Comeback of STDs
Antibiotic resistance and social taboo as opponents of effective therapies
about 340 million new cases are acquired by sexually transmitted diseases annually worldwide, being most affected men and women between 15 and 49 years. While Übersexualisierung society progresses in everyday life, at the same time also increases the taboo of STDs. Prevention campaigns - similar to the AIDS awareness since 1987 - are complicated because there are many different pathogens. A new problem is posed now represents rising antimicrobial resistance, which are observed in bacterially induced diseases.The most common sexually transmitted diseases
Sexually transmitted diseases or infections - STD (sexually transmitted diseases) and STI (sexually transmitted infections) - are those diseases that can be transmitted through sexual contact primarily - this includes finger and tongue contacts and the transmission through sex toys. Culprits are bacteria, viruses, fungi, protozoa and arthropods. Among the most common bacterial STI include chlamydia, syphilis and gonorrhea. Among the viral STI include not only HIV also
Human papillomavirus (HPV), genital herpes, and hepatitis B and C. The most common parasitic STI is caused by Trichomonas vaginalis. Pubic lice and scabies can also be sexually transmitted. The data situation on STIs in Germany is inadequate; there are only very few aspects that are scientifically sound. Epidemiological figures are only available for HIV and syphilis, there is no nationwide uniform documentation for all other STIs.
Germany Compared
Due to the HIV epidemic in the 1980er and 1990er years the sexually transmitted diseases went in the western industrialized nations sharply. Since 2000 again shows a 3-5 fold increase in HIV infection levels in Western countries, large increases in HIV / STI incidence can be found in almost all former Soviet states and China.
Germany has, despite doubling of HIV infection levels, to Finland and Andorra for about five years consistently the lowest HIV incidences with etwa3.000 cases per year. The incidence of syphilis and gonorrhea have increased fivefold in the past decade and continues to rise year on 4.600 syphilis and gonorrhea 16.000 cases of; Men are affected more often than women. These infections are acquired up to 90% of people with high-risk contacts of sexually transmitted infections: frequent change of partners, not using condoms, risk of sexual practices, which are also in response to minor, unnoticeable injuries.
Chlamydia, human Papiloma Virus (HPV) and herpes simplex infections occur in young people, win the first sexual experience and thereby become infected with these pathogens, heaped on - estimated about 80.000 infections annually.
An STI sufferers have a significantly increased risk of becoming infected with HIV. HIV is approximately three times longer transmitted, if present in the area of the genital mucosae inflammatory changes, which form an important input and exit gate for HIV. Conversely, people with HIV are at increased risk of becoming infected with other sexually transmitted diseases.
Frequent infection by HPV and their involvement in tumor diseases
HPV infections are the most common STI. HPV infection is up to 60% in 20 years men and women to finden.Derzeit more than 150 HPV types have been fully classified, continuously new HPV types are detected. Of clinical relevance so far about 40 HPV types that occur mostly in the anogenital region.
Sexual contact with a few different sexual partners are at the prevalence in Europe sufficient to achieve a high prevalence: In Germany infections per year is of 60.000 assumed. Again, the numbers end of the last millennium were significantly lower and have risen sharply again since 2000. Through well-established sexual practices such as oral and anal sex take to infections in the neck and throat, which demWandel sexual normality may be attributed. So have about 30% of heterosexual couples anal sex, a few years ago by most people as abnormally 'designated category.
High-risk HPV is responsible for the development of anogenital carcinomas. More than 99% of cervical cancers and more than 90% of anal cancers are HPV-positive. Next up to 70% of all cancers can the penis, vulva and vagina HPV are detected. Up to 30% of cancers in the throat and neck area (especially Tonsillenkarzinome) caused by HPV. The high relevance of HPV infection experts strongly urge political decisions to strengthen the vaccination against human papillomaviruses.
Therapierfolge and setbacks
While in AIDS, hepatitis and syphilis large therapy successes have been achieved, prepare antimicrobial medical professionals great concern. Especially with the gonorrhea develop for some time dangerous resistance, in Japan completely immune gonococcal have been discovered. "Pharmaceutical research must be strengthened and the legislature should intervene," says Professor Dr. Norbert H. Brockmeyer, President of the German Society STI (DSTIG) and dermatologist at the Department of Dermatology, Venereology and Allergology, Ruhr-Universität Bochum. So does the use of antibiotics in animal fattening absurd relations to, in the Netherlands, for example, are five times more antibiotics used for fattening animals as for medical care for the entire population. The development of resistance is thus predetermined.
Chlamydia as cause of infertility
In Germany, there are annually about 100.000 genital infections with Chlamydia trachomatis, the most common bacterial sexually transmitted pathogens - with the assumption of a very high number of unreported cases. Young women in particular to 25 years are affected, often in conjunction with HPV. Chlamydia are tiny gram-negative pathogens, like viruses can grow only in cells and cause inflammation, especially in the cervix and into the urethra. If these (despite the free, annual screening Offer until 25. Age) undetected and become chronic, can go through the closure of the fallopian tubes sterility. Estimates of DSTIG are at present concerned 100.000 women.
The disease of men - Syphilis
Syphilis has, quintupled among men who have sex with men in the past decade, especially in North America and Europe. The transmission of syphilis pathogen is generally effected only by moist mucosa moist mucous membrane (genital, anal, oral), a transfer takes place almost exclusively through sexual contacts. Left untreated it can extend over several decades and in four clinical stages to end of life, but also spontaneously curable. Penicillin is still the treatment of choice, resistance has not been observed. Concomitant disease from HIV infection and syphilis leads to considerable mutual influence: The syphilis facilitates HIV transmission and worsens the disease, HIV-related immunodeficiency affects the clinic of syphilis, the results of the detection methods and treatment.
The dangers of silent gonorrhea
Gonorrhoea is the WHO estimates that the third most common sexually transmitted infection in the world. In Germany are also most affected MSM. The infection of the urethra of the man usually causes acute symptoms that usually lead to early treatment.
For infections of the rectum or the pharynx, but that's not usually the case, so they are often not recognized. Also in women gonorrhea runs often asymptomatic, which increases the risk ascending infections. Gonorrhoea is next to the chlamydial infection is a major cause of chronic inflammation of the pelvis, with the consequence of sterility. Unlike chlamydia screening in women under 25 years or under the maternity guidelines, screening for gonorrhea in Germany has not yet been provided. As the first choice for the treatment applies a combination therapy with two antibiotics.
Since the introduction of the infection protection act 2001 exists in Germany for gonorrhea no reporting requirement, so here are hardly epidemiological data. In Saxony, the only state with a reporting requirement for gonorrhea, a doubling of reported gonococcal infections of 6,8Infektionen / 100.000 inhabitants in 2003 on 13,7 / 100.000 2011 year was observed.
Requirement of sexual education
In Germany the DSTIG is as a medical professional society the strongest institution that promotes education, prevention and optimized diagnosis and treatment of sexually transmitted infections in politics and society. "Only those who have access to information, know their rights and possibilities of medical or psychological care. Only one can also consciously behave preemptively detect signs of irregularities, problems and diseases and find counseling and treatment offers and perceive, "Brock Meyer summarizes the commitment of the resident in Bochum means together.
Needs improvement in Germany are also the supply structure and the strengthening of medical expertise. In the area of sexual health action is needed in medical education. This could be better informed about the benefits of the Public Health Service, so that practicing physicians could take these enhanced services. Following the example of Britain's integrated care structures could to sexually transmitted infections and sexual health patient care from a single source. should be involved this self-help groups, because with this the threshold of taboo sexually transmitted diseases could be quickly overcome.
Additional information
DSTDG guideline www.dstig.de
Robert Koch Institute (RKI). To estimate the prevalence and incidence of HIV infection in Germany, Booth 2012 end. Epidemiological Bulletin 2012. 47: 465-476.
Robert Koch Institute (RKI) 2010.Sechs years STD sentinel surveillance in Germany. Epidemiological Bulletin 3: 20-27.
BZgA: brochure of the Federal Centre for Health Education for youth and adults ... because what?
H. Nitschke, F. Oliveira, A. Knapp, A. Bunte. 2011. Seismograph for Migration and versor-supply deficits - STD clinic in the Health Office Cologne. Healthcare 73 (11): 748-755.
. Langanke H. et al, standards in the prevention of sexually transmitted infections, Epidemiological Bulletin, 2010, 35: 351-354.
Layer C, Peter Hinz B, C folding, Gille G. 2010. Medical explanatory meeting - foundation of STD prevention among girls and young women. The gynecologist, 43 (12): 1033-1040.
Source: Berlin [DDG]
