Interventions For Sexually Transmitted Diseases - Research Paper Example

Running Head: SEXUALLY TRANSMITTED DISEASES Interventions for Sexually Transmitted Diseases School Interventions for Sexually Transmitted Diseases Sexually transmitted diseases (STDs) are serious health problems that have affected a number of people for many generations. To date, it is considered a major public health concern especially in developing countries (Mullick, Watson-Jones, Beksinska & Mabey, 2005). According to Shim (2011), STD cases around the world increase by 350 million every year. The widespread occurrence of STDs makes it an important problem to be addressed promptly with proper interventions. This paper provides a review of current interventions to different kinds of STDs. For a clear description of STDs, the first part of this paper defines STD, enumerates its kinds, and describes its symptoms. The second part provides a literature review of interventions for the treatment of STDs. The last part of the paper provides the conclusion and recommendations for further study. STDs are likewise known as venereal diseases usually transmitted through sexual contact. STDs can be contracted through the sex organs, mouth, anus, and blood. Aside from sexual contact, STDs can be transmitted through blood transfusion, using unsterilized needles used on a person with STD, childbirth, and breastfeeding. Mothers may pass on some STDs to their babies during pre-natal stage or upon birth. Therefore, STD may affect people of all ages and backgrounds. In many states, practitioners are required to report to Child Protective Services on cases of children with STD. There are some diseases that are not totally considered as STD but may be passed on to another person during sexual contact. These diseases include hepatitis A, C, and E, jock itch, and yeast infections. There are cases when people without STD may serve as carriers of STD to their partner because some STDs may be present without the symptoms especially in women (Stoppler & Davis, n.d.). The symptoms may vary depending on the cause. STDs can be caused by viruses or bacteria. Among those caused by viruses include genital herpes, genital warts, hepatitis B and D, and HIV/AIDS. STDs caused by bacteria include chancroid, gonorrhea, Chlamydia, lymphogranuloma venereum, syphilis, and granuloma inguinale. There are also STDs which may be caused by fungi including jock itch and yeast infections. Other STDs are caused by parasites, namely, pubic lice and scabies. According to Workowski (n.d.), there are more than 25 infectious organisms resulting in STDs. Workowski and Berman (2010) report the findings of their consultation with professionals in the treatment guidelines for STD published by the Centers for Disease Control and Prevention (CDC). The guidelines were developed based on a literature review of published literature from peer-reviewed journals and consultation with experts in the field of STDs. The report includes prevention measures and counseling of STD and HIV patients, clinical interventions, and follow-up procedures. Prevention Measures The CDC report identifies a number of prevention measures that are currently being used to avoid contracting STDs. Definitely, counseling procedures done on the local level are fundamental in any program against STDs. These include counseling people to adopt prevent measures against STDs and counseling people who are at risk for STDs. Golden, Whittington, Handsfield, Hughes, Stamm, Hogben, Clark, Malinski, Helmers, Thomas and Holmes (2005) conducted a study for partner management to find out the effectiveness of expediting treatment of partners with STD by establishing the identity of the sexual partners of the patients and inviting partners for free screening and medication. The study found out that many individuals who were advised to undergo tests for STD were reluctant to avail of clinical services despite free service and follow ups. Culture played as one of the factors hindering individuals from showing up and availing of free services. This may relate to the findings that STDs are normally treated in private clinical institutions. The CDC report recommends measures including abstinence and sticking to one partner, male latex condoms, female condoms, pre-exposure vaccinations, and emergency contraception. In contrast, experts discourage the use of topical microbidices and spermicides, rectal use of N-9 spermicides, nonbarrier contraception, surgical sterilization, and hysterectomy. Meanwhile, condoms with N-9 vaginal spermicides are said to be no more effective than lubricated condoms and may cause urinary tract infection (UTI). They are also more costly and have shorter shelf life. Male circumcision and pre-exposure prophylaxis (PrEP) may reduce the risk for HIV and some STDs but are not ultimately enough to rid of STDs. Likewise, cervical diaphragms may protect against Chlamydia, trichomoniasis, and cervical gonorrhea but not against other STDs. Postexposure prophylaxis (PEP) are not advisable because they can cause UTIs. Moreover, patients should undergo retesting after several months after diagnosis of Chlamydia or gonorrhea to further promote prevention of STDs. Screening for STD is highly recommended for people at risk to prevent the spread of diseases. Pregnant women who are at the initial stage should submit to screening including HIV tests to help avoid debilitating effects of the disease on their children. At risk population of pregnant women are further recommended to undergo HIV testing on their 36th week of gestation. Furthermore, some tests like hepatitis B are required of pregnant women during the early prenatal visit to detect possible infection. Pregnant women who are tested positive of HBsAg should be placed under a case-management system and their infants should be provided appropriate and timely prophylaxis. Those who are infected with hepatitis C virus (HCV) should receive proper counseling and support; however, there is no treatment available for HCV infection at the moment. Treatments for STDs Chancroid is a sexually transmitted infection caused mainly by the bacterium haemophilus ducreyi (Stoppler and Davis, n.d.). This disease is usually present in persons infected with HIV. The symptoms of this disease include painful, open sores on the genitals, swollen tender lymph nodes in the groin, rectal bleeding, painful intercourse, or vaginal discharge. Any of these symptoms may occur but not all may be found in patients with chancroid. The CDC recommends azithromycin, ceftriaxone, ciprofloxacin, or erythromycin. Azithromycin and ceftriaxone are more preferable because they offer single-dose treatments. Meanwhile, some patients have reported resistance to either ciprofloxacin or erythromycin. After therapy, patients should be re-examined to see if ulcers are still present. If there is no improvement noted, then the diagnosis may be incorrect, and physicians should consider testing for other infections. Fitzpatrick, Tyler, and Gramstad (1981) conducted a study to treat 35 men with chancroid using oral sulfisoxazole, sulfamethoxazole-trimethoprim, sulfisoxazole and tetracycline, or intramuscular streptomycin. They found out that sulfamethoxazole-trimethoprim is as efficient as streptomycin and superior to sulfisoxazole and tetracycline in treating chancroid. Genital herpes or herpes simplex virus (HSV) are of two types, namely, HSV-1 and HSV-2. People with this kind of infection may be asymptomatic and transmit the disease without knowledge that they have it. The CDC recommends acyclovir, famciclovir, or valacyclovir as treatment for 7 to 10 days. The therapy may be extended by the physician to ensure complete healing. All patients with HSV should abstain from sexual activity when they have lesions or prodromal symptoms. As regards partner management, sex partners of patients should be advised that they may have infections and should submit as well for HSV screening. Granuloma inguinale otherwise known as donovanosis is a disease caused by the intracellular gram-negative bacterium called Klebsiella granulomatis. This disease is reported to be painless, despite “progressive ulcerative lesions without regional lymphadenopathy” (Workowski & Berman, 2010, p.21). The lesions are deep red, bleed easily during contact, and may cause other bacterial infections to develop. The CDC recommends doxycycline twice a day for at least three weeks or until the lesions are completely healed. Alternative medications could be azithromycin, ciprofloxacin, erythromycin base, or trimethoprim-sulfamethoxazole. Lymphogranuloma venereum (LGV), which is caused by C. trachomatis serovars L1, L2, or L3 is an uncommon infection of the genitals or anorectal cavity caused by a certain Chlamydia trachomatis. This disease is characterized by tender glands in the groin. Those who are infected with HIV may be suffering from rectal or anal inflammation, scarring, and diarrhea. The recommended treatments for LGV include doxycycline and erythromycin base. Syphilis or treponema pallidum is a highly infectious disease, which when passed from the mother to the fetus may cause serious damage to the brain, nerves, and body tissues. The CDC recommends penicillin G such as Benzathine penicilin, administered parenterally for all stages of syphilis. Several studies including Willcox (1981) and Alexander, Sheffield, Sanchez, Mayfield & Wendel (1999) confirm the efficacy of penicillin, with the latter study investigating on pregnant women. However, the dosage and duration of treatment depends on the stage and manifestation of the disease. There are reports that the combination of some types of penicillin may be inappropriate for the treatment of syphilis, thus physicians, pharmacists, and other medical practitioners should be aware of improper combinations of such drugs. Chlamydia or Chlamydia trachomatis is a kind of STD caused by bacteria. This disease can be passed on by a mother to a child during birth when the baby passes through the birth canal. Chlamydia should be treated properly because it can cause serious eye infections or pneumonia to the infant. However, many cases of Chlamydia are left untreated due to the absence of symptoms. The symptoms vary between men and women. Men with Chlamydia experience discharge, pain and burning during urination, and inflammation, infection, and pain in the testicles. Meanwhile, women experience pain during urination, bleeding in between menstrual periods and after sexual contact, pain in the lower abdomen, and vaginal discharge. The treatments recommended include azythromycin, doxycycline, erythromycin base, erythromycin ethylsuccinate, ofloxacin, or levofloxacin. Lau and Qureshi (2002) tested the efficacy of azythromycin and doxycycline for the treatment of Chlamydia, and found equal efficacy results. Meanwhile, Augenbraun, Bachmann, Duboucher, Wallace, McCormack & Hook (1998) found that non-completion of treatment for C. trachomatis prolonged the disease and developed the resistance of T. vaginalis to metronidazole Gonorrhea or Neisseria gonorrhea is the second most common bacterial STD. Gonorrhea can be either symptomatic or asymptomatic, and can result in tubal scarring which in turn leads to infertility or ectopic pregnancy (Workowski & Berman, 2010). Women who are over 25 years of age are more prone to gonorrhea, thus those at risk should be screened especially in pregnancy cases. Like Chlamydia, gonorrhea may be transmitted by a mother to the newborn through vaginal birth. The recommended treatments for gonorrhea include ceftriaxone, cefixime, ciprofloxacin, ofloxacin, or levofloxacin. Freedman (cited in Morisset, 1986, p.103) investigated the efficacy and tolerability of Miraxid in the management of acute gonorrhea. According to Freedman, miraxid is “a fixed combination of two β-lactam antibiotics, pivampicillin, and pivmecillinam in a ratio of 5:4” (p.103). The treatment yielded positive results, with 93% patient recovery after 7 days. Genital warts or venereal warts are flesh or gray-colored warts caused by human papillomavirus virus (HPV) that grows in the genital or anal area (Stoppler and Davis, n.d.). Genital warts are highly contagious and easily contracted. The CDC recommends Podofilox or Imiquimod 5% cream, which are both patient-administered and either cryotherapy with liquid nitrogen or Podophyllin resin, which are physician-administered. Some genital warts resolve on their own, while others can be easily cured when treated. Still, others take time to disappear while some do not disappear at all. There are warts that appear around the anus, which can be treated with Cryotherapy with liquid nitrogen. AIDS/HIV (acquired immunodeficiency syndrome/human immunodeficiency virus) has been identified as a life-threatening infection that can be transmitted sexually or congenitally. When HIV gets into a person’s body, it continually destroys the body’s cells, thus deteriorating the body’s immune system. Eventually, as the virus keeps on attacking the cells, the person experiences complications such as developing other infections as previously mentioned and certain cancers. Currently, there is no therapy for AIDS (Stoppler & Davis, n.d.) but there are drugs found to reduce HIV-related complications and to prolong life. The CDC emphasizes counseling of AIDS/HIV patients for proper management and care. Overall, there are STDs that can be treated with medications; however, many people suffering from the diseases are either unaware of their symptoms or are reluctant to undergo testing due to cultural resistance. It is important to note that the key to recovery from these diseases is early diagnosis, thus people should likewise be aware of the symptoms of STD and should be willing to undergo treatment and follow-ups with a medical practitioner. A number of studies have been conducted to assess people’s knowledge and awareness of STDs. Zeeb, Spallek & Zeeb (2011) report a number of studies identifying the common thinking especially among university students that the use of condoms is limited to contraception. This implies a problem related to the prevention of STDs. Nevertheless, DiClemente, Wingood, and Harrington (2004) found that small-scale studies that are gender-tailored and culturally supportive educational interventions are effective means to prevent the spread of STD. Conclusion To date, the literature on the treatment of STDs has been adequate to allow the CDC to establish recommendations for practitioners and patients. However, as discussed in this paper, there are still some studies that offer better treatments, which the CDC may have overlooked. Therefore, periodic review and revision of the CDC report is necessary to update practitioners not just in the US but around the world on the best treatments for STDs. Furthermore, a great deal of research is still necessary to find out the cure for AIDS/HIV. Researchers should then collaborate to conduct extensive studies regarding the disease. Best of all, prevention strategies relating to STD should be expanded especially for the adolescent population to dramatically decrease the rate of STD in the coming years. References Alexander, J., Sheffield, J., Sanchez, P., Mayfield, J. & Wendel, G. (1999). Efficacy of treatment for syphilis in pregnancy. Obstetrics and Gynecology, 93, 5-8. Augenbraun, M., Bachmann, L., Wallace, T., Duboucher, L., McCormack, W. & Hook, E.W. III. (1998). Compliance with doxycycline therapy in sexually transmitted diseases clinics. Sex Trans Dis, 25, 1-4. DiClemente, R.J., Wingood, G.M. & Harrington, K.F. (2004). Efficacy of an HIV prevention intervention for African American adolescent girls: A randomized controlled trial. JAMA, 292, 171-179. Fitzpatrick, J. Tyler, H. & Gramstad, D. (1981). Comparison of sulfamethoxazole-trimethoprim with recommended therapies. JAMA, 246, 1804-1805. Freedman, D. (1986). Treatment of gonorrhea with pivampicillin and pivmecillinam (miraxid). In R. Morisset. 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