REPORTSSexually Transmitted Diseases and Sexual Function
Introduction
It is a reasonable assumption that people who contract sexually transmitted infections (STIs) do not have sexual dysfunction and that those who are dysfunctional would not have the capacity to develop STIs. In this review, we have put forward what we believe is a raft of compelling scientific evidence showing that these realms do, in fact, interact, often in causative fashion. Because sexual dysfunction symptoms may be found in up to half of nonbiased population studies and the rates of STIs are measured in tens of millions, these issues potentially affect a sizeable proportion of sexually active men and women in most countries. To date, a systematic and broad review of the interaction of these two major themes has not been undertaken, but with the spread of HIV and other STIs worldwide, it is a timely mission that we have been asked to tackle. Although much of the material in this chapter has high-grade references, the evidence base levels are low in some instances. This is due to the newness of the topic, a fact that positively opens many future possibilities for future research and improved evidence-based levels.
Section snippets
Circumcision as a Strategy to Reduce HIV Infection in Men
Circumcision is believed to have originated in Egypt more than 6,000 years ago and may be the “oldest” elective operation in the history of man [51]. Today, circumcision has resurfaced as a hotly debated topic and come to occupy center stage in public health policy directed toward the control of the HIV epidemic. Studies have shown reduced relative risk of urinary tract infections in boys, carcinoma of the penis, genital ulcer diseases, and human papilloma virus (HPV) transmission in
HPV and Sexual Dysfunction
HPV causes benign condylomata or genital warts and is known to have oncogenic strains. More than 120 HPV subtypes have been identified. Of the 120 subtypes of HPV, 30 infect genital epithelium. HPV is spread through direct skin-to-skin contact during oral, genital, or anal sex with an infected partner. Genital warts can be caused by strains 6, 11, 30, 42, 43, 44, 45, 51, 52, and 54. However, types 6 and 11 are responsible for 90% of genital warts cases [130]. Most infected individuals do not
Genital Herpes (GH)
GH is usually caused by type 2 herpes simplex virus (HSV), but type 1 is becoming an increasingly common cause nowadays [139]. A recent population study in the United States estimated that 17% of those between the ages of 14 and 49 had acquired HSV type 2 [139]. Up to 90% of those who acquire HSV type 2 antibodies have never knowingly had a clinical outbreak of GH [140]. Symptoms can be severe in a primary outbreak, particularly in women, where fever, headache, malaise, and myalgia are reported
Chlamydia Trachomatis (CT), Gonorrhea (GC), and Associated Pelvic Inflammatory Disease (PID)
Recent WHO estimates estimate the prevalence of CT in European women as between 2.7% and 8.0%, with rates of up to 13% in African countries (http://www.who.int/vaccine_research/diseases/chlamydia_trachomatis/en/). Rates for GC worldwide ranged from between 0.1% and 3.5% and resulted in a total of 62 million cases between 1995 and 1999 (http://www.who.int/vaccine_research/diseases/soa_std/en/index2.html#disease%20burden).
Mass screening programs are important in order to decrease the prevalence
Recommendations for the Diagnosis and Treatment of HIV in Men
Early diagnosis of associated sexual dysfunction is important in the context of infection and units should have provision to diagnose/manage or refer to specialists as indicated. Physicians caring for both infected and negative MSM should be aware of the likely psychosocial interaction between recreational drugs, PDE5 inhibitors, unprotected sexual behavior, and transmission.
There should be recognition that there is a likely association between encephalopathy and sexual dysfunction. Specialist
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Overview on the clinical presentation and indications: Part B
2021, Herbal Medicine in AndrologyProstatitis and its Management
2017, European Urology, SupplementsCitation Excerpt :Clinical phenotyping of CPPS patients (UPOINT[s]) or adding a sexual dysfunction domain to the standard questionnaire might be helpful [4,5,28]. When discussing etiology of ED in these cases, there are hints that psychogenic factors are mainly relevant in all patients suffering from CPPS and ED [27,29]. Another very important entity is the interaction between CPPS symptoms and ejaculatory dysfunction.
Adult-Onset Hypogonadism
2016, Mayo Clinic ProceedingsCitation Excerpt :The impairment of the HP axis in HIV-infected patients is suggested by low T levels in combination with inappropriately low or normal serum LH. The pathophysiologic causes and mechanisms of the HIV-associated AOH are likely multifactorial, and include (1) poor clinical or nutritional status, (2) use of certain prescription medications used to treat HIV, (3) illicit drugs including opiates and methadone, (4) pituitary dysfunction, (5) hepatitis C coinfection and other opportunistic infections, (6) advancing age and increasing length of time diagnosed with HIV, (7) changes in body composition, (8) increased levels of estradiol and increased levels of SHBG, (9) normal age-related declines, (10) low CD4 cell count, (11) high HIV viral load and disease progression, (12) lean body mass, (13) MetS, and (14) wasting lipodystrophy.38-46 Testosterone levels can be affected by many pharmacologic agents47 that are frequently administered to or used by men (eg, opioids, glucocorticoids, cimetidine, tricyclic antidepressants, nicotine, and marijuana).
More than Foreskin: Circumcision Status, History of HIV/STI, and Sexual Risk in a Clinic-Based Sample of Men in Puerto Rico
2012, Journal of Sexual MedicineCitation Excerpt :However, data from this study where circumcision was not associated with reduced HIV risk suggests that circumcision may not confer sufficient protective benefit in all types of risk settings and populations. Consequently, as supported by other researchers [11,12], there is a need to apply caution in premature use of circumcision as an HIV prevention strategy, particularly in areas like the Caribbean where more effective combination of strategies for both primary and secondary prevention have yet to be fully implemented. For instance, in Puerto Rico, as in many countries in the region, since early in the epidemic primary prevention has been largely confined to conventional HIV testing and counseling, and there has been a general dearth of targeted behavioral prevention.