBV)
Human immunodeficiency virus (HIV) leads to severe depression of the immune system, resulting in opportunistic infections called "acquired immunodeficiency syndrome," or AIDS. HIV is transmitted by an infected person through semen, vaginal fluids, breast milk or blood. Herpes has two types. Type I generally appears as cold sores on the lips, while Type II is often found as sores on genitalia. The two types, however, can infect any mucous membranes. Infected people may experience outbreaks of sores several times a year, typically for about a week during each outbreak. Some people experience only a single episode or no episode at all. Human papilloma viruses (HPV), or genital warts, are a family of viruses that cause warts in the mouth, throat, genitalia or anus. While painless and often small, some people experience large warts that can cause problems, such as blockage of the urethra or the larynx in infants. The virus is the main cause of cancers of the cervix, penis and anus. Hepatitis B (HBV) causes liver damage and may be transmitted sexually. The virus is also transmitted by contaminated blood products or contaminated syringes. HBV is found in bodily fluids, including semen and vaginal secretions.
Symptoms -- In the first few months, HIV-infected people may experience fever, chills or similar signs. AIDS, which is actually complications from diseases that occur after an HIV- infected person's immunity is weakened by the virus, typically occurs years after infection. AIDS is nearly always fatal. Symptoms -- Most HSV infections are asymptomatic. Herpes can appear as sores or blisters on the genitalia, anus or mouth. In serious cases, it can infect a person's eyes. A burning, itching sensation with redness occurs initially, followed in a day or so by blisters. The blisters recede and disappear with time. Symptoms -- Warts grow in the mouth, throat, genitalia or anus. They are bumpy, fleshy growths that are painless. The HPV subtypes causing external warts are usually not those associated with cancers. Symptoms -- Nausea, stomach pain, loss of appetite and headaches are initial symptoms. Swollen glands and liver damage occur in later stages, and a person's eyes and skin turn yellow. In rare instances, some people die from severe damage to the liver. Some infected people have episodes of infection for life.
Treatment -- Several drug treatments show promise in reducing the level of HIV in blood and semen, reducing HIV related symptoms and delaying the onset of AIDS. These expensive treatments generally are not available in developing countries. Treatment -- The virus remains latent in the body between outbreaks and cannot be cured. Herpes remains in the infected person's body for life. Drugs are available to curtail the outbreak of sores and reduce pain. Herpes increases the risk of acquiring HIV, since sores make it easier for the AIDS virus to enter the body. Treatment -- Warts can be removed (by burning, freezing or with chemicals), but may recur since the latent virus remains in the body. Annual Pap smears are indicated to screen for cervical cancer. Treatment -- Ample rest helps people recover from acute disease. A vaccine is available and should be strongly encouraged.

Relative cell sizes
 
 Neisseria Gonorrhoeae (Gonorrhea)
 
 Graphic showing the sizes of Syphilis, Gonorrhea, and HIV relative to sperm  
  Treponema Pallidum (Syphilis)
HIV
 
 
 Sperm
 

Sources:

  1. Feldblum P, Joanis C. Modern Barrier Contraceptives: Effective Contraception and Disease Prevention. Research Triangle Park, NC: Family Health International, 1994.
  2. Holmes KK, Mardh P-A, Sparling PF, et al. Sexually Transmitted Diseases. New York: McGraw-Hill Book Company, 1990.


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