It really is a new epidemic that’s going on right now. I’ve diagnosed more cases of chlamydia in the last couple of years than probably the ten years before that.
Chlamydia is a virus that infects the cells of the cervix. It’s sexually transmitted. It can happen through oral, vaginal or rectal sexual intercourse. It can range from minor infections that are easily treated with antibiotics to major infections which require hospitalization and can affect future health.
The symptoms vary. There could be no symptoms at all. That’s why it’s important to get screened. We now screen all young women at every annual exam. We screen everybody at their first prenatal visit because it’s very important to catch it and treat it as early as possible.
The most common symptoms are a vaginal discharge and pain, especially with intercourse. In severe cases, it can cause severe abdominal pain. It can cause an infection that requires hospitalization with fever, chills, even rigid abdomen.
Men can get chlamydia. Men typically have less symptoms and that’s why it’s often transmitted. Men may get a urethral discharge, a discharge from their penis. They may get some pain with urination but often don't have any symptoms.
Gonorrhea is another bacterial infection. This is a little bit larger bacteria. But the symptoms are remarkably similar with gonorrhea and chlamydia. They often range from no symptoms at all to minor discharge and pain. It can also cause severe infection like pelvic inflammatory disease.
You get gonorrhea through sexual contact. Any oral, anal or vaginal intercourse can transmit gonorrhea.
Syphilis is another bacterial sexually transmitted disease but it’s a little bit different in how it presents.
Syphilis actually has three phases in its presentation.
The first phase involves a very tender painful lesion in the genital tract. It can happen near the vulva, vagina or inguinal area in women, and on the penis or in the inguinal area on men. Inguinal means the groin area where your thigh is attached to your torso. That lesion will go away on its own without treatment. It’s important if you’ve had a lesion like this to go in and be tested. Catching it early on makes a big difference.
If it goes on more than four to six weeks, it can turn into secondary syphilis. Those symptoms involve a general rash over the body that can look remarkably similar to measles and diffuse flu-like symptoms. But that will get better on its own also. After that, syphilis doesn’t have any more symptoms. People could go years undiagnosed if they don’t get checked with either of the first two stages.
With the increase in moms having more syphilis and not getting treated, we’re seeing more transmission to newborn babies and it can be a disaster. Gonorrhea and chlamydia will not transfer to the baby during pregnancy. They transfer at the time of delivery and we can treat the babies at the time of delivery and prevent bad outcomes.
Unfortunately, syphilis can cross the placenta and be transferred to the baby in utero. It can affect their bones, their liver, their soft tissue, even their neurologic system and cause symptoms that range from minor to even fatal symptoms. There was a 40% increase between 2018 and 2019 in the number of babies that died shortly after birth due to congenital syphilis.
Tertiary syphilis is that third stage we talked about, going from the painful lesion to the rash to the stage where there were no more symptoms. During that stage, the bacteria is still in your body but it’s now affecting your liver. It can affect your heart. It can affect your neurologic symptoms and do long-term permanent damage.
It can have significant effects on the newborn, ranging from mild skin or bone lesions, all the way up through severe neurologic consequences, causing long-term mental disabilities, and it can even cause death in the newborns.
Both are very important especially around pregnancy. If a woman has an active genital lesion at time of delivery, the genital herpes can be transferred to the newborn causing pneumonia. Even systemic herpes infection can be lethal.
With herpes, if a woman has a lesion, when either her bag of water is broken or she is in early labor, we recommend a C-section to bypass the genital tract.
Cold sores are also transmitted to babies. Just by kissing a newborn baby while you have an active cold sore lesion or by sharing bottles or things like that, it can transmit the virus and it can have significant effects.
In addition to herpes, other viral STDs include hepatitis B and C, and HIV, which can be transmitted sexually.
Bacterial STDs, such as gonorrhea, chlamydia and syphilis, can all be cured, especially if caught early with proper antibiotic therapy. The viral STDs, we don’t have a specific cure for. But they can be treated and the chances of transmission to partners or a newborn baby can be significantly reduced.
There’s no question that these two things are correlated. The statistics just bear this out over and over again. As drug abuse goes up, so do the incidences of STDs. There are multiple reasons why this may happen, but we’ve seen, especially with injectable drugs and heroin in particular, sharing needles can certainly transmit STDs like hepatitis and HIV.
But it’s the whole culture around it. We see more unprotected intercourse. We see more prostitution, both in men and women who are involved in drugs to raise money for their habits. The lack of safe sex practices and the sharing of needles both lead to an increase in these infections.
There are some significant long-term consequences of untreated STDs. Gonorrhea and chlamydia in particular, increase the risk of pelvic inflammatory disease, a disease of the pelvic organs that can result in long-term infertility issues. Even if it doesn’t cause infertility, pregnancy after an infection with an STD can increase your risk of ectopic pregnancy or a preterm birth.
With syphilis, there are effects on the liver, on the heart and on the brain, causing dementia, causing heart failure, even causing liver failure. Blindness is also one of the side effects.
It’s all about vigilance. It starts with safe sex practices, making sure that if you have a new partner, you use condoms. Once you’ve both been screened or are in a stable relationship or deciding to have children together, then you can move away from that.
There are programs for IV drug abusers to have access to safer products if they need them.
Getting early screening, once a year at your annual exams, asking your OB/GYN to screen for STDs, those are preventive measures and the standard of care for every woman at their new OB visit.
Hopefully within the first trimester you screened for STDs. If we get these treated early in pregnancy, we can help prevent transmission into the newborn baby and help prevent a lot of the long-term problems for both the pregnancy and the baby afterwards.
With cold sores, no matter how much you want to kiss that baby, you can’t do it. We do have antiviral medications that can help shorten the time cold sores are out. Speak with your doctor about getting on one of those medications.
If you’ve got a new partner, it’s good for both of you to get in and see your individual doctors and be screened at the beginning of a relationship. Once a year at your annual exam is a perfect time, at your first new OB visit or any time you have the least suspicion. If you have a suspicion about it, get in and get tested.
With any of these diseases, we can decrease those bad outcomes. If you just get in and see us, we can get this diagnosed and taken care of for you.
Lightly edited for clarity
Watch the San Diego Health video with host Susan Taylor and Dr. Ronal Salzetti discussing why sexually transmitted diseases are on the rise and what you can do to prevent and treat STDs.