Diagnostics and treatment of sexually transmittable diseases

Sexually transmitted diseases are infections that are passed through sexual contact. If untreated, these diseases can cause long-term and incurable complications in urinary and reproductive systems. According to the World Health Organization, sexually transmitted diseases are diagnosed for over 300 million people each year. Chances to get infected are higher for people who have many different sex partners and do not use barrier protection (condoms). In order to avoid diseases and possible complications, it is important to identify the infection in time. It is a must to consult with a doctor when the first symptoms appear.

The most common sexually transmitted diseases:

  • Syphilis;
  • Gonorrhea;
  • Chlamydia;
  • Trichomoniasis;
  • HIV – Human immunodeficiency virus;
  • HPV – Human papillomavirus infection;
  • Genital herpes.


It is an infection, caused by a bacterium Treponema pallidum. This bacterium penetrates through the irritated skin. A person who has syphilis is the cause of an infection. Syphilis can spread through a sexual intercourse, blood or it can be passed on from a pregnant woman to her child via placenta (from the 12th week).

Nowadays, syphilis is a very common disease in Eastern Europe.  Morbidity rates of syphilis vary and increase every 10-14 years. The highest number of patients with syphilis is among 15-40 year old people. Syphilis is a treacherous disease, its clinical manifestation can be very similar to other diseases.
Even three months can pass before the first symptoms appear, syphilis progresses slowly. It has three stages:

  • I. Primary stage. Incubation period lasts from 10 to 90 days. In the infected place (usually on the genitals) appears an ulcer (small, approximately 1cm in diameter, painless, with smooth and hard edges), which reminds a cartilage. These ulcers occur on the external genital organs: vagina, anus or rectum. Untreated ulcers heal after 3-12 weeks and leave scars. Enlarged lymph nodes can also occur around the mentioned areas.
  • II. Secondary stage. Starts after 3-6 weeks since the appearance of the first ulcer. Symptoms are similar to flu: tiredness, headache, decreased appetite, enlarged lymph nodes, not itchy rashes on the whole body, papules on foot soles or palms, wart-like skin growths around vulva or anus and hair starts falling out or gets thinner. The most common symptoms of syphilis are white lines on tongue and hair loss in stripes. These symptoms can disappear untreated.
  • III. Tertiary stage is the late stage, which begins after several months or years of untreated syphilis. This disease can affect not only the heart, circulatory and nervous systems but also other internal organs. The person who has syphilis can become mentally ill, blind, start limping or feel the first symptoms of psychosis. Non-healing ulcers can appear on the skin or internal organs.
    DIAGNOSIS: during primary and secondary stages of syphilis, secretion from the ulcers is tested in the laboratory (in order to identify the Treponema pallidum), blood tests help to find antibodies to syphilis. Genitals are examined, internal genital examination can be suggested for women.

TREATMENT: Syphilis can be cured if the treatment starts early. Patients are cured with antibiotics. The period of treatment lasts from one day to several weeks, according to the stage. After the treatment with antibiotics, another examination is made and blood samples are taken in the period of one year.
Sexual partners of the infected person should also get tested and start a treatment, if necessary.



Gonorrhea is a sexually transmitted disease, caused by a bacterium Neisseria gonorrhoeae. Gonorrhea can be transmitted through a direct contact with an infected person. Usually Neisseria gonorrhoeae travels via mucosa (genital, oral, rectum) or infects another person during the sexual intercourse. Gonorrhea most often affects urinary system or genitals. This infection causes inflammation in urine system, testicles, epididymis and prostate for men. For women, it manifests in urine system, fallopian tubes or causes a pelvic inflammatory disease. A pregnant woman with gonorrhea can give the infection to her baby during childbirth.

SYMPTOMS: The first symptoms of gonorrhea appear within 2-7 days after exposure to the bacteria.
In males, the most common symptoms are: burning or pain during urination, urethral or rectal discharge, sometimes even pain in the testicles, they can get bigger or red. As the disease progresses, it can cause a fever, hemorrhagic rash, joints can get swollen, red and painful.
The infection often remains symptomless for 70-80% of women or the symptoms are very light. When the symptoms do appear, females usually experience pain while urinating, increased vaginal discharge, bleeding between periods or after a sexual intercourse and heavier periods.
In both males and females, symptoms of anal gonorrhea include anal itching, soreness, bleeding or painful defecation.
In the case of oral gonorrhea, the infection manifests with changes in the mouth and throat.

COMPLICATIONS: For men, untreated gonorrhea causes disorders in brain, heart and joints. The infection can move into the epididymis and create an inflammation, which can cause infertility, if left untreated. In females, if the bacteria moves from the genitals further into a reproductive tract, pelvic inflammatory disease can result. This happens for 10-20% of the infected women. They may have a stomach ache, fever or internal abscess. The consequences from a pelvic inflammatory disease can lead to damaged fallopian tubes, ectopic pregnancy or infertility.

DIAGNOSIS: Testing for gonorrhea involves collecting samples from the infected place. Diagnosis is confirmed after the examination of the taken samples or after testing the first morning urine.

TREATMENT: Gonorrhea is usually treated with a single dose of antibiotics. A patient can swallow antibiotics or they can be injected into the muscles or the vein. Sometimes treatment lasts for a few days. Sexual partners of the infected person should also get tested and treated. After the treatment, a patient should occasionally visit the doctor.



It is one of the most common sexually transmitted diseases and urine tract infections. Chlamydia is caused by Chlamydia trachomatis bacterium, which disturbs epithelial tissue. Chlamydia spreads easily because usually it does not have symptoms. A pregnant woman with chlamydia can give the infection to her baby during childbirth. For a baby, the infection manifests by pneumonia or ocular inflammation. 60-70% of the infected people can have no symptoms. The first symptoms may appear after 2-6 weeks.

For women the symptoms can be:

  • painful urination;
  • bleeding after sexual intercourse or between periods;
  • painful periods;
  • pain in the lower abdominal area or during the sexual intercourse;
  • pelvic inflammatory disease, accompanied by a fever or pain;
  • itching or burning around the vaginal opening.

For men:

  • clear discharge from the urethra;
  • painful urination;
  • inflammation in urethra, testicles, epididymis, prostate or rectum, caused by Chlamydia trachomatis.
  • swollen and painful scrotum.

DIAGNOSIS: Chlamydia is diagnosed in the laboratory by testing the sample from the urethra, cervix or morning urine. Samples are tested by a direct immunofluorescence, immunofermental analysis, DNA-RNA hybridization and nucleic acid amplification methods.

TREATMENT: Chlamydia is treated with tetracycline or erythromycin. It is necessary to complete the course of antibiotics. Sexual partners should be treated together.


It is a sexually transmitted infection, caused by a bacterium Trichomonas vaginalis. The infection can spread during a sexual intercourse and in rare cases – by contact with an infected person or having poor hygiene.
30-40% of infected men do not feel any symptoms (however, they are the sources of infection).
The most common symptoms in men:

    • inflammation in urethra, prostate or genitals;
    • irritation or painful urination;
    • minor changes in foreskin or urinary meatus.
      50% of women do not feel any signs of this disease.

The most common symptoms among women:

  • vaginal discharge, which can be white, grey, yellow and have an unpleasant smell;
  • acute vaginitis, which can cause redness in vaginal mucosa and heavy discharge with ‘fishy’ odor, sometimes even blood;
  • irritation or itching on the external genital organs;
  • pain during a sexual intercourse;
  • a burning sensation and painful urination;
  • if Trichomonas vaginalis stays in a woman’s body for a long period of time, it can cause cervical cancer.

DIAGNOSIS: a smear is taken from the urethra or vagina and tested right away with a microscope, in order to find vegetative forms. Trichomoniasis is diagnosed when trophozoites are found in the discharge, urine or seminal fluid. Some cases can require a method of growing a culture of parasites in the artificial environment.

TREATMENT: This disease is treated by antibiotics. In order for the treatment to be successful, it is recommended to avoid alcohol during the period of treatment. Sexual partners should be treated together, even if they do not have any symptoms. If partners do not get treated at the same time, the disease may renew.
Local treatment of vagina does not give a long-term effect because single-celled eukaryotes can live in the urine system.


HIV (Human immunodeficiency virus) is an infection, which manifests by a progressive damage to the immune system. Human immunodeficiency virus may lead to death, if left untreated. HIV is caused by HIV-1 and HIV-2 immunodeficiency viruses. In human body, these viruses multiply and destroy the immune cells. Viruses are multiplying in billion particles every day.
HIV is diagnosed for approximately 330 million people in the world. HIV can be transmitted:

  • I. By blood or its components. Intravenous drug use, blood transfusion and organ transplantation (although all blood and organ donors are tested for HIV, the reliability is questionable because of the incubation period of HIV. During the first free weeks, it is impossible to identify antibodies to HIV with standard tests), tattooing.
  • II. During a sexual intercourse. 80% of people with HIV got infected by not using preventing methods during a sexual intercourse. If a person has sexually transmitted infections (chlamydia, syphilis, gonorrhea) or the mucosa is injured mechanically (anal sex, rape), chances to get infected are higher.
  • III. From mother to her child. There is a 13-30% possibility that a pregnant woman with HIV will pass the infection to her baby during childbirth.
    Stages of HIV infection:

Stages of HIV infection:

  • I. Incubation period. It is the time between catching an infection and acute manifestation of it. Incubation period lasts from 4 to 24 weeks or till the opportunity to diagnose HIV in the laboratory. Incubation period is asymptomatic.
  • II. Primary HIV infection is an acute manifestation of Human immunodeficiency virus, which starts after 2-4weeks and lasts for a few days or even a week. Symptoms are very similar to flu: a fever, swollen lymph nodes, sore throat, skin rash, joint pain, muscle pain, diarrhea, headache, nausea, vomiting. These symptoms disappear without treatment. However, not everyone will have this primary stage.
  • III. Asymptomatic HIV infection has no symptoms and this asymptomatic period can last for a few or even many years. The infected person can feel totally healthy but he can transfer the infection to other people. Sometimes it is necessary to examine the swollen lymph nodes.
  • IV. Symptomatic HIV infection manifests when a person’s immune system is damaged and a huge amount of virus causes such diseases: bacillary angiomatosis, oral candidiasis, oral hairy leukoplakia, cervical dysplasia, diarrhea, persistent fever.
  • V. AIDS (acquired immune deficiency syndrome) is the diagnosis of some specific diseases to the person with HIV. It is the last stage of HIV and it occurs when the human immunodeficiency virus strongly damages the immune system. AIDS-defining illnesses: tuberculosis, Kaposi’s sarcoma, illnesses caused by cytomegalovirus, pneumocystis pneumonia, tumors.

DIAGNOSIS: HIV is diagnosed by testing blood serum or blood, saliva. The aim is to find antibodies to HIV, HIV’s genetic material (DNA or RNA). Antibodies in the infected person can be identified after 4 weeks or several months (The window period), since the exposure to virus. After the identification of antibodies, some additional tests are done. The early stage of HIV can be diagnosed by HIV p24 antigen test or quantitative HIV RNA test. Test for AIDS can be done in 1-4 hours, due to the modern laboratory equipment. However, various laboratories have internal rules and regulations, this is the reason why the answer is given within a few days.

TREATMENT: HIV is treated with antiviral medications that slow the progression of the virus in the infected body. Antiviral medications stop the multiplying of the virus or its cells produce inadequate virus that cannot infect other people. The immune system remains healthy. It is very important to maintain the treatment, which lasts for the entire life.
In order to reduce the possibility of HIV transference from mother to her child, a pregnant woman with HIV has to start antiviral treatment, caesarean section should be planned in advance and she should not breastfeed her baby.


Human papillomavirus (HPV)
HPV is the most common sexually transmitted viral infection in the world. 70% of sexually active women (mostly under age 35) can have HPV. High oncogenic risk types of HPV are identified for 5-30% of healthy women and for 99,7% of those who have cervical cancer.
Human papillomavirus is transmitted during the sexual intercourse, through skin and minor injuries in mucous membranes. More than 200 types of this virus are identified till this day, 40 of them are found in the genital mucosa. 15 types of HPV contain oncogenic features, which can cause cervical cancer.
Most people with HPV do not have any symptoms or health problems.   Approximately 90% of HPV cases do not need treatment, HPV goes away on its own if a person has strong immune system. When HPV does not go away on its own, it can cause chronic inflammation, cervical cancer. Types of HPV which do not evoke cancer usually cause genital warts. For women, these warts appear around the vaginal opening, in vagina or on the cervix. For men, warts appear on the penis. Warts around the anus can occur for both, men and women. In the beginning, these warts are small and later on they grow and spread. Sometimes the infected person can feel itching, burning, pain or start bleeding.

DIAGNOSIS: HPV can be diagnosed by molecular diagnostics, testing the samples from cervix, urethra, rectum or larynx.

TREATMENT: Solutions and topical creams are used to treat warts. In some cases it is possible to get rid of warts by cryotherapy, radiofrequency, electrosurgery, laser or surgical procedure. Warts can grow back, thus it is important to start the treatment as soon as possible. The infection can be passed from a pregnant woman to the fetus. Usually warts disappear after the pregnancy.
Cervical screening (PAP smear) is recommended for girls who start being sexually active at a young age and frequently change their partners. Medicine has advanced, now it is possible to get vaccinated and, in 60-70% of all cases, successfully avoid cervical cancer and genital warts.


Herpes is a viral infection, caused by type 1 (HSV1) and type 2 (HSV2) of Herpes simplex virus. HSV1 usually affects the mucosa of mouth and lips, HSV2 manifests on the genitals (penis, vagina, cervix), skin and around the anus. During oral sex, HSV1 can affect the genitals, while HSV2 affects the mouth. Herpes can spread during the sexual intercourse or by a direct contact with mucosa. If the infected person has blisters, then it is the highest risk to get infected. The virus penetrates into the nerve cells and stays there for the entire life. In the beginning it is easy to notice the infection because of its symptoms but after 2 or 3 weeks they disappear. Menstrual period, another infection, low immune system or stress can evoke the manifestation of herpes. Symptoms of herpes usually manifest on the same places but they can be not so noticeable.

The most common symptoms:

  • tingling, redness on the genitals and mucous membranes;
  • small shiny blisters, which later on bursts, get itchy and painful;
  • urinary retention, painful urination;
  • swollen lymph nodes in the groin;
  • a fever, muscle pain.

DIAGNOSIS: testing the fluid from blisters. The mentioned substance is put into the special environment and the virus starts growing. It is also possible to test blood serum and search for the special immunoglobulins, which tend to develop in the infected body.

TREATMENT: There is no such treatment that could completely destroy the virus and protect from the recurrence of the infection. In order to shorten the duration and quantity of clinical symptoms, medications are prescribed since the appearance of the first symptoms. The purpose of treatment is to stop the multiplication of virus and stimulate the immune system.
Caesarean section is recommended for a pregnant woman if she has herpes rash in the fallopian tubes on the third trimester of pregnancy.