A Guide to STIs
Sexually transmitted infections, or STIs as they are more commonly known, are infections which are transmitted in different ways such as kissing, touching or rubbing genitals, oral sex, intercourse or using sex toys. Some STIs have noticeable symptoms while others remain asymptomatic which means you can have the infection but not have any symptoms to alert you to its presence.
Most GPs can offer a sexual health check. It can feel awkward or embarrassing to discuss your sex life but remember everything you discuss with your GP is completely confidential.
Sometimes you may be asked some personal questions:
What was the gender/s of the people you have had sex with?
What type/s of sex did you have?
When did you last have a sexual health check-up?
Did you use condoms or another barrier method?
How many partners have you had sex with in the last six months?
Even if you don’t feel comfortable answering these questions you can still speak to your health professional for a check-up. Asking these questions helps your health professional know what STIs you might be at risk of and what tests to do.
Remember you are in control.
It is important to know that you have the option to decline examination and still be tested.
If you don’t have any symptoms then most STI tests can be tested for by self-taken swabs or urine tests, if you feel comfortable doing so.
There are lots of myths and misconceptions about STIs and hopefully this blog will help to debug some of these. In this blog we don’t cover all STIs but talk about some of the more common ones.
Chlamydia
Chlamydia is a common STI which is caused by a bacteria. It can affect your genitals, anus, throat and rarely your eyes. Most people who have chlamydia have no symptoms which means they could be unaware they have the infection.
If you have symptoms these might include:
Discharge or change in discharge from your genitals or anus
Irregular bleeding or bleeding after sex
Pelvic pain or painful sex
Stinging or burning sensation when you urinate
Redness at the end of the penis
Pain and swelling in the testicles
You can test for chlamydia by taking a swab from your throat, anus or genitals, or from a urine sample. You might need more than one test for example, if you have had oral, vaginal and anal sex it might be recommended to swab all three areas. Remember, that if you prefer you can collect these samples yourself.
Chlamydia is usually effectively treated with antibiotics orally. If you have symptoms these usually go away pretty quickly after treatment. It’s usually recommended to book a follow up after a sexual health check-up to discuss your results and after treatment to ensure your symptoms have resolved.
Untreated chlamydia can lead to infertility so it is important to get tested.
It is recommend not having any sex for one week after treatment. Contact tracing is important which means contacting any people you have had sex with in the last six months. There is more information about contact tracing later in this article.
It is recommended that you get retested in one month if you have had anal/rectal infection, and after three months for any other sites of infection.
You can reduce the chance of getting chlamydia by using a barrier method such as condoms or dental dams but they aren’t 100% effective.
Genital Warts
Genital warts are a common STI caused by a virus called HPV which stands for human papilloma virus. Many people who carry the virus are unaware as they have no symptoms. If you have the virus you might develop warts but sometimes this can happen months after picking up the infection. Warts can vary in how they look but generally they are small growths or bumps. Most people who are sexually active will be exposed to the HPV virus in their lifetime and in the majority of cases the infections clear up without any treatment.
There is a link between some types of HPV infection and genital cancers including cervical and anal cancer. Therefore, the cervical screening test is an important way you can get tested for HPV and pick up early changes before they turn into cancer.
Read more about the cervical screening test here.
If you notice any lumps or bumps in or around your genitals or anus, any itching, pain or bleeding talk to your GP about your symptoms.
The diagnosis is made by having a look at them, you don’t need to swab or take samples. The most common treatment is cryotherapy/liquid nitrogen which involves freezing the warts. The treatment doesn’t get rid of the infection, just the warts.
There are treatments we can prescribe which you can apply yourself at home including podophyllotoxin (CondylineTM) and Imiquimod (AldaraTM).
Most of the treatments for warts take more than one application to clear the warts.
Condoms and dams can help to reduce the chance of getting genital warts but they don’t offer complete protection.
Gonorrhoea
Gonorrhoea is an infection caused by a bacteria and is spread through sexual contact with someone who has gonorrhoea. It can infect your genitals, anus, throat and eyes. Very rarely it can even spread to the bloodstream and this leads to joints pains, rashes and fever.
Not everyone who has the infection has symptoms but in those who do, symptoms might include the following:
Unusual discharge from your genitals or anus
Burning or stinging when you urinate
Irregular bleeding
Pelvic pain
Painful sex
Redness around the penis
A sore throat
Conjunctivitis
Irritation or discomfort in the rectum
Painful and/or swollen testicles
Infection in the rectum and throat rarely have symptoms.
You can diagnose gonorrhoea with a urine test and swabs which can be taken by your health professional or you. Remember, you might have to test more than one area.
Gonorrhoea can be treated with antibiotics. It normally involves some tablets and also an injection of antibiotics into your buttock muscle (there is usually some local anaesthetic mixed with the antibiotic to help with the discomfort).
After your treatment, it is recommended to have no sex for one week and to carry out contact tracing with anyone you have had sex with in at least the last two months.
Normally, you should get retested two weeks after completing your treatment to ensure the infection is cleared and retested again after three months.
Herpes
Herpes is a very common STI caused by the herpes simplex virus (HSV). There are two types of HSV: type 1 (HSV-1) and type 2 (HSV-2).
HSV-1 most commonly causes cold sores but can also cause herpes affecting the genitals. It is usually spread if someone who have HSV-1 performs oral sex on someone who doesn’t have the virus. The person doesn’t have to have a cold sore at the time to pass on the virus. The initial infection can be painful but recurrences are usually less painful and people with HSV-1 are generally at low risk of passing the infection on to sexual partners.
HSV-2 causes genital herpes, it is spread through sexual contact. People don’t have to have symptoms to pass on the infection. When someone doesn’t have symptoms and passes on the virus this is called asymptomatic viral shedding. The initial infection can be painful but recurrences are usually not as painful as the initial infection.
HSV can be passed on by skin to skin contact during sex, kissing, rimming or genital rubbing.
Symptoms include:
Ulcers, blisters or sores on the mouth, genitals or anus and the surrounding areas
Pain and swelling in the area around your genitals and anus which can make passing urine very difficult
Flu like symptoms
Itching
Redness or a rash
Recurrent episodes tend to have similar but less severe symptoms.
HSV is usually diagnosed by appearance and taking a swab from the ulcers. Generally, a blood test for HSV isn’t particular helpful in diagnosis or management.
There isn’t a cure for HSV but treatment is available which can help with the symptoms. You can be prescribed anti-viral medications which are generally safe and effective. Initial or first infections are usually treated with a ten-day course and recurrences can be treated with shorter courses, usually 1-3 days.
Sometimes, if recurrences are becoming a problem, you can be prescribed suppressive therapy which involves taking a tablet every day for about six months.
HIV
HIV is caused by a virus known as human immunodeficiency virus. HIV and AIDS aren’t the same thing but if left untreated, HIV can develop into AIDs. Thankfully, there are very effective treatments for HIV, however, there isn’t a cure.
HIV can be spread through any kind of sexual contact. Barrier methods like condoms reduce the risk of contracting HIV.
Many people may be unaware they have HIV but some symptoms can include:
Flu like symptoms
Extreme lack of energy/fatigue
Fever
Sweating profusely at night
Weight loss and loss of appetite
Swollen glands in the neck, underarm and/or groin
Persistent cough
Diarrhoea
You can test for HIV with a blood test. There can be a short period of time between contracting HIV and the blood test becoming positive which is called the window period. The window period can be up to three months so for that reason retesting three months after the potential exposure is usually recommended.
Please click on the link below if you would like to learn more about PrEP which can be used to reduce your chance of contracting HIV
Hepatitis A/B/C
Hepatitis A is caused by a virus and is spread through mouth to anal contact or consuming infected food or water.
Symptoms include nausea, fatigue, fever, dark urine, diarrhoea, jaundice (yellow discolouration of the eyes and skin), pain in the upper abdomen. Symptoms can last up to one month and it can take up to a month following exposure to develop symptoms. In most cases Hepatitis A is self-limiting illness. You can test for Hepatitis A infection or immunity in a blood test and if you are non-immune you can be immunised.
Hepatitis B is caused by a virus and is spread through contact with infected bodily fluids (blood, semen, saliva, vaginal and anal fluids). Many people with Hepatitis B have no symptoms but if present, symptoms include nausea, vomiting, loss of appetite, fatigue, fever, jaundice, painful joints and upper abdominal pains. Most people clear the infection themselves but some people become chronically infected.
As some people have no symptoms they can chronically carry the virus, feel completely healthy and unknowingly pass it on to others. Some people with chronic infection can develop problems such as cirrhosis (permanent damage) of the liver or in some cases liver cancer.
You can test for Hepatitis B with a blood test, there are treatments available. You can reduce your risk of contracting Hepatitis B by using a barrier method such as condoms and there is a vaccination which can offer protection.
Hepatitis C is cause by a virus and is spread by blood to blood contact. A proportion of people who get Hepatitis C clear the virus themselves however a larger proportion go on to develop chronic infection. People can have the infection for a long time without any symptoms and potentially unknowingly pass it on to others. The symptoms are similar to those of Hepatitis A and B.
You can test for Hepatitis C with a blood test and it is recommend to have a repeat test 12 weeks after the potential exposure. In people who are immunocompromised (such as with HIV infection or people on immunosuppressant therapy) a repeat test after six months is recommended. Left untreated it can lead to problems such as cirrhosis and liver cancer.
There are treatments available which are effective in most cases.
Mycoplasma genitalium
Mycoplasma genitalium is a less well known STI caused by a bacteria. It is usually spread by vaginal or anal sex without a condom. Symptoms include:
Pain on passing urine
Genital pain
Abnormal genital discharge
Abnormal vaginal bleeding
Abdominal pain
Painful sex
Sometimes people will have no symptoms at all
You can test for MG infection with urine test, vaginal swab and/or anal swab.
If someone has contracted MG there is an antibiotic treatment available.
Retesting 2 weeks after completion of antibiotic treatment is normally recommended.
Also, it is recommend to refrain from sex without condoms until you and your partner/ partners have received a negative MG test result.
Syphilis
Syphilis is an STI caused by bacteria transmitted by sexual contact with an infected person. People with syphilis might not have symptoms. In the month following infection a hard painless ulcer (sore) develops in the mouth, in/around the genitals and/or anus. Many people do not notice the ulcer and therefore do not know they have the infection. Several months later other symptoms can develop, such as fever, rash, swollen glands, hair loss and fatigue.
If the sore is present you can have it swabbed, if not you can have a blood test. Condoms can significantly reduce your chance of contracting syphilis. If the blood test is negative, and a suspected sexual contact was less than three months ago, it is recommend to repeat the blood test after three months. Syphilis can be treated with antibiotics and follow up blood tests are recommended in the year following treatment.
Trichomoniasis
Trichomoniasis is an STI which can be spread by unprotected sex with someone who has the infection. Most people don’t have any symptoms. People who have symptoms might experience genital discharge, pain or discomfort and/or pain on passing urine.
The test for Trichomonas is either a genital swab or a urine test, depending on symptoms.
The infection can be treated with antibiotic tablets. It is recommend to have no sexual contact for seven days after treatment and until your current partner/s also get treated.
Contact tracing
It is recommend that if you are diagnosed with an STI that you carry out contact tracing. This involves contacting current and previous partners, so that they can get tested and treated appropriately to stop the spread of STIs. Different STIs require different lengths of contact tracing. Please talk to your GP about your specific situation. If you don’t feel comfortable contacting your partner/partners, there are other options.
‘Let Them Know’ is an excellent website, that is anonymous, easy and quick to use. Please check out ‘Let Them Know’ here.
There are some really useful factsheets available from the Melbourne Sexual Health Clinic Website.