Sexually transmitted diseases

What are sexually transmitted diseases?

Sexually transmitted diseases (STDs), otherwise known as venereal diseases, are usually transmitted through sexual contact but they may be passed on in other ways.

Chlamydia, gonorrhoea and syphilis are bacterial STDs. Genital warts, hepatitis B (see hepatitis), HIV and genital herpes are viral STDs.

All STDs can be transmitted from mother to child during childbirth. Syphilis and, in rare cases, genital herpes can also be passed on during pregnancy. Syphilis and hepatitis B can also be transmitted by, for example, a blood transfusion or the use of infected needles.

What are the complaints associated with sexually transmitted diseases?

• In about 75% of infected men, chlamydia causes inflammation of the urethra, rectum and epididymis. The main symptoms of urinary tract infections are pain or a burning sensation when urinating, difficulty with urinating and/or the secretion of pus from the urethra. In about 30% of infected women, chlamydia causes inflammation of the urethra, cervix, fallopian tubes and rectum. Possible symptoms include pain or a burning sensation when urinating, increased vaginal discharge and bleeding between periods. ⁴³¹
  
• In about 90% of infected men, gonorrhoea causes inflammation of the urethra, rectum and epididymis. In about 40 to 60% of infected women, it results in inflammation of the urethra, cervix, fallopian tubes and rectum. ⁴³²
  
• Syphilis consists of different stages that can be distinguished on the basis of the clinical picture. The symptoms of primary syphilis are sores (chancres) at the site of the infection (penis, around the vagina, mouth and anus). The incubation time varies from ten to ninety days and is three weeks on average.
  After three to six weeks, most untreated patients will present with the symptoms of secondary syphilis: a diffuse skin rash associated with a loss of appetite, nausea, headache, insomnia, fever, and muscle and joint pain. After the spontaneous resolution of secondary syphilis, there are no clinical manifestations for one to two years. This is known as the latent stage. Sores may recur occasionally during this stage. Untreated syphilis can affect several organs, such as heart and blood vessels or the nervous system. Neurosyphilis is also possible during this stage. This form of syphilis can be associated with headaches, confusion, personality changes, palsy of the cerebral nerves and dementia. ⁴³³
• The first symptoms of genital warts are itching and irritation in the genitals. In some cases, there may be only a single wart but multiple warts may develop very quickly in others. In women, the warts may be on or around the vagina, in the vagina and/or on the cervix. In men, the warts are mainly found on and around the penis. They may also be located in or around the anus in both men and women. ⁴³⁴
  
• The initial symptoms of genital herpes often include fever, aching muscles and general malaise. These are followed by genital symptoms such as red rashes with blisters containing clear fluid. A primary infection causes symptoms such as pain, itching, difficulty with urination and swollen lymph nodes. Women will also have vaginal discharge and men sometimes also present with inflammation of the urethra. Soon afterwards, the characteristic blisters developed into painful ulcers. The ulcers often disappear within one to three weeks without leaving any scars. In men, the symptoms often last shorter (10 days) than in women (18 days). The main complaints associated with rectal infection are fever, pain in the anus or rectum, constipation, ulceration in and around the anus and swollen glands. ⁴³⁵
  
• An HIV infection often presents like flu. After an incubation period of varying duration, AIDS develops, with all kinds of infections and tumours. ⁴³⁶
  

How common are sexually-transmitted diseases in the general population?

Chlamydia was found in 2-3% of adolescents between 15 and 30 in 2014. ⁴³¹  This is the most common STD in all records.

The incidence rates for genital warts, genital herpes, gonorrhoea and syphilis were 10, 14, 3 and 0.5 in 10,000 respectively in 2014. ^{432 , 433 , 434 , 435}  Since there is no longer any obligation to report gonorrhoea, genital warts and genital herpes, or syphilis and not everyone has symptoms, these figures (which were obtained from the records of GPs and centres for sexual health) are probably an underestimate.

The incidence of HIV in 2014 was 14 in 10,000. ⁴³⁶

How common are sexually-transmitted diseases in people with intellectual disabilities?

Very little is known about the prevalence of sexually transmitted diseases in people with intellectual disabilities. In a selected population examined under anaesthesia, no one had chlamydia or gonorrhoea. ⁴³⁸

Some studies have been conducted of HIV in people with intellectual disabilities. An Israeli study of 1321 people with intellectual disabilities living in an institution found that no one was infected with HIV. ⁴³⁹

In a cohort of 8294 Americans infected with HIV, 119 had an intellectual disability (1.4%). ⁴⁴⁰

Another American study of 6703 people with intellectual disabilities living in an institution found that 0.16% were infected with HIV. ⁴⁴¹
However, other smaller studies found no one with HIV. ⁴⁴³