Sexually Transmitted Infections
What are STIs?
Sexually transmitted infections (STIs), are infections that are passed from one person to another by sexual contact. They do not always produce obvious symptoms and several can produce long-term complications such as pelvic pain, chronic cystitis, infertility or abnormalities of the cervix.
How are STIs diagnosed?
All sexually active people should undergo regular sexual health screenings, particularly if you have recently had unprotected sex, are experiencing unusual symptoms, or are changing partners. It is important to note that many STIs show no symptoms, so you can still have an infection without knowing about it.
STIs are easy to diagnose and most are easily treatable. Testing can be carried out through a specialised sexual health clinic, also referred to as a Genitourinary Medicine (GUM) Clinic, or through your GP or gynaecologist. Depending on your sexual history and lifestyle, the doctor or nurse might recommend a full sexual health screen. This consists of testing for all STIs, including HIV.
Getting tested and treated early on is important in preventing transmission of the infection to others and also in minimising any potential complications that may be borne as a result of an STD.
The most common types of STIs are:
- Genital Warts (HPV)
- Genital Herpes
- HIV and AIDS
Chlamydia is the most common STI in the UK, predominantly amongst 16-25 year olds. It is a bacterial infection which is passed from person to person through unprotected sexual contact or sharing sex toys. More than 200,000 people test positive for the infection per year in England, with 7 in 10 of these being people under 25 years old.
Chlamydia is very easily passed on through sexual contact. The bacteria is usually spread through infected genital fluids (either semen or vaginal fluid) and can be transmitted through vaginal, anal or oral sex.
Symptoms of chlamydia
Most people who are infected with chlamydia do not notice any symptoms and as a result, do not know they have it. It is for this reason that you should regularly undergo sexual health check-ups if you are sexually active.
If symptoms do occur, they may include:
- Pain when passing urine
- Unusual discharge from the vagina, penis or rectum
- Painful intercourse
- Bleeding between periods or after sex
- In men, pain in the testicles
Sometimes symptoms can disappear after several days, however it is important to note that even if symptoms go away, you may still carry the chlamydia infection and be capable of passing it on. As such, as soon as symptoms are detected, you should seek testing.
Side effects of chlamydia
Chlamydia usually causes no symptoms and is easily treatable through a short course of antibiotics. However, if left untreated the infection can spread to other body parts and can cause serious long-term complications.
In women, chlamydia can eventually spread to the womb, ovaries or fallopian tubes, which can result in pelvic inflammatory disease (PID). PID can make women infertile, can lead to chronic pain in the pelvis, or increase the change of having an ectopic pregnancy.
Chlamydia can be passed through a pregnant mother to her child, resulting in the baby developing conjunctivitis or pneumonia. It is therefore important to seek treatment before giving birth.
Testing and treatment
Chlamydia can be diagnosed with a vaginal or cervical swab, or through urine sample. If detected, chlamydia is easily treated with antibiotics. You should not have sex for a week whilst undergoing treatment and until your partner has also finished their treatment.
Genital Warts (HPV)
Genital Warts are the second most common STI in England, after Chlamydia. They are caused by the human papilloma virus (HPV) and are most prevalent in under 25s.
Genital warts look like small fleshy growths, bumps or skin changes which appear on or around the genital or anal area. Warts are usually painless, but can cause itching, redness or bleeding. Though they pose no serious health threats, they can be unpleasant and may cause emotional distress.
HPV is a family of over 100 different virus strains, affecting different parts of the body. Around 30 types of HPV can affect the skin around the genitals, though most cases of infection with HPV cause no visible symptoms. However, around 90% of genital wart cases are caused by two particular HPV strains; type 6 and type 11.
Genital warts are usually spread through vaginal or anal sex, even while using condoms, or through sharing sex toys. Since the infection is spread by skin-to-skin contact, penetrative sex need not take place to infect another person.
It may take months or even years for warts to physically appear following an infection with HPV. The infection is more likely to be transmitted when warts are present on the skin, however the virus may still be passed on when no warts exist.
Diagnosis and treatment
Genital warts can be identified though examination of the genital area by a health professional. Certain types of treatment will be required depending on the type, size, quantity and location of the warts.
Two types of treatment option exist for genital warts. A topical treatment in the form of a cream or lotion can be applied to the warts regularly until they disappear. Alternatively, warts can be destroyed through freezing (cryotherapy).
Many people only ever have one attack of genital warts, whilst others can have repeat occurrences throughout their life.
Herpes is an infection caused by the herpes simplex virus (HSV), which is the same virus that causes cold sores. It is a chronic, long-term condition, which means that the virus remains dormant in the body until a trigger reactivates it. As such, people with genital herpes will have several outbreaks throughout their lives, resulting in the appearance of painful, sore blisters on the genitals and surrounding areas.
The condition is most prevalent in the 20-24 age group and at least 8 in 10 people who carry the virus are unaware of the infection, since there are often no initial symptoms.
Testing and treatment
If you notice uncomfortable, sore blisters on your genital area, or have been informed by a previous partner that they have contracted herpes, you should see a medical professional immediately. Testing for herpes involves taking a swab of the genital area (if sores are present) or undergoing a blood test.
Symptoms often do not appear for a long time after the HSV virus is contracted. However, if symptoms do occur once exposed to HSV, they usually appear after 4-7 days. This is known as the primary infection and is typically more severe than any occurrences afterwards.
Unfortunately, there is no cure for the infection of genital herpes, though symptoms can be controlled and their effects minimised by using antiviral medications, such as Aciclovir.
It is important to not have sexual contact, including oral sex and sharing sex toys, until the symptoms of genital herpes have cleared up. When symptoms are present, the virus is highly contagious and can be easily spread. However, it is also possible to pass the infection to a partner when no symptoms are present.
You should also avoid sexual contact and kissing when a cold sore is present, since herpes can be contracted through genital area coming into contact with a cold sore.
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.
In 2014, around 35,000 cases of gonorrhoea were reported in England, with most cases affecting young people under 25.
Almost half of women and around 1 in 10 men who have gonorrhoea show no symptoms, meaning many are unaware that they have been infected. Symptoms usually occur within two weeks of infection, though sometimes they will not manifest for months.
In men, gonorrhoea can develop into painful infection of the testicles which may result in reduced fertility. It can also affect the prostate and lead to complications when urinating.
Symptoms can include:
- Pain when passing urine
- Thick yellow or green discharge
- Pelvic pain
- Bleeding between periods
If left untreated, gonorrhoea can cause pelvic inflammatory disease in women, which can cause infertility, chronic pelvic pain or ectopic pregnancy. While pregnant, gonorrhoea can cause miscarriage, premature labour or can mean the passing of the infection to the baby.
Testing and treatment
Testing is quick and painless and is carried out by urine test or swab. If detected, gonorrhoea is easily treated by a single antibiotic injection and a single antibiotic tablet. With treatment, the infection should go away within a number of days.
You should avoid having sex, including oral sex, for a week following treatment and until your partner has also finished their treatment.
HIV & AIDS
Human Immunodeficiency Virus (HIV) is a virus which attacks the immune system and weakens the body’s capability to fight disease and infection. It is contracted through having unprotected sex, but may also be passed on through the sharing of needles or in-utero, by a HIV-positive mother to her child.
The HIV infection exists in the bodily fluids of infected persons, which includes semen, vaginal and anal fluids, blood and breast milk. The most common way to contract the virus is through unprotected anal or vaginal sex.
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.
When HIV is first developed it may be accompanied by a flu-like illness but after this it may produce no symptoms.
Testing and treatment
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 GP or sexual health clinic.
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.
Treatment for HIV involves taking a combination of anti-retroviral tablets daily, which stop the virus spreading and allow the immune system to repair itself and prevent further damage occurring.
No cure exists for HIV, but with the right treatment and a healthy lifestyle, the condition is now very manageable and HIV-positive people can usually live long, healthy lives.