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Sexually transmitted infections

Introduction

Sexually transmitted infections (STIs) are passed on through intimate sexual contact. STIs include chlamydia, syphilis, and gonorrhoea. They can be passed on during anal and oral sexual intercourse, as well as through genital contact with an infected partner.

In the UK, STIs have been rising continually since the 1990s. Between 2004 and 2005, the Health Protection Agency (HPA) reported a 3% increase in the number of diagnosed STIs, with a total of 790,387 cases. The biggest increase was in the number of confirmed diagnoses of syphilis which rose by a massive 23%, to a total of 2,807 cases. There were also increases in positive diagnoses of chlamydia, genital warts, and herpes.

To some extent, the increase in the number of diagnosed cases of STIs is due to a greater awareness of the problem, more reliable diagnostic techniques, and an increase in the number of sexual health and GUM clinics carrying out tests. However, by far the highest increase in STIs has been among the 16 to 24 age group which is a worrying trend.

Symptoms

You should visit your GP or local GUM clinic if you experience itching, swelling or redness around the penis, unusual discharge from the penis, or pains in the lower abdomen.

Most conditions vary in their symptoms but the most common are listed below:

Chlamydia

Men with chlamydia commonly experience a urethral discharge from the penis, and may have inflammation of the tube leading from the bladder to the tip of the penis (urethritis), or of the tube leading from the testes to the penis (epidymitis). This discomfort may then disappear but the infection can still be passed on to a sexual partner.

Genital warts

Many people who get the virus that leads to genital warts do not show any recognisable symptoms, and this is why the infection can go undiagnosed for a long time. However, if symptoms are present, they may include small white spots or lumps that are hidden inside the anus.

Genital herpes

Like genital warts, genital herpes is a condition that often presents no symptoms and can remain undiagnosed for long periods of time. Symptoms may show in the form of flu-like symptoms, itchiness, burning or tingling around the genitals, small, fluid-filled blisters that burst to leave sores, and pain when passing urine.

Gonorrhoea

Gonorrhoea is an infection that is found in both sexes and can affect the genitals, anus, rectum and throat. Over 90% of men experience symptoms, including a thin, watery discharge from the tip of the penis that can appear yellow or green, and pain when urinating.

Syphilis

The symptoms of syphilis usually begin with a small sore on the penis. Up to six months after the initial symptoms occur, you may experience flu-like symptoms, such as aching and shivering.

HIV

Many people do not develop any symptoms when they first become infected with HIV. Some people, however, get a flu-like illness within three to six weeks after exposure to the virus. The only way to know if you are HIV-positive is to have a test. Over time, infection with HIV weakens the immune system leading to difficulty fighting off certain infections.

Non-specific urethritis

Non-specific urethritis is an STI that affects men. It causes discomfort of the urethra (the tube that leads from the bladder to the tip of the penis, along which urine is passed), and a urethral discharge is also common.

Pubic lice

Symptoms of pubic lice include itchy skin, and you may notice black powder (lice droppings) in your underwear and white eggs.

Scabies

Scabies can occur anywhere on the body, but sometimes the signs are hard to see. Symptoms can appear weeks after first contact and include itching (especially at night), a rash, and tiny spots.

Thrush

Symptoms of thrush include intense itching around your penis or vagina, with a thick, white discharge, and the appearance of tiny white spots around the genitals.

Causes

Sexually transmitted infections (STIs) are passed from person to person during intimate sexual contact. You can catch STIs through:

      - having unprotected anal sex,
      - having unprotected oral sex, or
      - having genital contact with an infected partner.

The risk of contracting infections such as gonorrhoea and syphilis through oral sex is much greater than the risk of contracting HIV. However, recent studies suggest that the potential risk of HIV through oral sex is higher than previously estimated.

Diagnosis

Most sexually transmitted infections (STIs) are initially diagnosed on presentation of the symptoms, and then formally through blood, urine and other tests. The results of an STI test are completely confidential.

Until a few years ago, GPs or GUM clinics commonly used a swab test which involved taking a sample of secretion from the penis using a piece of absorbent material attached to a rod, such as a cotton bud. The sample was then sent to a laboratory for examination.

In some cases, such as with pubic lice, STI testing is not necessary because the symptoms are conclusive. Other STIs are difficult to diagnose as they present few or no recognisable symptoms. For example, chlamydia sometimes presents no symptoms, and often goes undetected unless it leads to complications, such as pelvic inflammatory disease (PID), ectopic pregnancy or infertility.

Due to the increase in cases of chlamydia, and the difficulty in diagnosing it, in 2002 a National Chlamydia Screening Programme was launched. In England, a total of 85 areas are now covered by the programme. To find out which PCTs are currently involved in the scheme, please see the National Chlamydia Screening Programme in the selected links section. Ask you GP or click on this link to find to find your nearest GUM clinic. Alternatively, you can contact NHS Direct on 0845 4647.

Treatment

Most sexually transmitted diseases (STIs) can be treated using a single dose or course of antibiotics. These include chlamydia, gonorrhoea (although some strains are now showing signs of resistance to antibiotics), syphilis and urinary tract infections.

Antiviral drugs may be used to relieve the symptoms of genital herpes, but infection by the virus cannot be cured. Genital warts can be treated although they do eventually heal and disappear without treatment. Many people choose to have genital warts removed by a doctor, for cosmetic reasons. Caustic agents or liquid nitrogen are used to burn them away, or freeze them.

As STIs are easily passed on through sexual contact, if you have a positive diagnosis, it is important that your current and past sexual partners are notified and treated, in order to reduce the risk of spreading and re-infection. Your local GUM clinic may be able to provide help by notifying your previous partners on your behalf.

Below is a basic summary of the treatments that are used to treat the main STIs. Most of these STIs are also covered as separate health encyclopaedia topics which provide more detailed information and advice.

Chlamydia is easily treated with antibiotics, either using a single dose, or a course for a couple of weeks.

Trichomonas vaginalis (TV) is easily treated with a course of antibiotic tablets. Early treatment for gonorrhoea involves a single dose of antibiotics. If complications occur further treatment will be needed.

Non-specific urethritis (NSU) is easily treated with antibiotics, although damage to the urethra can take time to heal.

The virus for genital herpes remains in the body as there is no treatment that gets rid of it completely. Antiviral drugs may be used to relieve the symptoms. Self-help measures can reduce symptoms, or prevent outbreaks. For example, avoiding stress, resting, stopping smoking, cutting- down on drinking, and avoiding direct sunlight.

Pubic lice are easily treated. Special shampoos, creams or lotions are used to kill the lice and their eggs.

Scabies is easily treated. A special lotion is applied all over the body and is washed off 24 hours later.

While there is no cure for AIDS, drugs can be used to suppress the HIV virus and preserve the immune system for as long as possible. AIDS-related illnesses that arise can also be treated, and advice from specialists such as dieticians, physiotherapists, counsellors, and support groups is also available.

Syphilis can be easily treated during the early stages using a course of antibiotics for two weeks. It can also be treated during later stages of infection, but any damage to the heart or nervous system may be irreversible.

Thrush is easily treated using pessaries (tablets that are inserted into the vagina), cream or tablets. Creams are usually used to treat men who have thrush.

Genital warts are easily treated by either painting them with a liquid, or freezing them with a spray. However, some people need a number of treatments, and if the warts return, further treatment will be required.

Prevention

Practising safe sex is the most effective way of preventing sexually transmitted infections (STIs). The male condom is the most effective method of preventing STIs. However, you can never be 100% sure that a prospective sexual partner does not have an STI, and the more sexual partners that you have, the higher the risk of contracting an STI. Therefore, if you have a new partner, it is a good idea for you both to be tested for STIs before having sexual intercourse.

The Health Development Agency (HDA) has introduced a number of initiatives in an attempt to reduce the continually increasing levels of STIs in England. They include:

          - integrating STI prevention with family planning services,
          - partner notification (where health professionals contact a patients partners on their behalf),
          - increasing awareness about the ease of infection and the importance of taking preventative measures, and
          - the provision of education and counselling services.

If you have any of the symptoms mentioned in the symptoms section, and you think that you may have an STI, you should visit your local sexual health or GUM clinic to have them checked out. You should also ensure that your friends and family are aware of the various STIs and their consequences, and if necessary, encourage them to get tested.

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