Series on sexually transmitted infections (STIs)- Chlamydia

Chlamydia is a common STI. It is caused by bacterium Chlamydia Trachomatis which can cause serious damage to the woman's reproductive presenting with little or no symptoms. Chlamydia is now the commonest bacterial STI. It can be contracted through oral, vaginal, anal sex and by the infant through vaginal delivery. The greater the number of sexual partners the higher the risk of contracting Chlamydia.

Symptoms-
Chlamydia is often a "silent" disease, as many as 80% of patients do not have symptoms.
In females, it may present as mild burning on urination, an abnormal vaginal discharge, lower abdominal pain, fever, back pain, pain during intercourse or abnormal vaginal bleeding.
In males, it may present as discharge itching or burning in the penis.
If a person contracts Chlamydia during anal intercourse, it may present as rectal bleeding, rectal pain or discharge.

Chlamydia can lead to Inflammation and damage to the male or female reproductive organs and lead to male or female infertility. The presence of this infection increases the risk of contracting HIV, due to the damage that it causes in the reproductive tract ie eg cervix, uterus. There is also an increase risk of en ectopic pregnancy, that is a pregnancy located in the fallopian tubes which can be fatal.

Chlamydia can be diagnosed by simple laboratory tests ie cervical swab in the female and penile swab in the males.

It is treated with antibiotics ie. Azithromycin or Doxycycline are the commonest used and are very effective.

Prevention of this is by the use of a condom, which may offer some protection, (provided that the condom does not break during sex) or abstain from sexual intercourse, or be faithful to your partner in a mutually monogamous relationship.

Human Papilloma Virus (HPV)

Human Papilloma Virus (HPV)is the most common sexually transmitted infection (STI).It affects the skin and mucous membranes. It affects the cervix, vaginal area, anus, mouth and throat, and penis. 50 - 80% of people are infected. In Jamaica, the incidence is on the increase and we are seeing it in progressively younger patients. HPV causes genital warts, and cancers, but most of the time it is asymptomatic. Cervical cancer is by far the commonest cancer caused by HPV.

HPV is caused by genital contact during sexual intercourse. Rarely it can pass from mother to infant during vaginal delivery.

HPV can be prevented by abstaining from sexual intercourse and the HPV vaccine, the condom PARTIALLY protects from HPV. These vaccines are now available in Jamaica.

Cervical and other HPV related cancers can be prevented by doing the HPV vaccine. Doing the pap smears regularly ie. annually with or without combination of the HPV test can prevent cervical cancer. HPV testing is available in Jamaica, and may ne used as an adjunct to the Pap smear.

Genital warts tend to be more aggressive in pregnancy. They are treated medically eg. by the use of Imiquimod cream (such as Aldara, also chemical agents may be used to remove the warts and the warts can be removed surgically.
For more information please go to http://www.cdc.gov/STD/HPV/.

HPV Vaccine

The HPV vaccines Cervarix and Gardasil are now available in Jamaica. Most Gynaecologists, Family Doctors and Paediatricians have them available. They are both highly effective in preventing pre-cancerous lesions of the cervix and cervical cancer. Cervarix is indicated for women ages 9 to 55 years and Gardasil age 9 to 26 years. They also protect against genital warts.

What is HPV?

HPV is the Human Papilloma Virus. It is a sexually transmitted infection. There are many strains of this virus (over 100). Each strain is given a number eg. HPV 6 or HPV 45. HPV has high risk types such as HPV 16, 18, 45, these are more likely to cause cervical cancer, and also anal, penile (cancer of the penis), oral cancer, throat cancer. HPV 6 and 11 are low risk types and cause genital warts.
HPV is extremely common as much as 85% of people are exposed to the virus, but only few develop the warts and even fewer the cancers.

In Jamaica Cervical cancer is a big problem. It is the commonest cancer of the female genital tract in Jamaica. Gardasil is designed against HPV 6, 11, 16 and 18. Cervarix against HPV 6, 11. Both are highly effective in preventing cervical cancer caused by HPV 16 and 18 and also provide protection against other strains of the virus. These studies show that over 90% of patients did not develop precancerous lesions or cancer!! It is still important to do your annual pap smears. There are some intricate differences between each vaccine so ask your doctor about them. Even if you already had a previous pre-cancerous lesion and this was treated and cleared up, the vaccines have still been shown to be beneficial in most cases!

The Pap smear

At present so many Jamaican women are still not doing there pap smear. Some do it but not often enough. Some have never done it before, and yes there are those patients who do there pap smear annually on schedule. There are however too few of these last set of Women.

EVERY WOMAN SHOULD DO THEIR PAP SMEAR ONCE A YEAR, OR MORE FREQUENTLY IF INDICATED (ie. example if there doctor said the last smear was abnormal and they should do it sooner).

WHAT IS THE PAP SMEAR?
The pap smear is a screening test used to detect pre-cancerous or cancerous changes in the cervix. The procedure takes usually less than 30 seconds, the doctor will also do a vaginal examination after wards. At most, it is uncomfortable but not painful. But it is important to do.

All Gynaecologists, Family Doctors (GP, clinics, and The Cancer Society of Jamaica offers the pap smear. It may be free in the public setting and privately the cost may vary from JA$600 to JA $1500.

Cervical cancer is the COMMONEST gynaecological cancer in Jamaica and we are seeing it in YOUNGER women, even women in there 20s, although the peak age is said to be in the 40s and 50s.

Doing the Pap smear annually has been shown to decrease death from cervical cancer, as it picks up most commonly pre-cancerous changes that can be EASILY CURED.

In my practice I see about 1 precancerous lesion (called CIN- cervical intraepithelial neoplasia) in about every 25 to 30 smears. 1 in 25 to 30 that is really common AND A RIDICULOUSLY HIGH INCIDENCE!!!! Most of my patients are 18 to 35. So its really common. I treat the lesions so that they will not progress to cancer.

So please ladies do your pap smear once a year!!

By the way, CIN and cervical cancer is caused by a SEXUALLY TRANSMITTED INFECTION CALLED HPV (HUMAN PAPILLOMA VIRUS). Sticking to one faithful partner, using a condom or abstaining WILL help to protect against HPV. The condom only partially protects, but USE A CONDOM EVERY TIME MY SISTERS!!!