Sexually Transmitted Diseases
(and where to get help and advice)

There a number of risks factors and risk markers for sexually transmitted diseases (STI's). They will not identify all patients with infection but do provide guidance to those at greatest risk.
They include:

1. Young age (under 25's)
2. Single
3. More than one sexual partner
4. Non use of barrier contraception (use of a condom)
5. Ethnicity for some STI's
6. Sexual orientation
7. Residence in a large town or city

In the UK the rates of STI's have increased greatly in recent years. From statistics obtained from Genito-Urinary Clinics (GUM's) from 1995 to 2002, the percentage increases are:

1. Genital warts - up 17%>
2. Chlamydia - up 139%
3. Gonorrhea - up 106%
4. Genital Herpes - up 16%
5. Syphilis - up 870%

Genital Warts

The rates of the first episode, between 1972 and 2002, increased six fold in men and nine fold in women. Anogenital warts are the most commonly diagnosed STI diagnosed in GUM clinics. Highest rates of the first episode were among 20-24 males and 16-19 females.

Chlamydia

The numbers of uncomplicated chlamydia has risen since the mid-1990's. The highest rates were among 20-24 year old males and 16-19 year old females.

Gonorrhoea

Like other STI's young people share a disproportionate burden of gonorrhoea. In the UK in 2002, 40% of females diagnosed with gonorrhoea were under 20 and in males, the highest rates were in the 20-24 age range.

Genital Herpes

Between 1972 and 2002, the rates of genital herpes increased 5 fold in women and 20 fold in females. Highest rates of infection are similar to other STI's mentioned above.

Syphilis

Although numbers or relatively low, the rates of infectious syphilis have increased markedly in men and less so in women. This is likely to be due to local outbreaks that have occurred in recent years, predominantly among men who have had sex with other men.

HIV

By the second quarter of 2003, 57,763 infected individuals had been reported since data was first collected in 1982. 34% of the total have been reported as having AIDS of whom 64% died. However, since 1998  there has been a fall in symptomatic HIV infection and AIDS, which is partly associated with better treatment in this group.

Hepatitis B

The numbers of acute hepatitis B infection remains constant. Transmission is continuing among injecting drug users.

Genital Warts

There are many types of wart viruses, responsible for genital warts. The warts can be external (visible) on the genital area. The incubation period for warts is 3-18 months. Even if the wart is not visible, infected individuals can still transmit the virus.

Certain strains are associated in women with abnormal cervical smears. These strains are rarely visible but will be detected as part of a vaginal examination.

The aim of treatment is to eradicate visible warts. Treatment can be by podophyllotoxin cream or cryotherapy ('freezing' the warts).

Chlamydia

Chlamydia trachomatis is the most common STI in the UK. 80% of women and 50% of men have no symptoms. In women, untreated chlamydia can lead to an ascending infection pelvic inflammatory disease (PID), endometritis, salpingitis, tubal damage and chronic pelvic pain. PID increases the risk of ectopic pregnancy and infertility.

Symptoms (if any) in women include lower abdominal pain, purulent vaginal discharge and abnormal vaginal bleeding. In 30-50% babies born to infected mothers, neonatal conjunctivitis and, less commonly, pneumonitis (presenting commonly between 4-12 weeks of age) can occur.

Gonorrhoea

Neisseria gonorrhoea in the bacterium responsible for this sexually transmitted infection. In men 85% of men present with a discharge from their penis or pain passing urine within 10 days of infection. In women 70% have no symptoms but may have a vaginal discharge and low abdominal pain. Complications in men are epididymitis and the risk of infection in the penile glands. In women, the complications include infection of the lining of the womb, fallopian tubes and tubo-ovarian abscesses.

In both sexes, less common infection spread through the blood stream, include, septicaemia, arthritis and skin lesions.

Genital Herpes

This is caused by 2 types of virus HSV1 and HSV2. Transmission is spread by close physical contact, either sexual or oro-genital (oral sex). A minority will develop a severe primary attack within 2-12 days of infection. Untreated herpes can last 3 weeks or rarely longer. 70-80% of individuals have no clinical symptoms. symptoms of primary infection include painful genital blisters and ulcers, pain on passing urine and temperature and painful enlarged gland in the groins. Recurrent episodes are usually mild and resolve in 3-4 days. Those with type 1 infection may expect about 2 recurrent episodes a year; those with type 2 up to six episodes a year. Patients should seek treatment as soon as possible during an acute attack.

Syphilis

Primary syphilis presents as a painless ulcer and enlarged glands 9-90 days after infection. The ulcer is found on the anogenital area although women may know they have been infected if the lesion is not visible. Secondary syphilis presents as a rash, generalised swollen glands, warts, and eye, liver and kidney problems. This may occur within 2 years of infection. Tertiary (or late syphilis) can present as dementia, neurological problems, aortic valve disease and gummata (fibrous nodules that can be locally destructive-usually on the skin but also in any organ.

HIV

The onset of symptoms occur 2-4 weeks are exposure and lasts 1-2 weeks. The symptoms include a 'flu-like illness, fever, tiredness, sore throat, swollen glands and a rash. Indicators of HIV infection include oral thrush, recurrent chest infection without a known cause, TB, tongue lesions and persistent glands in the groin. There is an average time span of 11 years between ser-conversion with HIV and the development of AIDS. Common AIDS presentations include TB, non-Hodgkin's lymphoma, cerebral abscesses, retinitis (caused by the CMV virus) or (PCP) pneumonia.

The medical benefits of early HIV diagnosis is not cure but to prevent people becoming unwell, to prevent opportunistic infections and reduce the risk of transmission from an infected mother to her baby. With early treatment with which the patient is compliant, individuals may lead a long and full life.

Hepatitis B

This virus is 10-100 times more infectious than HIV. Sexual transmission occurs in hetero-sexual, homosexual contact, oral sex and by contact with infected blood (shared needles among drug users). In the acute infection less than 1% of patients with develop a severe hepatitis and less than 1& die. 5-10% will develop a chronic infection and 90% of babies born to infectious mothers will become carriers. 10-50% of chronic carriers will develop cirrhosis leading to premature death in about half of this group and 10% of cirrhotic patients will progress to liver cancer.

Prevention to non-immune patients can be given by vaccination (a course of 3).

Thrush

Thrush in women is caused by a yeast organism, commonly candida albicans. Symptoms include itchiness, vulval/vaginal soreness and discharge. Treatment is usually by antifungal pessaries or oral anti-fungal medication.

Trichomomas vaginalis (TV)

TV is protozoon organism, almost exclusively sexually transmitted. Symptoms in women include vulval irritation, discharge, pain passing urine and superficial pain on intercourse. In men, there may be no symptoms but there may be pain/soreness passing urine and inflammation of the penis. Treatment is with a course of metronidazole for 5-7 days.

Bacterial Vaginosis

Bacterial Vaginosis (BV) is strictly speaking a non-sexually acquired infection. The normal bacteria in the vagina (lactobacilli) are reduced and there is an overgrowth of organisms such as Gardinella vaginalis and Mycoplasma hominis. The symptoms include and offensive fishy smelling vaginal discharge and irritation but 505| of women have no symptoms. BV is associated with recurrent late miscarriage. Treatment is with metronidazole, either orally of intravaginally in the form of creams or pessaries.

Epididymo-orchitis

Epididymo-orchitis is inflammation of the testes and epididymis, situated at the lower pole of the testes. The symptoms is testicular pain, one or both sides, swelling and redness. This infection is caused by chlamydia (commonest in the under 35's), the gonococcus (50% of cases), and other less common causes. A full sexual health screen is indicated and appropriate antibiotics prescribed.

Pelvic Inflammatory Disease (PID)

PID is a syndrome which can be mild or severe. The infection is usually  the result of bacteria ascending through the cervix. The symptoms include pelvic pain, deep pain on intercourse, irregular periods, bleeding in the middle of the menstrual cycle, and discharge. If untreated, the condition can lead to chronic pelvic pain, ectopic pregnancy and infertility. Chlamydia, gonorrhoea and other organisms are responsible. Treatment is with antibiotics but close follow-up is necessary and current male partners should be contacted and screened for infection but even if found 'negative' antibiotic treatment is advised.