SEXUALLY TRANSMITTED DISEASE

(STD) any disease (such as syphilis, gonorrhea, AIDS, or a genital form of herpes simplex) that is usually or often transmitted from person to person by direct sexual contact. It may also be transmitted from a mother to her child before or at birth or, less frequently, may be passed from person to person in nonsexual contact (such as in kissing, in tainted blood transfusions, or in the use of unsanitized hypodermic syringes). Sexually transmitted diseases usually affect initially the genitals, the reproductive tract, the urinary tract, the oral cavity, the anus, or the rectum but may mature in the body to attack various organs and systems. Tertiary syphilis, or paresis, for example, may affect skin, bones, the central nervous system, the heart, the liver, or other organs. Persons infected by an AIDS virus may remain outwardly healthy for years before the disease takes hold within the immune system (or, often, the disease may never arise at all). The term venereal disease (VD), denoting any disease transmitted by sexual intercourse, lost favour in the late 20th century and was largely supplanted by the more comprehensive term sexually transmitted disease. Sexually transmitted diseases have a long history. The best known of these diseases, syphilis (q.v.), is caused by the bacterium Treponema pallidum. Syphilis was first widely reported by European writers in the 16th century, and some medical historians assume that it was imported into Europe by explorers returning from the New World. Other authorities believe that syphilis is of ancient origin and may at one time have been mistakenly identified as leprosy. At any rate, syphilis first became widely recognized and reported about the year 1500, when a virtual epidemic swept Europe. Urethritis is the infection and inflammation of the urethra (the passage that transmits urine from the bladder to the exterior of the body). Most cases of urethritis are in fact sexually transmitted. Urethritis that is caused by the gonococcus bacterium (Neisseria gonorrhoeae) is called gonorrhea (q.v.) and is one of the best-known sexually transmitted diseases. Gonorrhea was named by the Greek physician Galen and is thought to have been known to the ancient Chinese and Egyptians. Syphilis and gonorrhea were long thought to be one disease. Real progress in characterizing them did not occur until the early 20th century, when their different causative microorganisms were identified and reliable diagnostic tests were developed. Effective treatment in the form of sulfa drugs and penicillin was introduced in the 1930s and '40s, and the eradication of such diseases seemed imminent. By the end of the 1950s, however, the frequency index had begun to rise again; among the many reasons cited were the tapering off of active anti-VD campaigns, the causative microorganisms' growing immunity to the antibiotics used in treatment, and a variety of sociological factors influencing sexual behaviour. The widespread acceptance of oral contraceptives and their supplantation of other methods of birth control were possibly linked, for a variety of reasons, to the spread of sexually transmitted diseases. Not only had the lack of oral contraceptives tended to discourage sexual promiscuity but also the older methods of condom and diaphragm had provided some protection against disease. Only with the outbreak of the AIDS epidemic did a return to the condom and safe sex receive new encouragement. A disease that became especially widespread beginning in the 1960s and '70s was genital herpes (see herpes simplex). Herpes infections are significant not only in terms of the discomfort they cause but also for the potentially serious illness that might occur in infants born to mothers with genital herpes infections. A variety of treatments have been used for genital herpes, but none have been entirely satisfactory. The sexually transmitted disease that caused perhaps the greatest alarm in the late 20th century was acquired immune deficiency syndrome, or AIDS (q.v.). From the time of its first clear identification in 1981, AIDS spread rapidly, with reported cases rising at a high rate, especially among homosexuals and intravenous drug users in the United States and western Europe and among heterosexuals in tropical Africa. The high mortality rate from AIDS and the absence of a cure or vaccine against the disease had a sobering effect on sexually permissive societies. Promiscuity tended to be more widely discouraged, and the adoption of practices presumed to constitute safe sex (or, rather, safer sex)such as the use of condoms or avoiding anal intercoursetended to be encouraged. Nearly a score of other sexually transmitted diseases are known. All have reasonably effective drug cures. About half of all cases of urethritis that are not gonorrhea are chlamydia (q.v.), which is caused by an infection with Chlamydia trachomatis. The latter bacterium is also the infecting agent in pelvic inflammatory disease (q.v.) and in still another sexually transmitted disease, lymphogranuloma venereum (q.v.). The cause for the remaining 50 percent of nongonococcal urethral infections is not known; no organism has been definitely related. Trichomoniasis is an infection of the urogenital tract caused by a protozoan, Trichomonas vaginalis; males usually have no symptoms with this infection, and only a portion of infected females have a vaginal discharge. Candidiasis (yeast infection) is caused by Candida albicans (sometimes called Monilia albicans), which produces in women a thick, whitish vaginal discharge and causes irritation and itching in the genital area. Males may have irritation of the glans or skin of the penis. Because this yeast is ubiquitous in the environment, these infections are not always sexually acquired. Warts occurring in the genital areas are caused by certain types of papilloma viruses, and these types of warts can be transmitted to other people by sexual contact. Most often, genital warts are nothing more than a nuisance, but occasionally they can become so numerous or so large as to interfere with urination, bowel movements, or vaginal delivery. There is also mounting evidence that papilloma viral infections of the genital tract are a factor in the development of cancer of the cervix and possibly of the genitals themselves. Chancroid, granuloma inguinale, and lymphogranuloma venereum are three diseases that have their highest incidence in the tropics. Chancroid, also called soft chancre, is caused by the bacterium Haemophilus ducreyi and resembles in appearance the primary chancre of syphilis. Granuloma inguinale is thought to be caused by a bacterium, Calymmatobacterium (Donovania) granulomatis; the lesion begins as a small sore but may spread to involve large areas, usually in the genital region, in a destructive, ulcerating lesion. Lymphogranuloma venereum is caused by Chlamydia trachomatis and begins with a frequently unnoticed bump on the genitals. Later, lymph glands in the groin enlarge and may proceed to rupture and drain purulent material. Swelling of the genitals may develop much later. All of the aforementioned diseases are spread primarily by sexual contact, but there are other diseases that are transmitted sexually only in a minority of cases. Chief among such diseases are cytomegalovirus, a viral infection that is ubiquitous in humans and is spread by various means, including sex, and the hepatitis B virus, which is spread primarily through intravenous injections and blood transfusions but which can also be transmitted sexually. Finally, a common infestation is pediculosis pubis. The crab louse, Phthirus pubis, infests the hair of the pubic region, where louse eggs, or nits, are attached to the hairs. After about one week the larvae hatch, and in about two weeks they develop into mature crab lice. The lice attach themselves to the base of the hair and feed on the blood of the host. Persons become aware of the infection because they see the lice or the eggs or because intense itching develops after two or three weeks.