The group of sexually transmitted infections is extremely diverse in terms of transmission route, pathogen, affected groups of people and disease severity.
As the name suggests, STIs are diseases that are primarily transmitted sexually. However, this does not only include sexual intercourse in the true sense of the word, an infection is also possible during kissing. Furthermore, some STIs can also be contracted through contact with infected blood or from a mother to her child during pregnancy, birth or breastfeeding. Some groups of people, such as MSM (men who have sex with men), may have an increased risk of certain STIs.
The most common sexually transmitted bacterial diseases worldwide include trichomonas infections(trichomoniasis; the pathogen is the protozoan Trichomonas vaginalis) and chlamydia infections. These can make themselves felt, for example, through itching in the genital area and discharge. Gonorrhea is also a common STI.
Not only bacteria, but also viruses can be responsible for an STI. For example, the pathogens that cause genital warts are human papillomaviruses, or HPV for short. Infection with human papillomaviruses is by far the most common STI, and the presumed infection rate in the population is almost 100%. However, not every patient has the corresponding skin changes in the genital area. Doctors refer to this as intraepithelial neoplasia, i.e. new formations of body tissue on the vulva (VIN), the cervix (CIN) or the penis (PIN) or genital warts. The viruses are common and spread everywhere, even if patients show no symptoms.
Genital herpes is also a disease caused by viruses. In addition to viral infections, STIs also include fungal infections of the genitals and infestations with crabs and scabies mites . Other sexually transmitted infections include HIV and hepatitis B.
The "classic" STIs originally only included the following:
- Syphilis (Lues venerea; the pathogen is the bacterium Treponema pallidum) - unfortunately, there is currently a massive increase in infections here (as reported by the Robert Koch Institute).
- Gonorrhea(gonorrhea; the pathogen is the bacterium Neisseria gonorrhoeae) - not only the frequency of the disease is problematic, but also the existing antiobiotic resistance, which makes treatment more difficult.
- Ulcus molle (soft chancre, chancroid; the pathogen is the bacterium Haemophilus ducreyi)
- Lymphogranuloma inguinale(lymphogranuloma venereum, chlamydial infection; the pathogen is the bacterium Chlamydia trachomatis)
- Granuloma venereum(granuloma inguinale; growth; pathogen is the bacterium Klebsiella granulomatis)
The discovery of new pathogens as well as the discovery of genital transmission in the case of long-known infections has today expanded the list to over 30 STIs.
If an STI is suspected, the specialist will first talk to the patient. For example, the doctor will ask whether the patient has had unprotected sexual intercourse and ask them to describe the symptoms in detail. The subsequent physical examination is based on the symptoms, gender and sexual practices.
In particular, the urogenital tract including the genitals, the anal region and the mouth and throat area, but also the rest of the skin, are examined in detail and attention is paid to any skin abnormalities. The groin region is palpated.
A swab is taken to rule out or confirm an infection. Vaginal secretions, infectious secretions such as discharge from the urethra or skin material are examined. A pathogen strain can be isolated in the laboratory through microbiological processing. This enables the attending physician to make a reliable diagnosis.
In the case of some STIs, such as HIV or hepatitis B, the pathogens can also be detected in the blood. Direct detection of the pathogens in the blood is rarely carried out, partly for cost reasons. Current HIV and hepatitis B screening tests, however, work in such a way that the antibodies against the respective virus are detected indirectly.
Irrespective of the occurrence of symptoms, people with an increased risk of infection (including MSM and sex workers) should also be tested for STIs at regular intervals. The attending physician can determine which examination intervals are appropriate for each individual.
Treatment always depends on the type and severity of the infection. Antibiotics are the treatment of choice for a bacterial infection.
Antibiotics do not help with a viral disease - antiviral drugs, so-called antivirals, are used here. Local therapies with ointments are also available for parasitic STIs. Surgical interventions may be indicated for skin changes caused by the human papillomavirus (e.g. genital warts and precancerous lesions).
It is important to inform, examine and, if necessary, treat current and past sexual partners. If only one partner is treated for the sexually transmitted disease, there is always a risk of reinfection (so-called ping-pong effect).
At best, the treating doctor will also provide advice on safer sex. While unwanted pregnancies can be prevented by the pill and other hormonal contraceptives, the use of a condom is effective protection against certain STIs. Vaccinations are available against HPV and hepatitis A and B viruses.
If you suspect that you are suffering from a sexually transmitted disease, you should never delay seeing a doctor out of false shame.
Strictly speaking, there is no such thing as a "specialist in sexually transmitted diseases". Specialists in the diagnosis and treatment of sexually transmitted diseases are gynaecologists, urologists and venereologists. They can make a diagnosis quickly and reliably and therefore also initiate the necessary treatment quickly.
A dermatologist is usually the first point of contact for the care of patients with sexually transmitted infections, as STIs often manifest themselves on the skin. The specialist for sexually transmitted diseases in both sexes is therefore also called a venereologist, although the official title in Germany is specialist for skin and sexually transmitted diseases (dermatologist). A venereologist is therefore a dermatologist who specializes in venereal diseases.
However, specialists from other medical disciplines also treat patients with venereal diseases, such as
- Gynecologists deal primarily with the female reproductive organs. If the symptoms affect the female genital area, a gynecologist is a possible point of contact.
- Male patients with symptoms affecting the male reproductive organs can consult a urologist.
- In the case of symptoms in the area of the anus, a specialist with the additional qualification of proctologist may also be the right doctor to treat you, for example a dermatologist with an additional proctology qualification.
