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:
- Young age (under 25's)
- Single
- More than one sexual partner
- Non use of barrier contraception (use of a condom)
- Ethnicity for some STI's
- Sexual orientation
- 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:
- Genital warts - up 17%>
- Chlamydia - up 139%
- Gonorrhea - up 106%
- Genital Herpes - up 16%
- 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 50% 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.
Remember, safe sex is using a condom, EVERY time...
...irrespective of the method of contraception used. This is particularly important in those people with more than one
sexual partner or in those who are not in a longstanding relationship with one person or are at particular risk.
Department of Genito-Urinary Medicine
Please note that appointments can be made on Thursday morning for the following Monday and on Monday morning for the rest of the week. Appointments
for Wednesday evening are filled extremely quickly and are usually gone by 9.00am. Patients with acute symptoms requiring urgent treatment are
triaged by the nurses and if possible are fitted in that day or the next day. Phone lines are open from 08:15am.
Galen House, Fourth Avenue, Harlow
Appointments: 01279-694901
Results (1-2pm only): 01279-694903 (must have clinic number available).
Monday
8.30 am-11.30am by appointment only
2.00pm-4.00pm by appointment only
Tuesday
8.30am-11.30am by appointment only
2.00-3.30pm Appointments (Nurse only clinic)
Wednesday
3.00pm-4.30pm by appointment only
5.30pm-7.30pm by appointment only
Thursday
8.30am-11.30am by appointment only
1.30pm-4.00pm appointments (women only clinic)
Friday
8.30am-11.30am by appointment only
MALE PATIENTS SHOULD HOLD THEIR URINE FOR AT LEAST 4 HOURS BEFORE ATTENDING
As the department is very busy, routine appointment may take 6 weeks. However, with acute symptoms, the staff will see individuals immediately,
especially if the request comes from your GP.
In addition, many GP's are able to offer appropriate advice and treatment and arrange further follow up with the service.
For further information:
http:www.foryoungpeople.co.uk For information and confidential advice
http://www.sextransinf.com
http://www.herpes.org.uk
http://www.lovelife.org.uk
http://www.playingsafely.co.uk
For more information, you can call the sexual health line on 0800 567 123 or Text Phone on 088 521 361
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