Resistant STIs on Rise

This article is written by Dr. Sarita Jaiswal and Pooja Yadav

When we discuss life in general, we run across various issues that influence our lives, some which we physically observe and some which we candidly feel. As such, the subject of sex in India is surrounded by a multitude of social standards, religious confinements, and taboos which leave no scope for discussion about the sexually transmitted disease.

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There are more than 20 types of sexually transmitted infections (STIs) which are caused by bacteria, parasites, viruses, and yeasts. Bacterial infections such as gonorrhea, chlamydia, and syphilis are such little-discussed STIs. Though gonorrhea is as pervasive as chlamydia, it is rarely diagnosed and tested. These infections may cause infertility in women as well as in men and have the potential to become the next SUPERBUG within a decade.

From Khajuraho to condoms, we as a country are known for hypocrisy about ‘SEX’ in our mindset. A nation that has swung from the extremes of religious rigors to the extremes of uninhibited debauchery, STIs duck and display voluntarily. It leaves us no surprise when ongoing reports point at expanding patterns of STIs among teenagers. The reasons are their undisclosed curiosity and no sex education at schools or at home. Numerous reports point towards increasing number of child abuse reports in both rich and economically backward sections of our country.

Many people in India, consider STI as an ‘appearance from God,’ ‘an indication of developing youthfulness,’ ‘an indication of development,’ ‘the consequence of eating nettle leaves’ and ‘from sex with menstruating lady’. Not just in our country, such misleading thoughts regarding the causation of STIs are common throughout the world with shifting accentuation.

STIs are in general, more dynamic than other existing community infections. It is important to keep track of epidemiological changes in STIs especially in a densely populated country like India. A thorough understanding of the patterns of infections spread in a geographical region is important for planning its control strategies. Each year about 357 million STIs (chlamydia, gonorrhea, syphilis, and trichomoniasis) are reported worldwide. As per the warning from the World Health Organization (WHO), antimicrobial resistance in gonorrhea is emerging strongly while cases of untreated chlamydia and syphilis with reported antibiotic resistance are also making the news. Multidrug-resistant (MDR) is defined as resistance to at least ≥3 antimicrobial categories which are used earlier successfully. The gonococcus mutates rapidly and acquiring resistance even against new classes of antibiotics. Chlamydia is the world’s most common non-viral STI and gonorrhea is the second most common MDR infection. Gonorrhea might have existed since ages but its authentic records in India can only be found during and after the British Empire in India. It was referred to as “clap” disease before the actual cause was discovered and is caused by the obligate pathogen Neisseria gonorrhoeae which infect only humans. Chlamydia and syphilis are caused by Chlamydia trachomatis and Treponema palladium respectively.

Researchers in India have isolated around 124 strains of gonorrhea from Delhi, Hyderabad, Mumbai, Pune, and Secunderabad for testing antimicrobial susceptibility. As per their results, 98% isolates were resistant to ciprofloxacin, 52% to penicillin, 56% to tetracycline and 5% to azithromycin. Irrational use of antibiotics, gradual accumulation of antibiotics in the food chain, innate antimicrobial resistance and development of resistance due to mutation were major culprits for developing resistance. MDR in Neisseria gonorrhoeae is a big public health challenge.

Peoples, who have chlamydia, are more susceptible to gonorrhea and syphilis. These infections do not spread by shaking hands or toilet seats. The bacteria that cause syphilis can enter the body through a cut in the skin or through contact with a partner’s syphilis sore. It can also be passed from mother to newborn as the baby passes through the infected birth canal.

The incubation period, the time from exposure to the bacteria until symptoms develop depends on the sex of the patient, age and immune status of the infected person. In the case of gonorrhea, it is usually several hours to 4-5 days in males while in women it takes much longer and ranges from 7 to 14 days. In younger people, it proceeds rapidly, and its incubation period is also very brief. In older patients, sometimes infection is asymptomatic, progress to become chronic and eventually evident after a few months. In case the infected person was taking antibiotics for other medical ailments, its incubation period may extend further. In chlamydia, the incubation period is one to three weeks while in syphilis it is 21 days but can range from 10 to 90 days.

Infection and symptoms of chlamydia and gonorrhea are common which makes it difficult to distinguish these from each other. In comparison to men, women are around five times more prone to have asymptomatic urogenital infections. This infection can spread throughout the body, and affect joints, heart valves or other vital organs which can be deadly.

Symptoms of syphilis include 3 stages. In the primary stage of syphilis, it first appears as a painless chancre which goes away without treatment in 3-6 weeks. If it is not treated, the second stage begins as the chancre is healing or several weeks after the chancre has disappeared, when a rash may appear. The rash usually appears on the soles of the feet and palms of the hands, flat warts may be seen on the vulva. Some patients may exhibit flu-like symptoms. The rash and other symptoms may go away in a few weeks or months, but that does not mean the infection is gone. It still exists and referred to as the latent stage of its infection.

Unlike testing for chlamydia and gonorrhea, routine screening for syphilis is not recommended for women who are not pregnant. Diagnosis of these is cumbersome and time-consuming. Also, one may be tested for chlamydia and gonorrhea at a time as these two often occur together. Oral medicines and injectable antibiotics are prescribed in general to the patient and his/her partner to kill the infection and prevent its spread.