Combating sexuallt transmitted infections (STIs)

(Editor's Note: Sexually transmitted infections (STIs) remain a major health concern within the Bahamian population. Everyone that engages in sexual activities is at risk for contracting (a) sexually transmitted infection(s). Some persons are at greater risk than others. Tune in to Joining Hands for Health, this Wednesday evening at 7:30 p.m. on Radio Bahamas ZNS 1540 and 810 A.M as Mrs. Sherry Armbrister Nursing Officer I (coordinator of STI Services with the Department of Public Health) join (host) Mrs. Audrey Lightbourn in discussion on The Prevention and Management of STIs.)

WHAT ARE STIs?

Sexually Transmitted Infections (STIs) are infections that spread from person to person during sexual intercourse or intimate sexual contact – whether by vaginal, anal or oral route.

SOME COMMON STIs SEEN, SCREENED AND TREATED IN THE BAHAMAS

Some STIs commonly seen in the Bahamian population include:

v GONORRHEA – infection in the internal sex organs of both males and females caused by a bacterium called Neisseira gonorrhea. It may also occur in the anus, throat or eyes.

v HIV – an infection caused by the virus called Human Immunodeficiency Virus (HIV) which may lead to Acquired Immune Deficiency Syndrome (AIDS)

v CHLAMYDIA – infection in the male and female sex organs caused by the bacteria Chlamydia trachomatis,

v GENITAL HERPES – sores on the female (internal and external) and male (external) sex organ(s) caused by a virus called herpes simples virus (HSV),

v GENITAL WARTS – infection caused by the virus called Human Papillomavirus (HPV) that occurs in the vagina or on the cervix (opening of the womb) of females, on the penis or urethra(passage in the penis through which urine passes) or sometime on the scrotum (balls) or groin of males. It may also occur in or around the anus, or more rarely on the lips or in the mouth,

v HEPATITIS B – infection of the liver caused by the Virus called Hepatitis B Virus,

v SYPHILIS – an infection caused by the bacterium Treponema pallidum, which causes painless sores on the penis in the vagina or in the rectum or throat that may take as long a three (3) months after the infection to develop, and may be undetected.

v TRICHOMONAS – an infection by the protozoan parasite called Trichomonas vaginalis, which normally lives in the vagina in females and urethra in males.

v PUBIC/CRAB LICE – an infestation by lice (tiny crab-like insects) called Phthirus pubis

v SCABIES – infestation by mites (tiny parasites) called Sarcoptes scabies

Pubic/Crab Lice and Scabies are not as familiar as the others listed but they are among the STIs that are seen, screened and treated by the STI team.

CAN STIs BE CURED?

Treatment is available in The Bahamas for all of the STIs listed above. However, not all STIs are curable. Some STIs that are curable. These include Chlamydia and gonorrhea. Viral infections like herpes, genital warts, HIV, and Hepatitis B) are not curable (presently). However, symptomatic/ and supportive therapies are available that helps infected individuals to lead a relatively symptom free life. These persons still carrying the virus are can spread to others if they fail to practice safer sex by using a condom with each encounter.

WHO IS AFFECTED BY STIs?

Two thirds (2/3) of all STIs occur in persons under the age of 25 years old.

Recent statistic showed that 68 per cent of all persons in The Bahamas treated for Chlamydia were under the age of 25 years. Noteworthy was the trend that one in four (1:4) females seen and treated at the Adolescent Health Centre for STIs had Chlamydia.

WHO IS AT RISK FOR STIs?

Anyone can be affected by STIs. Certain types of STIs (Chlamydia, Hepatitis B and HIV) have no associated signs or symptoms in the early stage. Therefore infected persons are not aware that they have the infection and are infecting others. However, there are persons who are at greater risk for contracting STIs than others. These include:

v Sex Vendors (prostitutes)

v Promiscuous individuals (persons with more than one sexual partner, or engage in random (unprotected) sexual encounters)

v Users and abusers of drugs, alcohol, and other substances.

WHAT ARE SOME OF THE SYMPTOMS OF STIs?

It is important to note that many STIs (HIV, herpes, Chlamydia among others) have no signs and can be transmitted to others unknowingly.

Some of the signs and symptoms that would suggest that someone has a STI vary from disease to disease and may include one ore more of the following:

FEMALES

v Unusual vaginal discharge or odor:

v Itching, burning when passing urine,

v Abnormal or heavy vaginal bleeding during and after the period

v Bleeding after intercourse:

v Lower abdominal pain, and

v Blister or sores on the genitals or surrounding areas.

MALES

v Yellow or white discharge (drip) from the penis or stained underwear,

v Burning or pain when passing urine,

v Passing urine more often,

v Pain and swelling in the testes,

v Pain on passing urine.

WHAT SHOULD A PERSON DO IF HE /SHE SUSPECT THAT THEIR PARTNER HAS AN STI?

If you suspect that you or someone you know have a STI:

v Go to a health care provider immediately for testing and treatment.

v Ask whether your partner needs to be examined and treated, in order to avoid re-infection

v Inform all recent sex partners of the possibility of them being infected and encourage them to have themselves examined/screened by a health care provider for the infection.

v Take all medication as prescribed.

v Keep all follow up appointments for retesting, and monitoring the progress and effectiveness of treatment.

IS THERE A LINK BETWEEN STIs AND HIV?

YES! Persons infected with STIs are two to five (2-5) times more likely (than uninfected persons) to acquire HIV - if exposed to the HIV (virus) through sexual contact. If an HIV infected person has another STI, they are more likely to transmit the virus during sexual contact than other HIV infected persons who do not have another STI.

HOW CAN ONE PROTECT HIM/HER SELF FROM STI'S?

EVERYONE who has ever been, or will ever be sexually active is at risk for contracting (a) STI(s) and MUST TAKE RESPONSIBILITY for protecting themselves against such risk.

Any unprotected sex is high-risk behavior. Any activity that puts you in contact with another person's semen, vaginal secretions, anus or blood is considered high risk. Activities include unprotected penetration of the vagina, anus, fisting, and anilingus (rimming). Oral sex is considered outer-course, but as some infections may be transmitted this way, protection is recommended.

ABSTINENCE is the only true form of protection against these infections. Since abstinence (the restriction of all sexual contact with a partner until a monogamous commitment is made, usually marriage) is confining for too many people, other methods of control must be examined.

Many people see STI prevention as a drag. Men complain that condoms don't feel good and women say that it ruins the spontaneity of the moment. But KEEP IN MIND that there's a lot more at stake than just a lost moment; using prevention can be manipulated into something erotic. With all the different types, styles and colours of barriers, prevention can be playful. It also gives couples a chance to grow more intimate through discussion and to be more creative in sex play.

If you are in a sexual relationship, whether long-term or one night, you need to communicate with your partner. If you are mature enough to share your bedroom, be mature enough to share your thoughts. Talk about the issues, your concerns and the preventions you plan on taking together. It is usually a good idea to discuss this before engaging in the act, as communication usually becomes less comprehensible as the moment heats up.

It is imperative and strongly recommended that everyone opting to engage in (a) sexual encounter(s):

i. Make safe choices when selecting a partner – pre-encounter screening for STIs and other Disease processes enhances safety.

ii. Be in a mutually monogamous relationship with an uninfected partner. That is, ONLY have sex with someone who is having sex ONLY with you.

iii. MAKE CONSISTENT AND CORRECT use of condoms – EVERY TIME.

iv. Have a yearly STI screen as part of routine physical. This especially recommended for persons under 25 years of age.

HOW AND WHERE CAN ONE ACCESS SCREENING AND TREATMENT FOR STIs?

All government health care facilities throughout the Bahamas provide investigative services and primary treatment for STIs. However, once a case is confirmed as a STI, the patient and all contacts relevant to his or her case are referred to the STI Clinic of the Department of Public Health for investigation, treatment and follow-up care.

The Clinic is located on the grounds of the Public Hospitals Authority, Princess Margaret Hospital at Farrington House. Services are offered FREE OF CHARGE - Monday to Friday from 9:00 a.m. to 3:00 p.m.

NO APPOINTMENTS ARE REQUIRED. Persons needing to the access the services provided by the clinic are to report directly to the Clinic (at Farrington House) any time during the hours of operation (see below). There is no need for persons to register anywhere other than at the clinic, unless they have opted to see a doctor in another area of the Service.

WHAT ARE THE HOURS OF OPERATION AT THE STI CLINIC?

The clinic's hours of operation are 9:00 a.m. to 300 p.m. Monday to Friday except on holidays. Registration begins each morning at 9:00 a.m.

WHAT SERVICES ARE OFFERED AT THE STI CLINIC?

The services offered at the STI Clinic (commonly known as the Comprehensive clinic) include:

v Free and Confidential screening for sexually transmitted infections,

v Initiation of treatment for STIs,

v Health education and counseling,

v Contact tracing – partners brought in for screening and treatment,

v Referral to specialist clinics, Gynae or HIV clinic

Some STIs can have long term complications such as infertility and cancer it is therefore important for persons who are sexually active, especially persons with more than one sexual partner to:

Practice safer sex by using a condom each time.

Communicate about and agree to the use of prevention methods with their partner.

Have annual screening for STIs

For additional information on the prevention and treatment of and screening for STIs contact the staff at the STI (Comprehensive) Clinic at telephone number 322-2210.