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Sexually Transmitted Diseases - National Institute
NATIONAL INSTITUTES OF HEALTH National Institute of Allergy and
Infectious Diseases
OTHER IMPORTANT STDs
As medical science has become more precise in diagnosing
different infectious diseases, the list of known sexually
transmitted diseases (STDs) has grown. The National Institute of
Allergy and Infectious Diseases (NIAID) has published separate
fact sheets on the major STDs: chlamydial infections; gonorrhea;
pelvic inflammatory disease (PID); trichomoniasis and other
vaginal infections; syphilis; genital herpes; genital warts;
AIDS; and hepatitis. NIAID has prepared this fact sheet to
provide information on some of the other diseases that can be
transmitted sexually:
chancroid
cytomegalovirus infection
enteric infections
granuloma inguinale (donovanosis)
group B streptococcal infection
molluscum contagiosum
pubic "crab"
lice
scabies
HTLV-I and II
Although some of these diseases are less well-known in the United
States than other STDs, they are still important--some are
especially significant for pregnant women. Many of these
infections are of serious concern for people in other parts of
the world, particularly in developing countries.
Chancroid
Chancroid ("shan-kroid") is an increasingly prevalent bacterial
infection caused by Haemophilus ducreyi, which is spread by
sexual contact. It is particularly common among men who have
frequent contact with prostitutes. It is also called "soft
chancre," to differentiate its primary symptom from the "hard
chancre" of syphilis. The infection begins with the appearance
of painful open sores on the genitals, sometimes accompanied by
swollen, tender lymph nodes in the groin. These symptoms occur
within a week after exposure. Symptoms in women are often less
noticeable and may be limited to painful urination or defecation,
painful intercourse, rectal bleeding, or vaginal discharge.
Chancroid lesions may be difficult to distinguish from ulcers
caused by genital herpes or syphilis. A physician must therefore
diagnose the infection by excluding other diseases with similar
symptoms. Chancroid is effectively treated with one of several
antibiotics. Chancroid is one of the genital ulcer diseases that
may be associated with an increased risk of transmission of the
human immunodeficiency virus (HIV), which causes AIDS.
Cytomegalovirus Infections
Cytomegalovirus (CMV) is a very common virus that infects
approximately one-half of all young adults in the United States.
It rarely causes serious consequences except in people with
suppressed or impaired immune systems or in infants, whose immune
systems are still developing. The virus, a member of the
herpesvirus family, is found in saliva, urine, and other body
fluids. Because it is often found in semen as well as in
cervical secretions, the virus can be spread by sexual contact;
it also can be easily spread by other forms of physical contact
such as kissing. Day-care center staff caring for children under
the age of 3 are at increased risk of CMV infection and should
carefully wash their hands after changing diapers. Like other
herpesviruses, CMV remains in the body once infection occurs.
Although the virus usually remains in an inactive state, it can
reactivate from time to time.
Symptoms. In healthy adults, CMV usually produces no symptoms of
infection. Occasionally, however, mild symptoms of swollen lymph
glands, fever, and fatigue may occur. These symptoms may be
similar to those of infectious mononucleosis.
Diagnosis. The ELISA (enzyme-linked immunosorbent assay) test is
commonly used to detect levels of antibodies (disease-fighting
components of the immune system) in the blood. A number of other
blood tests can suggest a diagnosis of CMV infection, but no
blood test can reliably diagnose it. Although CMV can be
isolated from urine or other body fluids, it may be excreted
months or years after an infection; therefore isolation of the
virus from these fluids is not a reliable method of diagnosing
active infection.
Complications. Babies can develop CMV infection before birth if
their mothers become infected with the virus or develop a
recurrence of a previous infection during pregnancy. Although
most babies infected with CMV before birth do not develop any
symptoms, CMV is this country's leading cause of congenital
infection. An estimated 6,000 babies each year develop life-
threatening complications of congenital CMV infection at birth or
suffer serious consequences later in life, including mental
retardation, blindness, deafness, or epilepsy. Investigators
supported by NIAID are currently studying how the virus
interferes with normal fetal development and at which stages the
fetus is most susceptible to infection.
When CMV is acquired after birth, or if it reactivates, it can be
life-threatening for persons with suppressed immune systems, such
as those receiving chemotherapy or persons who have received
immunosuppressant drugs for organ transplantation. Persons with
acquired immunodeficiency syndrome (AIDS) may develop severe CMV
infections, including CMV retinitis, an eye infection that can
lead to blindness.
Treatment. NIAID scientists are testing new antiviral drugs that
might be effective against CMV infections. The antiviral drugs
foscarnet and ganciclovir have been approved for treatment of
AIDS-associated CMV retinitis.
Prevention. Because of the possibility of acquiring CMV
infection during pregnancy and the risk it poses to the newborn,
pregnant women should use barrier contraceptives to reduce their
risk of acquiring the virus, particularly during the first
trimester of pregnancy. Some experts believe that primary or
first-time exposure during pregnancy is a major cause of CMV
infection in newborns. Infants infected before or just after
birth are likely to be shedding CMV in saliva and urine, which
can infect others. Scientists are working to develop a vaccine
and other methods to provide immunity to CMV and offer protection
against severe disease.
Sexually Transmitted Enteric Infections
Some infections most commonly spread through contaminated food
and water are prevalent in people who engage in anal sex or oral-
anal contact, and these infections can cause intestinal and
rectal problems.
Hepatitis A, giardiasis, amebiasis and a variety of organisms
that cause infections of the small bowel (enteritis) and colon
(colitis) are among the most common of these infections. They
can sometimes be severe and debilitating, with symptoms that may
include diarrhea, fever, abdominal cramps, rectal pain, and blood
in the stool. Gonococcal, chlamydial, and herpes simplex
infections can also cause anorectal symptoms, and a specific
diagnosis is necessary to make sure that the infection is
properly treated.
Enteric infections in people with AIDS or other immune disorder
may cause particularly severe symptoms, and these infections may
spread to other sites in the body.
Giardiasis and other parasitic diseases can be diagnosed 90
percent of the time through microscopic examination of stool
specimens. When this method fails, proctoscopic examination or
other procedures may be necessary to diagnose the condition. A
proctoscope is an instrument that allows the physician to view
the inside of the rectum.
In otherwise healthy persons, enteric infections either clear up
on their own or can be successfully treated with various
antibiotics.
Granuloma Inguinale
A chronic, progressive bacterial infection of the genitals,
granuloma inguinale is also called donovanosis or granuloma
venereum. It occurs most frequently in tropical areas of the
world and is very rare in the United States. Characterized by
one or more painless, beefy-red open sores that slowly enlarge,
it affects the genitals of both men and women. Although
granuloma inguinale is only mildly contagious, it can be spread
unknowingly in its early stages, when the symptoms are easily
overlooked.
Sores may appear within one week of infection or may take as long
as 3 months to develop. These lesions may resemble those caused
by other diseases. The diagnosis can be confirmed by microscopic
examination of cells taken from the edge of a lesion. Granuloma
inguinale can cause serious complications if left untreated, but
antibiotics such as tetracycline can eliminate the infection.
Lesions should begin to clear within 7 days of initiation of
treatment and should heal completely with 3 to 5 weeks of
therapy.
Group B Streptococcal Infections
Group B streptococci (GBS) are bacteria that are commonly found
in the genital tracts of both men and women. The risk of
infection with these organisms increases with the level of sexual
activity. Between 20 and 35 percent of otherwise healthy young
women are infected with GBS. Adults usually have no symptoms of
GBS infection.
Approximately 1 to 2 percent of infants born to women who harbor
the bacteria develop serious illness. In fact, GBS is the
leading cause of infection-related death among newborns, with
one-half of these conditions being fatal. Many infants who
survive are left with blindness, mental retardation or other
serious consequences. Two-thirds of babies affected have early-
onset GBS, which occurs within the first 5 days after birth and
may be associated with premature birth and other maternal
complications. Babies with this more severe form of GBS may
develop respiratory distress, shock, and coma. Late-onset GBS,
which occurs more than 7 days after birth, is most commonly
characterized by fever and meningitis (infection of the covering
of the brain or spinal cord).
Newborns with GBS infection are treated with antibiotics.
Transfusions of white blood cells and other immune system
components may improve the outcome for some infants with severe
GBS infection. In addition, investigators are developing
vaccines that may be effective against GBS infection. NIAID-
supported researchers are testing an experimental vaccine for
pregnant women that may prevent transmission of GBS infection to
their babies.
More information about GBS is available from the Group B Strep
Association, P. O. Box 16515, Chapel Hill, North Carolina 27516.
Molluscum Contagiosum
This common viral infection most often affects young children,
who pass it to each other through saliva. In adults, however,
the virus is transmitted sexually, resulting in lesions on the
genitals, lower abdomen, buttocks, or inner thighs. Most people
with the infection do not have noticeable symptoms, although
sometimes the lesions, which are painless wart-like bumps, may
itch or become irritated. The lesions often heal without
treatment, although physicians may sometimes scrape them off or
treat them with chemical irritants.
Pubic Lice
Pubic lice (pediculosis pubis or crab lice) are very tiny insects
that infest the pubic hair and survive by feeding on human blood.
These parasites are most often spread by sexual contact; in a few
cases, they may be picked up through contact with infested
bedding or clothing. An estimated 3 million new cases of the
infestation are treated each year in the United States.
Symptoms. The primary symptom of infestation is itching in the
pubic area. Scratching may spread the lice to other parts of the
body; thus, every effort should be made to avoid touching the
infested area, although this may be difficult.
Diagnosis. Pubic lice are easily diagnosed because they are
visible to the naked eye. They are pinhead size, oval in shape,
and grayish, but appear reddish-brown when full of blood from
their host. Nits, the tiny white eggs, are also visible and are
usually observed clinging to the base of pubic hair.
Treatment. Lotions and shampoos that will kill pubic lice are
available both over the counter and by prescription. Creams or
lotions containing lindane, a powerful pesticide, are most
frequently prescribed for the treatment of pubic lice. Pregnant
women may be advised not to use this drug, and a physician's
recommendations for use in infants and small children should be
followed carefully. Itching may persist even after the lice have
been eradicated; this is because the skin has been irritated and
requires time to heal. A soothing lotion such as calamine may
offer temporary relief.
Prevention. All persons with whom an infested individual has
come into close contact, including family and close friends as
well as sex partners, should be treated to ensure that the lice
have been eliminated. In addition, all clothing and bedding
should be dry cleaned or washed in very hot water (125oF), dried
at a high setting, and ironed to rid them of any lice. Pubic
lice die within 24 hours of being separated from the body;
however, the eggs may live up to 6 days, so it is important to
apply the treatment for the full time recommended.
Scabies
Scabies is a skin infestation with a tiny mite, Sarcoptes
scabiei. Scabies has become relatively common throughout the
general population. It is highly contagious and is spread
primarily through sexual contact, although it also is commonly
transmitted by contact with skin, infested sheets, towels, or
even furniture.
Symptoms. Scabies causes intense itching, which often becomes
worse at night. Small red bumps or lines appear on the body at
sites where the female scabies mite has burrowed into the skin to
lay her eggs. The areas most commonly affected include the hands
(especially between the fingers), wrists, elbows, lower abdomen,
and genitals. The skin reaction may not develop until a month or
more after infestation. During this time, a person may pass the
disease unknowingly to a sex partner or to another person with
whom he or she has close contact.
Diagnosis. Scabies may be confused with other skin irritations
such as poison ivy or eczema. To make an accurate diagnosis, a
doctor takes a scraping of the irritated area and examines it
under a microscope, to reveal the presence of the mite.
Treatment. As with pubic lice, lindane is an effective treatment
for scabies. Pregnant women should consult a doctor before using
this product. Nonprescription remedies such as sulfur ointment
also are available. Sulfur is fairly effective but may be
objectionable because of its odor and messiness. Itching can
persist even after the infestation has been eliminated because of
lingering skin irritation. A hydrocortisone cream or ointment or
a soothing lotion may provide relief from itching.
Prevention. Family members and sex partners of a person with
scabies are advised to undergo treatment. Twenty-four hours
after drug therapy, a person with scabies infestation is no
longer contagious to others, even though the skin irritation may
persist for some time. As with pubic lice, special care must be
taken to rid clothing and bedding of any mites.
Human T-Cell Lymphotropic Virus
The human T-cell lymphotropic viruses, HTLV-I and HTLV-II, are
uncommon in the general U.S. population. They appear to be most
prevalent among IV drug users and persons who have multiple sex
partners, genital ulcers, or a history of syphilis. The virus
can be transmitted by blood or intimate sexual contact and can be
passed from mother to child during pregnancy and through breast
milk.
Most infected persons remain healthy carriers of the virus. In
rare cases, however, HTLV-I can cause adult T-cell
leukemia/lymphoma (ATL), a rare and aggressive cancer of the
blood. Infected persons may also develop myelopathy, a
neurological disorder that affects the muscles in the legs.
HTLV-I is also thought to play a role in the development of B-
cell chronic lymphocytic leukemia. HTLV-II can cause another
rare cancer called hairy-cell leukemia. Because the chances of
curing ATL rely on early detection, scientists are studying a
protein in the blood of HTLV-I infected persons that may help
predict who will develop the disease.
Blood donations are routinely screened for HTLV-I. Because lab
tests cannot easily distinguish between HTLV-I and HTLV-II,
experts believe many cases of HTLV-II are eliminated from the
blood supply as well.
Research
Research on STDs supported and conducted by the National
Institute of Allergy and Infectious Diseases, will help in the
search for new ways to diagnose, treat, and prevent these
infections. This is important not only for the well-being of our
adult population but also for the health of future generations.
Prepared by: Office of Communications National Institute of
Allergy and Infectious Diseases Bethesda, Maryland 20892
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health
Service
August 1992
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