February 2022 Newsletter
SEXUALLY TRANSMITTED DISEASES Safety starts with a C
Prepared in collaboration with l'Association scientifique des étudiants en pharmacie d'Alger (ASEPA)
TABLE OF CONTENTS
What are STDs and how are they transmitted? STDs statistics - February 2022 STDs diagnosis How to prevent an STI? Treatment Approach Breaking the stigma STDs and mental health Celebrities with STDs Myth vs. Facts
Let's meet the writers From LPSA
Hadi Haidar
Rêve Khaddaj
Kassem Hijazi
Mira Yamout
Mohamad Taleb
Let's meet the writers From ASEPA
Alyssa Boutnaf
Sara Amrane
Souhaib Kirat
Meryama Lina Medjahed
WHAT ARE STDS AND HOW ARE THEY TRANSMITTED? Sexually Transmitted Disease
PROTECT YOURSELF
Sexually Transmitted Infection
GET TESTED USE CONDOMS &
Educate your daughter/son
The first question that comes to mind now is:
WHAT ARE SEXUALLY TRANSMITTED INFECTIONS (STIS)?
Recently, with the spread of social media, we are listening to these sentences routinely, but we still avoid talking about this topic. However, these diseases are present and the infection is dangerous and might become life threatening. So instead of fear, there is change and instead of silence there is awareness.
Nathaniel Branden
once said:
The first step to ward change is awareness and the second step is acceptance.
STIs are infections that are transmitted from an infected person to another uninfected person through sexual contact (vaginal, oral or anal sex). They are very common but they might be asymptomatic for long period of time. If left untreated, STDs might lead to serious health problem. Most STDs affect both women and men; however main health problem affect women, especially if she is pregnant because this will lead to severe outcome for the baby. There is more than 20 types of STDs, mainly: Chlamydia, Genital herpes, Gonorrhea, HIV/AIDS, HPV, syphilis, pubic lice, trichomoniasis and others.
WHAT'S IN THIS MONTH'S ISSUE: In the following newsletter, we will tackle STIS diagnosis, some prevention techniques, the treatment approach, the effect of STIs on the patient social and mental health and we will end by talking about the role of pharmacist in spreading awareness about STIs and by listing some celebrities who were diagnosed with STIs.
STATISTICS February 2022
30
8
Pathogens are transmitted through sexual contact or intercourse.
4
of these are linked to the greatest incidence of sexually transmitted disease.
4
of these 8 are currently curable: Syphilis, gonorrhea*, chlamydia & trichomoniasis with a course(s) of antibiotics. are viral infections & are incurable: Hepatitis B, HSV or Herpes , HIV and HPV.
*However, the current surge of antibiotic resistant gonorrhea is proving to decrease the cure rate of gonorrheal infected patients.
STIs (Sexually Transmitted Infections) have direct impact on sexual and reproductive health through stigmatization, infertility, cancers and pregnancy complications and can increase the risk of HIV. According to the statistics gathered by WHO (World Health Organization), the incidence transmission rate of STIs is more than 1 million per day. Chlamydia, Gonorrhea, Syphilis and Trichomoniasis account for around 374 million new cases yearly.
HPV (Human Papilloma virus); the leading cause of cervical cancer, was associated with
HSV-1 (Herpes simplex virus) is estimated to infect more than
cervical cancer in 2018 & over
Syphilis affected more than
570,000 cases of 311,000
deaths annually.
500 million 1 million
people aged 15 to 49.
pregnant females
leading to 350,000+ birth adverse outcomes, 200,000 of which were stillbirths & newborn deaths.
1 MILLION case per day
Majority asymptomatic
Chlamydia
129M
500M 82M HSV GONORRHEA
296M HPV HBV 7.1M 300M Trichomoniasis SYPHILIS
156M
cases per year
Gonorrhea
Women have an 80-90% prevalence rate of acquiring secondary to sexual contact with an infected male. Male have a 50% prevalence rate post sexualcontact with an infected female. 25% post anal intercourse with a homosexual partner, and 10-25% post oral intercourse with an infected partner.
Chlamydia
7 out 10 infected women are unaware they have chlamydia. 3 out of 10 of infected males are unaware.
COMPLICATIONS Gonorrhea
< 1% bacteremia 1-3% Endocarditis & meningitis
Chlamydia 12.5% of 15 year olds: PID (Pelvic Inflammatory Disease) 12.1% Infertility post 1st episode of PID
Syphilis
Males: From 2000 to 2018, a huge surge of syphilis was seen which was attributed mainly due to MSM (men who have sex with men). MSM accounted for approximately 54 percent of all primary and secondary syphilis cases in 2018 Females: From 2013 to 2018 the rate of primary and secondary syphilis in women increased by over 170 percent. In 2018, the rate among women was 3 cases per 100,000 females. This was attributed to increased drug use mainly heroin and methamphetamine.
Trichomoniasis
2-5 out of 10 of infected females are asymptomatic. Majority of males (urethral infection) are asymptomatic.
STDS DIAGNOSIS 1. Physical Examination
The doctor will do a physical or pelvic exam to look for signs of infection, such as a rash, warts or discharge.
2. Laboratory Tests
Blood tests: They can confirm the diagnosis of HIV or later stages of syphilis.
Urine samples: Some STIs can be confirmed with a urine sample. Examples include Gonorrhea and Chlamydia Fluid samples: from the sores to diagnose the type of infection if there were open genital sores. Rapid STI testing: accurate, easy, 15 to 20 minutes (syphilis, hepatitis B & HIV). A rapid dual HIV/syphilis test is now available whereby a person can be tested for HIV and syphilis from a single finger-stick.
Cheek swab Exam of the genital area Testing discharge or cell samples from your body (usually the vagina, urethra, cervix, penis, anus or throat)
3. Screening Everyone ages 13 to 16
All people born between
1945 & 1965
Pregnant
women
Women
age 21 & older
Women under 25 who are sexually
active
The one STI screening test suggested is a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Experts recommend that people at high risk have an HIV test every year. There's a high incidence of hepatitis C in this category of people. Since the disease often causes no symptoms until it's advanced, experts recommend that everyone in that age group be screened for hepatitis C.
All pregnant women will generally be screened for HIV, hepatitis B, chlamydia and syphilis at their first prenatal visit. Gonorrhea and hepatitis C screening tests are recommended at least once during pregnancy for women at high risk of these infections. Rapid syphilis tests have been shown to increase the number of infected pregnant women. The Pap test screens for changes in the cells of the cervix, including inflammation, precancerous changes, and cancer. Cervical cancer is often caused by certain strains of HPV (Human Papillomavirus). Experts recommend that women have a Pap test every three years starting at age 21 and after age 30 to have an HPV test and a Pap test every five years. Alternatively, women over 30 could have a Pap test alone every three years or an HPV test alone every three years. To be tested for chlamydia infection and gonorrhea. The chlamydia test uses a sample of urine or vaginal fluid you can collect yourself. Reinfection by an untreated or undertreated partner is common, so you need the second test to confirm that the infection is cured. You can catch chlamydia multiple times, so get re-tested if you have a new partner.
3. Screening Men who have sex with men
People
Annual or more-frequent STI screening for these men. Regular tests for HIV, syphilis, chlamydia and gonorrhea are particularly important. Evaluation for hepatitis B also may be recommended.
If you have HIV, it dramatically raises your risk of catching other STIs. Experts recommend immediate testing for syphilis, gonorrhea, chlamydia and herpes after being diagnosed with HIV. They also recommend that people with HIV be screened for hepatitis C.
with HIV
Women with HIV may develop aggressive cervical cancer, so experts recommend they have a Pap test at the time of the HIV diagnosis or within a year of becoming sexually active if they are under 21 and have HIV. Then, experts recommend repeating the Pap test every year for three years. After three negative tests, women with HIV can get a Pap test every three years.
People
Before having vaginal or anal intercourse with new partners, be sure you have both been tested for STIs. However, routine testing for genital herpes isn't recommended unless you have symptoms. It is also possible to be infected with an STI yet still test negative, particularly if you have recently been infected.
who have a new partner
HOW CAN YOU PREVENT AN STI? A sexually transmitted infection (STI) has profound repercussions on sexual and reproductive health. It can also cause immune, joint and meningeal damage and can extend to the nervous system. Therefore, the prevention of STIs is essential and mainly involves the use of condoms to avoid the transmission of germs through sex.
There are two types of condoms
1. Male condoms
The condom is a latex or polyurethane sheath (in case of latex allergy) which will retain sperm and prevent contact between the mucous membranes.
2. Female condoms The female condom, a nitrile or polyurethane sheath with a flexible ring at both ends. It is placed in the vagina, in order to receive the male sex at the time of penetration.
Condoms are available single-use & over-the-counter in pharmacies or family planning centers in different lengths, widths, lubricated or not. There is one for all body types. The condom should be stored away from heat, humidity and light.
HOW CAN YOU PREVENT AN STI? However, the pharmacist has a very important role in ensuring the quality of condoms, the reliability of storage, which allows the integrity of the condom to be preserved, and a decisive role in forecasting needs.
The community pharmacist also Plays a role in the regular ordering of condoms to ensure an uninterrupted supply of products that comply with the recommendations of the World Health Organization (WHO) and that meet the needs of the community in terms of variety and convenience. Promotes the use of condoms and lubricants by the community, providing information on the compatibility of different lubricants and condoms through consistent demonstrations of use to reduce the risks associated with incorrect use (since misuse can cause tearing or slipping during sex). Allows the elimination of the social stigma surrounding the use of condoms in the population, by presenting it as an instrument of support for sexual health during sexual intercourse. At the pharmacy, the pharmacist reinforces the use of condoms on a regular basis if necessary, thanks to the ease of access to condoms in the pharmacies.
HOW CAN YOU PREVENT AN STI? The condom remains an essential means of protecting oneself from STIs, but it is not the only one.
Screening makes it possible to adapt the behavior of the infection so that it’s not transmitted during sexual intercourse. Indeed, there are several tests that can detect an infection, such as the Rapid Diagnostic Orientation Test (TROD) of HIV carried out using a vaginal smear in women (sampling of a liquid or cells from the body for microscopic examination), a urethral swab in men (sampling at the level of the canal used for the flow of urine and semen), or screening through a urine sample. Therefore, the earlier the infection is detected, the better. It is also recommended to get vaccinated, when vaccines are available, against hepatitis B and the papillomavirus, in order to prevent STIs. There are also therapies for the prevention of sexually transmitted infections indicated under certain conditions by the doctor.
HOW CAN YOU PREVENT AN STI? Sexually transmitted infections are frequent, silent and above all very dangerous, but not invincible. Researchers are working hard to find a vaccine against these infections such as AIDS, but hopes remain distant.
Indeed, condoms and early screening are the only weapons of prevention!
TREATMENT APPROACH
STDs are quite the dilemma, they represent a major Public Health problem as they not only cause severe damage to the affected individuals but their status as a
subject in many societies has made it possible to many cases to be left untreated or if poorly handled that result in severe damage or even death.
The main causes behind such infections are various, diverse and overall complex. They can range from the direct form of interactions to the most uncommon ones. Nowadays, STDs are a daily case at hospitals and clinics. They have become a common part of any doctor or pharmacist’s routine.
TREATMENT APPROACH Let us focus on the various treatment approaches for these types of pathologies. WHO and CDC made it clear in their Sexually transmitted Diseases/Infections Guidelines that the treatment of the aforementioned sicknesses depends on many factors and variants including:
Type of infection
Correct diagnosis
Duration of exposure
Treatment should be well detailed and planned and the process of selection of STI Drugs includes the following criteria: 1. High efficacy (at least 95%) and low cost 2. Acceptable toxicity and tolerance 3. Organism resistance unlikely to develop or likely to be delayed 4. Single dose through oral administration 5. Not contraindicated for pregnant or lactating women It is worth noting that the therapeutic plan should also include the treatment of STI-related symptoms including: Urethral and Vaginal Discharge Genital Ulcer Lower Abdominal Pain Cervical and Vaginal Infections Overall, the treatment approach should be situational while making sure to include as many facets of therapeutic advancements. The psychological follow up must also be a priority as well, be it through exercises or psychiatric visits as societies around the world still hold prejudice against this subject.
BREAKING THE STIGMA The assessment of patient risk, risk-reduction methods, determination of essential testing, and identification of anatomical areas from which to collect specimens for STD testing will all be guided by asking patients about sex behaviors.
That is why building confidence between the patient and the pharmacist is necessary and requires patient confidentiality. Patients who trust their healthcare providers are more inclined to reveal health information, and better interactions and higher-quality health visits can result from pharmacist-patient relationships built on trust. For this reason, and to better help patients when it comes to counseling on STDs, pharmacists must Know about epidemics and influences Know local STD testing locations Evaluate the accessibility of condoms in the pharmacy Enhance counseling for chlamydia (whose standard treatment is 1 gram of Azithromycin)
BREAKING THE STIGMA How do you have this conversation? Think about how the patient feels: Embarrassed & worried about confidentiality, cost... Find a truly private location to have the conversation.
Turn on the empathy, set aside your bias.
Did your doctor tell you what this medication is for?
This medication is used to treat a very common infection, chlamydia.
I care about your health, so there are some things that I need you to do to get better and not get the infection again.
STDs & Mental Health To every action, there is an equal and opposite reaction. Newton’s third law describes life as well as physics. Being diagnosed with a serious illness like STDs does not affect the patients only on a physical level; it also has a tremendous impact on their emotional well-being that varies according to their age, gender and type of the disease.
Over 40% of patients attending public STD clinics have been classified as having psychiatric problems based on screening tests. Patients with a history of mental illness are more likely to react abnormally to STD diagnosis. Patients also experience different levels of personal guilt because of contracting STIs, with women enduring greater humiliation and isolation than men.
Reactions to HIV infection for example are often more extreme than other STDs because the fully developed disease is generally fatal and associated with stigmatization. The psychological symptoms associated with HIV change as the disease advances through distinct stages: rage characterized mood states in the asymptomatic and moderate symptomatic phases, whereas loneliness characterized mood states in the terminal phase.
STDs & Mental Health The impact of STDs is more devastating when it affects people’s future dreams, such as infertility due to chlamydia or gonorrhea within couples wanting to start a family.
Negative life events, depression, low self-esteem, anxiety, anger, and social alienation were proven to contribute to the recurrence of STDs such as herpes simplex virus (HSV). Other STIs can result in brain damage, like syphilis causing dementia if left untreated. An STD can clearly have a huge impact on many aspects of a person's life that is why it is important to seek help for the good progress of treatment. Mental health providers like psychiatrists, psychologists or therapists, joining support groups, exercising regularly and meditation are all great options to improve well-being. People living with STDs have an increased risk for developing composite mental illness, depression, anxiety, and severe mental illnesses.
Education and support from healthcare professionals to help them cope with the emotional impact of a diagnosis, relationship issues, and fears about disclosure may be an important factor in reducing rates of transmission and enabling them to adapt to living with an STD.
Celebrities with STDs It is well known that STD’s are still a taboo topic to talk about loudly or to share with our families, friends… However, whether it is HIV, Herpes or other sexually transmitted diseases, many celebrities actually suffer from them and chose to disclose it to the world, in order to help break the stigma, as well as raising awareness.
They are singers, actors, models and even athletes, and some of them would even surprise you
David Hasselhoff
He is an American actor who has set a Guinness world record as the most watched man on TV, famously known for his role in the TV series Baywatch. He suffers from Herpes, nonetheless, it wasn’t made public until 2006 whilst he has been infected back in 1989.
Tommy Morrison
Tommy was a famous American professional boxer, also known for his acting career as he played in the very popular movie ‘’Rocky V’’ alongside Sylvester Stallone. Morrison retired from boxing after he was tested positive for HIV in 1996. Therefore, he founded KnockOut Aids Foundation to raise awareness and fundraising. He passed away in 2013 but the reason of his death may or may not be associated with HIV.
Celebrities with STDs Magic Johnson
He is known as one the greatest basketball players of all time, and announced publicly that he was living with HIV in 1991. Back then, it was stereotyped that people diagnosed with HIV ultimately meant dying. Magic continues to educate and break the stigma about being a strong athletic man living with an STD;
“I do have it and have had it for 22 years. It’s just laying asleep in my body. The drugs have done their part, and I’ve done my part by exercising and having a positive attitude about having HIV,” Johnson explained while appearing on SiriusXM radio’s Hip-Hop Nation in 2014.
Pamela Anderson
She is a famous Canadian-American actress, model and activist and is struggling against Hepatitis C. When opening up about her struggle, she admitted that she wasn’t expecting to live more than 10 to 15 years after she was diagnosed with her disease.
Here are some Myth and Facts to answer your remaining questions
Myths
Facts
Using multiple condoms at the same time prevents pregnancy.
Never use two or more condoms at the same time while having sex.
Regular sized condoms fit all and condom feels sometimes uncomfortable.
There are various sizes of condoms available in the market so you can choose the one that fit correctly.
You don’t need condoms when you are on contraceptive pills.
Pills do not prevent STDs; hence, it is always better to use condoms to stay safer.
Condoms break very easily.
To buy a condom you should be 18.
Condoms are just for men.
Condoms are indicative of sexual promiscuity by people who use them.
Generally, condoms don’t break down if used properly and are manufactured by reputable company. To buy a condom there is no age restriction. The female condom is just as effective and safe as the male condom and can be a wonderful option for women who have trouble convincing their partner to use a male condom. Everyone, including couples in long-term relationships, can benefit from condoms’ ability to prevent STIs and pregnancy.