Persisting and Recurring STDs- WHY?

It can be very disconcerting to know that the STD infections remain there or recur following treatment. This is not an uncommon scenario seen in STD consultation clinics, with one becoming a frequent outpatient attendee for recurring STD-related symptoms. Such vicious cycle can incur both emotional and financial burden to affected patients.

In this article, we wish to explore the causes of un-resolving STDs and possible ways to mitigate the situation, minimizing risk of recurrence of STDs.

Reasons for Recurrence of STD

Reinfection

This is one of the most common causes of recurring STDs. Despite receiving the right dose and right type of medication for the infection, the infection did not clear off. One may notice recurrence of symptoms, or their test results repeatedly showing a particular STD.

Reinfection occurs when the 'circle of disease' is not broken. STDs, as we know, are infections that are transmitted among couples sexually. If one has been treated, yet other partner(s) are not treated, inevitably, the treated person can be re-infected following intercourse with the untreated person(s).

Medication Resistance

Over the years, antibiotic resistance is progressively becoming a global concern. Due to repeated use of antibiotics, unnecessary treatment, blind treatment, bacteria are increasingly outwitting medication, they become more resilient towards medication.

Recent years of super gonorrhea incidence confirmed the rising resistance against antibiotics, leading to certain strong gonorrhea infection able to escape and survive conventional antibiotic treatment.

In the case of Mycoplasma genetalium infection, current guideline advised for 2 types of antibiotics to reduce the buildup of antibiotic resistance and better efficacy. Having said that, even with 2 antibiotics treatment regimen, some patients may require repeated rounds of antibiotic courses to successfully eradicate the infection.

Poor absorption of medication for STD

Medication (pills) for STD infections can come in the form of tablets (like a normal paracetamol shape), or capsule (typical antibiotic medication-rectangular in shape with 2 tone color coding). The coated capsules are to ensure the medication reaches the gut/intestinal passage before dissolved by gut enzymes into the circulation. One of the common mistake that one does is to break the capsules and place them directly onto the mouth- this causes poor and inadequate absorption of medication.

Also certain supplements such as calcium supplement may interact and reduce absorption of STD medications.

Concurrent gastrointestinal conditions such as gastroenteritis, nausea, vomiting can result in poor absorption of STD medications as well leading to failure of treatment.

Wrong and inadequate treatment of particular STDs

STDs will require specific antibiotics or antivirals- the right medication and the right dose. Commonly we may think any antibiotics or medication prescribed by doctors will treat STDs simultaneously. (Such in the case of flu medication does not clear off STDs!)

Poor compliant of medications whereby one forgets to consume their medications, or lost the pills can result in failure of treatment and persistent STD.

Certain STDs are incurable

While bacteria STDs are treatable, viral STDs such as HIV infection and Herpes Simplex Virus are not curable. Although there are effective medications to manage the infections, there remain no cure. Once a person has contracted these disease, they become life-long infected and have the ability to transmit to others.

Control of incurable STDs can be dependent on our general immune system

One may notice STDs symptoms may recur or flare during time of weakening immune system. This is often seen in viral STDs such as recurring herpes outbreaks or recurring HPV infection due to a poor immune system. One with concurrent medical conditions such as diabetes, chronic smoking, cancer, autoimmune conditions or those with long term immunosuppressive medications are particularly predispose to recurring of viral STDs.

STDs adapt and become chronic

Certain bacteria STDs, the bacteria acquire survival strategies to escape a person's immune system and antibiotics. Research has postulated STDs such as Chlamydia trachomatis may be able to alter its metabolism to persist and survive through antibiotics treatment, leading to failure of treatment and persistence in the body, making one chronically infectious.

Syphilis is another bacteria STD that can turn chronic. Following primary or secondary phase of syphilis one can progress to latent phase where the affected person can have no symptoms yet infectious to others.

What can we do to prevent recurrence of STDs?

1. Ensure receiving proper full treatment of STD if infected

STDs that are treatable should be nipped in the bud. Ensure obtaining the right dosed medication from your trusted physicians, follow through and complete the medication offered. It is worth checking with your physician the lead time from completion of antibiotics until the time it is safe to resume intercourse lifestyle.

2. Ensure sexual partner(s) are free of STDs

It is key to have an open and honest communication with your sexual partner(s) and encourage them to get screened and treated for infection if required. This will break the vicious cycle of STDs repeatedly passing back-and-forth between partner(s).

3. Regular STD testing

In view of most STDs are asymptomatic and some STDs have long incubation period even up to months or years, one should consider regular STD checking to detect infections early and receive treatment without delay.

Avoid blind treatment, presumptive treatment to reduce development of antibiotic resistance.

4. Full range coverage of STD testing

It is important to discuss with your trusted physicians on what STD tests to consider, as everyone's exposure risk may differ. Merely doing a basic urine test or HIV test may not be sufficient to detect more insidious STDs that one may be exposed to.

5. Extra-sites STD testing

If there is oral or anal intercourse involved, tissue samples from the mouth and anus may be required for STD testing. This is imperative to pick up and treat extra-sites STDs to break the vicious cycle of repeated transmission to sexual partner(s).

6. Receive preventative vaccinations/ medications against certain STDs

One should consider immunisation against certain STDs such as Hepatitis B, HPV. There are clinically-proven effective vaccines with minimal side effects to protect one against Hepatitis B or HPV infections. In the case of recurring herpes breakouts, long term suppressive medications may be offered to manage the symptoms.

7. Practise safe sex

Using barrier protection (condom) the right way is effective in preventing STDs. Consider limiting the number of sexual partner(s) and avoiding high-risk behaviors such as multiple sex partner(s), sex with alcohol and drugs.

Take home message…

While resurfacing of STDs can be terrifying and concerning, many of the STDs are treatable or manageable with current medical advancement. One should not hesitate to seek advice from their trusted healthcare providers on the best ways to protect self and others, reduce risk of exposure and recurrence of STDs.

Book an Appointment

If you’re experiencing recurring or persistent STD symptoms, it’s important not to ignore them. At Dr Ben Medical, we provide discreet consultations and evidence-based treatments tailored to your needs. Book an appointment today to take the first step toward better sexual health.

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