June 1998
Other Important STDS
As medical science has become more precise in diagnosing infectious
diseases, the list of known sexually transmitted diseases (STDs) has
grown. The National Institute of Allergy and Infectious Diseases (NIAID)
has published separate fact sheets on some of the major STDs: chlamydial
infection; gonorrhea; pelvic inflammatory disease (PID); trichomoniasis
and other vaginal infections; syphilis; genital herpes; genital warts;
and AIDS. NIAID has prepared this fact sheet to provide information
on some of the other diseases that can be transmitted sexually:
Although some of these diseases are less well-known in the United States
than other STDs, they are still important – some are especially
significant for pregnant women. Many of these infections are of serious
concern for people in other parts of the world, particularly in developing
countries.
Chancroid
Chancroid ("shan-kroid") is an important bacterial
infection caused by Haemophilus ducreyi, which is spread by
sexual contact. Periodic outbreaks of chancroid have occurred in the
United States, the last one being in the late 1980s. These outbreaks
are usually seen in minority populations in the inner cities, especially
in the southern and eastern portion of the country. Globally, this disease
is common in sub-Saharan Africa among men who have frequent contact
with prostitutes.
The infection begins with the appearance of painful open sores on
the genitals, sometimes accompanied by swollen, tender lymph nodes
in the groin. These symptoms occur within a week after exposure. Symptoms
in women are often less noticeable and may be limited to painful urination
or defecation, painful intercourse, rectal bleeding, or vaginal discharge.
Chancroid lesions may be difficult to distinguish from ulcers caused
by genital herpes or syphilis. A physician must therefore diagnose
the infection by excluding other diseases with similar symptoms. People
with chancroid can be treated effectively with one of several antibiotics.
Chancroid is one of the genital ulcer diseases that may be associated
with an increased risk of transmission of the human immunodeficiency
virus (HIV), the cause of AIDS.
Cytomegalovirus Infections
Cytomegalovirus (CMV) is a very common virus that infects
approximately one-half of all young adults in the United States. It
rarely causes serious consequences except in people with suppressed
or impaired immune systems or in infants, whose immune systems are still
developing. The virus, a member of the herpesvirus family, is found
in saliva, urine, and other bodily fluids. Because it is often found
in semen as well as in cervical secretions, the virus can be spread
by sexual contact; it also can be easily spread by other forms of physical
contact such as kissing. Day-care center staff for children under the
age of 3 are at increased risk of CMV infection and should carefully
wash their hands after changing diapers. Like other herpesvirus infections,
CMV is incurable; people are infected with it for life. Although the
virus usually remains in an inactive state, it can reactivate from time
to time.
Symptoms. In healthy adults, CMV usually
produces no symptoms of infection. Occasionally, however, mild symptoms
of swollen lymph glands, fever, and fatigue may occur. These symptoms
may be similar to those of infectious mononucleosis.
Diagnosis. The ELISA (enzyme-linked immunosorbent
assay) test is commonly used to detect levels of antibodies (disease-fighting
proteins of the immune system) in the blood. A number of other blood
tests can suggest a diagnosis of CMV infection, but no blood test
can reliably diagnose it. Although CMV can be isolated from urine
or other body fluids, it may be excreted months or years after an
infection; therefore, isolation of the virus from these fluids is
not a reliable method of diagnosing recent infection.
Complications. Babies can be infected with
CMV in the uterus if their mothers become infected with the virus
or develop a recurrence of a previous infection during pregnancy.
Although most babies infected with CMV before birth do not develop
any symptoms, CMV is the leading cause of congenital infection in
the United States. An estimated 6,000 babies each year develop life-threatening
complications of congenital CMV infection at birth or suffer serious
consequences later in life, including mental retardation, blindness,
deafness, or epilepsy. Investigators supported by NIAID are currently
studying how the virus interferes with normal fetal development and
at which stages the fetus is most susceptible to infection. Congenital
CMV is the most common cause of progressive deafness in children.
When CMV is acquired after birth, or if it reactivates, it can be
life-threatening for persons with suppressed immune systems, such
as those receiving chemotherapy or persons who have received immunosuppressant
drugs for organ transplantation. Persons with HIV infection or AIDS
may develop severe CMV infections, including CMV retinitis, an eye
disease that can lead to blindness.
Treatment. NIAID scientists are testing
new antiviral drugs that might be effective against CMV infections.
The antiviral drugs foscarnet and ganciclovir have been approved for
treating people with AIDS-associated CMV retinitis.
Prevention. There is no intervention to
prevent CMV. Use of the male condom may reduce risk although virus
in the saliva would be transmitted by kissing or oral intercourse.
Some experts believe that primary or first-time exposure during pregnancy
is a major cause of CMV infection in newborns. Infants infected before
or just after birth are likely to be shedding CMV in saliva and urine,
which can infect others. Hand washing and proper handling of diapers
may reduce risk. Scientists are working to develop a vaccine and other
methods to provide immunity to CMV and offer protection against severe
disease.
Molluscum Contagiosum
This common viral infection most often affects young children,
who pass it to each other through saliva. In adults, however, the virus
is transmitted sexually, resulting in lesions on the genitals, lower
abdomen, buttocks, or inner thighs. Most people with the infection do
not have noticeable symptoms, although sometimes the lesions, which
are painless wart-like bumps, may itch or become irritated. The lesions
often heal without treatment, although physicians may sometimes scrape
them off or treat them with chemical irritants.
Pubic Lice
Pubic lice (pediculosis pubis or crab lice) are very tiny
insects that infest the pubic hair and survive by feeding on human blood.
These parasites are most often spread by sexual contact; in a few cases,
they may be picked up through contact with infested bedding or clothing.
An estimated 3 million people with new cases of the infestation are
treated each year in the United States.
Symptoms. The primary symptom of infestation
is itching in the pubic area. Scratching may spread the lice to other
parts of the body; thus, every effort should be made to avoid touching
the infected area, although this may be difficult.
Diagnosis. Pubic lice are diagnosed easily
because they are visible to the naked eye. They are pinhead size,
oval in shape, and grayish, but appear reddish-brown when full of
blood from their host. Nits, the tiny white eggs, also are visible
and usually are observed clinging to the base of pubic hair.
Treatment. Lotions and shampoos that will
kill pubic lice are available both over the counter and by prescription.
Creams or lotions containing lindane, a powerful pesticide, are most
frequently prescribed for the treatment of pubic lice. Pregnant women
may be advised not to use this drug, and a physician's recommendations
for use in infants and small children should be followed carefully.
Itching may persist even after the lice have been eradicated. This
is because the skin has been irritated and requires time to heal.
A soothing lotion such as calamine may offer temporary relief.
Prevention. All persons with whom an infested
individual has come into close contact, including family and close
friends as well as sex partners, should be treated to ensure that
the lice have been eliminated. In addition, all clothing and bedding
should be dry-cleaned or washed in very hot water (125�
F), dried at a high setting, and ironed to rid them of any lice. Pubic
lice die within 24 hours of being separated from the body. Because
the eggs may live up to six days, it is important to apply the treatment
for the full time recommended.
Scabies
Scabies is a skin infestation with a tiny mite, Sarcoptes
scabiei. Scabies has become relatively common throughout the general
population. It is highly contagious and is spread primarily through
sexual contact, although it also is commonly transmitted by contact
with skin, infested sheets, towels, or even furniture.
Symptoms. Scabies causes intense itching,
which often becomes worse at night. Small red bumps or lines appear
on the body at sites where the female scabies mite has burrowed into
the skin to lay her eggs. The areas most commonly affected include
the hands (especially between the fingers), wrists, elbows, lower
abdomen, and genitals. The skin reaction may not develop until a month
or more after infestation. During this time, a person may pass the
disease unknowingly to a sex partner or to another person with whom
he or she has close contact.
Diagnosis. Scabies may be confused with
other skin irritations such as poison ivy or eczema. To make an accurate
diagnosis, a doctor takes a scraping of the irritated area and examines
it under a microscope, to reveal the presence of the mite.
Treatment. As with pubic lice, lindane
is an effective treatment for scabies. Pregnant women should consult
a doctor before using this product. Nonprescription remedies such
as sulfur ointment also are available. Sulfur is fairly effective
but may be objectionable because of its odor and messiness. Itching
can persist even after the infestation has been eliminated because
of lingering skin irritation. A hydrocortisone cream or ointment or
a soothing lotion may provide relief from itching.
Prevention. Family members and sex partners
of a person with scabies are advised to undergo treatment. Twenty-four
hours after drug therapy, a person with scabies infestation is no
longer contagious to others, even though the skin irritation may persist
for some time. As with pubic lice, special care must be taken to rid
clothing and bedding of any mites.
Human T-Cell Lymphotropic Virus
The human T-cell lymphotropic viruses (retroviruses), HTLV-I
and HTLV-II, are uncommon in the general U.S. population. They appear
to be most prevalent among IV drug users and persons who have multiple
sex partners, genital ulcers, or a history of syphilis. The virus can
be transmitted by blood or intimate sexual contact, and can be passed
from mother to child during pregnancy and through breast milk.
Most infected persons remain healthy carriers of the virus. In rare
cases, however, HTLV-I can cause adult T-cell leukemia/lymphoma (ATL),
a rare and aggressive cancer of the blood. Infected persons also may
develop myelopathy, a neurologic disorder that affects the muscles
in the legs. In addition, researchers think that HTLV-I plays a role
in the development of B-cell chronic lymphocytic leukemia. HTLV-II
can cause another rare cancer called hairy-cell leukemia. Because
the chances of curing ATL rely on early detection, scientists are
studying protein in the blood of HTLV-I-infected persons that may
help predict who will develop the disease.
Blood donations are screened routinely for HTLV-I. Because lab tests
cannot easily distinguish between HTLV-I and HTLV-II, experts believe
many cases of HTLV-II are eliminated from the blood supply as well.
Research
STD research that is supported and conducted by NIAID will
help in the search for new ways to diagnose, treat, and prevent these
infections. This is important not only for the well-being of our adult
population but also for the health of future generations.
NIAID is a component of the National Institutes of Health
(NIH), which is an agency of the Department of Health and Human Services.
NIAID supports basic and applied research to prevent, diagnose, and
treat infectious and immune-mediated illnesses, including HIV/AIDS
and other sexually transmitted diseases, illness from potential agents
of bioterrorism, tuberculosis, malaria, autoimmune disorders, asthma
and allergies.
News releases, fact sheets and other NIAID-related
materials are available on the NIAID Web site at http://www.niaid.nih.gov.
Prepared by:
Office of Communications and Public Liaison
National Institute of Allergy and Infectious Diseases
National Institutes of Health
Bethesda, MD 20892
Last Updated November 21, 2003 (alt)
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