The three most common bacterial sexually transmitted infections are Chlamydia, Gonorrhoea, Mycoplasma.

Sexually transmitted infections (STIs), formerly known as STDs (sexually transmitted diseases) are widespread in our society. They affect both men and women and are becoming increasing common in the global population. They can be both asymptomatic and symptomatic. They can have many consequences in women and need to be treated promptly.

Dr Camara-Sampil review some of the major features of STIs, the difference with cystitis and the range of symptoms observed in the most common STIs.

What is an STD?

Organs affected by STIs include:

• uterus (cervix), referred to as cervicitis
• endometrium, referred to as endometritis
• fallopian tubes, referred to salpingitis

There is a relatively low awareness of sexually transmissible infections. Frequent screening is important for anyone who is sexually active, as many sexually transmitted infections are asymptomatic, i.e. the carrier has no symptoms. However, this does not prevent them from infecting their partner.

The consequences of STIs can vary in their severity and include:

• serious genital infections,
• extrauterine pregnancy,
• sterility,
• cancer.

Factors favouring the transmission of STIs include:

• unprotected sexual relations,
• multiple sexual partners,
• precarious social circumstances,
• early sexual intercourse.

One study has shown than over 500,000 people contract an STI each day. The main bacteria responsible for STIs include: human papillomavirus (HPV), herpes simplex virus (HSV), human immunodeficiency virus (HIV), Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum.

What are the various forms of STDs?

In terms of sexually transmitted infections, a difference must be made between viral infections and bacterial infections (other types, including fungal infections, are possible but we will not discuss them here).

Viral STDs:

• HIV,
• Herpes simplex (HSV),
• HPV (Human papillomavirus),
• Hepatitis B,
• Hepatitis C.

Bacterial STDs:

• Syphilis (Treponema pallidium),
• Chlamydia trachomatis,
• Mycoplasma,
• Neisseria gonorrhoeae,
• Gardnerella vaginalis,
• Lymphogranuloma venereum (LGV).

Cystitis, in common with all sexually transmissible infections, affect the intimate area, but involves two different phenomena. STIs mainly infect the genital tract, while urinary infections such as cystitis affect the urinary tract.

Cystitis is not a sexually transmissible infection!

Here we will discuss bacterial STIs in women, especially the most common types: chlamydia, mycoplasma and gonorrhoea.

Focus on Chlamydia trachomatis

Chlamydia trachomatis is a bacteria that lives inside a cell. It has a 48-72 hour lifecycle. The bacteria colonise the mucous membranes, i.e. the urethra, endocervix, rectum, pharynx and conjunctiva.

Methods of transmission

Chlamydia trachomatis is transmitted in two main ways:

• Firstly, after unprotected sex, through the exchange of biological fluids from one mucous membrane to another.
• It is also transmitted through the “vertical transmission” of the pathogen (virus, bacteria) from the mother to the child. In the case of Chlamydia trachomatis, the bacteria is passed from the body of the mother to the child during childbirth.

Chlamydia trachomatis and Symptoms

In most cases, chlamydia is asymptomatic in women. If symptoms appear, they generally occur 1-3 weeks after the infection. Symptoms are discreet and wide ranging including:

• Unusual whitish vaginal discharge related to cervical inflammation and vulvar irritation,
• Pain during sexual intercourse,
• Pain in the lower stomach,
• Pain and burning sensation (like razor blades) when urinating,
• Bleeding possible after sexual intercourse or between periods,
• Possible sore throat,
• Anal pain and anal discharge.

When chlamydia is not picked up and, above all, not treated in time, the consequences can be very serious and include severe genital infections, extrauterine pregnancy, sterility, or even cancer, in the worst cases.

Focus on Gonococci

Gonorrhoea, also known as blennorrhagia (or more vulgarly as the clap or the drip), is an infection that affects a predominantly younger male population (under the age of 30).

Method of transmission

It is caused by gonococcus which like chlamydia is transmitted during unprotected sex. This bacterium colonises the mucous membranes (urethra, endocervix, rectum, pharynx or conjunctiva) and, through the exchange of biological fluids, passes from one mucous membrane to another. Gonorrhoea can also be transmitted through vertical transmission from a mother to a child during childbirth. Gonococcus infection increases the likelihood of an HIV co-infection.

Gonorrhoea and Symptoms

Like chlamydia, gonorrhoea is generally asymptomatic. If symptoms appear, they generally occur 2-5 days after the infection. When symptoms appear, they generally manifest as follows:

• Unusual vaginal discharge, pain in the lower stomach and vulvar irritation,
• Pain with a sensation of passing razor blades when urinating, bleeding between periods or even heavier periods,
• Sore throat and anal pain (often with discharge).

If gonorrhoea is not picked up and, above all, not treated in time, the consequences can be dramatic: chronic stomach pain, inflammation of the uterus and fallopian tubes, and sometimes even infertility.

Focus on Mycoplasma genitalium

Method of transmission

Like the two previously mentioned STIs, Mycoplasma genitalium is transmitted during unprotected sex (both anally and vaginally). It is rarely found in the throat. Mycoplasma infection increases the likelihood of an HIV co-infection.

Mycoplasma and Symptoms

Mycoplasma infection is mostly asymptomatic, which like the previously mentioned infections hampers its detection.

Symptoms of this infection include:

• Unusual vaginal discharge,
• Bleeding between monthly periods or after sexual relations involving vaginal penetration,
• Pain when urinating,
• Rectitis (inflammation of the rectum) accompanied by anal pain and bleeding.

If mycoplasma infection is not picked up and treated in time, the consequences are similar to those of other infections (stomach ache, inflammation of the uterus, sterility, etc.).

Conclusion

For these three sexually transmissible infections, the transmission mechanisms are fairly similar. The symptoms are also similar, which makes it difficult to distinguish chlamydia from gonorrhoea or mycoplasma. It is important to understand that most of these infections are insidious, as they are often asymptomatic, and the signs commonly appear at a very late stage meaning that any damage caused can be irreversible.

Prevention/monitoring

Due to the sometimes dramatic consequences of these STIs, as a preventive measure, annual screening is required followed by regular monitoring thereafter.

Protection during sexual intercourse is also required to avoid infection, as STIs are often asymptomatic.

Over to our Story Time!

Clarisse, aged 28, is a dynamic, sporty, strong and independent woman. She is intensely proud of her professional career. While her career is well on track, her private life is more tumultuous. She never misses drinks after work on Thursday evenings and often enjoys a glass or two of rosé.

One morning she woke up with a sensation of burning when going to the toilet. She knows that she is prone to urinary tract infections, so she doesn't ask any more questions, she takes her antibiotic as a single dose, and always has some “just in case”. She also goes to the pharmacy to get the probiotics that her GP has advised her to take in these situations.

The next day, there is still some discomfort, despite the fact that the medicines generally work rapidly. She also feels pain in the lower stomach and is having unusual discharges. She begins to feel concerned but since she had a busy day ahead of her with face-to-face and on-line meetings, she needs to be at the top of her game. She can’t see a doctor today, so she puts it off.

No matter how much she drinks (3 litres a day!) and how assiduously she takes her probiotics, Clarisse just can’t shake off this intimate discomfort. She realises that she needs to see her general practitioner. While talking the doctor she recalls the previous Thursday evening. After a long day she needed to unwind and met up with Phillip. One thing led to another and she invited him over to her place where they made love. And, on reflection, she can’t remember him using a condom.

Chlamydia trachomatis, a usually asymptomatic STI, was diagnosed. Luckily for Clarisse, her body sounded the alarm in time! Her doctor explained that if it had remained untreated this infection could have had dramatic consequences on her health. Fortunately, the treatment is simple, a single dose of antibiotics will be enough to get Clarisse back in shape!

She knows that protection and “safe sex” are essential After leaving the surgery she goes to buy condoms. You just never know. Maybe she will meet her prince charming at the next after-work drinks.