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About Common STIs (Sexually Transmitted Infections)

Sexually transmitted infections can be embarrassing and affect your confidence. In most cases, they are preventable. Further STI information can be found below - click on an infection to learn more about it.

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Bacterial Vaginosis

Vaginal discharge in women can be a perfectly normal physiological occurrence, but it can also be caused by infections. Not all infections are sexually transmitted; if you are unsure, it is important to have a check-up. Bacterial Vaginosis is a very common vaginal infection. It is caused by an overgrowth of bacteria that normally exist in the vagina. It cannot be passed to a man.

What are the signs and symptoms of Bacterial Vaginosis?

There may be none. However, there may be a change in your vaginal discharge - it may increase, become thin and watery, change colour and/or develop a strong fishy smell.

How does Bacterial Vaginosis develop?

It occurs when the acidity of the vagina changes. This can be caused by semen entering the vagina during unprotected sex, douching and washing out the vagina, or using too much soap/bubble bath/vaginal deodorant.

What are the tests for Bacterial Vaginosis?

This involves a genital examination by a doctor. Swabs are taken from the vagina and the acidity can be measured using pH paper. The test is not normally painful.

Diagnosis and Treatment

The diagnosis is made by looking at a specimen of discharge under the microscope in our laboratory. The result is usually available immediately. Treatment is easy - antibiotic tablets or a cream to put inside the vagina will be prescribed from our pharmacy. The tablets are called 'Metronidazole' (trade name Flagyl) and the cream is called 'Clindamycin' (trade name Dalacin). If it is possible that you are pregnant, it is important to tell the doctor, as Bacterial Vaginosis is a possible cause of miscarriage. It is important to finish the course of treatment once begun.

It is possible to have a sexually transmitted infection in addition to Bacterial Vaginosis - this why it is important to have an examination and full range of tests. The evidence linking bacterial vaginosis with early miscarriage is limited; nevertheless, common sense dictates that treatment of 'BV' under these circumstances is advisable. It is important to note that the standard course of treatment (Metronidazole antibiotics at a dose of 400mg twice daily) has not been shown to be harmful to unborn babies. As always, anyone taking Metronidazole must not consume alcohol until 48 hours after the treatment is finished.

Genital Herpes

There are two types of virus (both from the herpes virus family) that cause the genital herpes infection: Herpes Simplex 1 (HSV1) and HerpesSimplex 2 (HSV2). Whilst HSV1 is usually associated with cold sores around the mouth and HSV 2 with genital ulcers, in practice each virus can cause both types of symptom. If a patient is already infected with HSV1 then it is likely that this will modify the severity of a subsequent infection with HSV2 ,thereby making the symptoms less severe.

There is often tremendous anxiety surrounding a diagnosis of Herpes. This is due not only to the painful nature of the lesions but also the fact that once acquired the virus remains in the body permanently. There is also a large amount of myth and stigma surrounding this infection. An episode of ulceration can be thought of as primary (the first ever) or recurrent. Primary episodes are often the most painful and the severity of episodes often decreases greatly with recurrences. In between episodes, the virus lives in the body's nerve cells and periodically will cause either episodes of ulceration or asymptomatic viral shedding. This latter phenomenon is the release of the virus rendering it infective to a sexual partner without any symptoms at the time.

It is impossible to predict when viral shedding or ulceration will occur and recognising clear precipitants is not often feasible. Some people associate periods of stress with development of herpes ulcers, but this is largely anecdotal.

What are the signs and symptoms of Genital Herpes?

The symptoms of genital Herpes include painful blistering and ulceration or broken skin anywhere on the genitals: penis, scrotal skin, urethra, vulva, vagina and cervix. It is also possible to have ulcers on the skin of the thighs, pubic area and buttocks and also in the anus and rectum. Anal ulcers do not imply that a person has necessarily had anal sex. It is possible to pass Herpes infection on through oral sex if an infected partner has cold sores around the mouth. There are also general symptoms of fever, muscle aches and generalised pains in the groin and pelvis that can accompany attacks. The worst constitutional symptoms are often felt with a primary attack.

What are the tests for Genital Herpes?

If the virus is to be isolated by taking a swab, it must be remembered that the test will only come out positive if there is fresh blister fluid (pus) on the swab and as such, a negative swab does not imply an absence of infection. This scenario often occurs when a swab is taken during the recovery phase of an attack and the skin has started to heal. There is also a blood test available to show the presence of Herpes antibodies. In practice, this test is limited in that all it can do is tell you that, if positive, you have been infected with the Herpes virus at some time in the past. It does not tell you when, by whom or whether you will experience any symptoms in future.

What is the treatment?

Treating Herpes attacks is relatively simple. The fundamental points are to keep the area clean and dry and avoid sex until the skin is fully healed. By doing this, the risk of transmission to a partner is minimized but not eradicated. If you think logically, the majority of sexual transmission will occur when someone is feeling well and has no ulcers. Pain relief is vital and this can be achieved by using simple analgesics like Paracetamol and Ibuprofen, bathing in salt water and if necessary using local anaesthetic creams on the genitals.

The body's immune system will gradually help the ulcers to heal given time and the main purpose of treatment is symptomatic relief. In some cases, drugs are prescribed for Herpes attacks, but in general, these are only effective if started in the first 24 hours and are reserved for very painful attacks. For example, drugs may be used for cases where there are severe constitutional symptoms and complications such as urinary retention. This is where severe pain caused by ulcers in the urethra prevents a patient from urinating and so causes a dangerous and painful build up of pressure in the bladder.

Occasionally, an attack is so severe that a patient requires hospitalisation and needs drugs to be given by injection and a catheter inserted to help them pass urine. Fortunately, this is rare. The drugs used to treat Herpes include Aciclovir and the related compounds: Famciclovir and Valaciclovir. In general, these drugs are not effective if given as creams and most clinicians will only prescribe them as tablets. People who get regular recurrences of Herpes ulcers can take these medications as prophylaxis (prevention) against attacks. When taken daily, they can suppress the virus and can be very effective at minimizing or preventing further attacks and reducing the risk of passing on the infection. The drugs are taken in a different dosage to treatment, and treatment isusually continued for 6 months to a year.

An important area to consider is the management of the Herpes infection in pregnancy. Opinion is still divided as to what is best. However, most experts agree that a first episode in the third trimester of pregnancy is more serious than a recurrence. The main concern is the passage of HSV to the infant during delivery with subsequent development of a potentially serious eye infection in the child. As such, Obstetricians will consider giving Aciclovir to a woman with a primary Herpes attack in the third trimester of pregnancy and also performing a planned caesarean section.

On a practical level, it is worth remembering three important facts about genital Herpes. Firstly, infections are sometimes acquired a long time prior to the first recognised appearance of symptoms. As such, the development of Herpes ulcers may imply but not necessarily prove infection from a recent / current sexual partner. Secondly, treatment is simple and essentially aimed at keeping the patient free of pain whilst the immune system heals the skin. Finally, for particularly severe or frequently recurring attacks, effective drug treatments are available.

Genital Warts

These are small fleshy growths which may appear anywhere on a man or woman's genital areas. In 2004, more than 80,000 cases of genital warts were diagnosed in the UK, making it the second most commonly diagnosed sexually transmitted infection in Britain after Chlamydia. Genital Warts are caused by infection with the Human Papilloma Virus (known as HPV). It is estimated that there are more than 80 different types of Human Papilloma Virus - some cause genital warts, others cause warts on other parts of the body, such as the hands.

 

An effective vaccine against Genital Warts and Cervical Cancer in women, called Gardasil, has recently been approved by health authorities in Europe and is now available to patients of the Regent's Park Clinic.

What are the signs and symptoms of Genital Warts?

Following infection with wart virus it usually takes between 1 and 3 months for warts to appear, although some cases take longer, possibly up to one year. A proportion of people who come into contact with the virus do not develop warts at all - this is known as a 'Sub-clinical infection'.

 

Warts can appear around the vulva, in the vagina, the penis, the scrotum or the anus. They can be single or in groups. They may itch, but are usually painless. There may be no symptoms or, where there are, they may be difficult to see.

 

In women, warts can develop on the cervix and this may occasionally cause slight bleeding or an unusual discharge.

How are Genital Warts passed on?

Warts are spread through skin-to-skin contact. Genital warts usually develop following sex or genital contact with someone who already has them. They can be passed on during vaginal or anal sex. It is possible for warts to spread to the area around the anus without having had anal sex.

What are the tests for Genital Warts and the HPV Virus?

Checking for genital warts involves a visual inspection of the genital area by a doctor. The diagnosis is often made just by looking at the area, while sometimes a solution may be applied to see if any warts change colour. An internal examination of the vagina or anus may be necessary.

 

A HPV test is now available which checks for infection by 35 different types of the HPV virus, including all of the high-risk types. The test consists of a swab sample from the cervix and the vagina in women and is quite sensitive.

What is the treatment?

A common treatment is freezing the warts. This is known as Cryotherapy.

 

Another common treatment is the application of one of two special creams to the warts. Called Podophylloxin and Imiquimod, these treatments are applied at home over a number of weeks. More than one kind of treatment is often necessary before the warts are gone. These treatments may be uncomfortable but they should not be painful. Advice on sex while infected should be sought from the clinic doctor/health advisor/nurse. Never try to treat genital warts by yourself without seeking medical advice.

 

If you are pregnant or trying to conceive, it is important to inform the doctor, as Podophyllin treatment could be harmful to the developing baby and an alternative treatment can be used.

What follow-up will I need?

All patients with genital warts should have tests for the other common sexually transmitted infections and possibly also an HIV test depending on the patient's sexual history. Sexual partner(s) should also have a check-up.

 

It is important to return regularly for treatment until the warts have gone so that progress can be checked and any necessary changes in treatment can be instituted.

 

Treatment can take a long time. Some people whose warts initially disappear will suffer a recurrence although it is impossible to predict if or when this will happen.

Warts and the Cervix

Some types of wart virus may be linked to changes in cervical cells that can lead to cancer. It is important for all sexually active women over 20 years of age to have regular cervical smear tests.

 

There is no direct link between the types of wart virus causing visible genital warts and cancer of the cervix.

 

If a problem is suspected, a Colposcopy is done to look at cells on the cervix - this is a kind of small telescope used to give a magnified view of the cervix. Samples ('biopsies') may be taken at this time.

 

If there are genital warts on the cervix, vagina or intra-anally, specialist treatment may be required. Removal is often by freezing or by laser treatment under local anaesthetic.

Chlamydia

Chlamydia is the most common treatable bacterial sexually transmitted infection.

What are the signs and symptoms of Chlamydia?

Women: The majority of women have no symptoms. Where symptoms occur, these are likely to include:

  • Slight increase in vaginal discharge
  • Need to pass urine more often
  • Pain on passing urine
  • Lower abdominal pain
  • Pain during sex
  • Irregular menstrual bleeding
  • Painful swelling/irritation in eyes (if infected)

 

Men: Men are more likely to notice symptoms than women but may also have no symptoms. Where symptoms occur, these are likely to include:

  • Penile discharge
  • Pain or burning when passing urine
  • Painful swelling/irritation in eyes (if infected)

Rectal Chlamydia rarely causes symptoms.

How is Chlamydia passed on?

Chlamydia is usually passed on by having sex with someone who is infected. Mothers can also pass it to their babies at birth, and occasionally, the infection can spread from the genitals to the eyes. Chlamydia symptoms will usually appear between seven to fourteen days after the infection is acquired. If symptoms are absent, it is sensible to wait for fourteen days after a particular exposure before having tests for Chlamydia.

What are the tests for Chlamydia?

Tests involve a genital examination by a doctor. Swabs are taken from whichever place may be infected. Women may be given an internal pelvic examination.

Diagnosis and Treatment of Chlamydia

Samples are tested using a modern and highly sensitive nucleaic acid amplification test (NAAT). The result is available within 2-3 working days. The treatment is simple and effective once diagnosed - antibiotic tablets will be given. These are called either 'Doxycycline' or 'Azithromycin'. It is important to finish any course of treatment. It is also important to abstain from sex until you have finished the treatment. Your recent sexual partners should also receive treatment, regardless of whether they have symptoms.

What follow-up will I need?

A check to ensure the chlamydia infection has gone is not usually required as long as both you and your sexual partner have taken your treatment and you are symptom-free. However, if you do wish to have a “test of cure”, you need to allow at least 4 weeks to elapse after treatment - our tests are very sensitive and, if you re-test too soon, may pick up 'dead' chlamydia.

Are there any complications?

Women: If untreated, Chlamydia can lead to pelvic inflammatory disease. This is an inflammation of the fallopian tubes (the tubes along which an egg passes to get to the uterus or womb). Pelvic inflammatory disease can lead to problems with fertility. Many cases of infertility can be traced back to infection with Chlamydia.

If a woman has Chlamydia when she is pregnant, she risks having a premature birth or an ectopic pregnancy, which is a pregnancy that remains in the tube. The infection can be passed to the baby, giving it an eye or lung infection. Chlamydia can be safely treated during pregnancy.

Chlamydia can also lead to chronic or long term pelvic pain.

Men: Complications are uncommon. However, the infection may lead to painful inflammation of the testicles.

Men and women: Reiter's Syndrome can occur – this causes inflammation of the eyes and joints and sometimes a rash on the soles of the feet and genitals. Treatment is with anti-inflammatory tablets such as Ibuprofen.

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