STI's (Sexually Transmitted Infections)

What are Sexually Transmitted Infections?

Sexually Transmitted Infections are diseases that can be passed from person to person when having sex. They are sometimes known as Sexually Transmitted Diseases. (STD's).

STI's are caused by:

• bacteria (gonorrhoea and chlamydia are bacterial infections)
• viruses (HIV, hepatitis, herpes and warts are caused by viruses)
• parasites (creepy crawlies like crabs and scabies)

Numbers of all STI's have increased in the last few years and some of them, such as chlamydia, have doubled in the past 6 years, especially amongst young people and gay men. 1in 10 young people are said to have Chlamydia.

Most STIs are easily treated but treatment should be started as soon as possible. For some infections, such as HIV (the virus that causes AIDS) there is currently no cure and the treatment can be complicated. If left untreated many STI's can be painful and uncomfortable or, at worst, cause permanent damage to health and fertility.

How do I stop myself from getting an STI?

A condom will provide a protective barrier against many STI's, (including HIV and Hepatitis). However you need to make sure you use the condom properly. Having oral sex (sucking/licking) and anal or vaginal intercourse (fucking) without a condom is the most common way you can catch an STI. For sex between women dental dams can be used as protective barriers when having oral sex. Some STI's can be passed on through other types of sexual contact too, and it is a good idea to get to know what these are, how they may be passed on, and what symptoms to look out for. There are more than 25 STIs. Infections that are common include:

• Chlamydia,
• Genital Warts,
• Herpes,
• Gonorrhoea or 'the clap',
• NSU (Non-specific Urethritis),
• Syphilis,
• HIV,
• Hepatitis (A, B and C)
• TV (Trichomonas vaginalis)
• Pubic Lice and Scabies.

How will I know if I have an infection?

People can be infected with an STI and not have any symptoms at all, and it's not possible to tell by looking at them.

You could be infected (or infectious) and not know about it. However there are some symptoms you can look out for:

• Unusual discharge of liquid from the vagina or penis - it could be thick or watery, cloudy, white or yellow. It might be smelly.
• Pain or burning when you wee.
• Weeing more than usual.
• Itching, rashes, lumps, ulcers, sores or blisters on or around the genitals or anus.
• Pain in the testicles or lower abdomen.
• Pain and / or bleeding during sex.
• For women: bleeding between periods or after sex can be a sign.

Sometimes symptoms can come and go but that does not mean that the STI has gone away! It will not go away until it has been treated. Ignoring it will make it worse.

Symptoms usually appear within 2 to 14 days, but they can take up to 4 weeks (sometimes even longer). In the case of HIV infection, there are no symptoms - possibly for many years.

How do you catch an STI?

• Sexual contact (most commonly unprotected sexual intercourse)
• Semen, vaginal fluid and blood can all carry an infection.
• A man doesn't have to ejaculate ('cum') to infect a partner. A small amount of 'pre-cum' can leave the penis before or without ejaculation, and can be just as infectious.
• Some STIs can be passed from person to person by genital contact alone. Some STIs (including Herpes) can also be passed from person to person through oral sex (licking or kissing a partner's genitals). For crabs and scabies (which are crawling insect-like creatures), skin contact alone is enough.
• The more sexual partners someone has (unprotected) the more at risk they are of getting an STI.

What can I do if I think I have an STI?

If you are concerned that you have an STI then you need to get medical advice and possibly get tested (screened). There are several services that are available for help and advice:

• any NHS Genito-Urinary-Medicine (GUM) clinic (the Claude Nicol Centre is the sexual health clinic based in Brighton).
• your GP or practice nurse
• a sexual health clinic
• a family planning clinic
• Allsorts - we have a visiting sexual health advisor who can arrange to meet you at our drop in, or at the Claude Nicol GUM clinic

What about letting partners know?

Telling partners can be difficult. Partners may not be in touch anymore and people may be scared or may be really angry. But it is really important to let anybody who could be infected know as soon as possible. People infected should encourage current or past partners to visit a clinic and get themselves checked out. Sexual health clinics can help with this. The health adviser can arrange to send out contact slips that ask the person to go and see their GP or sexual health clinic. It will NOT give the patients name. But whatever happens, nothing will be done without the patient's agreement.

What will happen if an STI is NOT treated?

What will happen if an STI is NOT treated?

• It will NOT go away!! As long as someone has an STI, they can pass it on to somebody else, even if they do not have any symptoms.
• In the long-term, men can experience pain and swelling in the testicles and penis, and in the joints and eyes and may become less fertile. Women are even more likely to suffer long-term damage, including pelvic pain and damage to the Fallopian tubes. This can cause difficult pregnancies. It may even mean someone can't have a baby.
• Pregnancy: If a pregnant woman has an untreated STI, this may be passed on to her baby either in the womb or during birth. Most STIs can be treated during pregnancy without harming mother or baby.

What can I do to prevent getting and passing on an STI?

Practice Safer Sex!! Use a condom every time!! (Go to the condom section for more information.)

Tips for safer sex:

• You can still have plenty of fun and pleasure without penetration! - kiss, cuddle, massage, lick, stroke, snog, fondle, rub, play, mutual masturbation…
• Oral Sex is riskier if you or your partner has a cold sore, sores in or around the mouth, or inflamed/bleeding gums.
• Penetrative sex is riskier if you have any cuts or sores on your genitals.
• Anal intercourse is especially risky for both partners, because the skin in the rectum is delicate and breaks easily and it doesn't self-lubricate like the vagina does. This is why lubricant (water based so it won't rot the condom) is important to use for anal sex.

True or False: dispelling myths about STI's

There are treatments for most STIs. True or False?
True: Most STIs can be treated with antibiotics or lotions. That's why it's important for a person to go to a clinic if they think they've been at risk. The earlier they go, the easier it will be to treat.
There is no cure for HIV, though there are drugs which delay its development and relieve symptoms.

Some STIs can be caught from toilet seats. True or False?
False: It is not possible to catch an STI from a toilet seat. Or from sharing cups, or swimming pools, or holding hands!

Some STIs can be passed on via oral sex. True or False?
True: Many of the common STIs can be passed on this way, such as Gonorrhoea, Chlamydia, Syphilis, Hepatitis B and Herpes. There have been a few cases of HIV having been passed on via oral sex. Most of the other STIs are more infectious than HIV though. Flavoured condoms or dental dams should protect against most STIs being passed on via oral sex.

You always know when you have got an STI because it hurts when you wee. True or False?
False: Some STIs don't have any symptoms, especially in women. Or someone might have symptoms which then disappear. This doesn't mean the STI has gone away! So they should still get checked out.

You can only have one STI at a time. True or False?
False. If someone has one STI, they are more likely to catch or have another one because the vagina or anus may be damaged by the STI making it more susceptible to other infection.
Someone might think they have only one STI, but in fact have another one that doesn't have any symptoms. That's why it is so important that someone who might have been at risk of infection gets checked out.

Using a condom can always stop you catching an STI. True or False?
False: If used correctly and consistently, condoms can protect against STIs, but there is still a small risk that an infection could be passed on (for example, genital warts are around the genital area, therefore a condom would not necessarily protect that area although using a condom would certainly reduce the likelihood of transmission.

You have to sleep around to get an STI. True or False?
False : Someone could get an STI from having unprotected sex just once. If someone is having unprotected sex with lots of different partners this will increase their chance of getting an STI.

Sometimes an STI will go away by itself. True or False?
False: Even if the symptoms go away, the STI will not have gone. An STI will not go away until it has been treated. If left untreated it can cause more difficulties and health problems, such as effecting fertility (for men and women).

Most STIs occur in people under thirty. True or False?
True: 85% of infections occur in people aged 15-30.

It's only gay men that get HIV. True or False?
False : Anyone can get HIV if they have had unprotected sex. The latest national HIV statistics show that there are more new diagnoses in heterosexual people than in homosexual people.

You can get STI's from Kissing? True or False?
False: There are very few infections that can be passed on through kissing. You cannot catch Chlamydia or Gonorrhoea from kissing.

Some people may be at higher risk of catching STI's than others True or False?
True: Certain sexual activities and behaviours are more risky than others and people who practice these can take precautions to take care of their health. This includes those who have frequent new sexual partners, Injecting Drug Users, Commercial Sex Workers, and men who have sex with men. A GUM clinic will give relevant advice to all those who are at increased risk and help to provide information, and barrier methods. Hepatitis vaccination and emergency treatment in the event of a high-risk exposure to HIV infection (PEP) are available from a GUM clinic and they will also see people who have been sexually assaulted.

List of Sexually Transmitted infections

Bacterial Vaginosis ('BV')
This is caused by overgrowth 'unfriendly' bacteria in the vagina and leads to a thin, watery, grey discharge with an unpleasant smell in women. It can be caused by washing with any type of soap or detergent, smoking and hormonal changes. It is not a sexually transmitted infection (STI) but is more common in women who are sexually active. It can be easily tested for in the GUM clinic and treated with antibiotics.

Chlamydia
One in ten sexually active young people has Chlamydia which is caused by a bacteria which passes on through semen and vaginal fluids. You don't need to have lots of sexual partners to get it. It can live in the cervix (neck of the womb), the urethra (urine tube), the rectum (back passage) and the throat. It can cause painful inflammation of the testicles or rectum in men or serious inflammation of the womb in women effecting fertility so it is really important to have it treated with antibiotics (PID see later). 70-80% of men and women will have NO symptoms and may not know they have Chlamydia without having a test.
If you think you need a sexual health check-up you should try to get an appointment as soon as possible. Leaving it till later might mean any problem just gets worse and you may pass an infection on to partners.

Gonorrhoea
Gonorrhoea is a common STI which may cause a yellow or green discharge from the penis or the vagina. It may also cause pain on passing urine in men, low abdominal pain and bleeding between periods. Men and women can become infected if they come into contact with infected semen or vaginal discharge, or discharge from the throat or rectum. In 10% of men and 50% of women there may be no obvious symptoms. In women Gonorrhoea can cause PID and problems with fertility and in men it can cause painful infection in the testicles and prostate gland. More rarely it can spread to cause rashes, joint pains and even meningitis.

Hepatitis
Hepatitis is an inflammation of the liver, and can be caused by several viruses which cause different forms of the condition, some more serious than others The most common are Hepatitis A, B and C. You can get vaccinations that will protect you against Hep's A and B. Gay men are advised to get these vaccinations because Hepatitis B is much more infectious than HIV and can easily be passed on during sex. (Please click here for the more detailed section on Heptatitis)

HIV
Many people are not aware of the real facts about HIV (Human Immunodeficiency Virus). The virus can be passed on by men and women through sexual contact and by both heterosexual and homosexual sex. There is even a risk of passing on the infection through oral sex, pre-ejaculate fluid (pre-cum) and breast milk. Another important way infection is passed on is by drug users sharing injecting needles. Many people have no idea they are carrying the virus and only find out when they have a blood test. The number of people in Brighton and Hove with HIV infection is increasing. (Please click here for the more detailed section on HIV)

Itching and Scratching?
Several STIs can cause itchy symptoms including Genital Warts, Herpes (Herpes Simplex virus), Scabies (a mite infection) and 'Crabs' (a louse infection). Thrush (Candida) infection Eczema can be found in the genital area as well, so itchy symptoms are not always caused by STIs. Any itchy symptoms in the groin can be checked at the GUM clinic where they can be properly diagnosed and treated.

LGV
LGV (Lymphogranuloma Venereum) is a type of Chlamydia which is affecting men who have sex with men (MSM). It usually causes pain and discharge from your bum. It is a serious infection and needs to be treated with a longer course of antibiotics than the more common type of Chlamydia. If it is not treated it can cause scarring and long-term problems in the areas affected. It can be passed on sexually to partners and can be avoided by ALWAYS using condoms and using latex gloves for sexual activity like fisting.

PID
Pelvic Inflammatory Disease is a condition in which the uterus (womb) and fallopian tubes in a woman become inflamed. This is often associated with an STI,. Important causes of PID are Chlamydia and Gonorrhoea and in some women this can lead to infertility. The more times a woman gets PID, the higher the chance of infertility. If you have PID you should not have ANY sex until you are treated and given the all clear, and any recent partner is checked and treated so that you do not become infected again.

Syphilis
Syphilis is important because untreated it can cause serious health problems (including heart and brain problems). The bacteria that causes it is called Treponema pallidum and is easily passed on by sexual contact including vaginal, anal and oral sex and by skin contact with someone who has a syphilis ulcer (sore) or a syphilis rash. An ulcer could be in the back of the throat, in the back passage, on the penis or in the vagina. It usually does not cause any pain so it is often missed. Syphilis can be treated with antibiotics after confirming it with tests on an ulcer and a blood test. If it is treated early it will not progress to the serious late stage.

Ulcers or Sores
An ulcer is an area of skin where the surface has broken. An ulcer in the genital area should NEVER be ignored, as it may be a sign of a serious infection such as Syphilis. Alternatively, an ulcer might indicate Herpes or other infections. Herpes is a viral infection which can be passed to the groin by oral sex if someone has the cold sore virus or by sexual contact if someone has Genital Herpes. It causes painful outbreaks of blisters and sores. Whatever the cause, an ulcer should be looked at so that you can be properly diagnosed and treated before the problem gets worse, or you pass on an infection to a partner.

Vagina issues
Vaginal discharge and soreness are important symptoms to look out for. A foreign body or a lost tampon could potentially lead to infection in the vagina. Remember to change tampons regularly. Pain during sex (either on penetration, or deep inside) may be a symptom of an STI too. Being on your period at the time of your check-up will not cause any problem with the test results, all that really matters is that you feel comfortable having a check up at this time.

Warts
Genital Warts are one of the most common STIs and are caused by a virus that is passed on by sexual contact in the genital area. They are small bumps which occur in the genital area of both men and women. Many people will have been exposed to the virus in their lifetime and some people never see any warts appear, whereas others do. The infection can be passed on even if penetrative sex does not occur. The virus is not the same as the type commonly causing warts on the hands or the type strongly associated with cancer of the cervix (the neck of the womb). Genital warts don't look nice and may become itchy or bleed sometimes but they do not usually cause longer-term problems. The important thing is people who have warts may have other STIs too and so a sexual health check up is essential. The warts themselves can be treated by freezing or with a liquid or cream, which clears them over time.

Yeast Infections
Thrush (Candida) is a yeast infection that is common in women, causing itch, soreness in the vulva area and a change in vaginal discharge. Thrush can develop if you are pregnant, wear tight clothing with no ventilation, are taking antibiotics, have uncontrolled diabetes or use soaps and detergent products to wash with. It can be passed on by sex with someone who has thrush, but is not considered an STI as it can develop without having had sex. Men can get Thrush, causing irritation, itch and redness at the bell end of the penis (glans) and the foreskin, or a discharge like cottage cheese around the foreskin. Thrush can be treated with cream, pessaries or tablets for women and usually with a cream or tablet for men. It is possible to mistake the symptoms of an STI for Thrush, so it should be properly checked and treated.