Question 1

What is the difference between an STI and an STD?

Accepted Answer

"STI" (sexually transmitted infection) and "STD" (sexually transmitted disease) are often used interchangeably, but "STI" is the preferred term in public health and clinical settings. An infection refers to the presence of a pathogen; a disease implies symptoms. Many STIs are asymptomatic — chlamydia in particular — so "STI" more accurately captures the full spectrum of people who need testing and treatment, including those without symptoms.

Question 2

Which STIs are curable?

Accepted Answer

Four STIs are fully curable with current antibiotics: chlamydia (azithromycin or doxycycline), gonorrhoea (ceftriaxone — though resistance is increasing dramatically), syphilis (benzathine penicillin) and trichomoniasis (metronidazole). Four others are viral and currently incurable but manageable: HIV (ART controls infection); herpes simplex (antivirals reduce outbreaks and transmission); HPV (vaccines prevent, immune system usually clears infection; treatments address manifestations); and hepatitis B (antivirals suppress, vaccine prevents).

Question 3

Why is gonorrhoea becoming untreatable?

Accepted Answer

Neisseria gonorrhoeae has successively developed resistance to nearly every antibiotic class used against it — sulphonamides, penicillin, tetracycline, fluoroquinolones and now cephalosporins. Extensively drug-resistant (XDR) gonorrhoea — resistant to ceftriaxone (the current last-line treatment) — has been documented in multiple countries. Without new antibiotic development and strict antimicrobial stewardship, gonorrhoea could become untreatable. WHO has placed N. gonorrhoeae on its list of priority pathogens for new antibiotic research.

Question 4

What is congenital syphilis and how is it prevented?

Accepted Answer

Congenital syphilis occurs when Treponema pallidum (the syphilis bacterium) crosses the placenta to infect the fetus. It causes stillbirth, neonatal death, premature birth, and devastating disabilities including bone deformity, hearing loss, blindness and neurological damage. Prevention requires: antenatal syphilis testing (at first ANC visit and again at 28 weeks in high-prevalence settings); treatment with benzathine penicillin — safe, cheap and highly effective. Despite these interventions being available, over 300,000 congenital syphilis cases occur annually, reflecting inadequate antenatal care access.

Question 5

What is the link between STIs and HIV?

Accepted Answer

STIs substantially increase the risk of HIV acquisition and transmission. Ulcerative STIs (herpes, syphilis, chancroid) disrupt mucosal barriers, providing HIV a portal of entry. Inflammatory STIs (gonorrhoea, chlamydia) increase HIV viral shedding in genital secretions, enhancing transmission from HIV-positive people. Conversely, HIV infection increases susceptibility to STIs and worsens their clinical course. Integrating STI and HIV services is both clinically rational and cost-effective.

Question 6

What vaccines prevent STIs?

Accepted Answer

Three vaccines prevent STI-related infections: HPV vaccine (Gardasil 9, Cervarix) — prevents infection with the HPV strains responsible for cervical, oropharyngeal and other cancers, and genital warts; hepatitis B vaccine — prevents HBV infection; and JYNNEOS vaccine (Imvanex/Jynneos) — protects against mpox, which can be transmitted sexually, particularly in men who have sex with men. A gonorrhoea vaccine is in clinical development. No vaccines yet exist for chlamydia, herpes, syphilis or trichomoniasis.

Question 7

What is HPV and how does it cause cancer?

Accepted Answer

Human papillomavirus (HPV) is the most common STI globally — approximately 300 million women are infected. Over 100 HPV types exist; "high-risk" types (HPV-16, HPV-18) integrate their DNA into host cell chromosomes and interfere with tumour suppressor genes, driving malignant transformation. High-risk HPV causes virtually all (>99%) cervical cancers, and a large proportion of oropharyngeal, vulvar, penile and anal cancers. The HPV vaccine prevents infection with the most oncogenic types and — if given before sexual debut — is ~90% protective against cervical cancer.

Question 8

How does STI stigma affect health outcomes?

Accepted Answer

Stigma surrounding STIs prevents people from seeking testing, disclosing to partners and accessing treatment. Fear of judgment, moral labelling and discrimination leads to delayed diagnosis — allowing infections to progress (chlamydia causing PID, syphilis progressing to tertiary stages) and to spread. Stigma also affects healthcare providers, who may provide suboptimal or judgmental care. Non-judgmental, confidential STI services — including self-testing options, online results and anonymous notification systems — reduce stigma barriers.

Question 9

What is the impact of STIs in pregnancy?

Accepted Answer

STIs in pregnancy cause devastating consequences: congenital syphilis (stillbirth, neonatal death, severe disability); neonatal herpes (from HSV-2 during delivery — high mortality and neurological morbidity); neonatal HIV if untreated; neonatal gonococcal and chlamydial ophthalmia (eye infection causing blindness); and HPV (vertical transmission can cause recurrent respiratory papillomatosis in infants). Antenatal STI testing and treatment is one of the highest-value maternal and neonatal health interventions.

Question 10

What are the most common STIs in the European region?

Accepted Answer

In the WHO European region (including Georgia), chlamydia is consistently the most reported bacterial STI — with highest rates in young adults aged 15-25. Gonorrhoea rates have been rising across much of Europe. Syphilis has re-emerged, particularly among men who have sex with men in Western Europe. Eastern Europe (including Georgia) faces particular challenges with HIV, HCV and syphilis linked to injecting drug use. ECDC publishes annual STI surveillance reports for the EU/EEA.

Question 11

What is trichomoniasis?

Accepted Answer

Trichomoniasis — caused by the protozoan parasite Trichomonas vaginalis — is the most common non-viral STI globally, with approximately 156 million new cases per year. It most commonly causes vaginal discharge and discomfort in women; most men are asymptomatic. It increases HIV acquisition risk by approximately 2-fold. Easily treated with a single dose of metronidazole or tinidazole. Diagnosis requires microscopy or NAAT; self-clearance is rare, so treatment of sexual partners is essential.

Question 12

How does GMJ News cover sexually transmitted infections?

Accepted Answer

GMJ News covers WHO STI global progress reports, drug-resistant gonorrhoea alerts, HPV vaccination coverage, congenital syphilis elimination progress and the HIV-STI nexus. Georgia's STI epidemiology — including concentrated HIV and syphilis among key populations — is directly relevant to PHIG's public health mandate and the Georgian Medical Journal. All STI coverage applies standard evidence requirements and refers to WHO treatment guidelines.

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