Sexually Transmitted Diseases in Turkey

Sexually transmitted diseases are infections that develop as a result of the transmission of bacteria, viruses, or parasites through unprotected sexual contact with infected individuals, and if not diagnosed and treated early, they can lead to serious health complications. They may also progress clinically without showing symptoms.

Symptoms of sexually transmitted diseases usually appear as discharge, pain, ulcers, itching, and burning during urination in the genital area, and in some cases systemic findings may accompany them. Mild symptoms may cause the disease to be neglected and increase the risk of transmission.

Diagnostic methods for sexually transmitted infections include laboratory tests, blood analyses, and microbiological examinations, and an accurate diagnosis enables the determination of an appropriate treatment plan according to the type of disease. Early diagnosis is critically important in preventing complications.

Methods of protection from sexually transmitted diseases include regular health check-ups, monogamy, the use of barrier methods, and conscious sexual behaviors. Social awareness and educational efforts play an important role in reducing the spread of infections.

What are sexually transmitted diseases and how do they affect our body?

Sexually transmitted diseases are a group of diseases that threaten human health and are caused by a wide variety of microorganisms such as bacteria, viruses, fungi, or parasites that cannot be seen with the naked eye. These microorganisms find a perfect living environment for themselves in the moist, warm, and dark areas of the human body that are open to the outside environment. After entering the body, they begin to multiply rapidly by infiltrating the healthy cells in the area where they are located or by attaching to the outer surfaces of the cells. When the multiplication process begins, our body’s defense mechanism, the immune system, notices these foreign invaders and sends defense cells to that area. The situations patients feel, such as burning, redness, swelling, or discharge, are actually the outward reflections of the body’s battle with these microbes. If the microbes win this battle, the infection begins to progress from superficial tissues toward deeper organs.

Who is at the highest risk in terms of sexually transmitted diseases?

Not everyone is equally at risk for the transmission of these microscopic organisms; lifestyle and behavioral patterns play a decisive role in the spread of these diseases. People’s social habits, their level of awareness about taking precautions, and certain biological differences directly affect the likelihood of microbes settling in the body. Especially in young and active age groups, the inability to understand bodily boundaries and methods of protection greatly increases the risk. In addition, the person’s anatomical structure is also important. For example, even a tiny irritation or crack in the skin of the genital area, too small to be seen with the naked eye, acts almost like an open door for viruses to enter the bloodstream.

The main risk factors are:

• Multiple partners
• Unprotected contact
• Activity at an early age
• Existing infections

Are sexually transmitted diseases transmitted from person to person only through sexual contact?

Although when sexually transmitted diseases are mentioned among the public only a single route of transmission comes to mind, these microorganisms also have other routes they use to spread. Of course, the most common form of transmission is any kind of unprotected bodily contact. However, since some viruses and bacteria are also found in high amounts in human blood or body fluids, they can also easily be transferred to another body through blood. In addition, an infection present in the mother’s blood during pregnancy can pass to the baby through the placenta or during normal delivery, seriously threatening newborn health. Actions such as using the same toilet, hugging, or being in the same environment in daily life generally do not create a sufficient basis for the transmission of these microbes.

The modes of transmission are:

• Unprotected contact
• Blood transfusion
• Shared injector use
• Transmission from mother to baby

Can sexually transmitted diseases progress secretly in the body without showing any symptoms?

One of the greatest medical challenges of this disease group is that the silent phase of the infection, which we call the incubation period, can last a very long time. A microbe entering the body may succeed in hiding from the immune system for days, weeks, or even years in some virus types without causing any complaints. This condition is called asymptomatic carriage in medical language. The person feels completely healthy, continues daily life normally, and does not feel even the slightest suspicion. However, during this process, the microbe both continues to create damage at the cellular level in the person’s body and maintains its potential to infect others at the highest level. Especially in terms of public health, the most fundamental reason underlying the inability to control outbreaks is these hidden carriers who carry and transmit the microbe without showing any symptoms.

What place does urinary tract inflammation (urethritis) hold among sexually transmitted diseases?

The tube-shaped canal that carries urine from the bladder, that is, the urinary sac, out of the body is called the urethra. The inner surface of this canal is covered with an extremely sensitive mucosal layer that is vulnerable to outside threats. Many bacteria that we evaluate within the scope of sexually transmitted diseases use this canal as the first gateway into the body and start a serious inflammatory process there by attaching tightly to the mucosal membrane. This inflammatory condition is called urethritis. Urethritis is very different from urinary tract infections caused by an ordinary chill. Because the agents causing the inflammation here are specifically resistant bacteria transmitted sexually, and they cannot be eliminated from the body with simple urinary antiseptics or by drinking plenty of water. They absolutely require targeted, strong, and correctly selected antibiotic treatment.

What is gonorrhea and what is its importance on the list of sexually transmitted diseases?

The disease known among the public as gonorrhea, one of the infections that has historically challenged humanity the most, is the work of an extremely stubborn bacterium called gonococcus. The main reason it holds such an important place on the list of sexually transmitted diseases is that this bacterium has evolved over time to develop a serious resistance mechanism against many of the drugs we use. This disease, which in past years could be easily cured with a single simple drug, today tends to turn into a “superbug” requiring multiple and very powerful treatment combinations. After the bacterium enters the body, it multiplies very rapidly and makes its presence felt quite loudly by creating intense tissue destruction in the area it enters.

What distinct complaints do sexually transmitted diseases caused by gonorrhea lead to?

When the gonorrhea bacterium settles in the urinary canal, the immune system perceives this as a very urgent threat and piles millions of defense cells into the area. Dead bacteria and defense cells accumulate inside the canal, forming an intense, purulent, and thick fluid. Patients usually experience great panic when they notice this obvious stain in their underwear when they wake up in the morning. In addition, as urine passes through the inflamed urinary canal, a very sharp, stabbing-style burning and aching sensation is felt, as if salt were being rubbed into an open wound. These complaints are so severe that the person may even become afraid to urinate.

The main complaints are:

• Yellowish discharge
• Greenish discharge
• Burning during urination
• Frequent urination

How are sexually transmitted diseases other than gonorrhea (such as Chlamydia) recognized?

If a patient has a distinct urinary tract inflammation but gonorrhea bacteria are not found in detailed microscopic examinations, this condition is called non-gonococcal inflammation. This picture is most frequently caused by more insidious and slowly multiplying bacteria called Chlamydia, Mycoplasma, and Ureaplasma. This group among sexually transmitted diseases, unlike gonorrhea, manifests itself with a much milder, water-like transparent, and small amount of discharge. Patients feel only a slight stinging sensation while urinating. The fact that the symptoms are this mild is actually a great disadvantage; because the person postpones seeking medical help by saying, “it’s nothing important, I probably caught a chill,” and during this process, the bacterium continues its dangerous journey toward the body’s deeper and internal organs.

What do sores appearing in the genital area mean in the context of sexually transmitted diseases?

Disruptions in skin integrity, blisters, or deep sores that suddenly appear in one of the most sensitive areas of the human body are alarm signals that the body gives very clearly. When sexually transmitted diseases are concerned, the shape of these sores, their color, how regular their borders are, and most importantly whether they cause pain or not contain very critical clues about the disease. Sometimes these lesions may look like only a superficial skin rash, while at other times they may manifest as open ulcers with a hard base and reddened surroundings. The degree of pain felt when the sore is touched provides experts with strong guidance as to whether the disease is caused by a virus or bacteria and helps in choosing the correct tests.

How dangerous is syphilis on the list of sexually transmitted diseases?

Syphilis, which darkened the lives of millions of people in past centuries because there was no treatment, is a disease caused by a mobile, spiral-shaped bacterium and has the potential to collapse all systems in the human body. Among sexually transmitted diseases, the most frightening feature of syphilis is that it is referred to in the medical world as “the great imitator.” The symptoms it creates in the body can be exactly the same as the symptoms of dozens of different diseases, from allergies to skin diseases, from neurological problems to heart failure. If it is not diagnosed in the early stage and the correct antibiotic is not given, the bacterium enters the bloodstream and begins an insidious journey that will last for years, eventually settling in vital organs such as the brain, spinal cord, heart lining, and bones, leaving irreversible, permanent, and very severe damage.

How do the stages of syphilis progress in the course of sexually transmitted diseases?

Syphilis is like a time bomb with certain stops that progresses step by step after entering the body. At the first point of contact, usually in the area where the microbe entered the body, a clean-looking sore with a hard base and, most interestingly, completely painless appears. Because it does not cause pain, it is often ignored, and this sore closes and disappears on its own within a few weeks. However, this healing is deceptive. The bacterium spreads throughout the body through the bloodstream and starts the second stage; at this stage, red rashes appear all over the person’s body, including the palms and soles. If it still cannot be stopped at this stage, the disease enters a sleep mode that will last for years and then transitions to the final stage, which is extremely destructive and in which internal organs and brain tissue are broken down.

The main stages of the disease are:

• Primary stage
• Secondary stage
• Latent stage
• Tertiary stage

Is genital herpes a permanent problem among sexually transmitted diseases?

The herpes virus is a very close relative of the classic cold sore that appears on our lips and is a special type that targets the genital area. Among sexually transmitted diseases, the most annoying and wearing feature of herpes is that once it enters the body, it progresses toward the nerve roots, settles in the nodes there, and hides there for life. Modern medicine still does not have a drug that can uproot this virus from the nerve roots and destroy it completely. The first attack period during which it appears is quite distressing, with painful fluid-filled blisters and fever. In the following years, the virus waits dormant and takes advantage of every moment when the body’s defense mechanism weakens, waking up again and creating sores again in the same area. This condition creates both physical pain and chronic psychological stress on patients.

The triggering factors are:

• Excessive stress
• Fatigue
• Insomnia
• Low immunity

What is HPV (Genital Wart), the most common among sexually transmitted diseases?

Human Papillomavirus (HPV) is currently among the most common microorganisms encountered in society and has the highest rate of transmission. This virus, which settles in the skin of the genital area and moist mucosal areas, causes the skin cells in that region to multiply uncontrollably by interfering with their genetic structure. As a result of this uncontrolled proliferation, flesh-colored or dark-colored protrusions with a cauliflower-like appearance appear on the skin, sometimes as a single spot and sometimes forming wide clusters. These structures are called genital warts. Warts are generally painless, but because they have an extremely disturbing appearance aesthetically, they seriously damage people’s self-confidence and cause them to withdraw from sexual life.

Do sexually transmitted diseases caused by HPV carry a risk of turning into cancer?

The diversity of this virus in nature is very high and it has hundreds of different subtypes. The HPV types we examine within the scope of sexually transmitted diseases are basically divided into two major groups: low-risk and high-risk types. Low-risk types generally cause only harmless warts that are visible to the eye and create aesthetic problems, and they have almost no tendency to become cancerous. However, high-risk types are much more aggressive. These types infiltrate the cell nucleus, disrupt the rules of DNA division, and virtually turn the cell into a cancer factory. If not intervened early and not cleared from the body, these cellular disruptions create a very serious and vital threat over time, laying the groundwork for cervical cancer in women and cancers of the penis and anus in men.

By which modern methods are genital warts treated within the scope of sexually transmitted diseases?

The basic logic in the treatment of genital warts is the complete destruction of the damaged tissue that the virus has caused to grow uncontrollably by physical or chemical means, thus reducing the viral load in the area to a minimum level. In this way, the person’s own immune system can fight the small number of remaining viruses much more easily and suppress them. Many modern medical tools working with different mechanisms are used to eliminate visible lesions. The most suitable method should be carefully selected according to the extent of the lesions in the body, their size, and the sensitivity of the area where they are located. Tissue care after treatment is at least as important as the procedure itself in order for the treated area to heal quickly and not leave scars.

The treatment methods used are:

• Cryotherapy
• Electrocauterization
• Surgical excision
• Topical creams

Why and when is the cystoscopy procedure used in the diagnosis of sexually transmitted diseases?

In some cases, sexually transmitted diseases do not remain only in the externally visible parts of the body and may progress into the depths of the urinary canal or directly into the urinary bladder. To detect the damage, strictures, or hidden warts that have grown into the canal in these internal regions that cannot be understood by looking from the outside with the human eye, high-tech optical devices are needed. Cystoscopy is the procedure of gently advancing a thin, flexible instrument with strong illumination and a high-resolution micro camera at its tip through the urinary canal and examining the entire inner surface in detail on a screen as if it were on a cinema screen. When patients have persistent bleeding, unexplained chronic pain, or weakening in urine flow, this method is an indispensable gold standard in order to see the source of the problem from the inside and intervene immediately.

Do sexually transmitted diseases lead to chronic prostatitis if left untreated?

In male anatomy, the prostate gland is an important organ located just below the urinary bladder and surrounding the urinary canal like a ring, resembling a hard sponge in structure. If the stubborn bacteria that we evaluate within the scope of sexually transmitted diseases live in the urinary canal for a long time, they gradually begin to climb backward. These bacteria infiltrate the thin ducts inside the prostate gland and settle there. Because prostate tissue has a very tight and spongy structure, it is incredibly difficult for antibiotics arriving through the bloodstream to penetrate these depths. For this reason, the infection establishes a permanent nest there and causes chronic prostatitis, that is, a chronic inflammatory process that can last for years, causing groin pain, difficulties urinating, and reducing quality of life to zero.

How does infertility in men occur as a result of sexually transmitted diseases?

Sexually transmitted diseases not only cause pain and inflammation, but also directly sabotage the reproductive cells that ensure the continuation of the human نسل. The bacteria that cause infection and the toxic substances they secrete surround the sperm produced in the testicles and disrupt the tail structures that enable them to move healthily. Moreover, they completely prevent their journey toward the egg by causing the sperm to stick together and cluster. The most dangerous effect is that the intense inflammatory environment created by the infection (oxidative stress) damages the genetic codes (DNA) located in the nucleus of the sperm. Even if sperm with damaged DNA succeed in fertilizing an egg, healthy embryo development is not possible, and this directly gives rise to male-factor infertility.

Do sexually transmitted diseases lay the groundwork for testicular inflammation (epididymitis)?

Just behind the testicles, there is a very sensitive organ called the epididymis, consisting of coiled thin tubes where the produced sperm mature and are stored. Sexually transmitted diseases start from the urinary canal, pass the prostate, and reach this storage area directly through the ducts carrying semen (vas deferens). When bacteria reach here, a very severe, sudden-onset, and destructive inflammatory process begins. This condition is known as acute epididymitis. The thin tubes in that area swell and redden due to inflammation and cause the patient pain that is very difficult to endure. If this fire is not extinguished in time with very powerful antibiotics, the thin ducts stick together completely while healing and become blocked, and sperm output from that testicle never occurs again.

The distinct complaints are:

• Swelling in the testicle
• Redness in the testicle
• Severe pain
• Increase in temperature

Do fungi and parasites cause problems by falling into the class of sexually transmitted diseases?

Although viruses or bacteria always come to mind when sexually transmitted diseases are mentioned, microscopic parasites and fungi can also be transmitted in this way and cause quite serious discomfort. When the balance of the natural and healthy body flora is disrupted, especially after antibiotic use or when immunity falls, fungi can easily move between partners through sexual contact. The warm and moist tissue of the genital area acts as a perfect incubation machine for these organisms to multiply rapidly. Parasites generally live in body fluids without causing any symptoms, but when they get the opportunity, they are insidious guests that lay the groundwork for secondary inflammations in the urinary tract or prostate.

The signs of fungal infection are:

• Severe itching
• Scaling
• Redness
• White residues

Why is the partner’s condition of vital importance in the treatment of sexually transmitted diseases?

One of the most common mistakes made in the management of infectious diseases is seeing the problem only as the issue of a single individual who applies to the clinic. When sexually transmitted diseases are concerned, treatment is like the two sides of a coin. If one person is diagnosed and a flawless treatment is applied with the most effective drugs in the world, that person becomes completely free of microbes. However, if the partner with whom the infection is shared is not treated simultaneously (and the partner may have no complaints at all), the same microbe will be transmitted back again at the moment of the next contact. In the medical world, this endless cycle of transmission is called the “ping-pong effect.” The only way to break this cycle forever is for couples to be evaluated together and included in the treatment process at the same time.

What precautions should be taken in daily life to prevent the formation of sexually transmitted diseases?

The most logical and cheapest way to protect health and stay away from problems with serious consequences such as sexually transmitted diseases is not to seek treatment after catching the disease, but to prevent the disease from entering the body from the beginning. There are some basic principles that protect the human body like invisible armor. The correct use of physical barriers is the strongest line of defense that mechanically stops the microbe from passing from one body to another. In addition, benefiting from the vaccine technologies offered by modern medicine and regularly undergoing specialist check-ups to monitor the internal dynamics of the body are the most visionary steps to be taken in order to protect quality of life.

The protective precautions are:

• Condom use
• Regular health screening
• HPV vaccine
• Compliance with hygiene rules