Sexually Transmitted Infection

Sexually transmitted infections (STIs) are diseases passed on from one person to another through unprotected sex (sex without a condom) or sometimes through genital contact.

Chlamydia

Chlamydia is one of the most common STIs in the UK. Most people who have chlamydia don’t notice any symptoms and won’t know they have the infection. Otherwise, symptoms may include pain when you urinate, unusual discharge and, in women, bleeding between periods or after sex. Diagnosing chlamydia is easily done with a urine test or a swab of the affected area. Chlamydia is easily treated with antibiotics, but can lead to serious long-term health problems if it's left untreated. Chlamydia is passed on from one person to another through unprotected sex (sex without a condom). In 2010, there were 186,753 people who tested positive for chlamydia in England. Most of these - more than 150,000 - were people aged 24 or younger.

Symptoms of chlamydia

Most people who have chlamydia don’t notice any symptoms, and so don't know they have it. Research suggests that 50% of men and 70-80% of women don't get symptoms at all with chlamydia infection. Symptoms of chlamydia could be pain when you urinate, unusual discharge vagina or rectum or bleeding between periods or after sex. If you do get signs and symptoms, these usually appear between one and three weeks after having unprotected sex with an infected person. For some people, the symptoms occur many months later, or not until the infection has spread.

Symptoms in women

  • pain when urinating (peeing)
  • a change in vaginal discharge
  • pain in the lower abdomen
  • pain and/or bleeding during sex
  • bleeding after sex
  • bleeding between periods
  • heavier periods than usual

If chlamydia is left untreated in women, it can spread to the womb and cause pelvic inflammatory disease (PID). PID is a major cause of infertility, miscarriage and ectopic pregnancy (when a fertilised egg implants itself outside the womb, usually in one of the fallopian tubes).

Chlamydia in the rectum, throat or eyes

Chlamydia can infect the rectum, eyes or throat if you have unprotected anal or oral sex. If infected semen or vaginal fluid comes into contact with the eyes you can also develop conjunctivitis. Infection in the rectum can cause discomfort, pain, bleeding or discharge. In the eyes chlamydia can cause irritation, pain, swelling and discharge the same as conjunctivitis. Infection in the throat is less common and usually causes no symptoms.

Chlamydia Transmission

  • Condoms and lubricant - If you use lubricant when you have sex with a condom, make sure that it’s water-based (it will say on the label). Oil-based lubricant, such as lotion, baby oil, moisturiser or lipstick, can damage latex condoms.
  • Chlamydia is a sexually transmitted infection (STI), which means that you get it through having unprotected sex (sex without a condom) with someone who has chlamydia. You can get chlamydia through: unprotected vaginal sex, unprotected anal sex, unprotected oral sex, your genitals coming into contact with your partner's genitals or sharing sex toys when they are not washed or covered with a new condom between each person who uses them
  • Sexual fluid from the penis or vagina can pass chlamydia from one person to another even if the penis does not enter the vagina, anus or mouth. This means you can get chlamydia from genital contact with someone who has the infection even if there is no penetration, orgasm or ejaculation.
  • Chlamydia and giving birth - During childbirth, a woman with chlamydia can pass the infection on to her baby. If chlamydia develops in the baby there might not be any obvious symptoms at first. Chlamydia in a newborn baby can cause inflammation (swelling) and discharge in the baby’s eyes (known as conjunctivitis) and pneumonia.

Diagnosis of Chlamydia

The only way to find out if you have chlamydia is to get tested. You can get tested whether or not you have symptoms. The test for chlamydia is simple. Most people can have the test carried out on a urine sample. Some people have a swab test (a small cotton bud). The swab is used to gently wipe the area where you might have chlamydia, to collect some cells. The cells are then tested for infection. People who have had anal or oral sex might have a swab taken from their rectum or throat. This isn’t done on everyone. If you have symptoms in your eye, such as discharge or inflammation, a swab test might be taken to collect cells from your eyelid.

Chlamydia tests on women can be done with a urine sample or swab test. If a woman has a swab test, it can be taken from the cervix, or inside the lower vagina. Occasionally the doctor or nurse may advise you to have a swab test from the urethra (where urine comes out). Usually you can do a lower vaginal swab yourself, although sometimes a nurse or doctor may do it.

It is recommended that you get tested for chlamydia if:

  • you or your partner think you have any symptoms
  • you've had unprotected sex with a new partner
  • you’ve had a split condom
  • you or your partner have unprotected sex with other people
  • you think you have a sexually transmitted infection (STI)
  • a sexual partner tells you they have an STI
  • you're pregnant or planning a pregnancy
  • you have a vaginal examination and your doctor or nurse tells you that the cells of your cervix are inflamed or there is vaginal discharge

Treating chlamydia

Chlamydia is usually treated with antibiotics. Antibiotics are very effective for treating chlamydia. More than 95 out of 100 people with chlamydia will be cured if they take their antibiotics correctly. The two most commonly prescribed antibiotics to treat chlamydia are:

If there is a high chance that you have been infected with chlamydia (for example, your partner has been diagnosed with chlamydia and you have had unprotected sex with them) you might be started on treatment before you get your test results. The side effects of antibiotics are usually mild and these include: stomach pain, diarrhoea, feeling sick, vaginal thrush (also called candida). Also, occasionally, doxycycline can cause a skin rash if you are exposed to too much sunlight (photosensitivity).

Resuming Sex, and Treatment of Sexual Partners

You should not have sex for at least one week after you have finished your antibiotic treatment. You may need to avoid having sex for longer if your sexual partner has not been treated so that you do not become re-infected. You should also avoid having sex until your symptoms have gone.If you test positive for chlamydia, it's important that your current sexual partner and any other recent sexual partners are also tested and treated. In the UK, it's advised that you contact any sexual partners you've had within the past six months.

Complications of chlamydia

If chlamydia is not treated, it can sometimes spread and cause long-term problems. Chlamydia can spread to the womb (uterus), ovaries or the fallopian tubes. This can cause a condition called pelvic inflammatory disease (PID). Women may also develop an inflammation of the cervix (cervicitis), or an infection in the Bartholin’s glands near the vaginal opening. Very rarely women can develop a reactive arthritis.

PID - Chlamydia is one of the main causes of PID in women. PID is an infection of the womb (uterus), ovaries and fallopian tubes. It can cause infertility, persistent (chronic) pelvic pain and it increases the risk of miscarriage and ectopic pregnancy. PID can be treated with antibiotics, and the risk of infertility is reduced if PID is treated early.

Inflammation of the cervix (cervicitis) - Chlamydia can cause inflammation of the cervix (the neck of the womb), known as cervicitis. Cervicitis often causes no symptoms, but if you do get symptoms these may include: bleeding during or after sex, bleeding between periods, discomfort in your lower abdomen, vaginal discharge, pain during sex

Blocked fallopian tubes - Chlamydia can spread to cause inflammation in the fallopian tubes (known as salpingitis). This can make it difficult for an egg to travel from the ovary to the womb and can make becoming pregnant more difficult. Even if a fallopian tube is only partially blocked, this will increase the risk of ectopic pregnancy (when a fertilised egg implants outside the womb, usually in a fallopian tube). Blocked fallopian tubes can sometimes be treated with surgery.

Swollen Bartholin’s glands (Bartholinitis) - The glands that produce a woman's lubricating mucus during sex are known as the Bartholin’s glands. They sit on either side of the vaginal opening. Chlamydia can cause the glands to become blocked and infected, leading to a Bartholin’s cyst. The cyst is usually painless, but if it becomes infected it can lead to an abscess. An abscess is usually red, very tender, painful to touch, and can cause a fever. An infected abscess needs to be treated with antibiotics. Very occasionally an operation is needed to drain the abscess.

Genital warts

Genital warts are small fleshy growths, bumps or skin changes that appear on or around your genital or anal area. They are the result of a viral skin infection caused by the Human Papilloma Virus (HPV). Genital warts are very common. In England, they are the second most common type of sexually transmitted infection (STI) after chlamydia. Genital warts are most common in sexually active teenagers and young adults.

HPV is spread by skin-to-skin contact, so penetrative sex is not necessary for transmission. Genital warts are usually painless and do not pose a serious threat to a person’s health. However, they can appear unsightly and cause psychological distress. The Human Papilloma Virus (HPV) is not a single virus, but a family of over 100 different strains of viruses. Of these, 40 strains of HPV are known to cause genital warts. Other strains of HPV can cause cervical cancer.

Genital warts can be spread during vaginal or anal sex, and by sharing sex toys. Condoms do not provide complete protection because it is possible for the skin around your genital area (that is not covered by the condom) to become infected. HPV is most likely to be transmitted to others when warts are present, although it is still possible to pass the virus on before the warts have developed and after they have disappeared. The incubation period for genital warts (the time that it takes for symptoms to develop after developing an infection) can be as long as one year. Therefore, if you are in a relationship and you get genital warts, it does not necessarily mean that your partner has been having sex with other people.

Symptoms of genital warts

Genital warts usually appear within two to three months of developing an HPV infection, although incubation periods of up to a year have been reported. In women, genital warts usually begin as small, gritty-feeling lumps that become larger. A person can have a single wart, or clusters of multiple warts that grow together to form a kind of ‘cauliflower’ appearance. Warts are usually painless, although some people may experience symptoms of itchiness and irritation, particularly if warts develop around the anus (back passage). Warts that develop near or inside the urethra can disrupt the normal flow of urine. The urethra is the tube that is connected to the bladder, through which urine passes.

The most common places for genital warts to develop in women are:

  • around the vulva (the opening of the vagina), which occurs in 2 out of 3 cases of genital warts
  • inside the vagina, which occurs in 1 in 3 cases
  • between the vagina and the anus, which occurs in 1 in 3 cases
  • around the anus, which occurs in 1 in 4 cases
  • on the cervix (the neck of the womb), which occurs in 1 in 10 cases
  • at the opening of the urethra, which occurs in 1 in 25 cases

GENITAL WARTS (HPV) TRANSMISSION

Genital warts are caused by the human papillomavirus (HPV). HPV targets a type of tissue that is known as epithelial tissue, which is found on the skin, and on the lining of many of the body’s cavities, such as: the female genitalia, including the vagina, vulva and cervix, the anus and the mouth. In many cases, HPV does not cause any noticeable symptoms, so many people can be infected with HPV without realising it. The most common way that HPV can be passed from person to person is during sexual intercourse. Other forms of sexual activity where HPV can be passed from person to person include: oral sex, anal sex, non-penetrative genital to genital contact. Less commonly, a mother can pass HPV on to her newborn baby during birth.

Diagnosis of Genital Warts

Genital warts can usually be easily diagnosed by examining them. At a check-up, the doctor or nurse may use a magnifying lens to do this. Women will also have the inside of their vagina examined using a speculum, which is a specially designed instrument that incorporates a torch and a mirror.

Further testing may be recommended if: you have recently had anal sex and you were the passive partner, you have warts around your anus, you have experienced bleeding from your anus or urethra or if your normal urine flow has become distorted. The inside of the anus can be examined with a special metal instrument called a proctoscope. A proctoscope is a small metal tube that incorporates a torch and a magnifying lens. A similar tool called an endoscope (a thin, flexible tube with a camera at one end) may be used to examine the inside of your urethra.

Treatment of Genital Warts

There are two main types of treatment for genital warts:

  • topical treatment, where a cream, lotion or chemical is applied directly to the wart or warts
  • physical ablation, where the tissue of the wart is destroyed using external forces, such as lasers or electricity

Sometimes different people respond to treatments for genital warts in different ways. For example, one treatment can be very effective at treating one person’s symptoms, but fail to have much effect in someone else. However, topical treatments tend to work better on softer warts, and physical ablation tends to work better on harder and rougher feeling warts. Sometimes, a combination of topical treatment and physical ablation can be used. Either type of treatment can take several months to remove the warts, so it is important to be patient and persevere with the treatment.

Topical treatment of Genital Warts

There are several topical treatments that can be used to treat genital warts. These are:

Podophyllotoxin - Podophyllotoxin is usually recommended to treat clusters of small warts. It comes in liquid form and works by having a toxic (poisonous) effect on the cells of the warts. A special application stick is used to draw up the correct dosage of the liquid, which is then dripped onto the wart. You may experience some mild irritation when you apply the liquid to the wart. Treatment with podophyllotoxin is based on cycles. The first treatment cycle involves applying the medication twice a day for three days. This is then followed by a rest cycle where you have four days without treatment. Most people require four to five treatment cycles that are separated by rest cycles.

Imiquimod - Imiquimod is a type of cream that is usually recommended to treat larger warts. Imiquimod works by helping to stimulate your immune system into attacking the warts. You apply the cream to the warts and then wash it off after six to ten hours. This should be done three times a week. It can often take several weeks of treatment before you begin to notice an improvement in your symptoms. Common side effects of imiquimod include: hardening and flakiness of the skin, swelling of the skin, a burning or itching sensation after applying the cream, headache. These side effects are usually mild and should pass within two weeks of stopping treatment with imiquimod.

Trichloroacetic acid (TCA) - Trichloroacetic acid (TCA) may be recommended to treat small warts that are very hard. TCA is also recommended for use by women who are pregnant because it is thought to be the safest of all the topical treatments to use during pregnancy. TCA works by destroying the proteins inside the cells of the wart. However, if it is not applied correctly, TCA can damage healthy skin. Therefore, it is recommended that you do not apply TCA yourself. Instead, you will be asked to visit your local GUM clinic once a week so that a doctor or nurse can apply the medication. After TCA is applied, some people experience an intense burning sensation for around five to ten minutes.

Ablation Treatment of Genital Wart

There are four main methods used in the physical ablation of genital warts. They are: cryotherapy, excision, electrosurgery and laser surgery. These are described in more detail below.

Cryotherapy - Cryotherapy is usually recommended to treat multiple, small warts, particularly those that develop on the vulva. Cryotherapy involves freezing the wart using liquid nitrogen. Freezing helps to kill the cells of the wart by splitting their outer membranes. After being frozen, the wart is allowed to thaw out and, if necessary, it can be frozen and thawed again. During cryotherapy treatment, you will experience a mild to moderate burning sensation. Once the treatment has finished, it is likely that you may develop skin irritation, blistering and pain at the site of the wart. Your skin will take between one and three weeks to heal. Avoid having sex until the area of skin around the wart has fully healed.

Excision - Excision is sometimes recommended to treat small, hardened warts, particularly where this is a combination of smaller warts that have joined together to form a sort of cauliflower shape. At the start of the procedure you will be given a local anaesthetic to numb the area of skin around the wart. The wart will then be cut away with a surgical scalpel, and the remaining incision will be sealed with stitches. Excision can cause scarring so it may not be suitable for very large warts. The area of skin from where the wart was removed will be sore and tender for around one to three weeks.

Electrosurgery - Electrosurgery is often combined with excision to treat large warts that develop around the anus or vulva that have failed to respond to topical treatments. First, excision is used to remove the outer bulk of the wart. A metal loop is then pressed against the wart. An electric current is passed through the loop in order to burn away the remaining part of the wart.

Laser surgery - Laser surgery may be recommended to treat large genital warts that cannot be treated using other methods of physical ablation because they are located in a difficult position to access, such as deep inside your anus or urethra (the tube that connects the bladder to the penis or vulva, through which urine passes). Laser surgery may also be recommended for pregnant women who fail to respond to treatment with trichloroacetic acid (TCA). During the procedure, the surgeon will use a laser to burn away the warts. Depending on the number and size of the warts, laser surgery can be performed under either a local or general anaesthetic. As with other types of ablation treatment, you should expect soreness and irritation at the site where the warts were removed. This should heal within two to four weeks.

Genital warts and sex

It is recommended that you do not have sex, including anal and oral sex, until your genital warts have fully healed. This will help prevent you passing the infection on to others. It will also help speed up your recovery time, as skin friction that occurs during sex can cause treated skin to become irritated and inflamed. Even after the warts have gone, there may still be traces of human papillomavirus (HPV) in your skin cells. Therefore, it is recommended that you use a condom during sex for the first three months after the warts have cleared up.

Smoking

For reasons that are still unclear, many of the treatments discussed here are more effective in non-smokers than in smokers. Therefore, if you are a smoker, quitting smoking may help to speed up the time that it takes for the warts to heal. Quitting smoking will also bring a range of other important health benefits, such as significantly reducing your risk of developing lung cancer and heart disease.

Prevention Of Genital Warts

Condoms - Using condoms (male or female) every time you have vaginal or anal sex is the most effective way to avoid getting genital warts, other than being celibate (not having sex) or getting vaccinated (see below). If you have oral sex, cover the penis with a condom. A dental dam, which is a latex or polyurethane (plastic) square, can be used to cover the anal area or female genitals. Dental dams are usually only available at sexual health clinics clinics, although your local pharmacist may be able to order some for you.

Avoid sharing sex toys. However, if you do share them, wash them or cover them with a new condom before anyone else uses them. Following these measures will also help to protect you from getting a number of other sexually transmitted infections (STIs), such as HIV, chlamydia and gonorrhoea.

HPV vaccinations - There are currently two HPV vaccinations that are available for the virus:

  • Cervarix, which provides protection against some strains of HPV that are known to cause cervical cancer, but does not provide protection against the strains that cause genital warts
  • Gardasil, which provides protection against cervical cancer (in women) and genital warts (in men and women)

Cervarix was recently introduced as part of the routine vaccination schedule for girls, and is usually given to girls who are 12 or 13 years of age. Gardasil is not part of the routine vaccination schedule and it is not usually available on the NHS. It is likely that you will have to pay to have the vaccine privately if you want yourself, or your child, to be vaccinated against genital warts using Gardasil. The vaccine is estimated to be 99% effective in preventing genital warts in young men and women.

However, after being vaccinated, it is thought that a person’s immunity will gradually start to reduce after six years. The cost is around £140 to £180 a dose and three doses are required. There is a specific schedule for vaccination with Gardasil. The second dose should be given at least one month after the first dose. The third dose should be given at least three months after the second dose. All three doses should be given within a 12-month period.

The vaccination is injected directly into the muscles, either into the upper arm or the thigh. Common side effects of Gardasil include: pain, redness, bruising and swelling at the site of the injection , flu-like symptoms, such as a high temperature and joint and muscle pain

Genital Herpes

Genital herpes is a long-term condition caused by the herpes simplex virus (HSV). After you have become infected, the virus remains dormant (inactive) for most of the time. There are often few or no initial symptoms. However, certain triggers can activate the virus, causing outbreaks of painful blisters on your genitals and the surrounding areas. There's no cure for genital herpes, but the symptoms can usually be effectively controlled using antiviral medicines. Genital herpes is caused by the Herpes Simplex Virus (HSV) type 1 or type 2. It causes painful blisters to appear on the genitals and the surrounding areas. As genital herpes can be passed to others through intimate sexual contact, it is often referred to as a sexually transmitted infection (STI).

Genital herpes is a chronic (long-term) condition, with most individuals having recurrences. The average rate of recurrence is four to five times in the first two years after being infected. However, over time, the frequency of attacks decreases and the condition becomes less severe with each subsequent occurrence. HSV can affect any mucous membrane (moist lining), for example those found in the mouth, eyes, anal or vaginal areas. When around the mouth, HSV can cause blister-like lesions called cold sores to develop. Genital herpes is a common condition, especially between people aged 20-24 years.

The Herpes Simplex Virus (HSV)

HSV is highly contagious and can be passed easily from one person to another by direct contact. Genital herpes is usually transmitted by having sex (vaginal, anal or oral) with an infected person. Even if someone with genital herpes does not have any symptoms, it is possible for them to pass the condition on to a sexual partner. Once someone has been exposed to HSV, the virus remains dormant (inactive) most of the time. At least 8 out of 10 people who carry the virus are unaware that they have been infected because there are often few or no initial symptoms. However, certain triggers can activate the virus, causing an outbreak of genital herpes.

Symptoms of Genital Herpes

Most people with the herpes simplex virus (HSV) do not experience any symptoms of genital herpes when they are first infected and, as a result, they do not know they have the condition. Symptoms of genital herpes may not appear until months or sometimes years after you are exposed to HSV (usually by close sexual contact with someone who has the virus). If you experience symptoms when you are first infected, they begin to appear four to seven days after you have been exposed to the virus. A case of genital herpes that occurs when you are first infected is known as a primary infection. The symptoms in cases of primary infections are usually more severe than those in cases of recurrent infections.

Primary Herpes infection

A primary infection of genital herpes can cause several different symptoms including:

  • painful red blisters that burst to leave open sores around your genitals, rectum (back passage), thighs and buttocks
  • blisters and ulcers on the cervix (lower part of the womb)
  • vaginal discharge
  • pain when you pass urine
  • a high temperature (fever) of 38°C (100.4°F) or over
  • a general feeling of being unwell, with aches and pains

These symptoms may last for up to 20 days. However, the sores will eventually scab and heal without leaving any scarring.

Recurrent Herpes infections

Once a primary infection of genital herpes has subsided your symptoms will disappear, but HSV will remain dormant (inactive) in a nearby nerve. The virus may be reactivated from time to time, travelling back down the nerve to your skin and causing recurrent infections. If you have a recurrent infection of genital herpes, the symptoms and signs may include:

  • a tingling, burning or itching sensation around your genitals, and sometimes down your leg, before your blisters appear (this can signal the onset of a recurrent infection)
  • painful red blisters that soon burst to leave sores around your genitals, rectum (back passage), thighs and buttocks
  • blisters and ulcers on the cervix (lower part of the womb)

Recurrent infections of genital herpes are usually shorter and less severe than primary infections. This is because your body has produced protective antibodies (proteins that fight infection) in reaction to the previous infection. Your body now recognises the virus and mounts a response that is able to fight HSV more effectively.

Your symptoms may last for up to 10 days and, in most cases, you will not have any of the other symptoms that are associated with a primary infection, such as a fever or generally feeling unwell. In some cases, the blisters and ulceration may also occur in the same area each time you have a recurrent infection. Over time, you should find that any recurrent genital herpes infections become less frequent and less severe. Genital herpes that is caused by type 1 herpes simplex virus (HSV-1) tends to recur less often than infections that are caused by type 2 herpes simplex virus (HSV-2)..

Transmission of Herpes Virus

Genital herpes is caused by the herpes simplex virus (HSV). There are two types of HSV:

  • Type 1 (HSV-1)
  • Type 2 (HSV-2)

Genital herpes is caused by both type 1 and type 2 HSV.

The virus is very contagious and spreads from one person to another through skin-to-skin contact, such as during vaginal, anal or oral sex. Whenever HSV is present on the surface of your skin it can be passed on to a partner. The virus passes easily through the moist skin that lines your genitals, mouth and anus. In some cases it is also possible to become infected by coming into contact with other parts of the body that can be affected by HSV, such as the eyes and skin. For example, you can catch genital herpes if you have oral sex with someone who has a cold sore. A cold sore is a blister-like lesion around the mouth that is also caused by HSV.

Genital herpes cannot usually be passed on through objects, such as towels, cutlery or cups because the virus dies very quickly when it is away from your skin. However, you may become infected by sharing sex toys with someone who has the virus. Genital herpes is particularly easy to catch when an infected person has blisters or sores. However, it can be caught at any time, even when someone has no symptoms at all. Once you have been infected with HSV, it can be reactivated every so often to cause a new episode of genital herpes. This is known as recurrence.

Triggers of Recurrent Herpes

It is not completely understood why HSV is reactivated, but certain triggers may be responsible for the symptoms of genital herpes recurring. For example, friction in your genital area during sexual intercourse may cause a recurrence. Other possible triggers include:

  • being unwell
  • stress
  • drinking excess amounts of alcohol
  • exposure to ultraviolet light, for example, using sunbeds
  • surgery on your genital area
  • having a weakened immune system (the body’s natural defence system), for example, as a result of having chemotherapy (treatment for cancer)

Diagnosis of Genital Herpes

Genital herpes can be diagnosed more easily and accurately when the infection is still present, so you should seek medical attention as soon as you develop symptoms.

If you think that you may have genital herpes for the first time (a primary infection), you should visit your local sexual health clinic as soon as possible. Wherever possible, an initial diagnosis of genital herpes should be made by a GUM specialist. A swab will be used to collect a sample of fluid from a blister. The sample will be sent to a laboratory to be tested for the herpes simplex virus (HSV). You should be aware that even if your swab result comes back negative for HSV, you may still have genital herpes. See your GP if you have previously been diagnosed with genital herpes and you think that you may have a recurrent infection.

If you have genital herpes and you are pregnant, it is very important that you are referred for specialist treatment. This is because there may be a chance that the infection could pass to your unborn baby. You should also be referred for specialist treatment if you have a weakened immune system (the body’s natural defence system), for example, if you: have HIV and AIDS or if you are receiving chemotherapy (treatment for cancer). People with a weakened immune system will need specialist treatment because genital herpes can last longer and be more severe in these people.

Treating genital herpes

Treatment for genital herpes will depend on whether: you have the infection for the first time (a primary infection) or you have an infection that keeps coming back (a recurrent infection)

Primary infection – Your GUM Specialist or GP may prescribe antiviral tablets, called Aciclovir, which you will need to take five times a day. Aciclovir works by preventing HSV from multiplying. However, it does not clear the virus from your body completely and does not have any effect once you stop taking it. You will need to take a course of aciclovir for at least five days, or longer if you still have new blisters and ulcers (open sores) forming on your genital area when your treatment begins. Aciclovir can cause some side effects, including: feeling sick, being sick & headaches

Recurrent infections - You should visit your GP if you have been diagnosed with genital herpes before and you are experiencing a recurrent infection. In most cases, you will not need to return to your local GUM clinic. If the symptoms of your recurrent infection are mild, your GP may suggest some self-help measures to help ease your symptoms without the need for treatment. If your symptoms are more severe, you may be prescribed antiviral tablets (aciclovir), which you will need to take five times a day for five days. If you have fewer than six recurrent infections of genital herpes in a year, your GP may prescribe a five-day course of aciclovir each time you experience symptoms. This is known as episodic treatment. If you have more than six recurrent attacks of genital herpes in a year, or if your symptoms are particularly severe and causing you distress, you may need to take aciclovir every day as part of a long-term treatment plan. This is known as suppressive treatment and it aims to prevent further recurrent infections from developing. In this instance, it is likely that you will need to take aciclovir twice a day for 6 to 12 months. It is important to note that while suppressive treatment can reduce the risk of passing HSV on to your partner, it cannot prevent it altogether. Your GP may refer you for specialist advice if you are concerned about transmitting the virus to your partner while you are having suppressive treatment. After you have been taking aciclovir for 12 months, your GP will usually stop your suppressive treatment. You may continue to experience further recurrent infections of genital herpes after your treatment has been stopped. If you are experiencing recurrent attacks of genital herpes you should consider being tested for HIV. Recurrent attacks may be a sign of a weakened immune system (the body’s natural defence against infection and illness), which may indicate that you have HIV.

Self-Help

If your symptoms of genital herpes are mild, you may not need to have any treatment from your GP or a genitourinary medicine (GUM) specialist. The advice below may help to ease your symptoms.

  • Painkillers, such as paracetamol, can be taken to ease any pain that you have.
  • Keep the affected area clean using either plain or salt water. This will help to prevent the blisters or ulcers (open sores) from becoming infected and may encourage them to heal quicker. It will also stop the affected areas from sticking together and healing in the wrong position.
  • Apply petroleum jelly, such as Vaseline, or an anaesthetic (painkilling) cream to any blisters or ulcers to reduce the pain when you pass urine.
  • Drink plenty of fluids to dilute your urine. This will make passing urine less painful. Passing urine while sitting in a bath or while pouring water over your genitals may also make urinating less painful.
  • Avoid wearing tight clothing because it may irritate the blisters and ulcers.
  • Avoid sharing towels or flannels with others to ensure that you do not spread the herpes simplex virus (HSV).
  • Avoid having sexual intercourse, including vaginal, anal and oral sex, until your GP or GUM specialist advises that you can, or until all your blisters and ulcers have cleared up.
  • If you have a recurrent infection of genital herpes, you should avoid anything that appears to trigger an infection, such as excess alcohol and stress

Complications of genital herpes

In rare cases, the blisters that are caused by the herpes simplex virus (HSV) can become infected by other bacteria. If this happens, it could cause a skin infection to spread to other parts of your body.

Genital Herpes and Pregnancy

In some instances, the herpes virus can pose problems during pregnancy and may be passed to the baby around the time of the birth.

Existing genital herpes

If you had genital herpes before becoming pregnant, the risk to your baby is very low. This is because during the last few months of your pregnancy, you will pass all the protective antibodies (proteins that fight infection) to your baby. These will protect your baby during the birth and for several months afterwards.

Even if you have recurrent episodes of genital herpes throughout your pregnancy, your baby should not be at increased risk. However, you may need to take the antiviral medication, aciclovir, continuously from week 36 of the pregnancy until the birth to reduce the severity of your symptoms. If you have genital herpes blisters or ulcers (open sores) at the time of the birth, the chance of passing the infection on to your baby is up to 3 in 100.

First and second trimester

If you develop genital herpes for the first time (primary infection) during the first or second trimester, which is up to week 26 of the pregnancy, you may be at risk of having a miscarriage (losing the pregnancy). There is also an increased risk of passing the virus on to your baby. To prevent this, you may need to take antiviral medicine, such as aciclovir, while you are pregnant.

Third trimester

If you develop genital herpes for the first time during the third trimester (week 27 of the pregnancy until birth), particularly during the last six weeks of the pregnancy, the risk of passing the virus on to your baby is considerably higher. This is because you will not have time to develop any protective antibodies to pass to your baby, and the virus can be passed to your baby before or during the birth.

To prevent this happening, you may need to have a caesarean section delivery. If you give birth vaginally, the risk of passing the virus on to your baby is around 4 in 10. If you develop genital herpes during the latter stages of pregnancy, you will need to take antiviral medicine continuously for the last four weeks of your pregnancy. However, this may not prevent the need for a caesarean.

Neonatal herpes

Neonatal herpes is where a baby catches the herpes simplex virus around the time of the birth. It can be serious and, in some cases, it can be fatal. However, in the UK neonatal herpes is rare, affecting one or two babies in every 100,000 live births. There are three types of neonatal herpes that affect different parts of the body. Neonatal herpes can affect: 1) the eyes, mouth and skin, 2) the central nervous system (brain, nerves and spinal cord), 3) multiple organs. In babies with symptoms affecting only their eyes, mouth or skin, most will make a complete recovery with antiviral treatment. However, the condition is much more serious in cases where multiple organs are affected and nearly a third of infants with this type of neonatal herpes will die.

PREVENTION OF GENITAL HERPES

The following advice can help to prevent the herpes simplex virus (HSV) spreading to others.

  • Avoid having sex - If you have genital herpes, you should avoid having sex (vaginal, anal and oral) until any blisters or ulcers (open sores) around your genital area have cleared up. It is best not to have sex if you have symptoms of genital herpes because at this point the condition is very contagious, even from the first tingle or itch.
  • Always use a condom - Always use a condom while you are having any kind of sexual intercourse (vaginal, anal and oral), even after your symptoms have gone. This is particularly important when having sex with new partners. However, while using a condom may help to prevent genital herpes from spreading, the condom only covers the penis. If the virus is also present on or around your anus (the opening where solid waste leaves the body), it can still be passed on through sexual contact. As HSV survives within the nerves of your skin, the virus may still be present on your skin after you no longer have any symptoms. This means that there is still a chance you could pass it on to someone else.
  • Testing your partner - If you have genital herpes, you should encourage your partner to visit a sexual health clinic. They should be tested for the condition, even if they do not have any symptoms of genital herpes. A first case of genital herpes (a primary infection) often develops some time after exposure to the virus, so they may be unaware that they are infected.
  • Avoid sharing towels or flannels - Although it is very unlikely that HSV would survive on an object long enough to be passed on to someone else, it is a good idea to take precautions to prevent this from happening. Therefore, you should avoid sharing towels or flannels to ensure that you do not spread HSV to others

Gonorrhoea

Gonorrhoea is a sexually transmitted infection (STI) caused by bacteria called Neisseria gonorrhoeae or gonococcus. It used to be known as "the clap". Gonorrhoea is a bacterial infection that can cause an unusual discharge from your vagina or penis, and pain when urinating. Gonorrhoea can be easily diagnosed through a simple swab test and treated with antibiotics. If left untreated, it can lead to more serious long-term health problems and infertility. The bacteria are found mainly in discharge from the penis and vaginal fluid from infected men and women. Gonorrhoea is easily passed between people through: unprotected vaginal, oral or anal sex, and sharing vibrators or other sex aids, that have not been washed or covered with a new condom each time they are used. It can also be passed from a pregnant woman to her baby. Gonorrhoea is a less common STI in the UK than chlamydia, genital warts or genital herpes, but over 16,500 new cases of gonorrhoea were reported in 2008. Young men and women aged 16-24 are the most affected.

Symptoms of Gonorrhoea

Symptoms of gonorrhoea usually show up within two weeks of being infected. But sometimes symptoms may not appear until many months later, or until the infection has spread to other parts of your body. About one in 10 infected men and half of infected women will not experience any obvious symptoms after contracting gonorrhoea, which means it can go untreated for some time.

In women, symptoms of gonorrhoea can include:

  • an unusual discharge from the vagina, which may be thick, and green or yellow in colour
  • pain when passing urine pain or tenderness in the lower abdominal area (this is less common)
  • bleeding between periods or heavier periods (this is less common)
  • infection in the rectum, which may cause pain, discomfort or discharge
  • infection in the throat, which does not usually have any symptoms
  • infection in the eyes, which can cause pain, swelling, irritation and discharge (conjunctivitis)

Gonorrhoea can be passed from a mother to her baby during childbirth. Newborn babies normally show symptoms in their eyes during the first two weeks. The eyes become red and swollen, and have a thick pus-like discharge (conjunctivitis).

Transmission of gonorrhoea

Gonorrhoea is a sexually transmitted infection (STI) caused by the Neisseria gonorrhoeae bacteria. The bacteria are usually found in discharge from the penis and vaginal fluid of infected men and women, and are easily passed from one person to another through sexual contact. The gonorrhoea bacteria can infect the vagina or penis and other places that come into contact with infected semen or vaginal fluid during sex. It can live inside the cells of the cervix (entrance to the womb), the urethra (tube where urine comes out), the rectum, the throat and, very occasionally, the eyes. If you are a woman, it is possible for gonorrhoea to spread from your vaginal secretions to your anus. You do not need to have had anal sex for this to happen. If you are pregnant, gonorrhoea can be passed from you to your baby during birth. This can lead to your newborn baby having an infection of the eyes (conjunctivitis), which can lead to blindness if not treated. It is not clear if gonorrhoea can be spread by transferring the bacteria to another person on the fingers, or by female-to-female genital contact.

Diagnosis of gonorrhoea

The only way to find out if you have gonorrhoea is to be tested. If you suspect that you have it or any other sexually transmitted infection (STI), it is important not to delay getting tested. It is possible to be tested within a few days of having sex, but you may be advised to wait up to two weeks. You can be tested even if you do not have any symptoms.

Early diagnosis and treatment of gonorrhoea will reduce the risk of any complications developing, such as pelvic inflammatory disease. Complications that arise from long-term infection are much more difficult to treat.

Diagnosis of Gonorrhoea

There are different ways to test for gonorrhoea.

  • A doctor or nurse may take a swab to collect a sample from the cervix or vagina during an internal examination.
  • You may be asked to use a swab or tampon yourself to collect a sample from inside your vagina.

A doctor or nurse may take a swab to collect a sample from the entrance of the urethra (where urine is passed out). If you have had anal or oral sex the doctor or nurse may need to take a swab from the rectum or throat. If you have symptoms of conjunctivitis, such as red inflamed eyes with discharge, a sample of the discharge may be collected from your eye.

Some clinics may be able to carry out rapid diagnostic tests, when the doctor can view the sample through a microscope and give you your test results straight away. Otherwise, you will have to wait for the swab result.

Treatment of gonorrhoea

It is important to receive treatment for gonorrhoea as quickly as possible. It is unlikely the infection will go away without treatment and, if you delay treatment, you risk the infection causing complications and more serious health problems. You may also pass the infection onto someone else.

Gonorrhoea is treated with a single dose of antibiotics, usually one of the following:

  • Ceftriaxone
  • Cefixime
  • Spectinomycin

The antibiotics are either given orally (as a pill) or as an injection. If there is a high chance that you have gonorrhoea, you may be given treatment before you get your results back. You will always be offered treatment if your partner is found to have gonorrhoea. You should avoid sexual intercourse and intimate contact with other partners until you (and your partner) have both finished the course of treatment. This is to prevent reinfection or passing the infection onto anyone else. Babies who display signs of a gonorrhoea infection at birth (such as inflammation of the eyes), or who are at increased risk of infection because the mother has gonorrhoea, will usually be given antibiotics immediately after birth. This is to prevent blindness and other complications developing and does not harm the baby.

Follow up

Treatment is at least 95% effective and you should only have to go back for a follow-up test if:

  • the signs and symptoms do not go away
  • you had unprotected sex with your partner in the week following treatment
  • you think you have come into contact with gonorrhoea again
  • you had gonorrhoea of the throat
  • your test was negative but you develop symptoms of gonorrhoea

In these situations, you may need a repeat test.

Recovery

If the antibiotics have been effective, you should soon notice an improvement in your symptoms.

  • Pain and discharge when you urinate should improve within two to three days.
  • Pain and discharge in your rectum should improve within two to three days.
  • Bleeding between periods, or extra heavy periods, should improve by the time of your next period.
  • Pain in your pelvis should start to improve quickly but could take up to two weeks to go away.

If you have pelvic pain or experience pain during sex that does not go away after treatment, you should see your doctor or nurse. You may need further treatment, or it may be necessary to investigate other causes of pain.

Sexual partners

Gonorrhoea is easily passed on through intimate sexual contact. If you are diagnosed with it, anyone you have recently had sex with may have it too. It is important that your current partner and any other recent sexual partners are tested and treated. If you or your current partner is diagnosed with gonorrhoea, you should not have sex until you have both finished your treatment course.

Complications of gonorrhoea

If treated early, gonorrhoea is unlikely to lead to any complications or long-term problems. However, without treatment it can spread to other parts of your body and cause serious problems. The more times that you have gonorrhoea, the more likely you are to get complications.

  • Gonorrhoea can spread to the reproductive organs and cause pelvic inflammatory disease (PID). PID can lead to long-term pelvic pain, ectopic pregnancy and infertility.

In rare cases, when gonorrhoea has been left untreated, it can spread through the bloodstream to cause infections in other parts of your body. This can cause:

  • inflammation (swelling) of the joints and tendons
  • skin lesions (rash)
  • inflammation around the brain and spinal cord (meningitis), and the heart, which can be fatal.

Trichomoniasis

Trichomoniasis is a common sexually transmitted infection (STI) caused by a tiny parasite called Trichomonas vaginalis. Women may have soreness and itching around the vagina and a change in vaginal discharge. Trichomoniasis can be difficult to diagnose because there may not be any symptoms, and when there are symptoms, they can be similar to those of other conditions and STIs. Trichomoniasis is usually spread through unprotected sexual intercourse (without using a condom). Trichomoniasis is unlikely to go away without treatment. Most men and women are treated with an antibiotic called Metronidazole, which is very effective. Trichomoniasis rarely causes complications.

Symptoms of trichomoniasis

Trichomoniasis is believed to be very common, but many infected men and women will not have any symptoms. Women are more likely to have symptoms of trichomoniasis than men. The symptoms of trichomoniasis are similar to those of other sexually transmitted infections or conditions and they tend to appear 5 to 28 days after exposure to the infection. Trichomoniasis affects the vagina and urethra, causing any of the following symptoms:

  • Soreness, inflammation (swelling) and itching around the vagina. Sometimes your inner thighs also become itchy.
  • A change in vaginal discharge. Your discharge may appear thicker, thinner, frothy or yellow or green in colour. You may also produce more discharge than normal and it may have an unpleasant, fishy smell.
  • Pain or discomfort when passing urine.
  • Discomfort during sexual intercourse.
  • Pain in your lower abdomen (tummy).

Diagnosis of Trichomoniasis

If your GP or nurse suspects you have trichomoniasis, they will usually carry out an examination of your genital area. Trichomoniasis may cause red blotches on the walls of the vagina and on the cervix (the neck of the womb). After your physical examination, your GP or nurse may need to take a swab from either the vagina or penis so that it can be tested for the trichomoniasis infection. The swab will be sent to a laboratory for analysis. If your GP or nurse strongly suspects that you have trichomoniasis, you may be advised to begin a course of treatment before your results come back. This will ensure that your infection is treated as soon as possible and reduces the risk of the infection spreading. Sometimes, the result of a routine smear test may report that 'organisms consistent with trichomonas vaginalis have been seen'. This does not necessarily mean that you have trichomoniasis, so do not assume that you have an STI until further tests have been done. It is important that your partner(s) be notified and treated.

Treatment of Trichomoniasis

Trichomoniasis is unlikely to go away without treatment. In some rare cases, the infection may cure itself, but if you do not get treated, you risk passing the infection on to someone else. Trichomoniasis is usually treated quickly and easily. Most people will be prescribed an antibiotic known as metronidazole, which, if taken correctly, is very effective. You will usually have to take metronidazole twice a day, for five to seven days. Metronidazole can cause nausea, vomiting and a slight metallic taste in your mouth. If you cannot tolerate metronidazole, your GP may prescribe a single dose of another antibiotic called tinidazole.

Complications of Trichomoniasis

Complications are rare with trichomoniasis. The infection can sometimes weaken the barrier of mucus in the cervix (the neck of the womb). This mucus barrier helps to protect women from developing infection in their reproductive organs. If the mucus is weakened, this increases your risk of developing HIV. If you develop trichomoniasis while you are pregnant, your baby may be at risk of developing complications. Trichomoniasis may cause your baby to be born prematurely, or be a low birth weight

Syphilis

Syphilis is a bacterial infection that causes a painless but highly infectious sore on your genitals or sometimes around the mouth. The sore lasts two to six weeks before disappearing. Secondary symptoms, such as a skin rash and sore throat, then develop. These may disappear within a few weeks, after which you have a symptom-free phase. If diagnosed early, syphilis can be easily treated with antibiotics, usually penicillin injections. But if it is left to progress untreated, syphilis can go on to cause serious conditions such as stroke, paralysis, blindness or death.