Syphilis is a sexually transmitted disease caused by the bacteria Treponema Pallidum. The disease is expressed in a variety of ways that appear in approximately half of the patients. The rest are asymptomatic. It is common to classify syphilis as early syphilis (up to two years from infection) and late syphilis (5 years and onwards after infection). Early syphilis infects at a rate of approximately 30% and transmittance from mother to fetus is common. Late syphilis is less contagious and transmittance to the fetus is rare.
Antibiotic treatment in the early stages of the disease can fully treat and prevent later complications. Without treatment, several years after infection, there may be complications that appear, some of which are irreversible, in the central nervous system, the heart, the aorta, as well as the skeleton and different internal organs. Syphilis can appear in both men and women and may be transmitted from mother to fetus during pregnancy, and in some case it can cause the newborn severe disease with irreversible damage.
Symptoms of Syphilis
Primary syphilis is characterized by an ulcer (a craterlike lesion) that is not painful on or near the genitals or oral mucous. The ulcer appears between 10 days to three months after initial exposure. The ulcer passes on its own even without any treatment.
Secondary syphilis is characterized by fever accompanied by a widespread rash on the limbs and back (including the hands and feet), weakness, muscle and joint pain, hair loss, loss of appetite and enlarged lymph nodes. These symptoms appear between two weeks to six months after initial exposure and in most cases after the first ulcer has already disappeared. It is possible that there will be several attacks of secondary syphilis in the first few years after infection occurs (the early syphilis years).
Tertiary syphilis is expressed in one of three main ways: heart damage; nerve damage (paralysis, sensory damage, balance damage, eye problems up to blindness, dementia (loss of ability to think); destructive lesions called "gumma" that appear on different body parts (the skeleton, hypodermis, liver, etc.). This stage appears when not treated, from 5 to 35 years after initial exposure. As stated, the damage can be irreversible.
How is it detected? A blood test to detect antibodies against the bacteria.
Ways of becoming infected: all types of unprotected sex with an infected partner; from a mother to the fetus during pregnancy.
How is it treated? It is possible to treat the disease with penicillin shots. The treatment is administered in the Levinsky Center free of charge.
Prevention: proper and regular use of a condom provides good protection.
- If there is any concern of tertiary syphilis – you should be hospitalized (spinal fluid needs to be tested before treatment is started).
- In any situation that is not compatible with the descritpion listed above, consult with a specialist.
Window period: 3 months.
Genital herpes is caused by the herpes simplex virus (HSV). There are two strands of herpes simplex: HSV-1 which causes the appearance of a cluster of blistering and painful lesions in the mouth region and HSV-2 which causes the same symptoms but on the genitals. In recent years, there has been an increase in genital herpes caused by HSV-1.
The virus remains in the body throughout life with the possibility of recurring outbreaks (with or without symptoms). The disease is mostly contagious during a symptomatic outbreak but can also be contagious in an outbreak without symptoms (which is expressed only by the discharge of the virus).
Genital herpes is a very common sexually transmitted disease. Approximately 10% of the adult population are HSV-2 carriers. Most carries of the HSV-2 virus are not aware that they are carriers and never develop any symptoms of the disease. The disease, as mentioned, cannot be treated, but there is efficient treatment to ease and prevent the symptoms.
Symptoms of Genital Herpes
The first incident appears within 2-7 days of exposure and is characterized by blisters and painful lesions on the genitals. It is accompanied by redness and local swelling, and at times by inflammatory secretions. In addition, there may be localized symptoms (difficulty urinating, sensory disturbance) and systemic symptoms (fever, weakness, muscle and back pain, and even meningitis). Similarly recurring episodes to the first episode, locally speaking, are less expansive, inflammatory or painful. Local and systemic symptoms are rare. 90% of infected individuals will not develop any symptoms, however, they can infect their sexual partners.
How is it detected? By a clinical and laboratory diagnosis. The clinical diagnosis is based on the appearance of typical skin lesions. The laboratory diagnosis is through a urine culture that detects the virus in urine through a PCR test and a blood test that detects antibodies against the virus.
Ways of becoming infected: unprotected sex, including oral sex with an infected partner.
How is it treated? With Zovirax (Acyclovir) pills for the purpose of alleviating the symptoms and reducing the time of the disease. There is also a regimented treatment with Zovirax that is intended to prevent the appearance of recurring symptoms in the event that there are multiple difficult recurrences that disrupt everyday life. There is no cure for the disease.
Possible complications without treatment: a serious disease and even fatality for a newborn infected during childbirth.
Prevention: proper and regular use of a condom provides good protection, but it does not provide complete protection since the ulcers can be in places that are not covered by a condom.
There are two types of outbursts:
Clinical outbursts, where the herpes is visible.
Sub-clinical outbursts, where there are no lesions.
There is no way to completely prevent acquiring herpes. A condom only protects the genital region, but herpes can also be transmitted through the nerves.
The repercussions for a person infected are not great – there may be initial outbursts in the first year.
It is possible to also be infected with both type 1 and type 2, but most of the time people will only contract one type.
Chancroid, Donovanosis, and Lymphogranuloma venereum (LGV)
These are rare diseases in Israel but are common in countries with tropical climates. They are all first expressed with an ulcer or ulcers on the genitals. There should be concern in cases where someone had sex in countries with tropical climates or if their partner is originally from a country with a tropical climate.
LGV disease is more common amongst homosexuals. At later stages and without any antibiotic treatment in due time it can be similar to inflammatory bowel disease.
Mainly expressed with genital warts.
Condyloma – Human Papiloma Virus
The Human Papillomavirus, HPV, which is transmitted by sexual contact, causes genital and anal warts known as "condylomata acuminata", or briefly, "condyloma". Both women and men can be infected with the disease. Over the years, certain strains of the virus can cause cervical cancer for women and penile and anal cancer for men.
The virus is common among the younger population and different studies demonstrated a frequency of up to 50% in the sexually active population. Only a minority of the virus carriers develop visible warts. The disease is also contagious when there is no external expression. Majority of infected individuals will heal spontaneously within a few months or up to one year.
Symptoms of Condyloma
Within approximately 3 months from becoming infected, cauliflower like warts appear that are of the same color as the skin and for the most part are not painful. For women they are usually found on the vulva, the anal region, the vagina and the cervix. For men they are usually found on the penis, scrotum and anal region.
Pre-cancerous changes in the cervix occur within approximately 7-10 years of being infected.
How is it detected? Typical appearance of a wart; a biopsy of the wart with examination of the tissue under a microscope (histology test); a colposcopy (checking the cervix with a microscope) and a papanicolaou test (known as a Pap smear) in order to diagnose cancerous and pre-cancerous changes in the cervix.
A PCR test to detect the virus and its strain is a new test that at this point is being used for research purposes only.
Ways of becoming infected: All types of sexual contact with an infected partner, skin to skin contact. It is about broader regions than only the specific region.
How is it treated? Wart removal treatments (warm/cold burning; surgical/laser removal; creams to "dissolve" the warts) usually do not destroy the virus and it’s common for the warts to return within a short period of time. In most cases, as stated, there will be spontaneous healing and the warts will recede and disappear within a few months and up to one year.
In cases of pre-cancerous changes it is common to surgically remove lesions from the cervix. This procedure is called exocervix.
Possible complications without any treatment: cervical cancer (by certain strains, usually those strains do not cause warts).
Prevention: abstaining from any sexual contact when there is concern of the disease or the disease is active. Proper and regular use of a condom provides good protection, but it does not provide complete protection since the virus is transferred by skin-to-skin contact and can be found in areas that the condom does not cover.
Recently two genetically engineered vaccine solutions were developed and it is certain that they will be used against human papillomavirus strains that are responsible for most cases of cervical cancer. One of the vaccines provides protection from genital wart producing strains. The vaccine is recommended for women between the ages of 9-45, and it is particularly efficient for women to get vaccinated who have not yet been sexually active. Annual checkups and Pap smears are recommended for all sexually active women, even if they have received the vaccine, for the purposes of diagnosing pre-cancerous changes at an early stage to allow for early treatment and full recovery.
It is important to note:
- The strains causing warts are non-cancerous.
- There is no HPV test for men or women.
- Women's Pap smears check for changes that occur in the body as a result of the HPV virus. The test checks for pre–cancerous changes.
- Warts usually appear about 3 months after the initial infection.
- In about 85% of cases, warts pass on their own. Cosmetic treatments for wart removal do not cure the disease.
Time cures the disease.
Molluscum is a skin disease that manifests itself in warts caused by the virus Molluscum contagiosum. This disease is not only a sexually transmitted disease, it can also be contracted via skin-to-skin contact. The warts are usually common during childhood in the limb regions since it can be transmitted by contact with a child at home or in kindergarten. Sometimes, the warts appear in young people after they have had a sexual encounter. For people with healthy immune systems, the disease passes on its own within a few months after infection.
Symptoms of Molluscum
Skin colored warts with concavities in the center that appear within 2-7 weeks after exposure (but there have been cases where they appeared after 6 months). Usually the warts are neither painful nor itchy.
How is it detected? In most cases the unique appearance of the lesion with the concavity in the middle is sufficient for a clinical diagnosis. Laboratory diagnosis: detecting the antibodies for the virus in the blood (exist in approximately 75% of patients); typical appearance in a biopsy of the lesions.
Ways of becoming infected: Skin to skin contact, contact with an item infected by the virus (clothing, towel, tattooing machine), self-transmittance between different areas of the body due to scratching.
How is it treated? Although warts usually disappear on their own within 6-24 months, treatment will shorten the duration of the disease. The common treatment is to remove the warts by cutting or freezing them with liquid nitrogen.
Possible complications without treatment: infection of the wart by bacteria (the wart becomes red and painful).
Prevention: use of a condom.
Pediculosis pubis is a common sexually transmitted disease caused by lice known as Pthirus Pubis. For the most part, the disease is restricted to areas of pubic hair in the genitals and buttocks. It is possible for the lice to spread via human hair to the lower stomach, thighs and sometimes the underarms and face.
Symptoms of Pediculosis pubis
Itchiness in the genitals and anus that appears about a month after becoming infected. In a thorough physical examination, lice eggs attached to the pubic and buttocks hair can be detected. A rash composed of small bluish dots (which do not hurt when touched) can appear on the side of the body or thighs when there are intense, multiple treatments. This rash can also remain for some time after the treatment. In addition, scratches can be seen on the skin as a sign of the itchiness.
How is it detected? Infestation of pubic lice is usually detected by examining the pubic hair with the purpose of fining lice eggs, young lice and mature lice. Using a magnifying glass or microscope can help.
Ways of becoming infected: Contact with the genital region (including sex); contact with infected objects (towel, toilet seat, etc.)
How is it treated? With lice killing shampoos, such as Pyrethrin and Lindane. It is recommended to repeat the treatment after 7-10 days (the time it takes between laying eggs and hatching of new eggs). It is possible to get rid of lice and eggs also with tweezers or by removing the infected hair with scissors. If a family member is infected with lice, the other family members can become infected and require treatment as well.
A disease caused by the mite Sarcoptes scabiei, which digs under the skin, creating disease under the skin and arousing an allergic reaction with intense itching at night. The only host for the mite is a human, but it can also survive with no human skin contact for 3 days on sheets, towels and clothes. It frequently involves the folds of the fingers, face, wrists, elbows, underarms, bellybutton, hips, thighs, groin, genitals and the crack of the buttocks.
Symptoms of Scabies
As stated, intense itching at night and a raised rash that appears as thin, wavy, grayish-white lines in the regions of the body described above. For first time exposure to scabies, the time between becoming infected and the appearance of symptoms is 4-6 weeks. In recurring exposure, the symptoms appear within 1-4 days, but they are more moderate than the first time.
How is it detected? A culture of the infected skin and detection of the mite directly under a microscope.
Ways of becoming infected? Continuous and close contact between people (joint sleeping, physical proximity, daily caring such as feeding, bathing, etc.), sex, and transmittance from infected objects (bed linens, towels).
How is it treated? With the same preparations used to treat Pediculosis pubis, as well as with antihistamines for the itching.
Prevention: simultaneous treatment for all family members and the infected individual, washing laundry in boiling water and using a dryer at high temperatures for all textile items that came in contact with the infected individual and family members in the three days before the treatment.
Bacterial Vaginosis – BV
This is a disruption of the normal balance of bacteria in the vagina: instead of the normal and healthy quantities of each bacterium that resides in the vagina of a healthy woman, the balance shifts to increased levels of various bacteria, but all the bacteria is still that of the woman it does not come from her sexual partner. Therefore, this is not a sexually transmitted disease, however, it is more common among sexually active women and lesbians. Additional risk factors are smoking and douching. Even though this is not a sexually transmitted disease, VB is a risk factor for contracting other sexually transmitted diseases.
Symptoms of Bacterial Vaginosis – BV
Watery vaginal discharge and a repugnant odor (like smelly fish).
How is it detected? A clinical diagnosis based on unbalanced acidity in the vagina, odor test supported by a direct culture of the discharge and detection of a stratum of unbalanced bacteria under a microscope.
How is treated? With Flagyl (Metronidazole) antibiotic pills or gels inserted into the vagina.