Good sexual health has a positive impact on many aspects of a woman’s life, including reproductive health and wellbeing, and OBGYNs have a critical role to play in supporting informed, safe and responsible sexual health.
Unfortunately, sexually transmitted infections (STIs) remain a global public health problem. It was reported that more than 1 million STIs were acquired every day in 2016 with minimal improvement on 2012 estimates.
Women, adolescents and people affected by conflict and civil unrest are some of the most vulnerable populations.
Fertility risks from STIs
There are more than 30 different infectious agents responsible for STIs, including bacteria (chlamydia, gonorrhoea and syphilis infections), viruses (herpes, the human papillomavirus (HPV), the human immunodeficiency virus (HIV) and the hepatitis A, B and C), protozoa (trichomonas) and parasites (pubic lice).
A woman’s anatomy can place her at a unique risk for many of these, resulting in a profound range of risks for her health and fertility.
Left untreated, chlamydia and gonorrhoea can cause pelvic inflammatory disease (PID) which may permanently damage the fallopian tubes, leading to infertility and an increased risk of ectopic pregnancy. Genital herpes, syphilis and HIV can all be passed to babies during pregnancy and at delivery. The harmful effects may include stillbirth, low birth weight (less than five pounds), brain damage, blindness and deafness.
HPV is a group of more than 100 related viruses, and it has been estimated that 3 in 4 women will come into contact with the virus at some time during their lifetime. While low-risk HPV infections, like HPV 6 and 11, may resolve on their own and cause no clinical problems, high-risk HPV, like HPV 16 and 18, may lead to pre-invasive lesions.
Left untreated, these may persist and progress to cervical cancer, a largely preventable and treatable disease, which kills one woman every two minutes. Women with HIV are up to five times more likely to develop invasive cervical cancer.
Vaccination and screening is an essential priority for FIGO, with our Global Declaration on Cervical Cancer Elimination and our work alongside the World Health Organization (WHO) in the Working Group on Increased Access to Screening and Treatment.
Screening, diagnosis and treatment
WHO positions the health sector response to STIs as critical to the achievement of universal health coverage (UHC). Early diagnosis is essential to ensure the correct treatment is prescribed and administered as soon as possible. This means vaccination, testing, and prevention of reinfection through correct use of prophylaxis.
The three bacterial STIs (chlamydia, gonorrhoea and syphilis) and the most common parasitic STI, trichomoniasis, can usually be cured by single-dose antibiotic regimens. For herpes and HIV, the most effective medications are antivirals which are able to modulate the course of the infection, while for hepatitis B, immune system modulators and antiviral medications can help to fight the virus and slow down liver damage.
STI resistance to antibiotics, in particular in cases of gonorrhoea, has rapidly increased in recent years and reduced treatment options, making prevention even more vital.
Vaccines are a safe and effective way to prevent some STIs. The HPV vaccination protects against nine types of papilloma virus and reduces the risk of condyloma and pre-cancerous lesions, which, if left untreated, may persist and progress to cancer in both men and women (cervix, anus, vagina, penis, vulva, oropharynx, oral cavity). Vaccination against hepatitis B can also prevent serious consequences of this infection.
Most STIs are asymptomatic, especially in early stages, so it is important to be proactive about testing. A blood test or swab can often diagnose infections that, if promptly treated, can be cured. Others, such as HIV, require repeat testing or partner testing and treatment, and it is essential to visit a trained counsellor or healthcare provider to ensure the appropriate course of action.
Not only is good sexual health fundamental to women’s health and happiness, it has a positive impact on our societies and countries. FIGO believes that good sexual health the right of every woman, wherever she is in the world, and we commit to promoting best practices that can achieve it.