Authors: Dr Chinweuba A. U., Ezenwuba Clementina O. And Nwokolo Bridget. A.
University Of Enugu
Sexually transmitted infections (STIs) are infections that are often transferred from one person to another during sexual activity. STIs are attributed to increasing urbanization, modernization, travel, education and exposure to Western media which has led to increased sexual activity especially among young people. STIs exhibit a higher prevalence rates in developing countries. (Mayaud & McCormick, 2001).
STIs are caused by over 30 pathogens, including bacteria, viruses, protozoal agents, fungal agents and ecto-parasites. The World Health Organization (WHO) estimates that approximately 340 million incident cases of the four main curable STIs (Gonorrhoea, Chlamydia, syphilis and Trichomonas vaginalis) occur every year, with 85% in non-industrialised countries. STIs are often asymptomatic, particularly in women and diagnostic tools are usually not readily available (Mabey & Mabey, 2014).
STIs impose an enormous burden of morbidity and mortality in developing countries, both directly through their impact on reproductive and child health, and indirectly through their role in facilitating the sexual transmission of HIV infection. The high prevalence of STIs has contributed to the disproportionately high HIV incidence and prevalence in Africa. WHO (2001).
Gonorrhoea is an STI caused by the bacterium Neisseria Gonorrhoeae. The disease primarily affects individuals between 15–24 years of age and has an incubation period of 2–7 days. Gonorrhea is commonly asymptomatic, especially in women, which increases the chance of further spreading and complications. In symptomatic cases, typical clinical symptoms include purulent vaginal or urethral discharge, dysuria, and (e.g., scrotal pain) or PID (e.g., pelvic pain, dyspareunia. Gonorrhea may also cause extra genitourinary manifestations, such as proctitis and pharyngitis. Rarely, disseminated disease may occur, which typically manifests with a triad of arthritis, pustular skin lesions, and tenosynovitis. Syphilis is a systemic infection caused by treponema pallidum a spirochete bacterium that is transmitted primarily through sexual activity and vertical transmission characterized by episodes of active clinical manifestations interrupted by periods of latent infection absence of treatment, patients who acquire Treponema pallidum remains chronically infected and syphilis generally progresses in stages. Untreated syphilis in pregnant women can lead to fetal demise and devastating congenital infection for neonates born to an infected mother.
PROGRAMS TO CURB STI’s
In 2016 the World Health Assembly adopted the global strategy on Sexually Transmitted Infections (STIs) 2016 ± 2021 aiming to reduce curable STIs by 90% by 2030. The strategy therefore set as targets at 90% reduction in incidence rates of syphilis and gonorrhea from 2018 as the baseline, less than 50 cases of congenital syphilis per 100,000 live births in 80% of countries, and a sustained 90% national coverage and at least 80% in every district countries which have HPV vaccination in their national immunization program
ROLE OF STIs IN FAMILY SOCIAL LIFE.
STIs and Infertility: -
Failure to diagnose STIs at an early stage results in serious complications. The most serious health consequences of STIs other than HIV/AIDs tend to occur in women and new born children. Complications in women include cervical cancer, pelvic inflammatory disease (PID) with resultant infertility, chronic abdominal pain, ectopic pregnancy, preterm labour and related maternal mortality. Women may lose their fertility without ever realizing that they had PID. Infertility can occur when the fallopian tubes become blocked or damaged by STIs. Research revealed that of all women who are infertile due to tubal damage, no more than one – half have previously been diagnosed and treated for acute PID. The remaining half also had PID. Chlamydia and Gonorrhea are the important causes of PID and infertility. Untreated, about 10 – 15% of women with Chlamydia will develop PID. Chlamydia can cause fallopian tube infection without any symptoms.
STIs AND MARITAL DISHARMONY:
Special problems are created when a husband or a wife acquires STIs and more especially when one partner infects the other. STIs can also have severe social consequences. Women especially in developing countries may be blamed for STIs or the resulting infertility. This may lead to violence, abandonment or divorce. Most times when one of the spouses is hospitalized, the running of the family will be left in the hands of the other leading to stress. The children at the same time are also suffering the absence of their parents when hospitalized thus resulting in disharmony in the family. STIs can also result in loss of work time due to illness. It has enormous social and economic consequences. (Bruham etal (2001). For example, marital disharmony may occur when one partner develops STIs or has infertility due to STIs. The cost of drugs for treating STIs may place a heavy financial burden on families, communities and a country at large. This is in part because antimicrobial resistance of several sexually transmitted pathogens has been increasing in most parts of the world and has rendered some low cost regimen ineffective.
STIs AND DOMESTIC VIOLENCE
WHO (2013) reported that female victims of domestic violence in some regions are 1.5 times more likely to acquire HIV than women who have not experienced violence at the hands of an intimate partner. Domestic violence contributes to the spread of HIV/AIDs and other STIs in various ways. Lack of bargaining power, economic dependence and fear ostracism affect women’s ability to protect their sexual health. At the core of the problem are gender inequalities that set the stage for various factors that directly and indirectly attribute to the spread of the STIs. Piot (2013) noted that women cannot insist on fidelity, demand for condom use, or refuse sex to their partner even when they suspect or know he is already infected himself, and that they often lack economic power to remove themselves from relationships that carry major risk of HIV. Piot further explained that women who are unable to negotiate contraceptive use may attempt to use contraceptive covertly thus putting themselves in further damage if their husbands should discover their contraceptive use.
CONTRIBUTIONS OF STIs TO DIVORCE:
Special problems are created when a husband or a wife acquires STIs and more especially when one partner infects the other. Women especially in developing countries may be blamed for STIs or the resulting infertility. This may lead to violence, abandonment or divorce.
In fact it does not take a great imagination to understand the additional immeasurable devastation that one would experience when he or she is informed that he or she has been infected with STIs by an unfaithful spouse. Many women have had a surprise gift from their spouses who infect them with STIs after a prolonged business trip or job transfer that separated them from their families and on several occasions leads to divorce. Some husbands have divorced their wives because of STIs they contracted through rapes or sexual abuses from their bosses in offices. Law suits involving transmission of venereal diseases are considered a form of personal injury claim and may be based on the concepts of battery, fraud or negligence. In addition, some courts have held that because the relationship between a husband and a wife is a special confidential relationship. The marital relationship imposes a duty upon the infected spouse to disclose his or her disease to the other. In addition, a number of states make it a crime if you do not inform anyone with whom you are having sex with that you have a STIs. According to Blackard (2015), If your spouse has knowingly transmitted STIs to you and you would like to file for divorce based on the fact, you may file for divorce on the grounds of cruelty and adultery. Blackard further explained that having intercourse with your spouse without telling him or her that you have STIs may be considered cruelty in Texas
HEALTH EFFECT OF STIs ON PREGNANT WOMEN AND INFANTS:
STIs are associated with multiple acute complications for pregnant women and infants. Pregnant women with STIs may transmit the infection to the fetus, new born or infants through the placenta, during passage through the birth canal, or after birth as a result of breast –feeding or close direct contact. Common STIs that have been shown to cause adverse health effects among pregnant women and their infants include; Chlamydia, Gonorrhoea, Syphilis, cytomegalovirus, genital hepes and HIV etc. Active STIs during pregnancy may cause abortion, still births, premature rupture of membrane and preterm delivery.
In infants, sexually transmitted pathogens that have serious consequences among adults tend to cause more severe potentially life-threatening health conditions in the fetus or new born, whose immune system is immature. Damage to the brain , spinal cord and the organs of special senses (especially the eyes and auditory nerves) are of particular concern with many STIs. in the fetus or infants, Some infections with CNS can result to growth retardation. Complications in the new born include congenital syphilis, gonococcal infection of the conjunctiva – a potentially blinding condition, Chlamydia pneumonia and perinatal hepatitis B infection, premature delivery, low birth weight, growth retardation. Urethral stricture and infertility are complications that could occur in men who are not treated early. Majority of the complications of STIs are preventable if the patient is diagnosed and treated early. (Westrom etal (2012).
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