Genital warts (anogenital warts)
Genital warts, otherwise known as condylomata acuminata is a skin disease caused by the human papillomavirus (HPV) which affects the external genitalia, the area between the penis/vagina and the anus, anus, vagina, cervix and the penis. This virus is responsible for the most widespread sexually transmitted disease. 75-80% of all sexually-active people encounter it within their lifetime. There are dozens of types of this virus, some of which will manifest themselves externally. Low-risk types are responsible for causing genital warts in an infected individual. The more serious form of the disease is caused by high-risk HPV is responsible for causing precancerous changes of the cervix, the skin of the external genitalia, the vagina as well as the anus. If these changes are not detected in time and treated accordingly, the infected individual can develop a malignant tumor and cancer.
Symptoms, transmission and diagnosis
Genital warts are tiny (millimeters) flat or cauliflower-shaped (multiple) skin growths of a pinkish/grayish color. Sometimes individual warts can group themselves into what appear to be several centimeter wide growths. The disease is often accompanied by itchiness, soreness, redness or pain in the affected region. The disease is most commonly transmitted via sexual intercourse and less frequently from mother-to-child during birth. Alternatively, it can be transferred by autoinoculation which refers to transmission of the disease from infected skin of the body to a non-infected region (for example from scratching the wart). The formation of warts usually occurs 3-6 months (sometimes years) following infection. Diagnosis can be made following a gynecological examination and alternatively by taking samples from the infected tissue and then undergoing a histological examination (under a microscope).
Treatment and prevention
There are many available treatment options. It can be in the form of a locally-applied cream (Imiquimod) or a solution (podophyllin, trichloroacetic acid), burning of the lesions using liquid nitrogen (cryotherapy) or through surgical removal (scraping off of the lesions with a scalpel or their removal using a laser). The selected treatment method depends on the extent and progression of the disease as well as the individual desires of the patient in question. HPV infections as well as genital warts can be avoided with widely available immunization. Optimal protection is achieved when immunization takes place prior to being sexually active.
Yet another common sexually transmitted disease is genital herpes. It is caused by the herpes simplex virus (HSV). It is estimated that 1 out of 5 sexually active people will contract the virus, while in most of them, the infection has no apparent symptoms. 8 out of 10 infected people have no knowledge of being infected. There are two known types of the herpes simplex virus. Type 1 is associated with herpes found around the face, while in some cases, for example through oral sex, it can also be transferred to the genital region as well. Type 2 is responsible almost solely for genital herpes.
Symptoms, transmission and diagnosis
Although the initial infection may occur without any symptoms, some infected individuals experience a sudden and quick outburst of many small and very painful blisters. They may also experience an increase in body temperature/fever, joint pain and muscle aches. Even after the symptoms have subsided, the virus survives in the body and a patient can experience repeated outbursts. Generally however, repeat outburst have a milder progression. Approximately 1/2 of all infected individuals experience a feeling of tension, itchiness and pain (so-called prodromes) prior to the appearance of the blisters. At this time, they can consume antiviral medication that often results in the complications subsiding very quickly, often avoiding the occurrence of the blisters themselves.
To confirm infection, it is best to visit a doctor at the point at which the blister outburst occurred. The doctor can retrieve a scrape sample and then confirm the presence of the virus at the laboratory. Blood sampling is less effective and is therefore not suitable for general testing.
Treatment and prevention
With the help of modern antiviral medication, we have a very effective and safe (even with long-term usage) method of treatment. In the case of the first infection, the treatment may last anywhere between 7 to 10 days, and with repeat outburst, 1-2 days. If the disease reappears too often, it is recommended to take long-term antiviral medication. People infected with Type 2 HSV are more prone to repeat infections and outbursts.
The greatest risk of transmission from an infected individual to a healthy individual is within the first 12 - 18 months. This is why in cases when one of the partners suffers from genital herpes and the second partner does not, it is recommended to use a condom for the first 12 months of sexual intercourse. This limits the likelihood of transmission by 50%, which is equal to that of long-term usage of antiviral medication.
Genital herpes during pregnancy
A commonly discussed question revolves around genital herpes during pregnancy because HSV can have a very negative impact on the health of a child. The highest risk of transmission from the mother to child occurs when the mother is first infected with the virus during pregnancy. If the woman already suffered from genital herpes in the past, then the likelihood of transmission during pregnancy is very small. This does not apply to cases where blister outburst occur at the time when the mother is giving birth.
Human immunodeficiency virus (HIV)
The human immunodeficiency virus has been known for over 35 years. It is responsible for causing the breakdown of the human immune system, known as AIDS. During this time, the virus has infected 76 million people around the World through sexual intercourse, blood transfusion (very rare in modern days), infected needles, mother-to-child transmission during pregnancy, during birth or through breastfeeding.
Symptoms, transmission and diagnosis
In terms of the risk of transmission through sexual intercourse, the most dangerous practice is considered to be anal intercourse. Genital Intercourse (penile-vaginal) is considered much less likely to result in contracting the disease (however, there is an increased risk of transmission from males to females). The likelihood of contracting the disease during oral intercourse is generally very small.
The disease progresses in multiple stages. Within one month in approximately 1/2 of all infected individuals develop a feverish episode accompanied by a skin rash. It can be accompanied by a swelling of the lymph nodes, headaches, throat pain, joint pain, malaise, diarrhea or sweats at night. Often, the disease resembles a much more common disease known as mononucleosis. Even without treatment, the symptoms subside and the disease enters the asymptomatic stage. This can last for several years. Even though the person may appear to have no symptoms, the virus reproduces and slowly destroys the immune system. Throughout this whole time, the person can develop pain-free swelling of the lymph nodes across the body. However this occurs in at least two places on the body (so-called persistent generalized lymphadenopathy). At the end of this stage, the person starts suffering from repeat infections, blisters, yeast infections of the oral cavity, unexplained fevers, diarrhea, night sweats and a general loss of weight. Such a state indicates the transition of the disease into the final stage, known as AIDS (Acquired immune deficiency syndrome). This is where the immune system is damaged to such an extent that it is no longer able to counter common and less common infectious diseases. At this stage, patients can also develop rare malignant tumors. Without treatment, the infected individual dies within several weeks or months.
Diagnosis and quality of life
Despite ongoing efforts and scientific progress, HIV remains to be an incurable disease. On the other hand, with the help of modern antiviral medications, the infected individual can live a long and full-fledged life without any significant health complications. However, the prerequisite for this scenario rests in timely diagnosis prior to the virus being able to severely damage the immune system. Many blood tests available to us allows for detection of the infection 4-6 weeks after being infected. To be certain however, the final verdict can be made 3 months following the suspected event. This is why it is important to not hesitate in case of doubt. Yet another important factor in the success rests in following the correct and regular prescribed medication plan, which are unfortunately accompanied by many undesired side effects. By not using them properly, the virus can become resistant and the treatment can fail.
The sad fact remains to be that despite widely-available information, the risk of HIV infection is often underestimated. Many people falsely believe that the disease is curable. It is not and likely won't be for some time to come. Although effective treatment is available and it allows for the disease to be suppressed, it does not come without risks, side effects or other limitations. Prevention therefore remains to be the best weapon in fighting this disease. In addition to practicing safe sex, using preventive antiviral medication (post-exposure HIV prophylaxis) is possible for people who have been potentially subjected to the risk of infection (for example when cut by an infected needle).