Sexually Transmitted Diseases | Specialists and Information

Sexually transmitted infections differ in terms of:

• Route of transmission
• Pathogens
• Affected population groups, and
• Severity of the disease

As the name suggests, STIs are primarily transmitted through sexual contact. However, this does not only include sexual intercourse in the strict sense; infection is also possible through kissing.

Furthermore, some STIs can also be transmitted through infected blood. Transmission from mother to child during pregnancy, childbirth, or breastfeeding is also possible.

Certain groups of people, such as MSM (men who have sex with men), are at increased risk for specific STIs.

The Most Common Sexually Transmitted Infections @ GraphicsRF /AdobeStock

The most common sexually transmitted bacterial infections include:

• Trichomoniasis: The causative agent is the protozoan Trichomonas vaginalis
• Chlamydia infection: Symptoms may include, for example, itching in the genital area and vaginal discharge. 
• Gonorrhea

Trichomoniasis can be effectively treated with antibiotics @ blueringmedia /AdobeStock

Not only bacteria, but also viruses can cause STIs. For example, the pathogens responsible for genital warts are human papillomaviruses, abbreviated as HPV.

Infection with human papillomaviruses is by far the most common STI; the estimated prevalence in the general population is nearly 100%.

Of course, not every patient has visible skin changes in the genital area. Medical professionals refer to these as intraepithelial neoplasia, meaning abnormal growths of body tissue:

• Vulva (VIN)
• Cervix (CIN)
• Penis (PIN) or
• genital warts

These viruses are common and widespread, even when patients show no symptoms.

Genital herpes is also a disease caused by viruses. Like viral infections, genital fungal infections, pubic lice, and scabies mites are also classified as STIs. Other sexually transmitted infections include, for example, HIV and hepatitis B.

The “classic” sexually transmitted diseases originally included:

• Syphilis (Lues venerea): The causative agent is the bacterium Treponema pallidum. Unfortunately, there has recently been a massive increase in infections (according to the Robert Koch Institute).
• Gonorrhea: The causative agent is the bacterium Neisseria gonorrhoeae. Not only is the prevalence of the disease a concern, but so are the existing antibiotic-resistant strains, which complicate treatment.
• Chancroid (Ulcus molle): The causative agent is the bacterium Haemophilus ducreyi
• Lymphogranuloma inguinale (lymphogranuloma venereum, chlamydial infection): The causative agent is the bacterium Chlamydia trachomatis
• Granuloma venereum (granuloma inguinale; chancre): The causative agent is the bacterium Klebsiella granulomatis

With the discovery of new pathogens, the list has expanded to over 30 STIs.

Syphilis is a highly contagious sexually transmitted infection caused by bacteria that affects the entire body @ SecondSide /AdobeStock

If a sexually transmitted disease is suspected, the specialist first conducts an interview with the patient. The doctor asks, for example, whether the patient has had unprotected sexual intercourse.

The doctor will also ask the patient to describe their symptoms in detail. The subsequent physical examination is tailored to the patient’s symptoms, gender, and sexual practices.

The doctor carefully examines the urogenital tract (genitals, anal region, and oropharyngeal area) and the rest of the skin in particular. They pay special attention to any skin abnormalities and palpate the groin area.

To rule out or confirm an infection, the doctor performs a swab test.

This involves examining:

• Vaginal discharge
• Infectious secretions
• Discharge from the urethra or
• skin samples

Through microbiological analysis, the laboratory can isolate the pathogen strain. This allows the treating physician to make a definitive diagnosis.

For 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 relatively rare, partly due to cost considerations.

Current HIV and hepatitis B screening tests work by indirectly detecting the respective virus.

Regardless of symptoms, individuals at increased risk of infection should be screened for STIs at regular intervals.

Risk groups include:

• MSM (men who have sex with men) and
• sex workers

The treating physician can determine which screening intervals are appropriate for each individual.

Swabs and blood tests are used to detect sexually transmitted infections @ Master Video /AdobeStock

Treatment always depends on the type and severity of the infection. The treatment of choice for a bacterial infection is antibiotics.

Antibiotics are not effective against viral infections—in these cases, antiviral medications, known as virostatics, are used.

For parasitic STIs, topical treatments with ointments are also available.

Surgical procedures may be indicated in cases of skin lesions caused by the human papillomavirus (e.g., genital warts and precancerous lesions).

It is important to inform, examine, and, if necessary, treat both current and past sexual partners. If only one partner is treated for the sexually transmitted infection, there is always a risk of reinfection (the “ping-pong effect”).

The treating physician also provides counseling on safer sex. While the birth control pill and other hormonal contraceptive methods prevent unwanted pregnancies, condoms offer effective protection against sexually transmitted infections.

Vaccines are available against HPV and hepatitis A and B viruses.

If you suspect you have a sexually transmitted disease, you should not delay seeing a doctor under any circumstances.

Strictly speaking, there is no such thing as a “specialist in sexually transmitted infections.” Specialists in the diagnosis and treatment of sexually transmitted infections include gynecologists, urologists, and venereologists. They can make a diagnosis quickly and reliably and promptly initiate the necessary treatment.

For the care of patients with sexually transmitted infections, the dermatologist is the first point of contact. STIs usually manifest on the skin.

The specialist in sexually transmitted diseases is therefore called a venereologist. The official title in Germany is “specialist in skin and sexually transmitted diseases” (dermatologist).

A venereologist is, therefore, a dermatologist who specializes in sexually transmitted diseases.

However, specialists in other medical fields also treat patients with sexually transmitted diseases, such as:

• Gynecologists primarily deal with the female reproductive organs. If symptoms affect the female genital area, a gynecologist is a possible point of contact.
• Male patients with symptoms affecting the male genital organs can consult a urologist.

For symptoms in the anal area, a specialist with a subspecialty in proctology may be the appropriate doctor to treat you. This specialist is known as a dermatologist with a subspecialty in proctology.