They arrived together. The two women, in their
30s, working in a private institution came because they suspected
they had contracted a sexually transmitted infection.
Why did they have such suspicions, asked the doctor
at the clinic run by the National STD/AIDS Control Programme. Yes,
they were both married and they each had a child. But both of them
were also having extra-marital relationships with two others.
Don't you feel guilty? Yes, they do, they conceded,
while one added: Den meka pattern eka, explaining this was the trend
Tested for sexually transmitted infections (STIs),
one turned out to be negative but the other positive. She had gonorrhoea.
Pleas to get her husband to come to the clinic for treatment were
futile, because she feared what the outcome would be even though
the doctor assured her that he will not indicate what the problem
"In such situations at least four people
are involved," says Dr. Shantha Hettiarachchi of the National
HIV/AIDS Prevention Project. The husband, the wife, the person one
partner is involved with and that person's spouse are all vulnerable,
some even without knowing that they are exposed to these diseases.
Those days, extra-marital affairs were "unusual"
and frowned upon by society, but these days they seem to be "usual"
and sadly accepted by society, he laments.
A sexually transmitted disease is usually contracted
through sexual intercourse and not by touching, kissing, through
insects or the use of common items such as plates and cups or even
toilet seats, he says. "You cannot get them through swimming
pools or by bathing in rivers."
The main method of transmission is through unprotected
sexual contact, MediScene learns, with other modes being mother
to child and through infected blood transfusions.
Common STIs in Sri Lanka are:
=Non Gonococcal Urethr-itis/Cervicitis
|Syphilis rash on palms and feet
Ulcers in the genital region, a discharge from
the genitals or lumps in the genital or anal region could be some
of the signs that indicate a sexually transmitted infection, says
The STIs which cause ulcers:
1) Syphilis (primary) - Caused
by a bacteria called Treponema Pallidum, an ulcer may develop within
three months of exposure. Usually the person who has contracted
the infection has a single deep, painless ulcer. There could also
be painless, lymph node enlargement in the inguinal region.
This is a curable disease. If the infection is
not treated the ulcer may heal but the patient may develop secondary
syphilis in a few months.
Syphilis (secondary) - The symptoms are a skin
rash, typically involving the palms and soles. Generalised, painless
lymph nodes enlargement. Oral lesions and lumps in the genital region
Late latent syphilis - No clinical
features. Can be detected by blood tests (VDRL & TPHA). Most
patients are detected in this stage of the disease, when taking
blood tests for some other reason such as for foreign employment,
antenatal investigations in pregnancy or voluntary testing. The
infection can be cured if detected even at this stage.
Syphilis (tertiary) - A few patients
may develop cardiovascular syphilis (involving the heart and main
blood vessels) or neurosyphilis (involving the central nervous system)
after about 20 years of exposure, without treatment.Then it could
Syphilis can be transmitted from an infected
mother to her newborn baby.
2) Genital herpes - Caused by
the virus, Herpes Simplex, the clinical features may develop within
a few days or a few weeks. There will be flu like symptoms before
the development of ulcers. The vesicles appear first and develop
into ulcers which are painful, superficial and multiple. There will
also be painful enlargement of the lymph nodes in the inguinal region.
There is treatment only to relieve the symptoms. Genital
herpes may recur during the patient's whole life-time as it is a
viral disease. When recurring, the patient will develop
only a few ulcers.
The factors which precipitate recurrences are
fever, stress, anxiety, fatigue, menstruation, infections, pregnancy
and some drugs.
The infection of a newborn baby can be prevented
if the obstetrician is aware of the mother's condition during her
STIs which cause a genital discharge.
1) Gonorrhoea - Caused by the
bacteria, Neisseria Gonorrhoeae, the clinical manifestation in males
is a continuous, yellowish urethral discharge in about two to seven
days after exposure. There will also be a burning sensation while
passing urine with frequent micturition (urination). Most females
exposed to the infection will remain symptom-less. Such asymptomatic
patients are diagnosed through a smear and culture test carried
out on a specimen of the discharge. A few female patients will have
a discoloured vaginal discharge, burning sensation while passing
urine, frequent urination and vaginal bleeding in-between menstruation.
Gonorrhoea is curable but if it is not treated,
the infection can spread to neighbouring structures of the genitourinary
tract. This may lead to infertility. This disease can be
transmitted to a newborn baby, if the mother is infected.
2) Non gonococcal urethritis/cervicitis
- Caused mainly by the bacteriae, Chlamydia trachomatis, the clinical
manifestations are a urethral/vaginal discharge, burning sensation
while passing urine, increased frequency of urination and lower
abdominal/scrotal pain. The symptoms may develop within three weeks
of exposure. This infection is treatable but if not neighbouring
structures of the genitourinary tract can be infected and could
lead to infertility. This too can be passed on from mother
3) Trichomoniasis - The parasite
Trichomonas Vaginalis causes this infection, with symptoms appearing
in females within 30 days of exposure. The clinical manifestations
are a profuse, offensive and frothy vaginal discharge, itching and
burning sensation while passing urine. This is a treatable disease.
The STIs which cause lumps:
Genital warts - Caused by the
virus, Human Papilloma, lumps in various shapes and sizes will develop
in the genital or anal region within six months of exposure. Genital
warts can be removed with topical applications or surgery. The selection
of the topical applications or type of treatment may differ according
to the site and type of the warts and the condition of the patient.
Genital warts may recur during the patient's life-time.
Genital warts and cancer of the cervix in females
are linked. Patients are likely to develop cytological changes in
the cervix, therefore, early detection through a pap smear is essential
to prevent cancer of the cervix.
Complications of STIs - There
could be systemic involvement if the infection is not treated properly
at the right time. Recurrences of the disease, mainly in infections
caused by viruses, could occur. There could also be mother-to-child
transmission especially when the mother is not treated.
STIs which can be transmitted from mother
1) Congenital syphilis -The clinical
manifestations in the baby would be a nasal discharge, nasal bleeding,
skin rash and involvement of internal organs such as the heart,
liver, spleen and bones. If the mother is diagnosed during pregnancy,
the infection of the child can be prevented. The relevant blood
tests are carried out at the antenatal clinics.
2) Gonorrhoea and Non gonococcal cervicitis
(ophthalmia neonatarum) - The newborn child will be infected
with these two conditions during delivery, if the mother is not
treated. The clinical manifestations in the baby will be a purulent
(yellowish) discharge and swelling and redness of the eye. If not
treated in time, the baby could develop visual damage.
Dealing with the gravity of STIs, Dr. Hettiarachchi
urges that safe sex is of paramount importance. "Even in case
someone is tempted to have a casual sexual encounter, then use a
However, his final advice on how to keep the danger
of sexually transmitted disease at bay, is very simple -- Be faithful
to one partner and have one faithful partner.
A fun overnight trip has turned out to
be a nightmare for an 18-year-old Advanced Level student,
for now he has to deal with a sexually transmitted disease,
which though the symptoms can be treated may recur on and
off throughout his life.
A group of youth had got permission from their parents and
gone on a holiday away from home. What their parents did not
know, when they said goodbye and gave them plenty of spending
money was that one youth brought along a girl. The group stayed
in the vacant home of a friend, without any elders. Given
the situation, the inevitable happened.
It was three weeks later that one of them discovered ulcers
on his genitals and was diagnosed with genital herpes. Several
of the youth had had a sexual encounter with the girl, says
Dr. Hettiarachchi, adding that even others may have got infected.
He urges adolescents to delay sexual relationships until
marriage and if there are any problems to discuss them with
parents and teachers while he tells youth to take the right
decision, identify limitations and avoid risky behaviour.
Today when compared to the past more young patients are
seen with STIs and the worst is that more of these are caused
by viruses for which there is no cure. "We can treat
only the symptoms," he reiterates but the virus could