Every day in the world there are more than a million sexually transmitted infections (STIs), a figure that rises every year, also in Spain. All of them are infected, as their name indicates, sexually, but some of them, those in which the condom is not infallible, are spread even more easily. Also, when we already have an STI, even if it is asymptomatic, it is easier to catch others. Avoiding risk behaviors and early diagnosis of STIs would help reduce the number of infections, as Dr. Yuliya Poliakova, is the Technical Director of Microbiology at SYNLAB in Spain, tells us.
What are the most frequent STIs
The most common treatable sexually transmitted infections are clamidia, gonorrhea (gonorrhea), syphilis and trichomoniasis, which cause, according to WHO data, some 374 million infections a year. They are also the most common and the ones that have increased the most in Spain, “according to the report on Epidemiological Surveillance of sexually transmitted infections in Spain, a continuous increase in cases has been observed in recent years. Thus, in the period between 2013 and 2019, the number of reported gonorrhea cases has increased from 3,315 to 12,359, syphilis from 3,723 to 5,822, and chlamydia from 7,236 in 2016 to 17,718 in 2019”, alerts Dr. Poliakova.
The human papillomavirus deserves special mention, which is the most frequent STI, since it is estimated that between 70 – 80% of the sexually active population can be infected by some type of HPV. The difference with others is that in most cases they do not develop the disease, although they can spread it. In addition, also unlike the former, it cannot be cured, as is also the case with hepatitis B, the herpes simplex virus (HSV or herpes) and HIV.
Why are some STIs spread more than others?
Whether or not we get infected with an STI has to do above all with risk behaviors, but other factors also play a role, as Poliakova explains, “the load of microorganisms, the stage of the disease, type and duration of contact, the immune status of the person , presence of other STDs, use of the prevention method, etc. Therefore, the individual risk of contracting an STD can vary widely. Risk behaviors aside, there are STDs that, having another source of contagion, in addition to sexual, are transmitted more easily. These are, for example, “the hepatitis Cin which the sexual route is less frequent than parenteral hepatitis (hepatitis caused by transfusions, drugs, etc.), but its relevance may increase in people with HIV or in the case of certain risky sexual practices”, he clarifies.
In addition, there are infections in which the main route of transmission is sexual, but for which the use of condoms does not protect 100%. It is the case of:
•Human Papilloma Virus (HPV). Most commonly it is transmitted through penetrative genital contact. However, since the lesions that it can cause, warts, can exist in other parts of the body where the condom does not cover, such as the groin or perineum, if the genital fluids of an infected person touch the skin of another, this too you can get it.
•Sífilis. Something similar happens with syphilis, because sometimes the sores that cause the disease and also do not produce symptoms, are outside the area covered by the condom.
•Herpes genital. Apart from sexual intercourse, the genital herpes virus can be transmitted from cutaneous-mucosal lesions and through secretions in which the virus is present. In addition, this virus can cause sores outside the genital area, such as the buttocks and anus, areas that the condom does not protect.
•Molusco genital (VMC). This STD is also spread by skin-to-skin contact, so the condom, although it prevents a large part of the infections because the sexual route is its main route, does not protect if the skin-to-skin contact goes beyond the genital area and there are injuries outside this area, such as faces, armpits, arms or neck.
In addition, protection must not be neglected when having oral sex, as it is an important route of transmission for some diseases, such as gonorrhea, chlamydia, syphilis, herpes and the Human Papilloma Virus.
Easier if we are already infected with another STI
Already having an STI predisposes us to infecting others more easily, as Dr. Yuliya Poliakova explains, “the risk of simultaneously or later contracting a new infection is high. First, the risk is related to the risk behavior. In other words, if a person contracts an STD, he surely engages in unprotected sexual practices, and it is the main risk factor for contracting other STDs. Secondly, the inflammatory changes at the genital level that produce STDs (for example, gonococcus or chlamydia) can favor the spread of other infections, such as HIV”. For this reason, it is recommended to carry out screenings that detect several STIs at the same time, “there are multiplex panels that simultaneously detect several microorganisms that can cause infection. National and international guidelines recommend ruling out HIV infection and syphilis in all patients diagnosed with STDs such as gonorrhea, chlamydia, etc. Screening for hepatitis A, B and C in men who have sex with men is also recommended. SYNLAB, for example, has 2 panels, a basic one in which we detect chlamydia, gonorrhea, Mycoplasma genitalium and trichomoniasis, and a more complete one in which, to the previous panel, we add Mycoplasma hominis, Ureaplasma, Hepatitis B, Hepatitis C, Syphilis and HIV”.
The importance of early detection
Prevention is the best way to avoid the increase in sexually transmitted infections, and this is achieved with the use of condoms and with the available vaccines, but it is also very important to early detection. As many of them are asymptomatic or do not show their faces until weeks or months have passed, many people infect others without knowing it, “for those people who have a sex life Activa recommend regular check-ups, as well as if a risky sexual relationship is suspected or those people who want to know their current sexual health status and take preventive action against the spread of STDs. In order to carry out this early detection correctly, we have to take into account what is called the ‘window period‘, which is “the minimum number of days that must elapse between the moment in which you have been exposed to a possible risk contact and the moment in which the infection can be detected. Respecting this deadline allows early detection of most of the infections included in the different panels”.
If we do not respect this period, that is, if we do not wait the necessary days, this may lead to false negatives. This period varies from test to test and from infection to infection. Thus, for example, as Yuliya Poliakova tells us “the window period for the basic SYNLAB panel (chlamydia, gonorrhea, Mycoplasma genitalium and trichomoniasis) is 10 days and for the complete panel (chlamydia, gonorrhea, Mycoplasma genitalium and trichomoniasis, Mycoplasma hominis, Ureaplasma, Hepatitis B, Hepatitis C, Syphilis and HIV) is 21 days”. Thus, if we suspect that we have been infected with an STI on a specific day, it is important to wait these days and not have sexual relations until we can confirm whether or not we are infected.