LET’S HEAR FROM A COLLEAGUE
Updates on Sexually Transmied Infecons in the Philippines
Emmerson Gale S.Vista, MD, FPDS, FPSVI
Sexually transmied infecons (STIs) remain a public health problem worldwide, with more than 1 million people acquiring an STI every
day. In the Philippines, the total number of people with STIs other than human immunodeciency virus (HIV) infecon is not known.
Hence, the Philippine Dermatological Society (PDS) has taken the iniave to document STI cases in its instuons since 2011.
Syphilis, human papillomavirus (HPV), herpes simplex virus (HSV) and HIV infecons are some of the common STIs in our country. A
total of 665 syphilis paents, 2,053 HPV-infected paents and 977 paents with herpes have been seen and treated in PDS instuons
throughout the country from 2011 to 2018. The number of HIV cases on the other hand, have already reached 58,181 from January
1984 to August 2018. In August 2018 alone, 1,047 new cases of HIV have been reported to the HIV/AIDS & ART Registry of the Philip-
The rates of STI infecons like HIV, syphilis, HPV and herpes may be on the rise but clinicians can have a signicant impact on this
trend. With eecve counselling, early and accurate detecon, diagnosis and treatment, the threat and burden of STIs can be greatly
Keywords: Sexually transmied infecon, syphilis, human papillomavirus, herpes simplex virus, human immunodeciency virus,
exually transmied infecons (STIs) remain a public health
problem worldwide. According to the World Health Orga-
nizaon (WHO), more than 1 million people acquire an STI
every day. Unfortunately, there is currently no available data on
the number of STI cases in the Philippines except for HIV. There
are also few local journals on STI. Hence in 2011, the Philippine
Dermatological Society (PDS) started to document STI cases in all
One major barrier to STI prevenon and control is the
sgma associated with STIs. Sgmasing beliefs and fears of dis-
criminaon have been shown to inuence decisions to seek STI
tesng and treatment. , STI counselling in primary care can help
encourage paents to undergo STI tesng, treatment and partner
referral.2 It may also help promote safe sex and reduce risky be-
In 2017, the Philippines has registered the fastest-grow-
ing HIV/AIDS epidemic in the Asia-Pacic. One thousand forty-
seven new cases of HIV have been reported to the HIV/AIDS &
ART Registry of the Philippines (HARP) in August 2018 alone. This
brings up the total number of reported HIV cases in the Philip-
pines since January 1984 to 58,181.6
The risk of HIV infecon may be reduced by abstaining from sex,
liming the number of sexual partners or scking to a monoga-
mous relaonship, using condoms the right way when engaging in
sex and avoiding sharing of needles. There is also a newer tool for
HIV prevenon, which is pre-exposure prophylaxis (PrEP) or the
use of a daily anretroviral medicaon such as tenofovir-emtric-
itabine by HIV-negave individuals. PrEP was introduced in the
Philippines in 2017 through a pilot project led by experts from
the WHO, the Research Instute for Tropical Medicine (RITM) and
non-governmental organizaons. Two hundred HIV-negave men
who have sex with men (MSM) and transgender women were
enrolled in the project. Results of this two-year study are set to
inform naonal policies and the possible wider implementaon
of PrEP in the Philippines.
In HIV-posive individuals, early iniaon of anretrovi-
ral therapy (ART) is said to improve their overall health and re-
duce the risk of HIV transmission. Anretroviral (ARV) drugs are
commercially available but the Department of Health (DOH) also
provides free ARV drugs or ART in treatment hubs throughout
the country. The number of such treatment facilies has been in-
creased in recent years such as in Central Visayas, where the num-
ber has increased from three hospitals to six in this year alone.
Despite increased government support and availability of free
treatment, only 30,004 people living with HIV (PLHIV) in the Phil-
ippines were enrolled in free ART as of July 2018.6 The DOH said
that “the low percentage of ART enrollees is due to the sgma and
fear of knowing one’s HIV status”.
PhilHealth is in full support of these STI prevenon and
control measures of DOH. There is a PhilHealth Outpaent HIV/
AIDS Treatment (OHAT) package that covers up to P30,000-worth
of anretroviral treatment and laboratory exams, which can be
availed of at any accredited HIV treatment facility. PhilHealth also
provides hospitalizaon benets for PLHIV, which ranges from
P11,000 to P20,000 depending on the case.
Government support is not merely limited to treatment
but includes HIV tesng and screening as well. Accurate HIV diag-
nosc tesng however, can be challenging. The most sensive and
reliable method for tesng, which is nucleic acid tesng, is expen-
sive and oen limited to centralized tesng facilies. Outpaent
HIV test kits are now commercially-available but the reliability of
these may not be high. Another obstacle to early detecon is the
seronegave window period or WP, the me between infecon
and the producon of detectable levels of anbodies (seroconver-
sion). WP is esmated to be about 3 months. If an HIV anbody
test is done during the WP, the result will be negave even if the
person is infected and could transmit the virus to others. There-
fore, if an HIV test is negave, a follow-up test should be done
aer 2-3 months to conrm the results.
Syphilis, an STI caused by the spirochete bacteria Trepo-
nema pallidum, is another chronic STI that may cause major com-
plicaons, if not detected and treated properly. It is also known as
the great imitator because its symptoms are oen similar to many
other diseases. A total of 665 paents have been seen and
treated for syphilis in PDS instuons since 2011.
Syphilis paents oen seek dermatologic evaluaon for
signs and symptoms such as chancre (primary stage) or diuse
rash (secondary stage). In the latent stage, the paent has acve
infecon but may be asymptomac.
Screening for syphilis should be performed when pa-
ents show signs or symptoms of the disease or when they are
highly at risk from acquiring the infecon. Screening may be done
through a direct test or a serological test. The direct test is very
specic but the serological test is more popular and more roune-
ly performed. However, there are some challenges with the inter-
pretaon of results in serological tesng such as the possibility
of a false negave or a false posive result. False negave results
may be due to the prozone eect, prior treatment or the specic
stage of infecon upon tesng (early stage or latent stage may
test negave). Prozone eect is the false negave result due to
high levels of anbodies to cardiolipin cholesterol lecithin angen
in an infected person. False posive results on the other hand,
are aributed to other clinical condions and other factors like
repeated infecon and laboratory error.
Treatment of primary or secondary syphilis with penicil-
lin or other anbiocs is necessary to prevent progression into
neurosyphilis or the life-threatening terary stage and to mini-
mize the risk of HIV acquision.
Human papillomavirus (HPV) infecon characterized by
anogenital and oropharyngeal disease is sll very common. Ac-
cording to PDS data, 2,053 paents with HPV infecon have been
seen in its instuons since 2011. Diagnosis of HPV is mostly clini-
cal but when diagnosis is uncertain, a biopsy may be required.
There is no cure for HPV infecon; only reduc-
on of infecvity and removal of visible and symptomac warts.
Treatment may be topical or surgical. Imiquimod and chemical
peel are the only widely available topical methods for HPV treat-
ment in the Philippines. These can be quite expensive and based
on a systemac review of treatment modalies, most topical
methods do not yield a high success rate of clearance and recur-
rence is common. Among the surgical methods, electrocautery is
most commonly performed locally. It is also the most appropriate
as it immediately clears lesions.
Vaccines that protect against inial HPV infecon have
been developed and proven eecve. In fact in some countries,
it is now included in their mass vaccinaon program for young
people who are not yet sexually acve. HPV vaccinaon has also
been shown to increase natural HPV immunity in people who
have been previously infected with HPV.
Genital herpes is another STI that is highly prevalent and
has a signicant impact on sexual health and the risk of HIV acqui-
sion and transmission. It is usually caused by herpes simplex vi-
rus-2 (HSV-2) but may also be due to herpes simplex virus-1 (HSV-
1). WHO esmated more than 500 million people to be infected
with HSV worldwide in 2016.1 In the Philippines, 977 paents
have been seen and treated for herpes in PDS instuons since
Herpes is characterized by frequent viral shedding
throughout the genital tract that leads to inammaon. People
suspected to have genital herpes should undergo laboratory tests
such as PCR analysis to conrm the diagnosis.
Like HPV, HSV infecon is incurable. However, interven-
ons that suppress viral shedding may prevent transmission of
HSV and the risk of HIV acquision.14 Treatment also reduces
pain, duraon of shedding and healing me. Treatment may be
episodic or chronic suppressive. Chronic suppressive therapy is
usually oered to paents who experience six or more clinical
episodes per year or those who experience signicant anxiety or
distress due to the clinical recurrences.
The rates of STI infecons like HIV, syphilis, HPV and her-
pes may be on the rise but clinicians can have a signicant impact
on this trend. With eecve screening, counselling, early and ac-
curate diagnosis and treatment, the threat and burden of STIs can
be greatly reduced.
ABOUT THE AUTHOR
Dr. Emmerson Gale Silverio Vista is a consultant and
faculty member at the Research Instute for Tropical Medicine
(RITM), Department of Dermatology. He is also a consultant at
St. Luke’s Medical Center in Bonifacio Global City and a vising
consultant at Cavite Medical Center. He nished his dermatology
residency training at RITM and parcipated in the dermatology
fellowship observership program at the Naonal Skin Centre in
Singapore and dermatology mentorship training on STD-HIV at
the Ludwig Maximilian University of Munich, Department of Der-
matology and Allergy in Germany. His current research interests
include knowledge, atudes and pracces of dermatology pa-
ents or health care workers regarding HIV/AIDS and other STIs.
*You may contact the author at:
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