Sexually transmitted infections are usually transmitted during sexual activity by the contact of body fluids or mucosal surfaces on the skin. The transmission of infections during unprotected sexual intercourse is very common.
According to the World Health Organization (WHO), in 2016, the number of people newly diagnosed with HIV (which is in fact just one of the sexually transmitted infections) in 51 of 53 European countries was about 160,450 people.
The ways of transmission of sexually transmitted infections are the following:
(Note: Each of the Sexually Transmitted Infections has separate transitional characteristics. The STIs in the following sections are described in general and in broad terms.)
Unprotected sexual intercourse can cause an infection because of the transmission of STIs through prostate fluid, semen, rectal or vaginal fluids. This might happen during unprotected anal, oral and vaginal intercourse between individuals.
The common use of blood-related materials such as injectors and razors can cause bloodstream infections. In addition, the transfer of blood and other blood products (as well as the use of such products for transplantations) without previous STI checks may cause infections.
Some of the STIs may be transmitted through pregnancy, during delivery or after delivery or while breastfeeding the baby.
Sexually transmitted infections caused by bacteria (Gonorrhea, Chlamydia, Syphilis, etc.) can be treated completely by the use of antibiotics.
However, Hepatitis B and HIV infection need a chronic treatment, whereas HPV has no definite but a symptomatic treatment.
HIV, HPV, and Syphilis, even if settled in the body, may not show symptoms for long periods and are difficult to be diagnosed by clinical examinations.
For this reason, it is important for you and your partner to be aware of STIs and to regularly access sexual and reproductive health care, which also includes STI testing at least once a year or at appropriate intervals after risky contacts, even if there are no symptoms.
Possible symptoms of STIs:
– Swelling, wounds, redness and itches in the genital area, oral area or anus area;
– Burning and pain when urinating;
– Sudden vaginal or penile discharge or itching of the genitals;
– Unusual vaginal or rectal bleeding;
– Colorful and foul-smelling discharge;
– Pain in the lower abdomen;
– Painful and swollen lymph nodes in the groin and around;
– Painful sexual intercourse.
The most effective method of protection against sexually transmitted infections is the continuous and accurate use of condoms
Some infections occur because of the contact with the surface of mucous membranes of body fluids that carry bacteria or parasites.
A condom protects sexual partners against sexually transmitted infections as it prevents the contact of the body fluids with the mucous membrane surface by forming a barrier.
In addition, a condom provides protection against infections such as genital herpes, HPV (human papillomavirus) and syphilis, which are transmitted by contacting infected skin or mucous membranes.
You can go to primary health care facilities for the diagnosis and treatment of sexually transmitted infections.
In Migrant Health Centers, Migrant Health Training Centers, Family Health Centers, and Community Health Centers, you can obtain simple tests for outpatient examinations and diagnoses, receive treatment for some infections and get condoms.
You can also go to other centers where you can get SRH health care for HIV, but also services and diagnostic tests for some other infections. Furthermore, you can receive condoms free of charge.
For a more comprehensive examination, diagnosis and treatment, you can obtain all the screening tests related to STIs, such as gynecology, urology, dermatology or infectious diseases in outpatient clinics of state hospitals and private hospitals, and also in special diagnosis and treatment centers.
If you need advanced care, you can contact training and research hospitals that provide tertiary level health care.
Sexually Transmitted Infections
Some of the most common sexually transmitted infections are the following:
Syphilis is a sexually transmitted infection caused by the bacterium “Treponema Pallidum”. It is one of the most common sexually transmitted infection in the world. According to the data provided by Turkish physicians, it appears as much as HIV infections in Turkey. It is also known that Syphilis facilitates the passage of HIV. Syphilis, which can be completely healed when detected in stages 1 and 2, can nonetheless produce fatal outcomes in stage 3 or afterwards. Syphilis can be transmitted by kissing, oral and anal intercourse or by any other contact with infected areas, e.g. where trauma-based skin integrity is impaired. Symptoms:- Fluidness;
– Hard and painless scars on those body parts that contact sexual fluids;
– Swollen lymph glands;
– Common skin eruption on arms and body, especially on the palms and soles;
– Muscle pain, fever, sore throat, swollen lymph nodes.
Diagnosis and Treatment: The primary stage of syphilis occurs about three months after the bacteria entered the body. Although a preliminary diagnosis can be made by a clinical examination, the definite diagnosis is made by a blood test. Syphilis is treated and followed up by a specialists of STIs. The clinical course of the infection may be based on a 1 or 3 week treatment protocol, depending on the blood test markers. Penicillin and derived antibiotics are used for the treatment. An additional routine monitoring should be done 3-6 months after the treatment is completed. Sexual partners (even if one of the sexual partners has no symptoms) are treated together.
Syphilis is a sexually transmitted infection caused by the bacterium “Treponema Pallidum”. It is one of the most common sexually transmitted infection in the world. According to the data provided by Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. It can be transmitted via oral, anal and vaginal sexual intercourse. The first indication of being infected with Gonorrhea becomes obvious within the first 7-10 days after the infection with the bacterium. However, in some cases, no symptoms may occur. Gonorrhea is an infection that can be treated with antibiotics. It is the most common STI in Turkey. Symptoms:- Pain, aches or burning sensations while urinating;
– Chronic inguinal pain;
– Redness in the rectal area, mucopurulent stool;
– Painful sexual intercourse;
– Yellow-green discharge from the penis, the vagina or the anus
Diagnosis and Treatment: The diagnosis is made by a clinical examination taking a smear test from the penis or the cervix. The treatment should be regulated and monitored by a physician. Not use random antibiotics as they may cause serious problems in the treatment of further infectious diseases. The use of random antibiotics can lead to the formation of bacterial resistances to these drugs.
Hepatitis means an inflammation of the liver. Hepatitis B is one of the viruses that causes this infection. After the infection, the virus settles in the liver and causes destruction of the tissues over time. If not treated, Hepatitis B can cause serious consequences. Hepatitis B infections can be completely cured, but they can also become chronic in advanced cases. In some cases, Hepatitis B remains a carrier. Hepatitis B can be transmitted via the passage of sexual fluids during sexual intercourse. It can also be transmitted via uncontrolled blood and blood products, the use of non-sterile injections, injectors and subcutaneous materials or via direct transmissions from mothers to babies. Symptoms: Hepatitis B, which is mostly symptomless, is usually detected by pre-op tests, premarital and work-in-progress examinations and pre-blood tests. Symptoms include fever, fatigue, loss of appetite, nausea and vomiting, abdominal pain, thickening of urine, jaundice in the skin and eyes and arthralgia. In Turkey, one of three people is infected with a Hepatitis B infection and one of ten people is just a carrier.
Condyloma Acuminatum is an infection which is caused by a virus called Human Papilloma (HPV). Symptoms occur within the first three months after the virus has entered the body. Symptoms: – Painless acne on the penis or on the vagina, as well as skin and genital warts. Diagnosis and Treatment: The symptoms shown on the external sexual organs have no effect other than being contagious and aesthetically disturbing, but the viruses located in the cervix cause cervical cancer. There is no definitive treatment against HPV, the most effective prevention is a HPV vaccination.
Due to a virus that causes genital herpes infections, fever blisters might occur in genital areas. Such symptoms occur within one week after the infection with the virus. Symptoms:- Muscle aches and pain,
– High fever;
– Fluid-filled blisters in the genital areas;
– Swollen lymph nodes.
Diagnosis and Treatment: The diagnosis of genital herpes is possible by testing the blood. However, even after a treatment, the virus might reappear later onwards.
HIV stands for the Human Immunodeficiency Virus. By damaging or killing cells of the body’s immune system, HIV progressively destroys the body’s ability to fight against infections and certain types of cancers. HIV is a chronic infection with treatment possibilities, however the virus, if not treated, can lead to the Acquired Immune Deficiency Syndrome, known as AIDS.
AIDS is an abbreviation of the Acquired Immune Deficiency Syndrome (The same word is used in Turkish.) AIDS is not a disease or infection by itself. The damage of the immune system occurs if HIV is not treated. In such a case, other opportunistic infections entering the body might cause a variety of disease patterns. The table of diseases that occur at this stage is called AIDS. AIDS can be controlled by appropriate and regular treatment. Detection can be reversed by regular treatment. When return is made without any interruption, people who continue the treatment without interruption can continue their lives without encountering any negativity. However, interrupting the treatment or taking the treatment irregularly may even cause the virus to develop resistance to treatment, which complicates the treatment process and reduces its success rate.
1) Transmission – The period of infection.
2) Acute HIV infection – The first reaction of the body can be seen 2-4 weeks after the HIV transmission. It is often difficult to understand because the symptoms are very similar to general infectious diseases. During this time period, antibody tests are often negative. The time period is therefore known as window period. However, the person is already infectious from this point of the HIV stage.
3) Seroconversion Period – At this stage, the presence of the HIV- infection might be detected by laboratory tests.
4) Non-Diagnosis Period – During this period, no symptoms occur and the normal health conditions remain. This period can take up to 10-12 years. HIV might be diagnosed in blood tests that people have done for various other reasons (pre-surgery, pre-pregnancy or start of an employment). In case HIV is diagnosed, the immediate treatment begins. The infection status of the person receiving treatment does not go beyond this condition.
5) Early Diagnosis Period – Symptoms such as a weakened immune system, headache, intense weight loss, and unexplained fever, prolonged or unstable diarrhea occur during the early diagnosis period.
6) Acquired Immune Deficiency Syndrome (AIDS) – AIDS is monitored in the absence of a diagnosis or treatment of HIV in previous stages. Immune system deficiencies are evident and opportunistic cancer types can be observed. With a treatment, it is possible to return to a non-diagnosis period.
7) Advanced Stage – The advanced stage occurs for people who have not been diagnosed or who have not been treated despite the diagnosis. Losing muscle masses, dysfunction in the nervous system and similar symptoms are observed. Untreated cases usually result in death.
Modes of Transmission:
HIV can be in blood, vaginal fluid, semen and in the mother’s milk.
– High fever;
– Swollen lymph glands;
– Infections of mouth, esophagus and/or genital area;
– Muscle pains and other related pains;
– Diarrhea that doesn’t last long;
– Respiratory disorders such as cough;
– Nausea and vomiting, loss of weight;
– Recurrent infections.
Unprotected sex: The risk of transmission increases with the number of unprotected sex.
Blood: Blood and blood products that are HIV-infected can be transmitted by tissue and organ transplantations, however nowadays HIV scanning is a legal requirement before performing a transplantation. The most common cause of a HIV – positive blood transfusion is the use of intravenous injections.
Mother-to-Child Transmission: A mother may transmit HIV to her baby during the pregnancy, during delivery or by breastfeeding. However, with the necessary precautions and treatments, the virus transmission rates from mothers to babies can be reduced to very low levels.
HIV is not transmitted through body fluids such as saliva, sweat, urine, or tears. Behaviors such as sneezing, coughing, using the same plates /forks/glasses, or using common toilets/bathrooms, using a swimming pool, handshaking and kissing do not transmit HIV.
Regular blood testing is important. When a person encounters symptoms that might indicate a HIV infection, the person should be tested for HIV without further delay. Even if you do not have any symptoms, you should have a test after 3 months if you have had a risky experience. Counseling can be provided before and after the HIV test. If your test result is positive, you should refer to a specialist physician and start treatment while profiting from the received counseling services. The HIV virus cannot be totally removed from the body but the virus can be controlled by several treatment methods and the disease agents can be eliminated. During the treatment of HIV, the so-called “Antiretroviral Therapy” stops influencing the immune system. It is important to continue treatment even if the virus is undetectable. Irregularly starting and stopping the HIV treatment or using irregular medication complicates the treatment process and can lead to the failure of the treatment. HIV treatment is covered by the general health insurance. Refugees can benefit anonymously and free of charge from HIV testing. However, refugees are required to register for further HIV treatment and they have to have an ID number starting with “99” and need to be registered in the province where they ask for services
Any suspicious feeling is a form of preventive treatment to reduce the risks of infection after a risky situation.
After any suspicious behavior, PEP helps to prevent the spreading of the virus.
PEP should be firstly taken within 72 hours after the risky behavior. However, even if taken during this time, PEP may not provide absolute protection.
For this reason, you should in any case consult a specialist physician or talk to a health unit, providing HIV diagnosis and treatment services.
Pre-exposure prophylaxis is a method used by people who do not live with HIV but who have practices (e.g. sex, injection drug use) that increase the likelihood of getting infected with HIV.
It is applied by regular use of a medicine used in the treatment of HIV. In the case that HIV has been transmitted to one´s body, the virus will stop its replication and an infection will be prevented.
It is important to take the medicine for the PrEP treatment as consistently as prescribed by the physician.
PrEP is an alternative method of contraception in situations where the time of the risky behavior is known in advance. A double-dose of the medicine should be taken within 2 to 24 hours before the risky behavior, one dose within the 24 hours after the risky behavior and another dose of medicine after 48 hours.
The treatment must be prescribed by a physician.
PrEP is not recommended as a lifetime protection, it should be used during periods when the risk for HIV infections is high.
However, PreP is very important for the protection of high-risk groups, especially sex workers.
HIV -Protection Methods:
In order to be protected from HIV, the ways of transmission must be considered.
Medical support and counseling from specialists must be obtained to prevent a mother-to-child transmission of HIV.
Sterile injections should always be used for intravenous use and injections, and injections should not be shared with other people.
The most important method of HIV prevention is the continuous use of condoms. In the case of monogamous relationships, people think that the use of condoms is not necessary, however, monogamy is not a protection method. It reduces the risk of getting a virus, when the partner is sure that, he/she is not HIV-infected.
Living with HIV
For people who are diagnosed with HIV, several HIV life counseling services can be provided.
Such counseling services can be found at university affiliated training and research centers that are specialized on HIV, community-based Health Organizations (approved by the municipality and the Ministry of Health), or at support centers and service units of some NGOs working on HIV.
Counseling for people living with HIV includes:
– Guidance about the treatments post- diagnosis;
– Psychosocial support in order to handle difficulties regarding education, work and family life;
– Legal support in cases of social exclusion and discrimination.