Sexually transmitted infections (STIs), are infections which are passed from one person to another through sexual contact.

All sexually active persons should undergo regular sexual health check-ups. This is especially important if you have recently had unprotected sex, are experiencing unusual symptoms, or are changed partners, or have concerns about infidelity. Many STIs show no symptoms at all, so you may have an infection without knowing, eventually leading to long-term complications such as pelvic inflammatory disease, chronic cystitis, infertility or abnormalities of the cervix.

STIs are easily treated and diagnosed by your gynaecologist.

Early diagnosis and treatment is important in preventing transmission of the infection to others and preventing any long-term complications.

The most common types of STIs are:

Chlamydia | Gonorrhoea | Genital Warts (HPV) | Genital Herpes | HIV and AIDS

Chlamydia

Chlamydia is an extremely common STI particularly amongst 16-25 year olds.

Chlamydia is caused by a bacteria that is usually spread through infected genital fluids (either semen or vaginal fluid) and can be transmitted through vaginal, anal or oral sex.

Chlamydia is known as a ‘silent’ infection because most infected people are asymptomatic and lack abnormal physical examination findings. Regular sexual health check-ups are therefore advised if you are sexually active. Symptoms include:

  • Pain when passing urine
  • Discharge from the vagina, penis or rectum
  • Painful intercourse
  • Bleeding between periods or after sex
  • In men, pain in the testicles

Though symptoms may disappear after a few days, you may still carry the chlamydia infection and be capable of passing it on. Therefore as soon as symptoms are detected, you should seek testing and treatment.

If left untreated chlamydia can spread to other body parts and can cause serious long-term complications.

Chlamydia can eventually spread to the uterus, ovaries or fallopian tubes, which is known as pelvic inflammatory disease (PID). PID can lead to can lead to chronic pain in the pelvis, infertility and an increased risk of an ectopic pregnancy.

It is possible for a pregnant mother to pass chlamydia to her baby, resulting in the baby developing pneumonia or conjunctivitis(inflammation of the thin layer of tissue that lines the inner surface of the eyelid and covers the white part of the eye, leading to blindness). It is therefore important to seek treatment before giving birth.

Chlamydia infection are diagnosed by testing first-catch urine or swabs from the endocervix or vagina in women and urethral swab or first-catch urine specimens in men. NAATs(Nucleic Acid Amplification tests)are the most sensitive tests for these specimens.

Chlamydia is easily treated with antibiotics. You should avoid sex or use condoms whilst you and your partner are undergoing treatment and for at least 3 weeks afterwards .

Gonorrhoea

Gonorrhoea is a bacterial infection which is easily passed on through unprotected sex or sharing sex toys. The bacteria is found in discharge from the penis or vaginal fluids and can be contracted through vaginal, anal or oral sex.

Almost 50% of women and 10% of men exhibit no symptoms, meaning many are unaware that they have been infected.

Symptoms typically appear within 14 days of infection, though sometimes they may not appear for months.

In the 90% of men that do exhibit symptoms, gonorrhoea can develop into painful infection of the testicles(epididymitis) which may result in reduced fertility. Most commonly though men experience pain/burning on urination or a white, yellow, or green urethral discharge(from the penis). It can also affect the prostate and lead to complications when urinating.Symptoms in women can include:

  • Pain when passing urine
  • Thick yellow or green discharge
  • Pelvic pain
  • Bleeding between periods

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements

If left untreated, gonorrhoea can cause pelvic inflammatory disease in women, which can lead to infertility, chronic pelvic pain or ectopic pregnancy. In pregnant women gonorrhoea can cause miscarriage, preterm labour or passing of the infection to the baby. This can cause blindness, joint infection, or a life-threatening blood infection in the baby.

Testing is quick and painless. It is diagnosed by testing urine, urethral (for men), or endocervical or vaginal (for women) specimens using nucleic acid amplification testing (NAAT). It can also be diagnosed by culturing the bacteria, which requires endocervical or urethral swab specimens. If a person has had oral or anal sex, pharyngeal(throat) or rectal swab should be collected either for culture or for NAAT (if the local laboratory has validated the use of NAAT for extra-genital specimens).

Gonorrhea can be cured with the right antibiotics. It is important to take all of the medication prescribed as due to increasing antibiotic resistance, successful treatment of gonorrhea is becoming more difficult.

You should avoid having sex, including oral sex, for a week following treatment and until your partner has also finished their treatment.

Genital Warts(HPV)

This is most common sexually transmitted infection. HPV is a family of over 100 different viral strains, affecting various parts of the body. Approximately 30 strains of HPV can affect the skin around the genitals. HPV is usually harmless and goes away by itself, but some types can lead to cancer or genital warts.

Around 90% of genital wart cases are caused by two HPV strains; type 6 and type 11.

Genital warts appear as small fleshy growths, bumps or skin changes which appear on/around the genitals or anus. They are painless, but can cause itching, redness or bleeding. Genital warts pose no serious health threats but they can be unpleasant and may cause emotional distress. For many people the first attack of genital warts, will be their only episode, whilst others can have repeat occurrences throughout their life.

Genital warts are spread through vaginal or anal sex. Condom use does not prevent all HPV infections, since the infection is spread by skin-to-skin contact, for example from the vulva to the male groin. Penetration is not required to infect another person and may also be contracted from female to female sexual contact.

Warts may appear months, even years following an infection with HPV. The infection is more likely to be transmitted when warts are present, but you may still infectious when no warts are apparent.

Genital warts are diagnosed on examination of the genital area by your gynaecologist
The type, size, quantity and location of the warts determines what type of treatment is best for you.
There are various treatment options for genital warts.

  • A cream or lotion can be applied to the warts until they disappear.
  • Cryotherapy: the removal of warts by freezing them
  • Electro-surgical removal
  • Surgical excision of very large warts

Gential Herpes

Herpes is an infection caused by the herpes simplex virus (HSV). There are two subtypes of the herpes simplex virus.

  • Herpes Simplex 1 which typically causes cold sores
  • Herpes Simplex 2 which is the most common cause of genital herpes

Many people consider HSV-1 more benign, but it turns out there’s not much difference between the two types of virus. While it’s true that HSV-2 is a sexually transmitted disease (STD) and can cause genital sores or blisters, type 1 can do the same thing. A common misconception is that cold sores are caused by HSV-1 and genital herpes are always type 2, but that’s not always the case. Cold sores are so common they’ve been normalized at this point; but genital herpes is sometimes the exact same virus (type 1) — just in a different location.

According to the World Health Organization, 3.7 billion people under age 50 have herpes simplex virus type 1 (HSV-1), this is approximately 67% of the global population in that age group. Another 417 million people (11%) between ages 15 and 49 worldwide have herpes simplex virus type 2 (HSV-2).

Genital Herpes is a chronic condition,with the virus remaining dormant in the body until a trigger reactivates it. People with genital herpes can have several outbreaks throughout their lives.

It presents as painful, sore blisters on the genitals and surrounding areas.

The condition is most prevalent in the 20-24 age group. At least 8 in 10 people who carry the virus are unaware of the infection, since there are often no initial symptoms. You should not have sexual contact, including oral sex or sharing sex toys, while experiencing an outbreak of herpes. Large amounts of virus particle are shed during an outbreak and it is therefore more easily spread.

HSV-1 is mainly spread by mouth to mouth, via contact with the HSV-1 virus in sores, saliva, and surfaces in or around the mouth. However, HSV-1 can also be transmitted to the genital area through oral-genital contact causing genital herpes.

HSV-2 is mainly transmitted during sex, through contact of genital surfaces, skin, sores or fluids of someone infected with the virus. HSV-2 can be transmitted from skin in the genital or anal area that looks normal. In rare circumstances, HSV-2 infection can be transmitted from a mother to her infant during delivery.

Testing for herpes involves taking a swab of the genital area (if sores are present) or undergoing a blood test.

Symptoms may not appear for a long time(occasionally years) after the virus is contracted. However, if symptoms do occur once exposed to HSV, they usually appear 4-7 days after becoming infected. This is called the primary infection and is typically more severe than any future outbreaks.

Unfortunately, there is no cure for genital herpes, but symptoms can be managed and their effects minimised by antiviral medications. Treatment with antiviral drugs can help you stay symptom-free longer and also reduce the severity and duration of symptoms when they do flare up, making living with the condition easier.

There are three major drugs commonly used to treat genital herpes symptoms: acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). These are pills but severe cases may be treated with the intravenous (IV) drug acyclovir.

HIV and AIDS

Human Immunodeficiency Virus (HIV) is a virus which attacks the immune system and weakens the body’s capability to fight disease and infection.

You can contract or transmit HIV only through specific activities. Most commonly, through sexual activity or sharing needles. Only certain body fluids—blood, semen (cum), rectal fluids, vaginal fluids, and breast milk—from a person who has HIV can transmit HIV. These fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the bloodstream (from a needle) for transmission to occur. Mucous membranes are found inside the rectum, vagina, penis, and mouth.

HIV may be spread by a mother to her child during pregnancy, birth, or breastfeeding. Although the risk can be high if a mother is living with HIV and not taking medicine, recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV.

Two to four weeks after being infected with HIV a person may develop a flu-like illness but after this it may produce no symptoms.

Without treatment, it usually takes about 10 years for someone with HIV to develop AIDS. Treatment slows down the damage the virus causes and can help people stay healthy for several decades. When HIV infection is in its final stages, it is called AIDS and represents that the immune system is weakened such that it is unable to fight infections.

There are a few ways that you can avoid contracting or spreading HIV to or from other people:

  • Get tested regularly. Get tested when starting a new relationship
  • Always use condoms when you have vaginal and anal sex.
  • Use dental dams when having oral sex
  • Start treatment for HIV as soon as possible, and keep taking your HIV medicine if tested positive. When you take it correctly, HIV treatment can lower or even stop your chances of spreading the virus to your sexual partners (and help you stay healthy).
  • There’s a daily pill your partner can take to lower their risk of getting HIV if you are infected, called PrEP. Condom use is still advised if only one person in the relationship has HIV.
  • Don’t share needles for shooting drugs, piercings, or tattoos.
  • Get tested and treated for other STDs besides HIV regularly. Having other STDs makes it easier for you to spread HIV to others.

It is important to seek medical advice as soon as possible if you think you may have been exposed to HIV. Testing for the virus is carried out by a simple blood test which can be done by your gynaecologist.

If you think that you have been exposed to HIV, emergency anti-HIV medication called post-exposure prophylaxis (PEP) may prevent infection, if taken within three days of exposure. With HIV, the earlier the diagnosis is made, the better the chances of being able to control the condition.

The treatment of HIV involves taking a combination of anti-retroviral tablets daily.Antiretroviral therapy (ART) stops the virus multiplying and spreading and allows the immune system to repair itself and prevents the occurrence of further damage.

If you have HIV/AIDS you should have your pap smear test performed yearly as the risk of cervical cancer is increased.

HIV-positive people can usually live long, healthy lives, with the right treatment and a healthy lifestyle. Though the condition is now very manageable, there is no cure exists for HIV.