Chlamydia
What
Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatic which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man.
Transmission
Chlamydia can be transmitted during vaginal, anal, or oral sex.
Symptoms and Signs
Women
- An increase in vaginal discharge caused by an inflamed cervix;
- The need to urinate more frequently, or pain whilst passing urine;
- Pain during sexual intercourse or bleeding after sex;
- Lower abdominal pains;
- Irregular menstrual bleeding.
Men
- A white/cloudy and watery discharge from the penis that may stain underwear;
- Burning sensation and/or pain when passing urine;
- Pain and swelling in the testicles.
Men are more likely to notice chlamydia symptoms than women, though they too may be asymptomatic.
Testing
A
woman can provide a urine sample, which is sent to a laboratory for testing. Alternatively a swab can be taken from the vagina (either by a doctor or nurse, or by the woman herself) that is sent to a laboratory. Results for the chlamydia test are usually available within one week, though this may vary depending on location.
For
men, either a urine sample is taken, or a swab is taken from the opening of the urethra at the tip of the penis. Many testing sites now just take a urine sample. This is an easier and less painful procedure, but is slightly less reliable than a swab.
Treatment
Chlamydia can be easily treated and cured with antibiotics. A single dose of azithromycin or a week of doxycycline (twice daily) are the most commonly used treatments. HIV-positive persons with chlamydia should receive the same treatment as those who are HIV negative.
All sex partners should be evaluated, tested, and treated. Persons with chlamydia should abstain from sexual intercourse for 7 days after single dose antibiotics or until completion of a 7-day course of antibiotics, to prevent spreading the infection to partners.
Women whose sex partners have not been appropriately treated are at high risk for re-infection. Having multiple infections increases a woman's risk of serious reproductive health complications, including infertility. Women and men with chlamydia should be retested about three months after treatment of an initial infection, regardless of whether they believe that their sex partners were treated.
Complication
Women
- Pelvic inflammatory disease (PID) - an infection of the uterus, ovaries and fallopian tubes. PID increases the future risk of ectopic pregnancy (a pregnancy outside the womb) or premature birth. If the fallopian tubes are scarred, it can also lead to problems with fertility.
- Cervicitis - an inflammation of the cervix. Symptoms include a yellowish vaginal discharge and pain during sex. In long-term cervicitis the cervix becomes very inflammed and cysts can develop and become infected. This can lead to deep pelvic pain and backache.
Men
- Epididymitis - painful inflammation of the tube system that is part of the testicles, which can lead to infertility.
- Urethritis - inflammation of the urine tube (urethra), causing a yellow or clear pus-like discharge to collect at the tip of the penis. Left untreated it can lead to a narrowing of the urethra, which can affect the ability to urinate easily and can potentially cause kidney problems.
- Reactive arthritis - symptoms include inflammation of the joints, urethra and eyes.
Gonorrhea
What
Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is caused by Neisseria Gonorrhoeae
, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.
Transmission
Spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from mother to baby during delivery.
People who have had gonorrhea and received treatment may get infected again if they have sexual contact with a person infected with gonorrhea.
Symptoms and Sign
Women
- A change in vaginal discharge; it may appear in abundance, change to a yellow or greenish colour, and develop a strong smell.
- A burning sensation or pain whilst passing urine.
- Irritation and/or discharge from the anus.
Men
- A white or yellow discharge from the penis.
- A burning sensation or pain whilst passing urine.
- Irritation and/or discharge from the anus.
Transmission
To test for gonorrhea an examination of the genital area will be carried out by a doctor or nurse and samples will be taken, using a cotton wool swab or sponge, from any infected areas - the cervix, urethra, anus or throat. Women will also be given an internal pelvic examination, similar to a smear test. A sample of urine may be taken.
None of these tests are painful, but they may cause minor discomfort. If a person has had anal sex, it is important they tell the doctor so that a swab can be taken from the rectum. They should also tell the doctor if they have had oral sex so swabs can be taken from the throat.
Treatment
Treatment is easy and essential. The patient will be given an antibiotic in tablet, liquid or injection form.
If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, it is very important that the doctor is informed as this may affect treatment options. Once a course of treatment is started it is important to complete it, even if symptoms diminish, to ensure the infection is cured.
The doctor or health advisor will discuss the gonorrhea infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with as they will also be at risk of having gonorrhea and should be tested.
The patient should not have penetrative sex until they have returned to the clinic and it is confirmed that the infection is gone. The doctor or health adviser will inform the patient which sexual activities are safe.
Complications
Women
- Gonorrhea can cause Pelvic Inflammatory Disease (PID), an inflammation of the fallopian tubes (the tubes along which an egg passes to get to the womb), which increases the future risk of ectopic pregnancy (a pregnancy outside the womb) or premature birth.
- If a woman is pregnant and has gonorrhea when giving birth, the infection may be passed on to her child. The baby could be born with a gonoccocal eye infection, which must be treated with antibiotics as it can cause blindness. It is better for the woman to get treatment before giving birth.
Men
- Gonorrhea can cause painful inflammation of the testicles and the prostate gland, potentially leading to epididymitus, which can cause infertility.
- Without treatment, a narrowing of the urethra or abscesses can develop after time. This causes considerable pain and problems whilst urinating.
Genital Herpes
What
Genital herpes is caused by infection with herpes simplex virus (HSV). There are two types of HSV, HSV-1 and HSV-2, both of which belong to a wider group called
Herpesviridae. Another well-known virus in this group is varicella zoster virus, which causes chicken-pox and shingles.
In general:
- HSV-1 is acquired orally, causing cold sores.
- HSV-2 is acquired during sexual contact and affects the genital area.
Although genital herpes used to almost always be caused by HSV-2 infection, HSV-1 is accounting for an increasing number of cases of genital herpes in developed countries.
Only around 10-25 percent of people infected with HSV-2 are aware they have genital herpes. This is because genital herpes will often produce mild symptoms or no symptoms at all (asymptomatic infection). As a result, many cases of genital herpes go undiagnosed and frequently people unknowingly pass the virus on to their sexual partners.
Transmission
Genital herpes is passed on through skin contact with a person infected with the virus, most frequently during sex. The virus affects the areas where it enters the body. This can occur during:
- vaginal sex
- anal sex
- oral sex (HSV-1 or HSV-2)
- kissing (HSV-1 only)
Herpes is most infectious during the period when itchy sores start to appear on the skin during an outbreak. But even if an outbreak causes no visible symptoms or breaks in the skin, there is still a risk of the virus being passed on to another person through skin contact.
Symptoms and Signs
If symptoms do occur, they will usually appear 2 to 7 days after exposure and last 2 to 4 weeks. Both men and women may have one or more symptoms, including:
- Itching or tingling sensations in the genital or anal area;
- small fluid-filled blisters that burst leaving small painful sores
- pain when passing urine over the open sores (especially in women);
- headaches;
- backache;
- flu-like symptoms, including swollen glands or fever.
Subsequent outbreaks are usually milder and last for a shorter period of time, usually 3 to 5 days. The sores are fewer, smaller, less painful and heal more quickly, and there are no flu-like symptoms. Subsequent outbreaks, or primary outbreaks in people who have had the virus for some time but have previously been asymptomatic, usually occur during periods of stress or illness when the immune system is functioning less efficiently than normal.
Testing
A herpes test will usually involve the following examinations, which are carried out by a doctor or nurse.
- A clinical examination will be done of a patient’s genital area.
- A sample will be taken, using a cotton wool or spongy swab, from any visible sores.
- Women may be given an internal pelvic examination (similar to a smear test).
- A sample of urine may be taken.
If the patient’s symptoms have already disappeared, or if there were no symptoms to begin with, a blood test can be taken to look for the virus. As in HIV testing, the herpes test works by searching for antibodies that the immune system produces to fight the virus. This means that the test is not effective until 3 months after exposure, as the body can take up to 3 months to produce an immune response.
It is possible to have more than one sexually transmitted infection at the same time, so it is advisable to have a full check-up.
Samples taken during an examination are sent to a laboratory for testing, and the result is usually available within 2 weeks, although this varies between countries.
Treatment
There is no treatment that can cure herpes, but antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.
Taking Care of yourself and your partner
During an outbreak of genital herpes, the sores are highly infectious and the virus can be passed on to others by direct contact. To prevent this from happening, you should avoid:
- Kissing when you or your partner have cold sores around the mouth;
- having oral sex when you or your partner have oral or genital sores;
- having any genital or anal contact, even with a condom or dental dam, when you or your partner has genital sores;
- using saliva to wet contact lenses if you have sores around your mouth.
Remember - wash your hands with soap before and after touching the sores.
Although the likelihood of transmitting genital herpes to your partner between outbreaks is much reduced, there is still some risk. Having genital herpes does not mean the end of your sex life. Ask your doctor or clinical health advisor for advice.
Remember, a condom will only protect against herpes infection if it covers all the sores. Herpes can also be transmitted by non-penetrative sex.
Complication
HIV and genital herpes
Those with suppressed immune systems are likely to have more frequent and severe recurring episodes of genital herpes. They may also have more asymptomatic outbreaks (where the virus travels up the nerve to the surface of the skin but causes no blisters) during which time the virus can be passed on.
A genital herpes infection increases the risk of becoming infected with HIV by up to three times in both men and women. This is due to the breaks in the skin caused by HSV, that facilitate entry of HIV.
Pregnancy and genital herpes
Having herpes does not affect a woman's ability to become pregnant. However, if herpes is transmitted in the first 3 months of pregnancy there is a small risk of a miscarriage. A first episode of herpes during pregnancy carries a greater risk of transmission to the baby. Becoming infected towards the end of pregnancy may cause the baby to be born early.
Though transmission of herpes from a mother to her newborn is rare, if it does occur, it can pose a serious
risk to the baby. If left untreated, the infection can cause damage to a newborn's internal organs, skin, and central nervous system and may even prove fatal. Prompt testing and treatment with acyclovir of any baby thought to be at risk is therefore essential.
However, most women who have an outbreak (or even several outbreaks) of genital herpes during pregnancy have a normal delivery and a healthy baby.
Trichomoniasis
What
Trichomoniasis is a common sexually transmitted disease (STD) that affects both women and men, although symptoms are more common in women.
Transmission
Trichomoniasis is caused by the single-celled protozoan parasite,Trichomonas vaginalis
. The vagina is the most common site of infection in women, and the urethra (urine canal) is the most common site of infection in men. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva (the genital area outside the vagina) contact with an infected partner. Women can acquire the disease from infected men or women, but men usually contract it only from infected women.
Symptoms and Signs
Most men with trichomoniasis do not have signs or symptoms; however, some men may temporarily have an irritation inside the penis, mild discharge, or slight burning after urination or ejaculation.
Some women have signs or symptoms of infection which include a frothy, yellow-green vaginal discharge with a strong odor. The infection also may cause discomfort during intercourse and urination, as well as irritation and itching of the female genital area. In rare cases, lower abdominal pain can occur. Symptoms usually appear in women within 5 to 28 days of exposure.
Testing
For both men and women, a health care provider must perform a physical examination and laboratory test to diagnose trichomoniasis. The parasite is harder to detect in men than in women. In women, a pelvic examination can reveal small red ulcerations (sores) on the vaginal wall or cervix.
Treatment
Trichomoniasis can usually be cured with prescription drugs, either metronidazole or tinidazole, given by mouth in a single dose. The symptoms of trichomoniasis in infected men may disappear within a few weeks without treatment. However, an infected man, even a man who has never had symptoms or whose symptoms have stopped, can continue to infect or re-infect a female partner until he has been treated. Therefore, both partners should be treated at the same time to eliminate the parasite. Persons being treated for trichomoniasis should avoid sex until they and their sex partners complete treatment and have no symptoms. Metronidazole can be used by pregnant women.
Having trichomoniasis once does not protect a person from getting it again. Following successful treatment, people can still be susceptible to re-infection.
Complication
The genital inflammation caused by trichomoniasis can increase a woman’s susceptibility to HIV infection if she is exposed to the virus. Having trichomoniasis may increase the chance that an HIV-infected woman passes HIV to her sex partner(s).
Syphilis
What
is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum.
It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
Transmission
Syphilis can be transmitted through direct contact with a syphilis sore. The methods of transmission are:
- By having vaginal, anal or oral sex with someone who has the infection.
- From a mother to her unborn baby.
Syphilis cannot be passed on by sharing baths, toilets, towels or eating utensils.
Symptoms and Signs
The symptoms of syphilis are the same in men and women. They can be mild and difficult to recognise or distinguish from other STDs. Symptoms may take up to 3 months to appear after initial infection. Syphilis is a slowly progressing disease that has several stages. The primary and secondary stages of syphilis are very infectious.
Primary stage of syphilis
One or more painless ulcers (know as chancres) appear at the place where the syphilis bacteria entered the body. On average, this will be 21 days after sexual contact with an infected person. Chancres may be difficult to notice and are highly infectious. The usual locations for chancres are:
- On the vulva (outside the vagina) or on the cervix (neck of the womb) in women.
- On the penis in men.
- Around the anus and mouth (both sexes).
Without treatment, the ulcers take between 2 and 6 weeks to heal.
If the infection is not treated at this point then it will progress to the secondary stage.
Secondary stage of syphilis
If the infection has not been treated, the secondary stage of syphilis will usually occur from 3 to 6 weeks after the appearance of chancres. The symptoms often include:
- A flu-like illness, a feeling of tiredness and loss of appetite, accompanied by swollen glands (this can last for weeks or months).
- A non-itchy rash covering the whole body or appearing in patches.
- Flat, warty-looking growths on the vulva in women and around the anus in both sexes.
- White patches on the tongue or roof of the mouth.
- Patchy hair loss.
During this stage syphilis is very infectious and may be sexually transmitted to a partner. These symptoms will usually clear up within a few weeks, but may re-occur for years.
Treatment at any time during the first two stages of syphilis will cure the infection.
Latent and tertiary stages of syphilis
If a person infected with syphilis has not received treatment during the first two stages of the disease then it will progress to the latent stage. The person will no longer experience any symptoms of the earlier stages, but their infection can still be diagnosed with a blood test.
If left untreated, the infection may develop into symptomatic late syphilis, also known as the tertiary stage. This usually develops after more than 10 years and is often very serious. It is at this stage that syphilis can affect the heart and possibly the nervous system.
If treatment for syphilis is given during the latent stage the infection can be cured. However, any heart or nervous-system damage that occurred before the start of treatment may be irreversible.
Testing
To find out if someone has syphilis, a doctor will usually carry out the following examinations and tests:
- A blood sample is taken and sent to an STD testing laboratory.
- A specimen of fluid is taken from all sores using a cotton swab and examined under a microscope.
- The genital area is examined for any primary signs of syphilis. The rest of the body is also checked.
- Women are given an internal examination to check for sores.
- A sample of urine is taken.
None of the examinations should be painful, but they may be slightly uncomfortable. The blood samples taken by the doctor are examined in a laboratory under a microscope to confirm a diagnosis. Various tests can be used on the blood sample. The most common and least expensive looks for antibodies.
The examinations and tests can be done as soon as a person thinks they might have become infected with syphilis. If the result is negative then it is usually recommended that the person retests at a later time, as it can take up to 3 months for the immune system to produce the antibodies that are detected by the test.
Treatment
Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.
Because effective treatment is available, it is important that persons be screened for syphilis on an on-going basis if their sexual behaviors put them at risk for STDs.
Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.
