Common STI's in China: Symptoms, Treatment & Prevention

STI & STD Acronyms Demystified

We hear these two terms being used interchangeably. But what's the difference? STIs are sexually transmitted infections. Well, STDs are sexually transmitted diseases. If an infection leads to symptoms, then we say you have an STD.

What’s Common in CHINA?

Globally, there are millions of cases of sexually transmitted infections (STIs) every year and China is no exception. Traditional concepts believe infections can only be passed person to person through some form of sexual activity, but STIs can also be passed through non-sexual means! China’s most common STIs, in order of occurrence in 2008, were Syphilis, Chlamydia, Human Papilloma Virus/Genital Warts (HPV), Gonorrhea and Genital Herpes (HSV). (Source: The increase of sexually transmitted infections calls for simultaneous preventive intervention for more effectively containing HIV epidemics in China, 2014).

Numbers are increasing, and so too is drug resistance!

In China, since the 1980s, STIs have shown dramatic increases, with annually reported STI cases increasing from 23,534 in 1986 to 859,040 in 2000. Syphilis having been largely eliminated in the 1960s in China, through free screening and treatment, made a dramatic comeback to one of its top STIs nowadays. In one study carried out in Guangzhou on a particular strain of Syphilis, drug resistance to penicillin, tetracycline and ciprofloxacin was as high as 85%, 85% and 78% respectively in 2001, progressing to 81.9%, 100% and 98.4% in 2011, respectively. (Source: 2014 Royal College of Obstetricians and Gynecologists)

Please note: having HIV/AIDS, syphilis and gonorrhea are reportable STIs according to the Law of the People's Republic of China, meaning that statistics will be shared by hospitals to the government.

STD: Added Risk to HIV

In terms of HIV/AIDS alone, the Chinese Center for Disease Control and Prevention, World Health Organization, and UNAIDS estimate that there were 1.25 million people living with HIV/AIDS in China at the end of 2018, with 135,000 new infections from 2017. A commonality among STD sufferers is that they are more likely to acquire and transmit HIV. Why? Because STD sufferers can more easily contract HIV through unprotected sex with an HIV+ individual. STDs alter the cell lining of the vagina, penis, rectum or mouth making it easier for HIV to enter the body. (https://www.cdc.gov/std/hiv/stdfact-std-hiv-detailed.htm) (https://www.health.ny.gov/diseases/aids/consumers/hiv_basics/stds_hiv.htm)
 

Sex Ed 101: The Three Types

Sex education is taught in middle school in the states, but the when, where and how of this type of education can vary around the world. Here is a quick refresher course or perhaps news-to-you, if you haven’t sat through an awkward teen lecture during puberty. STIs are classified as either bacterial (syphilis, chlamydia, gonorrhea), viral (HPV, HSV, HIV, HBV) or parasitic (trichomoniasis). Treatment depends on the type of STI a person contracts.

The Fine Print：STI treatment Vs. cure

Currently, these four STIs: herpes (HSV), hepatitis B (HBV), human immunodeficiency virus (HIV), and human papillomavirus (HPV) are merely treatable with medications and/or topical ointments but are incurable. Still, antibiotics, often in a single dose, can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomoniasis.

There’s also a silver lining for those infected with HIV. HAART (highly active antiretroviral treatment) medication makes it possible for those living with HIV to achieve a zero viral load, preventing the spread of the virus. See <Date Night China: PrEP & PEP HIV Prevention in Beijing> for details.

No Symptoms = No STI?  

Many STIs have no signs or symptoms, but that doesn’t mean you’re infection-free. Infections can still be passed on to your partner. When symptoms occur, your STI is then classified as an STD.

Having STD Symptoms

Symptoms can include mouth or genital lesions, eye infections, vaginitis (urethral or vaginal discharge and/or pain when urinating), and, in women, bleeding between periods. These symptoms may be mild or severe and can cause long-term health risks to men and women.

STDs: The Complications

PID: Chlamydia and gonorrhea are major causes of pelvic inflammatory disease (PID) in women. This can inflame and scar the fallopian tubes, making it hard for sperm and eggs to find each other, causing infertility. In its later stages, syphilis can cause serious cardiovascular and neurological disease.

Liver Disease: Hepatitis B is a serious infection of the liver caused by a virus and can cause liver disease.

Male Sterility: Nongonococcal urethritis—or NGU—is an infection of the urethra caused by pathogens (germs) other than gonorrhea which can cause infertility if untreated. Urethra infections should always be treated immediately, and not all are caused by an STD.

Pregnancy Complications: Transmission of any of these four (Trichomoniasis, Chlamydia, Syphilis and Gonorrhea) STIs during pregnancy can lead to serious consequences for babies including ectopic pregnancy (fallopian tubes not transferring the embryo into the uterine cavity), stillbirth, neonatal death, low birth-weight and prematurity, sepsis, blindness, pneumonia, and congenital deformities.

Surgical Intervention: Abnormal cells are found on the surface of the cervix. CIN 2/3 is usually caused by certain types of HPV and is found when a cervical biopsy is done. Usually, surgery is required to remove the abnormal cells from the cervix.

Prevention: It’s the best defense

• Condoms provide protection against HIV and most STDs and unintended pregnancies. No method is 100 percent effective against HIV infection, but together, these methods offer more complete protection
• -Limit the number of sexual partners, talk with your new partner, and get tested regularly with your partner.
• For details on Testing, read on below.

(MEN) Dr. Alex Zhang, Urologist: what to do and why not to be nervous or afraid

How often should I get tested?
It’s recommended to get an 8-panel screening once per year.

Who should I make an appointment with (type of Doctor)?
Men can see either a Urologist or a Dermatologist, depending on the type of visit. Patients will generally see a Dermatologist for skin-related inquiries or a Urologist for questions or conditions related to urination.

How to prepare yourself before your test?
There’s nothing you need to prepare in advance for an STD screening. Fasting for blood tests is also not necessary.

Is it invasive, how long with it take, what is involved?
Testing for HPV requires a cotton swab with about a 1cm insertion to test for discharge from the urethra and is not painful; other screening involves blood testing and urine testing.

Any common questions, issues you have encountered with patients that would be informative or helpful to new/first time patient’s coming for testing?
As a result of having unprotected sex, patients will come and ask about their main symptoms and if they have an STD. Most come asymptomatic and want to confirm if they’re in the clear. Early finding, early diagnosis, and early treatment is the best approach if symptoms are found, that generally means it’s already been 1-2 months after contraction has occurred.

(WOMEN) Dr. Dai Jiru OB/GYN: common issues for women and early treatment

How often should I get tested?
Every year or in the case of symptoms, anytime. In China, Cervical Cancer screening involves a combination of TCT and HPV testing; if one test is negative, the next testing can be done 3 yrs later; if both tests are negative, testing can be done 5 yrs later. 

Who to make an appointment with (type of Doctor)?
You should first see a Gynecologist to discuss your testing plan or if you have symptoms; if necessary, he/she can transfer you to a Dermatologist.

How to prepare yourself before your test?
Please abstain from unprotected sex (sex with condoms is ok) 48 hours prior to your appointment, as semen may contaminate results. Also, fasting is not required.

Is it invasive, how long with it take, what is involved?
A speculum is used to open up the vagina and a swab is used to test for discharge. If directed by the doctor, a blood test may be performed. These tests take only a few moments to complete and aren’t painful.

Any common questions, issues you have encountered with patients that would be informative or helpful to new/first-time patients coming for testing?
Patients generally raise two major concerns when they come to see me: (1) they’d like to know the reason for having these symptoms and, (2) They’d like to know if they need to treat before having a baby and how it could affect the health of the baby if they become pregnant.

READ: Getting Tested for STDs in Beijing: Where to Go and What to Do

Images: Deon Black via UNSPLASH