Test Complete

  • Questions
  • Score
  • Minutes
Overall Results
Total Questions
Category Results

Category: Special Populations

Topic: Gynecology

Level: EMT

Next Unit: Vaginal Bleeding

20 minute read

Sexually Transmitted Diseases (STDs), also called STIs (Sexually Transmitted Infections--same thing), are diseases that are transmitted sexually. Below are the ones most often encountered, although there are many others that are rare (tuberculosis) or innocuous (Molluscum, etc.)

One cannot get an STD from a toilet seat (unless that is the unromantic place one chooses to have sex), but it is possible to contract some with skin-to-skin contact without actual intercourse. Hot tubs theoretically may put a woman at risk for bacterial vaginosis or trichomonas, but this has been hard to prove.


The Rogues Gallery of STDs

HERPES SIMPLEX: This is the herpes simplex virus (HSV), which is very contagious. Although the skin lesions come and go, the virus never actually goes away, continuing to reside in the dorsal root ganglion of the nerves at the spine.

The initial infection can cause fever and painfully swollen lymph glands in the pelvic area, conditions severe enough to warrant admission to a hospital for pain management. The lesions are exquisitely tender to the touch, making even wearing clothes painfully prohibitive.

Later--and repeatedly--whatever area of the skin is innervated by this nerve will be where eruptions of very painful blisters will occur. It cannot be cured, but episodes of eruptions can be made less frequent, and the severity lessened by treatment with antivirals such as acyclovir and valacyclovir. Aside from the misery and stigma herpes infections cause, it is harmless unless passed on to an infant at delivery, which can be life-threatening to the newborn (prevented via C-section).

Some persons are diagnosed with herpes simplex with an initial lesion, but it never returns. These more likely are NOT herpes (although the lesion can look identical) but aphthous ulcers--an autoimmune lesion; differentiation is accurate via a herpes culture, which will be either positive or negative.

HPV: Human Papillomavirus causes cervical cancer and genital warts, depending on which type one contracts--usually by direct skin-to-skin contact and intercourse. There is now a vaccine available for adolescents to prevent it.

BACTERIAL VAGINOSIS: This can develop independently, without sexual contact, but it can be acquired by intercourse, too. Most cases have no symptoms, diagnosed incidentally during a routine GYN visit. Treatment is with antibiotics or antibiotic vaginal cream. When symptomatic, a vaginal discharge is noted.

TRICHOMONIASIS: Infection with a protozoan, trichomonas, can lead to preterm labor in pregnancy, and vaginal discharge, spotting, and pain in non-pregnant women. Treatment is with antibiotics.

CHLAMYDIA: This is a bacterium that infects men and women, sometimes without any symptoms at all. This silence can be very disturbing when it results in a surprising case of infertility years later in a woman. Symptoms of it can include pain, burning with urination, painful intercourse, and fever. It is diagnosed with a culture and treated with antibiotics. Untreated, it can cause adhesions in the female reproductive tract that can cause ectopic pregnancy or infertility.

GONORRHEA: this is almost always symptomatic with a purulent discharge from the vagina or penis and severe dysuria (pain with urination). In the woman, it can rise into the pelvis to involve the uterus (endometritis), fallopian tubes (salpingitis), and ovaries--tubo-ovarian abscess. In both men and women, it can infect the throat (gonococcal pharyngitis) and the joints (gonococcal arthritis). 

Untreated, it can lead to life-threatening sepsis or burn itself out, leaving adhesions that cause ectopic pregnancy or infertility. Other adhesions can be at the liver, with fibrous strands from the liver to the peritoneum, to an adjacent liver lobe, or to the diaphragm, called "perihepatic adhesions," or Fitz-Hugh-Curtis Syndrome.

SYPHILIS: Also called "Lues," it comes in three waves of presentation.

  1. Primary Syphilis. The first presentation is a painless ulceration at the site of contact with an infected person, usually on the vulva in the woman or the penis or scrotum of a man. This ulcer goes away spontaneously.
  2. Secondary Syphilis. After the initial lesion resolves, all can remain quiet until a rash develops--typically on the palms of the hands and soles of the feet, although it can also occur elsewhere. This rash, like the initial painless lesion of primary syphilis, goes away spontaneously. At this point, Tertiary Syphilis begins.
  3. Tertiary Syphilis. This is central nervous system involvement, leading eventually to
  • ataxia (uncoordinated movements),
  • delirium, and
  • death.

All three phases can be treated with antibiotics, more intensely used the further into the stages one is.

It is diagnosed with a test called a VDRL, which can be a false positive, so when it is positive, it can be verified with a special antibody test--fluorescent treponemal antibody absorption (FTA-ABS), which is definitive.

HIV/AIDS: The Human Immunodeficiency Virus (HIV) is the cause of Acquired Immune Deficiency Syndrome (AIDS). Although once an inescapable death sentence, the virus can be treated and often kept in check at the HIV stage, followed by a count called the "viral load." It is still deadly to some, and no one has any certainty that the current treatments will work on them.

Patients with AIDS will present with cancers since the immune system keeps cancer at bay; they can also present with other abnormalities, such as bleeding disorders (and hemorrhage) and pneumonia.

HEPATITIS: With all of the intense fear and sensationalism in the media about HIV and AIDS, Hepatitis B and C are usually not on the minds of those engaging in casual intercourse. There is a continuum from mild involvement of the liver all the way to hepatic failure and death. Also, hepatitis can lead to liver cancer. Jaundice in the absence of alcoholism can occur.

ECTOPIC PREGNANCY: Many consider ectopic pregnancy an STD since the most common cause of ectopic (tubal) pregnancy is an STD, with both gonorrhea and chlamydia being the most frequent offenders. In general, women are vulnerable to fertility problems arising from STDs and, even when pregnant, are susceptible to complications such as ectopic pregnancy.

PID: Pelvic Inflammatory Disease. Many feel the phrase "Pelvic Inflammatory Disease," or "PID," is an obsolete term since it originally was meant to refer to generally infected pelvic organs from any STD. Gonorrhea, chlamydia, and even tuberculosis can present in ways to satisfy this term. Although E. coli infections can cause it, it is most often due to STDs (STIs). It is associated with generalized pelvic pain, tenderness, purulent vaginal discharge, and/or fever. Exposure of the internal pelvis to infection and purulent (pus) exudate creates a dramatic level of inflammation. 

According to the criteria of pelvic pain and infected reproductive organs, even appendicitis can present as PID, especially if there is a limited rupture of the appendix that adheres to the right ovarian area.

"PID Shuffle": Moving in short, shuffling steps is one of the main symptoms of PID.

"Cervical Motion Tenderness"Patients with PID generally have pain during intercourse. The pain is usually prohibitive--intercourse is not even possible due to the pain. This is because of one of the signs of PID, "cervical motion tenderness." Although this is a sign elicited from a pelvic exam by a physician, it can happen via the penetration of intercourse. The cervix provides a mechanically connected communication between the back of the vagina and the pelvic structures. If these pelvic structures are infected and inflamed, as they are in PID, the cervical motion will jostle these sensitive organs and be exquisitely painful. Intercourse, with penetration, is one way that the cervix can encounter such mechanical manipulation.  

The term still suffices in the field, and you will hear it, but in gynecology texts, it has been replaced with more specific conditions, such as endometritis, salpingitis, etc.