ADDRESSING HIV & AIDS

UNIT 5 SECTION 3 MAJOR

Unit 5, section TYPES
3: Major types OF STIs
of STIs,
STIGMA THROUGH
EDUCATION

Welcome to section 3 of unit 5. In Section 2 we examined some risky

behaviours that may lead to STI infections. We shall discuss in this section
two bacterial infections - chlamydia and syphilis and the fungal infection
candidiasis. We shall study four other STIs, namely gonorrhoea, genital
warts and hepatitis B and C.

By the end of this section, you should be able to:

 identify the pathogens that cause chlalmydia, syphilis, candidiasis,
gonorrhoea, genital warts and hepatitis B and C;
 identify the symptoms of the six major types of STIs;
 explain the importance of avoiding infection; and
 explain the need to seek early treatment when infected.

Chlamydia
Chlamydia infections are caused by a bacterium Chlamydia trachomatis
which may result in the inflammation of the urethra and epididymis in males
leading to epididymitis or the inflammation of the vagina and the cervix in
females.

Transmission
Chlamydia infections are mostly transmitted through penile-vaginal sex, but
the bacterium can also be transmitted through penile-anal intercourse. It can
also be transmitted from an infected mother to child during delivery. This
results in conjunctivitis and pneumonia in the baby.

Symptoms and impact on Health

Most often chlamydia has no symptoms or mild symptoms. Therefore, it is
referred to as a “silent” STD. Chlamydia infections in females affect the
vagina and the cervix. Females who have fewer reproductive tract infections
experience no symptoms. Those who have symptoms may have irritation
and itching in the genital area, burning during urination, and vaginal
discharge. If the infection is not treated the upper reproductive tract will be
affected. This will lead to pelvic inflammation disease (PID). PID is a
serious infection of the entire pelvic region.

It may cause scarring of the reproductive organs which may result in

infertility or ectopic pregnancy. Symptoms of PID include fever, abdominal
pain, nausea, vomiting, tachycardia, and disrupted menstrual periods.

Chlamydia does not respond to penicillin. It is treated with tetracycline type

of drugs and both sexual partners need to be treated simultaneously so that
infection is not passed back and forth.

Syphilis
The causative agent of syphilis is the bacterium Treponema pallidum,
otherwise known as spirochaete because of its corkscrew shape. The

UEW/IEDE, B.Ed Inservice

189
ADDRESSING HIV & AIDS
STIGMA THROUGH
EDUCATION Unit 5, section 3: Major types of STIs

bacterium penetrates the mucous membranes and abrasions in the skin. This
causes lesions that may involve an organ or tissue.

Transmission
The bacterium is transmitted through direct contact with infected lesions
during penile-vaginal, penile-anal and oral-genital intercourse. The
bacterium actually drills or bores itself into the skin wherever it makes
contact. As early as four months, a pregnant female can transmit the
bacterium through the placenta to the foetus. When infection occurs at this
time, 25 percent of the pregnancies result in stillbirth or neonatal death.
Between 40-70% of such pregnancies will result in a syphilis-infected
infant. A mother to foetus transmission results in congenital syphilis.
Treatment with penicillin will cure both the mother and the foetus.

Symptoms
After penetrating the skin and mucous membranes, the bacteria quickly
spread into the lymphatic system and the blood stream. This results in
systemic infection. The bacteria would have spread through the body before
the first signs and symptoms of syphilis occur.

When not treated syphilis progresses through four stages: primary,

secondary, latent and tertiary.

At the primary stage chancres appear. The chancres which are hard, round,
painless sores with raised edges develop mostly in the genital area three
weeks or longer after exposure.

If a person engages in oral-genital intercourse, the chancres will appear in

the mouth, on the lips, tongue, fingers or nipple. The size of the chancres
may range between the size of a pimple up to 22mm. The chancres are full
of the Treponema pallidum bacteria. As such any contact with it may
result in transmission.

The chancres may appear on the labia or within the vagina or cervix in
females. Since they are painless, they are often not noticed when they
appear internally (vagina or cervix). In males, chancres may appear on the
penis, the scrotum, or in the pubic area. They may also appear in the anus or
within the rectum of males who are receptive partners.

The chancres heal and disappear without treatment thus giving the infected
person a false sense of security that the condition has cured itself. No further
symptoms may be experienced by the infected partner. However, the person
is a carrier of the bacteria and can infect others.

Secondary syphilis has symptoms similar to other diseases such as

hepatitis, arthritis, and meningitis - fever, skin rash which does not itch,
muscle aches and pains, large genital warts, and smaller lymph nodes. The

190 UEW/IEDE, B.Ed Inservice

 ADDRESSING HIV & AIDS
STIGMA THROUGH
Unit 5, section 3: Major types of STIs, EDUCATION

person will also experience weight loss and at times loss of hair. When the
rashes appear on the moist areas of the body like the genitals, mouth, anus,
the lesions may open and become contagious. Without any treatment, after a
few weeks the symptoms may subside at the secondary stage. The person
will have some relief as the symptoms disappear, however at this stage the
person can still pass on the infection.

Latent Stage: At this stage the syphilis shows no symptoms giving a false
feeling of being cured. However, it is actively destroying organs and tissues
in the body.

Tertiary: When the infection is not treated it passes to the tertiary stage.
This is the most serious stage and it may result in death. The symptoms
include blindness, paralysis, liver damage and mental problems. The tertiary
stage may occur many years after the initial infection with syphilis.

Syphilis is not difficult to treat but early detection is very important for a
successful treatment. Later stages of syphilis must be treated with antibiotics
for long periods of time.

Activity 3.1
These are very personal questions that you need to answer. Do not worry!
You are not to write the answers for questions 1-9 down. Write down you
responses to questions 10-12. You may choose to discuss some of your
responses with your sexual partner or partners as the case may be if you
think he/she/they are at risk.
 Which risky behaviours do you engage in?
 Do you believe you are at risk for STI?
 If yes are you capable of stopping the risky behaviour?
 Have you had any of the symptoms discussed under the two bacterial
infections?
 Did you seek medical treatment?
 If no, are you prepared to seek for treatment?
 Do you believe that various types of herbal preparations sold on the
Ghanaian market can cure the two STIs?
 When you think you have an STI do you self medicate?
 Do you think it’s good for females to use douches, herbal concoctions,
(“nnansa yi woaye fe” meaning ‘you look good of late’) to enhance
sexual pleasure of their sexual partners?
 As a teacher do you think any of the pupils/students you teach are at
risk of STIs?
 If your answer is yes, how are you going to help them prevent
infection?
 What help can you offer to those who are infected?

UEW/IEDE, B.Ed Inservice

191
ADDRESSING HIV & AIDS
STIGMA THROUGH
EDUCATION Unit 5, section 3: Major types of STIs

Candidiasis
Candidiasis is caused by the fungus Candida albicans. It is commonly
called a yeast infection, or white. The fungus Candida albicans is normally
present in the vagina of most female. However when the vaginal
environment changes the fungus begins to multiply.
Several factors can change the sugar concentration in the vagina tissue.
Some of these are pregnancy, diabetes, use of birth control pills and use of
antibiotics. Antibiotics destroy the resident bacteria that normally keep
fungal growth under control. Douching and insertion of some herbal
preparations may also increase the onset of candidiasis.

Transmission
The fungus that causes candidiasis can be spread from an infected female to
an uninfected male through penile-vaginal intercourse. The fungus can be
found under the foreskin of the penis of an infected male and therefore can
be transmitted from an infected male to an uninfected female during penile-
vaginal, penile-anal and oral-genital intercourse. Using water closets with
many people can cause transmission.

Symptoms and impact on health

In females there is a white, foul-smelling discharge and itching while
infected males may experience itching and burning during urination. During
treatment it is important to keep the affected area clean and dry. Females
may wear a sanitary pad to protect their clothing. Common treatment is
vaginal suppositories.

Gonorrhoea
Gonorrhoea is a STI caused by Neisseria gonorrhoea. It infects the
mucosal surfaces, the moist surfaces of the body: the urethra, cervix,
rectum and the throat.

Transmission
It is transmitted through sexual contact, vaginal, anal and oral intercourse. It
can also be transmitted by an infected mother to her baby during vaginal
delivery. The infected baby will be born with a severe eye infection. Unless
the baby is treated immediately it may lead to blindness.

Symptoms
Symptoms appear in two days to a week after infection where there is a
discharge from the penis. Gonorrhoea leads to urethritis, an inflammation of
the urinary tract resulting in frequent urination that is accompanied with a
lot of pain in men. Those who are infected through penile-anal or oral-
genital intercourse may have discharge from the anus or pharynx. However
a small percentage of men show no signs of infection. If infection is left
untreated, the infection will spread to the prostrate gland and the other
reproductive organs leading to sterility.

192 UEW/IEDE, B.Ed Inservice

 ADDRESSING HIV & AIDS
STIGMA THROUGH
Unit 5, section 3: Major types of STIs, EDUCATION

Infected females may experience increased vaginal discharge, genital

irritation, pain during urination and abnormal bleeding as well as abdominal
tenderness. The infection may be in the urethra, vagina, cervix, pharynx or
rectum. If gonorrhoea is left untreated it will spread to the uterus, ovaries
and fallopian tubes that may lead to infertility.

Normally gonorrhoea is treated with penicillin, but some strains of

Neisseria gonorrhoea have become resistant to penicillin.

Activity 3.2
1. Name the pathogen that causes gonorrhoea
2. What is the major mode of transmission?
3. When left untreated in females what organs may be affected?
4. Can gonorrhoea be prevented when condoms are used for sex?

Genital warts
Genital warts are dry wart-like growths caused by the virus human
papilloma virus (HPV). The warts are yellow-grey in colour and look like
small cauliflower. Some of the warts may be flat. Flat warts have a link to
cervical cancer.

Transmission
Genital warts can be transmitted mainly through penile-vaginal, penile-anal,
and oral-genital sexual intercourse. Genital warts may also be transmitted
through direct contact with infected bed linen, towels and clothing. The risk
of genital warts increases if the person engages in sex at an early age.

Symptoms and long term impact

Genital warts appear three to eight weeks after infection and may last for a
few weeks or longer. In males, the warts appear on the penis and
occasionally in the urethra. The warts appear on the labia and in the vagina
of infected females. However at times HPV infection may be asymptomatic.
The virus can also cause “flat warts” that usually appears on the penis and
the cervix. Flat warts have strong connection with cervical cancer.

Genital warts can be treated by laser treatment (burning off) or cryo-surgery

(freezing off with liquid nitrogen). None of the treatments will prevent the
warts from reoccurring because the virus remains in the body tissues.

Hepatitis
Viral hepatitis is an inflammatory infection of the liver caused by a virus.
There are four types of viral hepatitis. We have hepatitis A, B, C and D. In
this study we shall discuss hepatitis B and C.

Hepatitis B is found in the blood, blood products, saliva, semen and vaginal
secretions. It can be transmitted through intravenous drug use when
infected persons share needles. People who have multiple sexual partners
are at risk of infection.

UEW/IEDE, B.Ed Inservice

193
ADDRESSING HIV & AIDS
STIGMA THROUGH
EDUCATION Unit 5, section 3: Major types of STIs

Symptoms and long term impact

The symptoms include profound fatigue, jaundice, nausea and abdominal
pain. Most people do recover after treatment, while about 4% die from it,
some 5 to 10 percent become chronic carriers of hepatitis B and have the
possibility of transmitting the virus to others. There is a vaccine for the
prevention of hepatitis B.

Hepatitis C was first referred to as non-A/non-B hepatitis. Hepatitis C is

transmitted through penile-vaginal, penile-anal and oral-genital intercourse,
as well as through intravenous drug use. It can also be transmitted through
infected blood transfusion.

Symptoms and long term impact

The symptoms vary from mild to severe. Infected persons may have
diarrhoea, poor appetite and fatigue. They will experience high fever and
jaundice.

In this section, we discussed six major types of STIs namely, Chlamydia,

Syphilis, Candidiasis, gonorrhoea and genital warts; and two viral infections
-- hepatitis B and C. In each case we examined the cause, mode of
transmission, symptoms and impact on health. For example, we leant that
gonorrhoea is caused by the pathogen Neisseria gonorrhoea. Gonorrhoea
may be found in the urethra, vagina, cervix, pharynx or rectum in females
and the urethra where it may spread to the uterus, ovaries, and the fallopian
tubes. In males gonorrhoea causes urethritis, an inflammation of the urinary
tract resulting in frequent urination that is accompanied with a lot of pain in
men.

Genital warts, which are caused by the human papilloma virus, can be
transmitted through sexual contact as well as through direct contact with
infected clothing, bed linen and towels. Early sexual experience increases
the chances of infection. The warts appear on the penis and occasionally in
the urethra of males, while in females they are found on the labia and
vagina. Flat warts have strong connection to cervical cancer.

194 UEW/IEDE, B.Ed Inservice