Introduction

Sexually transmitted infections (STIs) are infections that can be passed on through sexual contact. STIs can often be passed on during intimate physical contact as well as full sexual intercourse, including sexual foreplay, anal, and oral sex.

STIs are on the increase in England. Particularly sharp increases have been reported in the number of cases of chlamydia, gonorrhoea and genital warts.

Over 600,000 STI diagnoses were made in genito-urinary medicine (GUM) clinics in 2000, an increase of 33% since 1995 . The Public Health Laboratory Service also reported that cases of infectious syphilis had more than doubled between 2001 and 2002. However, these increases are thought to reflect not only a rise in transmission of STIs within the population, but also higher acceptance of GUM clinics, heightened awareness of STIs, and more reliable diagnostic techniques.

Symptoms

You should visit your GP or local GUM clinic if you experience itching, swelling or redness around the vagina or penis, unusual discharge from the vagina or penis, or pains in the lower abdomen.

Most conditions vary in their symptoms but the most common are listed below:

Chlamydia. A white or cloudy looking discharge from the penis or vagina, pain when passing urine, and bleeding between periods or after sex (women only).

Trichomonas vaginalis (TV) Sometimes there are no symptoms, but if there are there is an increased yellow/ green discharge from the vagina with soreness.

Men usually act as carriers and do not show symptoms.

Gonorrhoea. This infection can affect the genitals, anus, rectum and throat, and can affect both men and women. Around half of all women infected by gonorrhoea and over 90% of men experience symptoms, including a thin, watery discharge from the vagina or tip of the penis that can appear yellow or green, and pain when urinating.

Non-specific urethritis. Discharge and discomfort from the male urethra (urine outlet tube).

Genital herpes. This condition often presents no symptoms and can remain undiagnosed for long periods of time. Symptoms may show in the form of flu-like symptoms, itchiness, burning or tingling around the genitals, small, fluid-filled blisters that burst to leave sores, and pain passing urine.

Pubic lice Symptoms include itchy skin, black powder (lice droppings) in underwear and white eggs.

Scabies can occur anywhere on the body, but sometimes the signs are hard to see. Symptoms can appear weeks after first contact and include itching (especially at night), a rash and tiny spots.

HIV There are no symptoms after infection. The only way to know if you are HIV-positive is to have a test.

Syphilis. Symptoms usually begin with a small sore on the penis or vagina.

Up to six months after the initial symptoms occur, the patient may experience flu-like symptoms such as achiness and shivering.

Thrush. Symptoms include intense itching around the penis or vagina, with a thick, white discharge likened to cottage cheese in women, and the appearance of tiny white spots around the genitals.

Genital warts. Few people who contract the virus actually show recognisable symptoms, this is why the infection can go undiagnosed for a long time. If symptoms are present they will include small white spots or white lumps, but they may be hidden inside the vagina or anus.

Causes

STIs are transferred from person to person during close physical contact and sexual intercourse. Most STIs can be passed on during vaginal and anal intercourse, oral sex and other sexual foreplay.

The risk of contracting infections such as gonorrhoea and syphilis through oral sex is much greater than the risk of contracting HIV. However, recent studies suggest that the potential risk of HIV through oral sex is higher than previously estimated.

Diagnosis

Most STIs are initially diagnosed on presentation of the symptoms and formally through blood, urine and other tests.

GPs or GUM clinics will usually carry out a simple and painless swab test, which will then be sent to a laboratory for testing. A swab test involves a doctor taking a sample of secretion from the vagina or penis using a piece of absorbent material attached to a rod (such as a cotton bud). Swab tests can now be carried out routinely during cervical smear tests. In some cases this is not necessary as the symptoms will be conclusive, such as with pubic lice.

Some STIs are difficult to diagnose as they present few or no recognisable symptoms. An example of this is chlamydia, which, if left untreated, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility.

Because of this, the National Strategy for Sexual Health and HIV is piloting a chlamydia screening programme, available at selected GUM clinics throughout the country. To find your local GUM clinic ask your GP or contact NHS Direct on 0845 4647.

Some STIs, such as HIV, will need to be diagnosed through a blood test.

Blood tests can be carried out either by a GP or GUM clinic and the results are completely confidential.

Treatment

Chlamydia is easily treated with antibiotics, either a single dose or a course for a couple of weeks.

Trichomonas vaginalis (TV) is easily treated with a course of antibiotic tablets.

Early treatment for gonorrhoea involves a single dose of antibiotics. If complications occur further treatment will be needed.

Non-specific urethritis ( NSU) is easily treated with antibiotics, although damage to the urethra can take time to heal.

Genital herpes- The virus for genital herpes remains in the body and there is no treatment that gets rid of it completely. Antiviral drugs may be used to relieve the symptoms. Self-help measures help in reducing symptoms or preventing outbreaks, such as avoiding stress and resting, cutting down on smoking and drinking and avoiding direct sunlight.

Pubic lice are easily treated. Special shampoos, creams or lotions are used to kill the lice and their eggs.

Scabies is easily treated. A special lotion is applied all over the body to and washed off 24 hours later.

While there is no cure for AIDS or the HIV virus, its effects can be slowed down with a combination of drugs, most recently the highly active antiretroviral treatment (HAART).

Syphilis can be easily treated during the early stages, usually with a two-week course of antibiotics. It can also be treated during later stages of infection, but any damage done to the heart or nervous system may be irreversible.

Thrush is easily treated using pessaries (tablets that are inserted into the vagina), cream or tablets. Men are usually treated with creams.

Genital warts are easily treated by either painting with a liquid or freezing the warts with a spray. Some people need a number of treatments however and sometimes the warts return and require further treatment.

Prevention

The Health Development Agency (HDA) is examining three core ways to reduce the level of STIs in England. They are:

integrating STI prevention with family planning services, partner notification (where health professionals contact patients' partners on their behalf), and the educational approach including learning, counselling and media campaigns.

Education is an ongoing attempt to teach people about safe sex practices.

The only way to have safe sex is to use a reliable barrier method of contraception such as a condom. The male condom is the most efficient method of preventing STIs. You can never be 100% sure that a prospective sexual partner does not have an STI and the more sexual partners you have, the higher the risk of contracting an STI.

Hepatitis B, which can result in permanent liver damage if left untreated, can now be vaccinated against, however there are no vaccinations available for other types of STI.

Source NHS Direct 01/10/2005