STIs

GAY MEN/MSM COMMUNITY HEALTH SECTION

STIs

Common STIs

1. Hepatitis C

Hepatitis C is a viral infection that causes liver inflammation, which can lead to serious liver damage including cirrhosis, liver cancer, and liver failure. The hepatitis C virus (HCV) spreads when blood contaminated with the virus enters the bloodstream of an uninfected person.
Transmission can be caused by sharing needles, syringes, toothbrushes and more. Hepatitis C can also be acquired through sexual intercourse.

Hepatitis C can go undiagnosed for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease. Soon after getting infected, some people may get flu-like symptoms, nausea, or abdominal pain. Other signs and symptoms include:

  • Fever
  • Fatigue
  • Dark-coloured urine
  • Poor appetite
  • Abdominal pain
  • Nausea, vomiting or diarrhea
  • Jaundice (yellow discoloration of the skin and eyes
  • Joint pain

Risk factors

  • Your risk of hepatitis C infection is increased if you:
  • Have ever injected or inhaled illicit drugs
  • Have HIV
  • Are a health care worker who may have contact with blood
  • Received a blood transfusion or organ transplant before 1992
  • Were born to a person with a hepatitis C infection
  • Have sex with an infected partner
  • Received a piercing or tattoo in an unclean environment using unsterile equipment

Prevention

Unfortunately, there is no vaccine that you can get to prevent infection from the hepatitis C virus. However, there are precautions you can take to protect yourself:

  • Do not share needles, syringes, or body piercing and tattooing equipment. Always use fresh sterile needles.Practice safe sex. Avoid engaging in unprotected sex with multiple partners. If you’re having sex with more than one partner, use latex condoms correctly and every time.
  • Only use approved lubricants like water or silicone-based lube with condoms. Oil based lubricants can damage condoms and cause them to break.
  • Sex toys should not be shared with multiple partners, and you should always put a condom over sex toys that are inserted. Sex toys should be washed before and after use.
  • Don’t share personal care items such as razors, toothbrushes, cuticle scissors, or nail clippers.
  • It’s also possible for hepatitis C to spread through accidental contact with an infected person’s blood. You should wear disposable gloves if you need to give someone first-aid treatment, or before cleaning contaminated surfaces.

Get Tested for Hepatitis C and Know Your Status

If you suspect that you’ve been exposed to the virus at some point, talk to your doctor about getting tested, even if you don’t have any symptoms.
Hepatitis C is diagnosed by blood tests. There are two types of tests to confirm hepatitis C infection: antibody test and hepatitis C PCR test. An HCV antibody test is used for initial tests, and if positive, an HCV RNA test is used to confirm the presence of the hepatitis virus itself.
If you have been diagnosed with HIV, you should have a hepatitis C test at least once a year.

Treatment of Hepatitis C

Hepatitis C can be treated and cured. Improved treatments are available which are highly effective at clearing the virus from your body, thus avoiding ongoing symptoms and liver damage from cirrhosis, liver cancer, and liver failure.
People who have had hepatitis C should investigate minimising further damage to their liver from alcohol and drug use.
Even if you are cured of hepatitis C, it is possible to be reinfected should you come into contact with the virus again. Unlike with hepatitis A and hepatitis B, you cannot develop immunity to the hepatitis C virus.
In order to access HCV treatment, it is necessary to see your doctor to discuss treatment options. The sooner you are diagnosed, the sooner you can get treated, and you have a better chance of being cured with early treatment.

I already have Hepatitis C

Hepatitis C is a contagious and serious liver disease. There’s no vaccine to protect against the virus, but with the right safety measures, you can prevent spreading the infection to others. If you do become infected, starting treatment can improve your liver health and lessen the likelihood of spreading the virus to others.
If you are living with hepatitis C and you cut yourself or have some other skin wound, cover it with sterile, waterproof dressing – be careful not to get blood on anything. Always wear a condom and use a water-based lube during sex. Make sure to dispose of soiled care items like bandages in a sealed bag.

 

2. Chlamydia

Chlamydia is one of the most common sexually transmitted infections you can get. It is caused by bacteria called Chlamydia trachomatis and it can infect both men and women in equal measure across all age groups. Women can get chlamydia in the cervix, rectum, or throat. Men can get chlamydia in the urethra (inside the penis), rectum, or throat. You may not know you have chlamydia because many people never develop any signs or symptoms, but chlamydia isn’t difficult to treat once you know you have it. If left untreated, however, it can lead to more-serious health problems, including infertility in both men and women, pelvic inflammatory disease, and ectopic pregnancy. Untreated chlamydia may also increase your chances of getting or giving HIV/AIDS.

Symptoms of chlamydia

Early-stage Chlamydia infections rarely cause any symptoms. When signs do start to occur it is usually a few weeks after exposure to the infection. Signs and symptoms of a chlamydia infection can include:

Women:

  • Painful urination
  • Vaginal discharge
  • Lower abdominal pain
  • A burning sensation when urinating
  • Pain during intercourse
  • Bleeding between periods and after sex in women
  • Swelling in the vagina or around the anus
  • Nausea or fever

Men:

  • Discharge from the penis (pus, watery, or milky discharge)
  • Testicular pain and swelling in one or both testicles
  • Pain in the lower abdomen
  • A burning sensation when urinating
  • Burning or itching around the opening of the penis

Chlamydia can also infect the rectum causing rectal pain, discharge or bleeding.
It’s also possible to acquire chlamydial eye infections (conjunctivitis) through contact with infected secretions.
Both men and women can also develop reactive arthritis because of a chlamydia infection – this is a type of arthritis that happens as a “reaction” to an infection in the body.

How do you get chlamydia?

Chlamydia is most commonly spread during oral, vaginal, or anal sex with someone who has the infection. It’s also possible for a mother to spread chlamydia to her child during delivery, causing pneumonia or a serious eye infection in her new-born. Chlamydia can also cause premature birth.
If you’ve had chlamydia and were treated in the past, you can get re-infected if you have unprotected sex with someone who has it.

Risk factors

Chlamydia is more common in young people. You are more likely to get it if you don’t consistently use a condom, or if you have multiple partners.

Factors that increase your risk of a chlamydia infection include:

  • Being sexually active before age 25
  • Multiple sex partners within a short period of time
  • Not using a condom consistently
  • History of prior sexually transmitted infection
  • Men who have sex with men

How is chlamydia diagnosed?

Lab tests are used to diagnose chlamydia. Your doctor may ask you to provide a urine sample. For women doctors may use a cotton swab to get a sample from your vagina to test for chlamydia.

Who should be tested for chlamydia?

You should go to your doctor for a test if you have symptoms of chlamydia, or if you have a partner who has a sexually transmitted disease. Those at higher risk should get checked for chlamydia every year.

Treatment of chlamydia

Treatment of chlamydia is very important as it can lead to serious long term health consequences. Antibiotics are effective in treating chlamydia and will cure the infection. You may get a one-time dose of antibiotics, or you may need to take medicine every day for 7 days. Antibiotics however cannot repair any permanent damage that the disease has caused.
To prevent spreading chlamydia, you should not have sex until the infection has cleared up.
Repeat infections are common, so you should get tested again approximately three months after treatment.
Depending on the test used to diagnose chlamydia, a person may also be treated for gonorrhoea because these two bacteria often occur together

 

3. Gonorrhoea

Gonorrhoea is a very common sexually transmitted infection caused by bacteria that can infect both men and women, and was commonly known as ‘the clap’. It can cause infections in the genitals, rectum, and throat. In females, gonorrhoea can also infect the cervix. You can get gonorrhoea by having vaginal, anal, or oral sex with someone who has gonorrhoea.

Abstaining from sex or always using a condom when you have sex, and being in a mutually monogamous relationship are the best ways to prevent sexually transmitted infections such as gonorrhoea.

Symptoms of Gonorrhoea

Both men and women with gonorrhoea often have no symptoms at all, or symptoms might be mistaken for a bladder infection.

Symptoms in men can include:

  • A burning sensation when urinating
  • A white, yellow, or green discharge from the penis
  • Painful or swollen testicles

Symptoms in women can include:

  • Painful or burning sensation when urinating
  • Increased vaginal discharge
  • Vaginal bleeding between periods

Rectal infections can involve discharge, anal itching, soreness, bleeding, and painful bowel movements.

You should be examined by your doctor if you notice any of these symptoms.

Risk Factors for Gonorrhoea

Any sexually active person can get gonorrhoea through unprotected vaginal, anal, or oral sex. Other factors that can increase your risk include:

  • Having a new sex partner, a sex partner who has other partners, or by having multiple sex partners
  • Sharing sex toys without washing them and covering with a new condom each time they are used
  • Having had gonorrhoea or another sexually transmitted infection

If you are a sexually active man who is gay, bisexual, or who has sex with men, you should be tested for gonorrhoea every year.
Annual screening is recommended for sexually active women younger than 25, or older women with risk factors such as new or multiple sex partners, a sex partner with other partners, or a sex partner who has a sexually transmitted infection.
Having gonorrhoea makes you more susceptible to infection with HIV, and subsequently AIDS. If you have HIV and also have gonorrhoea, your viral load will increase, making you more likely to pass on HIV if you have sex without a condom, even if you are taking antiretrovirals.

Prevention of Gonorrhoea

To prevent gonorrhoea you should:

  • Use a condom if you have sex, including anal sex, oral sex or vaginal sex.
  • Use male and female condoms, dental dams and latex gloves.
  • Stay in a monogamous relationship in which neither partner has sex with anyone else.
  • Before you have sex, you and your partner should get tested and share your results with each other.
  • Don’t have sex with someone who appears to have a sexually transmitted infection e.g. burning during urination or a genital rash or sore.

How is Gonorrhoea diagnosed?

A simple urine test or a swab taken by your doctor will show whether or not you have gonorrhoea.
If you have had oral or anal sex, swabs may be used to collect samples from your throat or rectum. In some cases, a swab may be used to collect a sample from a man’s urethra (urine canal) or a woman’s cervix.

Treatment of Gonorrhoea

Gonorrhoea can be cured with the right treatment, but though medication will stop the infection, it will not undo any permanent damage caused by the disease. You should always wait seven days after finishing all medications before having sex. If you’ve had gonorrhoea in the past, you can still get infected again if you have unprotected sex with a person who has gonorrhoea.
Untreated gonorrhoea can cause serious and permanent health problems in both men and women and can lead to permanent infertility in both. In rare cases, untreated gonorrhoea can spread to your blood or joints – this condition can be life-threatening.

 

4. Syphilis

Syphilis is a sexually transmitted infection (STI) caused by bacteria that causes infected sores, blisters or ulcers on your genitals, anus, or mouth.

The bacteria enter your body through minor cuts or abrasions in your skin or mucous membranes. It’s normally contracted through vaginal, anal, or oral sex without a condom, or by sharing sex toys with someone who has the infection. You can also contract syphilis by having direct contact with an infected sore or rash (such as during kissing) – even if you don’t have sex.

Syphilis is also contracted by sharing needles with someone who has syphilis. It’s possible for syphilis to be passed from mother to unborn child during pregnancy, if the infection is left untreated.

After the initial infection, the syphilis bacteria can remain dormant in your body for decades before becoming active again.

Early syphilis can be cured, but without treatment syphilis can severely damage your heart, brain or other organs, and can be life-threatening.

Symptoms of Syphilis

Many people with syphilis won’t present with symptoms for years. Once it begins to show it develops in three stages, and symptoms vary with each stage.

  1. The first stage is known as primary syphilis, and is a small painless sore called a chancre (shang-kur) which usually develops about three weeks after exposure. This can occur on the penis or vagina, in the mouth or around the anus. The sore usually heals within two to six weeks and may go unnoticed as it may be painless or hidden in the vagina or rectum. Glands near the site if the sore (in the neck, groin or armpit) may get bigger. If the infection is not treated, it will move to the second stage.
  2. Secondary syphilis usually occurs a few weeks after the sore disappears. You may now get a rash on your body that begins of your trunk, but can spread to the palms of your hands, or on the soles of your feet. The rash is usually not itchy and can be accompanied by wart like sores or skin growths in your mouth or genital area. You might feel ill with a fever or headache, and experience muscle aches, weight loss, a sore throat, and swollen lymph nodes.
    These symptoms may disappear within a few weeks, or repeatedly come and go.
    The infections then enter a period known as the latent (hidden) stage where people do not experience any symptoms. This latent stage can last for years.
  3. The third stage known as tertiary syphilis the disease may damage your heat, brain, nerves, eyes, blood vessels, liver, bones and joints. These problems may occur many years after the original, untreated infection. The infection is usually detected by this point.

Neurosyphilis: At any stage, syphilis can spread and cause damage to the brain and nervous system (neurosyphilis) and the eye (ocular syphilis). Such damage can include stroke, meningitis, dementia, and impotence in men.

Risk factors for Syphilis

You face an increased risk of acquiring syphilis if you:

  • Engage in unprotected oral, anal or vaginal sex
  • Have sex with multiple partners, or your partner has multiple partners
  • Are a man who has sex with men
  • Are infected with HIV

Prevention of Syphilis

The only guaranteed way to avoid syphilis is to avoid any sexual contact with an infected person. Otherwise it is best to be in a monogamous relationship with someone you know who does not have the illness.

Condoms can reduce your risk of contracting syphilis, but only if the condom covers the syphilis sores – this will not work if the sores are in your mouth.

Diagnosis of Syphilis

Your doctor can examine your genital area, mouth and throat, and check for rashes or growths. If you have sores, a swab will be taken. Blood tests will be used to confirm the presence of antibodies that the boy produces in reaction to the infection.
If you have nervous system complication from syphilis, you may have a procedure called a lumbar puncture (or spinal tap) to collect a sample of cerebrospinal fluid.

If you have syphilis you should be tested for other sexually transmitted infections.

Treatment for Syphilis

When diagnosed and treated in its early stages, syphilis is relatively easy to cure. The preferred treatment at all three stages is penicillin. If you are allergic to penicillin alternative antibiotics will be prescribed.

Treatment can help prevent future damage but can’t repair or reverse damage that’s already occurred.

Once cured, syphilis doesn’t recur on its own. However, you can become reinfected if you have contact with someone’s syphilis sore.

You will need to have regular blood tests for at least a year after treatment, to ensure that the infection has cleared. Avoid having sex until you have finished your treatment, the sores have healed, and your doctor says you can.

Without treatment, syphilis can lead to damage throughout your body and even death. It also increases the risk of HIV infection and, for women, can cause problems during pregnancy including a drastically increased risk of miscarriage, or your new-born’s death within a few days after birth.

 

5. Herpes, Genital & anal warts, crab

Herpes

Genital herpes is a sexually transmitted infection which causes infected sores, blisters, ulcers and cuts in both men and women. It is caused by the herpes simplex virus (HSV) which can be passed on even if the person does not have any symptoms. Sexual contact is the primary way that the virus spreads.

After the initial infection, the virus will lie dormant in your body and can reoccur many times a year, for many years.

Genital herpes can cause pain, itching and sores/ulcers in your genital area until the infection clears. During an initial outbreak of genital herpes, you may experience flu-like symptoms such as swollen lymph nodes in your groin, headache, muscle aches, and fever. You can spread the infection on yourself by touching an infected sore and then touching another area of your body. Sores can develop on the buttocks and thighs, urethra, anus and mouth. Women can also develop sores in or on the vaginal area, external genitals, and cervix. Men can also develop sores in on the penis or scrotum.

Genital herpes is caused by HSV-2. The virus spreads through skin-to-skin contact. It is very common and highly contagious, whether or not you have an open sore.

There’s no cure for genital herpes, but medication can help to relieve symptoms, and reduce the risk of infecting others. Condoms also can help prevent the spread of a genital herpes infection.

Genital & Anal Warts

Genital warts are caused by the sexually transmitted human papilloma virus (HPV), of which there are over 100 strains, and are usually found around the penis, vagina, and anus. They can be passed on through sexual intercourse without a condom, or via sharing sex toys without appropriately washing them.

Genital warts are often diagnosed by appearance, and are most often small, raised, painless growths that resemble cauliflowers. They are rarely painful and not likely to bleed or pus.

A few types of genital HPV have been linked to anal and cervical cancer. Samples can be taken of these cells to be tested for the cancer-causing HPV strains.

The HPV virus that causes genital warts cannot be cured, though the warts themselves can be treated and gotten rid of. Treatment is administered by applying a cream or chemicals to the warts, or by freezing them off.

If you have genital warts you can expect to have repeat outbreaks throughout your lifetime.

Genital warts are passed on from someone who has the virus through oral, anal, or vaginal sex without a condom or dental dam, or even through close genital contact.

Vaccines are available to protect girls against certain types of HPV that can cause genital warts – but you need to have this vaccine before you start having sex. The vaccine is not a guarantee that you will not contract HPV in the future, but certainly goes a long way towards preventing it.

If you have genital warts you should be tested for other STIs.

Pubic Lice / Crabs

Pubic lice, also known as crabs, are tiny parasitic insects found in your genital area or other areas with coarse body hair. They are a different type of lice from head lice and receive their nickname because their bodies resemble miniscule crabs.

The most common way to acquire pubic lice is through sexual intercourse, or close bodily contact with someone who has public lice. They cannot be prevented from spreading during sex, even with the use of condoms. You may also acquire pubic lice from contaminated sheets, blankets, towels or clothes.

To prevent an infestation, you would need to avoid sexual or other close contact with, or sharing bedding or clothes with someone who has lice.

Pubic lice feed on your blood, and their bites can cause severe itching, which can lead to inflammation and irritation caused by scratching, which in turn can lead to an infection such as impetigo. Eye infections, such as conjunctivitis, and eye inflammation, can sometimes develop if your eyelashes have been infested with pubic lice.

The lice lay their eggs in sacs that stick to hair. Pubic lice don’t carry other diseases or sexually transmitted infections.

Treatment includes applying over-the-counter creams and lotions that kill the parasites and their eggs, which is available from pharmacies. Most often, the whole body will need to be treated, and treatment usually has to be repeated after a few days. At the same time all clothes and bedding should be washed in hot water.

 

6. Hepatitis A & B

Hepatitis A

Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus and is usually passed on through faecal matter via contaminated food and water but is also a sexually transmitted infection. It mainly causes inflammation of the liver – which is when your liver becomes swollen and painful.

Hepatitis A can be prevented by washing your hands frequently, being careful where you eat and drink, and by practising safe sex including using male and female condoms, dental dams, and latex gloves. You should never share sex toys with someone who has the virus. You can also be infected by sharing contaminated needles and syringes.

Vaccines are available for people at high risk.

Usually hepatitis A is not serious, and it generally only lasts around 10 to 14 days, and then clears up on its own. Signs and symptoms can include fatigue, nausea or vomiting, abdominal pain by your liver, loss of appetite, and jaundice.  

You’re at increased risk of hepatitis A if you have any type of sexual contact with someone who has hepatitis A.

Your doctor can carry out a simple blood test which will show if you have hepatitis A. It is important to be tested to make sure you do not have something more serious like hepatitis B or C. But unlike other types of viral hepatitis, hepatitis A does not cause long-term liver damage, and it does not become chronic.

 Hepatitis B

Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV), which can cause liver failure, liver cancer, or cirrhosis – leading to death.

The virus is passed from person to person through blood, semen or other body fluids. You may contract HBV if you have unprotected sexual intercourse with someone who is infected or share sex toys. The virus can spread if the person’s blood, saliva, semen or vaginal secretions enter your body. HBV is also easily spread through needles and syringes. It does not spread by sneezing or coughing.

There is a vaccine available to prevent hepatitis B, but there is no cure for the illness. Infected people should take precautions to prevent spreading the virus to others.

Symptoms generally occur a few months after infection and can include:

  • Abdominal pain
  • Dark urine
  • Fever
  • Joint pain
  • Loss of appetite
  • Nausea and vomiting
  • Weakness and fatigue
  • Yellowing of your skin and the whites of your eyes (jaundice)

Your risk of HBV increases if you:

  • Have unprotected sex with multiple sex partners
  • Share needles or syringes
  • Are a man who has sex with other men

Hepatitis B can be prevented by practising safer sex including using male and female condoms, dental dams and latex gloves, and never sharing needles or syringes.

You should contact your doctor immediately if you’ve been exposed to hepatitis B as preventative medication may reduce your risk of infection if you receive treatment within 24 hours.

 Getting tested for STIs

If you’ve had unprotected sex, or you’re worried about a sexually transmitted infection, get tested as soon as possible – even if you don’t have any symptoms.

Otherwise you should make an appointment with a doctor when you become sexually active, and before you start having sex with a new partner.

Sexually transmitted infections (STIs) are generally acquired by sexual contact with an infected person. The bacteria or viruses may pass from one person to another in blood, semen, or vaginal and other bodily fluids. STIs can be caused by:

  • Bacteria (gonorrhoea, syphilis, chlamydia)
  • Parasites (trichomoniasis)
  • Viruses (HPV, genital herpes, HIV)

If left untreated, STIs, can cause severe health problems, including infertility, cancer, blindness and organ damage.

STIs do not always cause symptoms and can be contracted from someone who may appear to be perfectly healthy. Because of this STIs can often go unnoticed until complications occur, or a partner is diagnosed. Visible symptoms can include:

  • Sores or bumps on the penis, genitals or in the oral or rectal area
  • Painful/burning urination
  • Strange discharge from the penis
  • Unusual or odd-smelling vaginal discharge
  • Unusual vaginal bleeding
  • Pain during sex
  • Swollen lymph nodes
  • Lower abdominal pain or in the genital areas
  • Flu-like symptoms like fever, body aches, swollen glands, and feeling tired

STI symptoms can come and go over time, but that doesn’t mean the STI is gone.

STI testing may include urine tests, blood tests, swabs, and physical exams. There are a number of different STIs, and the test type will depend on which STI you are being tested for. Most STIs can be tested for using urine or blood samples. Your doctor can order urine or blood tests to check for chlamydia, gonorrhoea, hepatitis, herpes, HIV and syphilis.

If you are a sexually active adult, you should get tested every 3 to 12 months, depending on your level of sexual activity.

 Treatment of STIs

If you have an untreated STI it can cause a range of mild to severe health complications and create other health conditions.

STIs caused by bacteria are easier to treat than viral infections, which can be managed but not necessarily cured. Treatment for STIs usually consists of one of the following:

  • Antibiotics are used to cure many sexually transmitted bacteria and parasitic infections including gonorrhoea, syphilis, chlamydia and trichomoniasis. Typically, you’ll be treated for gonorrhoea and chlamydia at the same time because the two infections often appear together.

Once you start a course of antibiotics it is important to complete the course. It’s also important to abstain from sex until seven days after you’ve completed antibiotic treatment and any sores have healed.

  • Antiviral drugs. If you have herpes or HIV, you’ll be prescribed an antiviral drug. Antiviral drugs will reduce the number of herpes recurrences if you take daily suppressive therapy, but you will still be contagious.

Antiviral drugs can keep HIV infection in check for many years and even reduce your virus count so low that it can hardly be detected, but you will still have the virus and can still transmit it.

 Prevention of spreading STIs

There are several ways in which you can avoid or reduce your risk of spreading STIs. These include:

  • Abstinence – the surest way to prevent spreading an STI is to abstain from having sex completely.
  • Avoid sexual intercourse with new partners until you and your partner(s) have been tested for STIs.
  • Get vaccinated early before exposure e.g. hepatitis.
  • Use condoms and dental dams consistently and correctly. Never use oil-based lubricants with a latex condom or dental dam.
  • Wash sex toys thoroughly after each use and do not share sex toys outside of your relationship with your partner.

 Risk factors for STIs

Anyone who is having sex is at risk of contracting a sexually transmitted infection. Factors that can increases that risk include:

  • Unprotected sex (vaginal or anal penetration) with an infected partner who isn’t wearing a condom significantly increases the risk of getting an STI.
  • Unprotected oral sex with an infected partner.
  • Sexual intercourse with multiple partners. No judgement here. We’re just giving you the facts.
  • A history of STIs – having one STI makes it easier for another to take hold.
  • Injecting drugs – sharing needles or syringes spreads serious infections such as hepatitis and HIV.