Women with no sexual autonomy twice likely to get STIs: study

Women with no sexual autonomy twice likely to get STIs: study

Sub: Science and tech

Sec: Health

Context: omen who had controlling husbands and had experienced intimate partner violence in their married life are more at risk of developing sexually transmitted infection (STI) or reproductive tract infection (RTI) than women who do not report facing control or intimate partner violence (IPV) in their marriage, a new study reveals

What are STIs?

More than 30 different bacteria, viruses and parasites are known to be transmitted through sexual contact, including vaginal, anal and oral sex. Some STIs can also be transmitted from mother-to-child during pregnancy, childbirth and breastfeeding. Eight pathogens are linked to the greatest incidence of STIs. Of these, 4 are currently curable: syphilis, gonorrhoea, chlamydia and trichomoniasis. The other 4 are incurable viral infections: hepatitis B, herpes simplex virus (HSV), HIV and human papillomavirus (HPV).

In addition, emerging outbreaks of new infections that can be acquired by sexual contact such as monkeypox, Shigella sonnei, Neisseria meningitidis, Ebola and Zika, as well as re-emergence of neglected STIs such as lymphogranuloma venereum. These herald increasing challenges in the provision of adequate services for STIs prevention and control.

Prevention of STIs

When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Although highly effective, condoms do not offer protection for STIs that cause extra-genital ulcers (i.e., syphilis or genital herpes). When possible, condoms should be used in all vaginal and anal sex.

Safe and highly effective vaccines are available for 2 viral STIs: hepatitis B and HPV. These vaccines have represented major advances in STI prevention. By the end of 2020, the HPV vaccine had been introduced as part of routine immunization programmes in 111 countries, primarily high- and middle-income countries. To eliminate cervical cancer as a public health problem globally, high coverage targets for HPV vaccination, screening and treatment of precancerous lesions, and management of cancer must be reached by 2030 and maintained at this high level for decades.

Research to develop vaccines against genital herpes and HIV is advanced, with several vaccine candidates in early clinical development. There is mounting evidence suggesting that the vaccine to prevent meningitis (MenB) provides some cross-protection against gonorrhoea. More research into vaccines for chlamydia, gonorrhoea, syphilis and trichomoniasis are needed.

Other biomedical interventions to prevent some STIs include adult voluntary medical male circumcision, microbicides, and partner treatment. There are ongoing trials to evaluate the benefit of pre- and post-exposure prophylaxis of STIs and their potential safety weighed with antimicrobial resistance (AMR).

Diagnosis of STIs

STIs are often asymptomatic. When symptoms occur, they can be non-specific. Moreover, laboratory tests rely on blood, urine or anatomical samples. Three anatomical sites can carry at least one STI. These differences are modulated by sex and sexual risk. These differences can mean the diagnosis of STIs is often missed and individuals are frequently treated for 2 or more STIs.

Accurate diagnostic tests for STIs (using molecular technology) are widely used in high-income countries. These are especially useful for the diagnosis of asymptomatic infections. However, they are largely unavailable in low- and middle-income countries (LMICs) for chlamydia and gonorrhoea. Even in countries where testing is available, it is often expensive and not widely accessible. In addition, the time it takes for results to be received is often long. As a result, follow-up can be impeded and care or treatment can be incomplete.

On the other hand, inexpensive, rapid tests are available for syphilis, hepatitis B and HIV. The rapid syphilis test and rapid dual HIV/syphilis tests are used in several resource-limited settings.

Several other rapid tests are under development and have the potential to improve STI diagnosis and treatment, especially in resource-limited settings.

Treatment of STIs

Effective treatment is currently available for several STIs.

• Three bacterial (chlamydia, gonorrhoea and syphilis) and one parasitic STIs (trichomoniasis) are generally curable with existing single-dose regimens of antibiotics.
• For herpes and HIV, the most effective medications available are antivirals that can modulate the course of the disease, though they cannot cure the disease.
• For hepatitis B, antivirals can help fighting the virus and slowing damage to the liver.

AMR of STIs – in particular gonorrhoea – has increased rapidly in recent years and has reduced treatment options. The Gonococcal AMR Surveillance Programme (GASP) has shown high rates of resistance to many antibiotics including quinolone, azithromycin and extended-spectrum cephalosporins, a last-line treatment (4).

AMR for other STIs like Mycoplasma genitalium, though less common, also exists.