SEXUALLY TRANSMITTED INFECTIONS

What do we mean by a Sexually Transmitted Infection

Sexually Transmitted Infections (STIs) are spread through intimate contact. You do not need to have coitus or vaginal sexual intercourse to become infected. Having oral or anal sex also puts you at risk of becoming infected, and some STIs, for example herpes or genital warts, are spread by skin-to-skin contact.

You cannot tell by looking at a person (or their genitals!) whether or not they have an STI. Often there are no symptoms and therefore lots of people unknowingly have an STI.

Sexual activity at a young age, having sexual contact with many different partners, and having unprotected sex (i.e. not using a condom EVERY time) all increase your chances of getting an STI.

Remember the only way to be 100% sure you won’t get an STI is to abstain from any sexual activity. However using a condom every time greatly reduces your risk.

If you are sexually active then you need to see your doctor for regular examinations. Don’t let embarrassment keep you from seeing a doctor early on if you think you may have an infection. Waiting to see a doctor may allow the infection to progress and cause permanent damage. Remember if left untreated an STI may lead to infertility (the inability to have children) or even death.

Not all genital infections are caused by an STI. Thrush, a yeast infection, is very common in girls and may be spread by sexual contact. Hair follicles, pimples and other harmless bumps on the penis may be confused with an STI. See your doctor for reassurance.

What are some of the more common STIs

Chlamydia.
Chlamydia is caused by bacteria which are found in bodily fluids (semen, vaginal fluids and blood) and are spread through sexual intercourse and possibly oral sex. In most people symptoms of Chlamydia may appear about 1-3 weeks after infection.  Some people however, especially boys, may not experience any symptoms at all.

Girls may experience:

• an unusual vaginal discharge
• pain during urination
• pain in the lower abdomen
• pain during sexual intercourse
• bleeding between menstrual periods
• flu-like symptoms such as - mild rise in temperature, aching muscles and headache

Boys may experience:

• a discharge from the urethra (where urine comes out)
• itching or burning sensations around the penis
• swollen testicles (this is rare)

If left untreated Chlamydia in girls may lead to an infection of the urethra and inflammation of the cervix. It can also lead to pelvic inflammatory disease (see below). In boys it can cause inflammation of the urethra and epididymis (a coiled structure within the testicles that stores, matures and transports sperm).

Treatment is with antibiotics.

Genital Herpes
Genital Herpes is caused by a virus called herpes simplex (HSV). There are two types of herpes virus HSV-1 and HSV-2.

HSV-1 causes cold sores on or around the mouth, lips, or nose of many people and can be spread by kissing and through oral sex to another person’s genitals.

HSV-2 is an STI and causes herpes sores in the genital area. It is spread through intimate contact (vaginal, oral or anal sex).

Not everyone experiences sores and a person may not be aware they have genital herpes. Itching or pain may be experienced 2-20 days after becoming infected and is followed by sores within a few days. These sores may appear on the vagina, buttocks, anus, scrotum, or penis. They start out as red bumps that soon turn into red, watery blisters, and can cause passing urine to be very painful. They usually open up, ooze fluid or bleed and then heal within the next 2-4 weeks. The entire genital area may feel very painful and the person may experience flu-like symptoms including fever.

There is no cure for herpes. Most people will have 4-5 outbreaks a year. The virus always remains in the body and can always be passed on.

Genital Warts
Genital Warts are warts that may be found in girls in or around the vulva, vagina, cervix or anus, and in boys on or near the penis, scrotum or anus.

The warts are whitish or flesh coloured bumps or growths which may be flat or raised, small or large, single or several.  They can sometimes be very hard to see.

Genital warts are caused by a group of viruses called Human Papillomavirus (HPV).

More than 30 types of HPV cause genital warts. Genital warts can be passed through intimate sexual contact (vaginal, oral or anal sex).
About 70% of cases of cervical cancer are caused by HPV infection. A vaccine is now available that protects against some of the types of HPV that can cause cervical cancer. It is approved for girls from the age of 9 in Singapore.

Usually the warts go away by themselves in time, however treatment is available to remove the warts although they often return.

Gonorrhea
Gonorrhea is caused by bacteria which can be spread through vaginal, oral or anal sex even when no symptoms are present in the infected person. Symptoms usually appear 2-7 days after becoming infected with the virus, but may appear later in girls.

Girls are less likely to have symptoms but may experience:

• burning sensation when passing urine
• a yellow-green vaginal discharge
• bleeding between menstrual periods
• no symptoms at all
• Pelvic Inflammatory Disease (see below) if the infection becomes more widespread

Boys are more likely to have symptoms and may experience:

• burning sensation when passing urine
• yellow-whitish discharge from the urethra

If left untreated gonorrhea can be very dangerous, even when the symptoms are very mild. It can cause pelvic inflammatory disease in girls and lead to scarring and infertility. In boys it can spread to the epididymis causing pain and swelling in the testicular area which can create scarring leading to infertility.

Gonorrhea is treated with antibiotics, but like Chlamydia the infection should be treated early on to minimise complications and damage.

AIDS
AIDS is caused by the human immunodeficiency virus (HIV). HIV destroys the CD4 cells of the body which are part of the immune system (our defence system against infection).  As HIV destroys these cells it weakens the immune system allowing infections to make the person sick i.e. they become immune deficient. This condition is called acquired immunodeficiency disease (AIDS).

Drugs have been developed to inhibit HIV and slow the progression of the disease. However there is no cure for HIV or AIDS.

HIV is spread through blood, semen, vaginal fluids and breast milk. It is also spread when needles are shared for drug use.

When a person's immune system is overwhelmed by AIDS, the symptoms can include:

• extreme weakness or fatigue
• rapid weight loss
• frequent fevers that last for several weeks with no explanation
• heavy sweating at night
• swollen lymph glands
• minor infections that cause skin rashes and mouth, genital, and anal sores
• white spots in the mouth or throat
• chronic diarrhea
• a cough that won't go away
• trouble remembering things

Girls may also experience severe vaginal yeast infections that don't respond to usual treatment, as well as pelvic inflammatory disease (PID).

Because the symptoms may take years to appear, a person can have the virus for a long time without knowing it.

Hepatitis
Hepatitis is a disease of the liver. It is usually caused by a virus, although it can also be caused by long-term overuse of alcohol or  by other toxins (poisons).

Hepatitis B is present in the blood and other bodily fluids of an infected person. It is spread through sexual intercourse and sharing needles — such as those used by intravenous drug or steroid users who have the virus, or tattoo needles that haven't been properly sterilised. A pregnant woman can also pass hepatitis B to her unborn baby.

Not everyone gets symptoms, but they may appear 1 to 5 months after infection and be similar to flu – e.g. tiredness, nausea, loss of appetite, mild fever, and vomiting and abdominal pain. Hepatitis B can be prevented by; not having oral, vaginal or anal sex; always using a condom for all types of sexual intercourse; avoiding contact with an infected person’s blood; and never sharing needles.

Immunisation against Hepatitis B is available.

Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is an infection of the fallopian tubes, uterus, cervix, or ovaries. Most girls develop PID as a result of sexually transmitted infections (STIs), such as chlamydia or gonorrhea.

In the United States the highest infection rate of PID is amongst teenagers.

Untreated PID may lead to internal scarring of the ovaries, fallopian tubes and uterus causing chronic pelvic pain and infertility.
PID can cause very mild to severe symptoms or even no symptoms at all. Symptoms may include:

• pain and tenderness in the lower abdomen
• large amounts of foul-smelling or abnormally colored discharge
• pain during sexual intercourse
• heavier than normal periods
• more painful periods with more cramps than usual
• spotting between periods
• chills, fever, and vomiting
• increased tiredness
• loss of appetite
• backache and perhaps even difficulty walking
• painful or more frequent need to pass urine

Treatment is with antibiotics and may require hospitalisation if the symptoms are severe.

Pubic lice
Pubic lice are tiny insects that can crawl from the pubic hair of one person to the pubic hair of another person during sexual intercourse. People can also catch pubic lice from infested clothing, towels, and bedding. Once they are on a person's body, the insects live by sucking blood from their host. Pubic lice are sometimes called "crabs" because when seen under a microscope they look like tiny crabs.

The symptoms are intense itching and you may notice tiny tan to grayish-white insects in your pubic hair or tiny yellow-white, pinhead-sized nits (eggs) clinging to the hair.

Treatment is available over the counter (without prescription) and you need to wash bedding, towels etc in a very hot wash.

Although condoms help protect against other STIs, a partner could still get pubic lice because the condom does not cover the entire pubic area.

Syphilis
Syphilis is caused by bacteria. It is now very rare now in developed countries.

Syphilis may be spread by contact with any sores or rashes that cannot be covered by the condom during vaginal, anal or oral sex.

Painless, red, firm, and sometimes wet sores appear on the vagina, rectum, penis, or mouth. These sores are highly contagious and are not always easy to see, e.g. they may be under the foreskin, or there may be only one.

After a few weeks the sores disappear. A rash usually develops later, and the sores may return.

The disease then enters a latent phase – in other words it is hidden and there are no symptoms. This stage can last for years.

The infection eventually spreads all over the body and can affect the brain, heart, spinal cord and bones.

In its early stages, syphilis is easily treated with antibiotics. However, if left untreated, it can cause serious health problems - even death.

Trichomoniasis
Trichomoniasis is spread by a parasite that can be passed from one person to another during sexual intercourse.

Unlike most STIs, the parasite can live for about an hour on damp towels, washcloths, and bathing suits. If someone uses these towels or washcloths or puts on the bathing suit, the disease may be passed on that way.

Symptoms usually appear 5 to 28 days after a person has been exposed. A girl with trichomoniasis can get vaginitis (inflammation of the vagina), this usually causes a vaginal discharge that can be gray or yellowish green, and may be foamy. This discharge may have a foul odor, and a girl's vagina may feel very itchy. She may also find it very painful to pass urine. Trichomoniasis can also cause an achy abdomen and pain during sexual intercourse.

In most cases, boys won't notice any symptoms. However, a boy who has trichomoniasis may notice some temporary irritation inside his penis or a mild burning feeling when he passes urine.

Trichomoniasis is not dangerous but may be very uncomfortable. It is easily cured with antibiotics.

Reviewed by Ailsa S Ritchie, Infection Control Consultant.
RGN. SCM. HV. Grad. Cert Infection Control (Sydney Hospital).  Grad Dip Acute Care. Grad Dip Bio Ethics (University of Technology, Sydney)