Dear Doctor,

I have gotten STIs a couple of times and I wonder why. What is the issue? I try to be careful but I think there is more to it. Is it using public toilets? Is there something I may be doing that makes me vulnerable to these infections? Please advise.

 Kami

Dear Kami,

How long have you been getting recurrent STIs? What are the symptoms when you develop a STI? Is it a confirmed diagnosis or you suspect it, due to vaginal discharge, itching, and other symptoms?

A woman’s anatomy makes her more vulnerable to develop a sexually transmitted disease, as compared to a man. The cover of the vagina, as well as inner lining, is very delicate. It is easily breached during intercourse and thus provides easy access to germs causing STI. As such, the environment of the vagina is also moist and a bit warm, thus allowing microbes to multiply if they reach there. Dampness is enhanced during menstrual periods due to bleeding, which increases vulnerability to acquire infections. Blood itself provides a rich medium for bacteria and fungus and other infecting agents to grow, thus increasing vulnerability to infection. Using common toilettes, particularly sitting on common toilette seats, increases risk of urinary tract infection, due to short length of the urethra (tube connecting bladder to exterior) in women. This infection is easily transmitted to pelvic parts, due to the anatomical proximity. Most of the STIs in women may be asymptomatic in early stages. The symptoms may be nonspecific and overlap with other conditions. Like lower abdominal pain during menses and or during ovulation may be normal in some women. Hence, the diagnosis and treatment is delayed.

The risk of acquiring STI is also increased due to frequent intercourse, with multiple partners. Reduced immunity of the body as in HIV infection, uncontrolled diabetes, protein malnutrition, and et cetera, conditions, increases risk of acquiring a sexually transmitted disease as well.

Diagnosis of the type of infection is based on clinical features, microscopic examination of the genital discharge or genital fluid and culture if possible.  An individual can have more than one type of STI at the same time. Treatment is by specific antibiotics.

However, it should be known that the treatment taken cures the current prevailing infection. But it does not prevent a subsequent infection. Hence, after treatment, if any unprotected intercourse is done, chances of acquiring an STI are increased.

Recurrent STIs can cause complications in a woman. These include, chronic infections like HIV, infertility, ectopic pregnancy (where fertilised ovum is implanted outside uterus). Even if a woman conceives, there is increased risk of miscarriage, still birth. Many infections like syphilis, gonorrhoea, chlamydia, etc. can pass from a pregnant mother to her baby and cause complications in the baby.

Prevention of STI lies in maintaining good sexual discipline and hygiene. Ideally one should stick to one partner for sexual activity. Sex should be avoided with a person having genital sores, discharge or ulcers. Condoms help in protecting one from STI. It is important to use good quality condoms made of latex, which would not rupture during intercourse. After the act, it is good to wash genital organs with water. This cleans the surface, removing any germs deposited there. While using public toilettes, one should avoid sitting on the seat directly. If necessary, the seat can be washed or wiped with napkin, to clean it of any microbes.

A healthy life style increases the body’s immunity, which prevents infections to grow and cause disease.   

Dr. Rachna   Pande is a  specialist in internal medicine.