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Malattie sessualmente trasmissibili, gli over 50 spesso si credono immuni

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Secondo il British Medical Journal negli ultimi 10 anni c’è stato un incremento del contagio del 100% negli over 50.

Sifilide, clamidia, gonorrea, HIV e HPV sono le malattie in crescita anche nei nostri paesi.

Le Malattie Sessualmente Trasmissibili (MST), dette anche malattie veneree, sono malattie virali o batteriche che si possono trasmettere e contrarre soprattutto attraverso l’attività sessuale.

Per quanto ci sia già il rischio di contrarle nel corso di un unico rapporto sessuale, anche fosse il primo, bisogna puntualizzare che sono in larga parte malattie curabili e, se la diagnosi è tempestiva, non danno luogo a sequele a distanza. Si consiglia quindi, in caso di secrezioni anomale, ulcerazioni o piccole escrescenze sull’apparato genitale o anche solo quando si hanno dubbi sui rapporti sessuali avuti, di ricorrere ad una consulenza con il proprio medico o con lo specialista.

In ogni modo bisogna ricordare che le malattie sessualmente trasmesse riguardano entrambi i partner ed è quindi la coppia che deve essere trattata per una eradicazione della malattia, impedendone così l’ulteriore diffusione. Le uniche malattie per le quali la guarigione è in dubbio ed a maggior rischio di evoluzione sono quelle a trasmissione virale. Tra queste, l’AIDS è sicuramente quella più conosciuta e per la quale non esiste ancora un rimedio efficace.

L’unica maniera per evitarla consiste nella prevenzione. E’ fondamentale usare sempre il profilattico durante ogni tipo di rapporto sessuale (orale, anale, vaginale), fin dall’inizio.

La Gonorrea (o blenorragia) È una infezione acuta contagiosa a trasmissione sessuale, causata da un microrganismo gonococchico e localizzata nella maggior parte dei casi a livello delle vie urogenitali.

Presenta un breve periodo di incubazione, che va dai 2 ai 5 giorni. Nell’uomo si manifesta con una secrezione mucopurulenta bianco-verdastra, densa, accompagnata da bruciori e dolori soprattutto durante la minzione, fino a giungere anche alla comparsa di pustole e infezione del prepuzio con durata di circa 15 giorni, dopo la remissione dei sintomi e la cronicizzazione della malattia.

Nella donna si manifesta con una secrezione vaginale e/o uretrale bianco-verdastra purulente. Quando l’infezione è localizzata in zone non genitali (retto, faringe, congiuntive) può essere asintomatica. Se non opportunamente curata, la gonorrea può portare ad ulteriori complicanze: nell’uomo a epididimite, sterilità, prostatite, infezione ghiandolare; nella donna a bartolinite, gravidanza extrauterina, sterilità. Il fatto di avere contratto la Gonorrea una volta non immunizza il soggetto dal poterla contrarre successivamente.

La Sifilide È una malattia infettiva batterica, trasmissibile principalmente con i contatti sessuali o attraverso la placenta della madre malata al feto. Si manifesta con sintomatologia ad andamento cronico: lesioni o sintomi a carico della cute, del sangue, di organi interni, che compaiono in sequenza. Conseguentemente la malattia è divisa in tre periodi: primario, si manifesta dopo un periodo di incubazione asintomatico di 3 settimane circa e può durare fino a 50-70 giorni, con fenomeni locali determinati dalla penetrazione dei batteri nell’organismo: formazione di un piccolo nodulo (che può scomparire dopo circa un mese anche in assenza di terapie) e ingrossamento persistente dei linfonodi regionali; secondario, segue la fase precedente nei casi non curati e corrisponde alla diffusione del batterio nel sangue e in tutti gli organi; in mancanza di cure ha una durata che va dai 2 ai 4 anni. Si manifesta con eruzioni della cute e delle mucose soprattutto intorno alle orecchie, sotto le mandibole, nelle regioni cervicale, dei gomiti, mammarie, ascellari, inguinali; terziario, preceduto da un periodo di latenza che può durare anche anni senza manifestazioni apprezzabili, è dovuto alla possibilità di diffusione della malattia in altre zone. È caratterizzato da manifestazioni circoscritte, uniche o poco numerose, a lenta evoluzione, non dolorose, profonde e distruttive che possono colpire la cute, l’apparato scheletrico, l’occhio, l’orecchio, l’apparato digerente, la lingua e, più frequentemente, l’apparato cardiovascolare e il sistema nervoso.

Quando la sifilide viene contratta dal feto durante la gravidanza può determinare l’aborto, un parto prematuro, o infine un parto a termine con manifestazioni precoci o tardive della malattia nel neonato. La prognosi è tanto più favorevole quanto più è tempestiva la diagnosi e quanto più è precoce e regolare il trattamento.

Condilomi acuminati Sono escrescenze papillomatose che si localizzano ai genitali, alle regioni perigenitale e perianale. Sono manifestazioni di un’ infezione da virus HPV contagiosa e trasmissibile sia per via sessuale che per altre vie e attraverso la placenta della madre malata al feto. Il 75% della popolazione sessualmente attiva ha l’HPV ma solo l’1% delle persone che ha l’HPV manifesta i Condilomi. Tale manifestazione può essere favorita da fattori quali il fumo, il diabete o una depressione immunologica del proprio organismo. I condilomi acuminati si presentano dopo un periodo di incubazione che va da 1 a 8 mesi. Inizialmente si presentano come piccoli rilievi filiformi o granulosi; successivamente, crescendo, assumono l’aspetto di escrescenze ramificate o a “cavolfiore”. Hanno un colorito roseo o rosso e solitamente non provocano dolore e possono localizzarsi nella vulva e nella vagina nella donna, alla base e/o nel corpo del pene, sul glande, sul frenulo, sul prepuzio o nella regione perianale nell’uomo. Se non curata, questa malattia presenta un decorso cronico e frequenti ricadute.

Herpes Simplex Si conoscono due varietà di virus Herpes: una responsabile dell’ herpes labiale e una dell’herpes genitale. L’herpes può essere asintomatico ed essere saltuariamente rilasciato dalla cute e/o mucose infette. È una infezione a carattere ricorrente, caratterizzata dalla comparsa di piccole vescicole rotondeggianti che tendono a riunirsi a grappoli, piene di liquido chiaro, che si localizzano più frequentemente sulle labbra (infezione da virus di tipo 1) e sui genitali (infezione da virus di tipo 2). Dopo alcuni giorni le vescicole si rompono, dando luogo ad erosioni superficiali che, essiccandosi, si ricoprono di croste bruno-giallastre che scompaiono del tutto nell’arco di 2 settimane circa. È tipica la recidiva sempre nelle stesse sedi. È un virus a cui sono più soggette le donne e la probabilità di contrarlo aumenta con l’avanzare dell’età e con il numero di partner.

Ulcera molle È una malattia batterica altamente infettiva a trasmissione sessuale. Dopo una incubazione che va da 2 a 14 giorni, si formano nella regione genitale e in quella anale lesioni che, rompendosi, danno origine a ulcerazioni dai bordi tumefatti mentre il fondo è molle (da qui il nome). Può presentarsi anche una infiammazione delle ghiandole linfatiche regionali.

Linfogranuloma venereo Malattia contagiosa a trasmissione sessuale causato da Chlamydia trachomatis, che si localizza ai genitali esterni e alle regioni circostanti. La lesione iniziale è un’ulcera singola , non dolente, che regredisce spontaneamente in pochi giorni; successivamente compare una linfoadenopatia a carico soprattutto dei linfonodi inguinali, che tendono a confluire tra di loro e con i tessuti soprastanti e sottostanti, costituendo piastroni duri e infiltrati. La cute sovrastante assume una colorazione violacea; di seguito al centro dei piastroni si aprono delle fistole con fuoriuscita di pus. Il paziente manifesta febbre, dolori articolari, dolori addominali e cefalea. Se non curata può degenerare in sclerosi tessutali ed elefantiasi dei genitali.

Chlamydia La Chlamydia è una delle malattie sessualmente trasmissibili più diffuse e particolarmente presente tra le femmine sessualmente attive con meno di 20 anni. Si tratta di un’infezione dovuta ad un batterio, la Chlamydia Trachomatis. I primi sintomi si manifestano da una a tre settimane dopo l’esposizione e possono essere molto lievi (un certo bruciore quando si urina). Tuttavia nel 75% dei casi per le donne e nel 50% dei casi per gli uomini l’infezione è addirittura asintomatica, per cui la malattia è diagnosticata per le complicanze che sviluppa. Nelle femmine è responsabile di cerviciti, malattie infiammatorie pelviche e salpingite (infiammazione delle tube di Falloppio). Nei maschi provoca uretriti (infiammazione dell’uretra)e epididimiti (infiammazioni dei testicoli). Trascurare questa infiammazione può essere causa di sterilità: nelle donne l’azione del batterio distrugge le tube e nell’uomo porta all’occlusione dei deferenti. Si può trasmettere o prendere la Chlamydia attraverso rapporti vaginali o anali non protetti. Prevenzione significa affrontare le relazioni sessuali con responsabilità: limitare il numero di partners, utilizzare profilattici e, se si ritiene di essere infettati, evitare contatti sessuali fino alla completa guarigione.

Uretriti Infiammazioni dell’uretra acute o croniche, dovuta a vari agenti patogeni (gonococchi, colibacilli, stafilococchi, micoplasmi, clamidie) che si localizzano nell’uretra o nella vescica nel corso di cistiti acute o croniche. Per le uretriti gonococchiche vedi àGonorrea. Le uretriti non gonococchiche possono essere provocate nel 25-50% dei casi da Clamydia oppure da Trichomonas, Herpes virus, Candida, Micoplasma. Presentano un lungo periodo di incubazione che va da 2 a 3 settimane, presentano sintomatologia simile alla Gonorrea ma più lieve con complicanze uguali ma più rare.

Candida albicans È un genere di funghi normalmente presente sulla nostra cute e sulle nostre mucose e solo quando si riproduce eccessivamente, per riduzione delle difese immunitarie dell’organismo o quando si viene a contatto diretto (trasmissione sessuale) o indiretto (indumenti), dà origine alla malattia. Si manifesta con emissione di secrezioni vaginali dense e biancastre accompagnate da prurito, bruciore, a volte dolore; nel maschio si può manifestare con un’infiammazione superficiale del glande e spesso pure del prepuzio,anche asintomatica. L’infezione da Candida può recidivare se non adeguatamente trattata o in presenza dei fattori favorenti sopra elencati.

Vaginiti aspecifiche Infiammazioni acute o croniche della vagina provocate da diversi funghi e/o batteri, agenti chimici e stimoli meccanici prolungati. Sono caratterizzate dalla formazione, sulla superficie della mucosa, di piccoli rilievi (vaginite nodulare), strutture papillari (vaginite papillare), cisti (vaginite cistica), ecc.

Scabbia Malattia parassitaria della pelle dovuta ad un acaro. È contagiosa e può essere trasmessa attraverso la biancheria ed il contatto diretto tra persona malata e sana. Si presenta sotto forma di eruzione, localizzata in diverse sedi (spazi interdigitali, lato interno del gomito, ascella, areola mammaria, dorso del pene, glande, scroto) accompagnata da prurito, specie notturno, a volte intenso. Le possibili complicazioni (vescicole, pustole, eczemi, ecc.) sono provocate dal trattamento.

Molluschi contagiosi Dermatite infettiva di origine virale che si manifesta con piccoli rilievi, ombelicati al centro, di colore biancastro o roseo, che si possono localizzare a livello dei genitali.

AIDS (Sindrome da immunodeficienza acquisita) Questa malattia è causata dal virus HIV e comporta un progressivo deterioramento delle funzioni del sistema immunitario. L’infezione si contrae per contatto diretto tra piccole lesioni della cute o delle mucose con sangue, sperma o secrezioni vaginali infette, per trasfusione di sangue o trapianto di organi infetti, per via placentare oppure, al momento del parto o durante l’allattamento, per contagio da una madre infetta al neonato. L’infezione può rimanere silente per diversi anni (stato di sieropositività) o può portare a manifestazioni cliniche generiche che, nello stadio più avanzato, conducono alla morte. Dal momento in cui si è contratto il virus HIV si diventa potenziali veicoli di trasmissione. Attualmente non esistono vaccini che possono prevenire l’infezione da HIV, l’unica difesa è la prevenzione: evitare rapporti sessuali non protetti sia etero che omosessuali, sia anali che vaginali o orali, con partner occasionali o con partner sospetti e nel dubbio utilizzare il profilattico; non fare uso di droghe perché queste deprimono le difese immunitarie; usare solo siringhe monouso ed evitarne assolutamente lo scambio o il riutilizzo; in caso di trasfusioni rivolgersi solo a centri autorizzati. Se si vuole accertare il proprio stato di salute o nel caso si abbia avuto un rapporto sessuale non protetto a rischio di infezione, è opportuno eseguire il test di sieropositività (test che rileva gli anticorpi prodotti dall’organismo contro il virus HIV) dopo 1 mese dall’episodio di rischio, dopo 3 mesi e dopo 6 mesi: solo dopo questo periodo di tempo il test può essere definitivamente considerato negativo.

 

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