Let's Talk About STIs

With any type of sexual activity, unless flying solo, it's important to know the risks to your sexual health. As part of her Let's Talk About Sex campaign, VP Wellbeing & Diversity Henn Warwick takes it back to basics with STIs, going through the different symptoms, and how they're spread and treated.

With any type of sexual activity, unless flying solo, it's important to know the risks to your sexual health. It's best to take things back to basics when discussing sexual health, so for Let's Talk About Sex week we are starting here, with sexually transmitted infections (STIs).

This article will delve into the most common symptoms of each STI, how they're spread and treated.

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Chlamydia

Chlamydia is one of the most common STIs. Around 50% of people with penises and 70% of people with vaginas who have chlamydia have no noticeable symptoms, any symptoms they do have may be mild. It is therefore important to get tested as regularly as possible. It can take around one to three weeks post-contact with the infection for symptoms to show, but it can also take much longer than this.

Most common symptoms

  • Vaginal bleeding after sex or between periods
  • Discharge from the penis or vagina
  • Pain in the pelvic, or testicular pain
  • No symptoms

?Treatment

Chlamydia is usually treated with antibiotics, either through a course of capsules to take for a week or tablets all to be taken in one day. It's really important to not engage in any sexual activity until you and your current partner have finished treatment or wait at least a week after taking the antibiotics in one day. This is because there is a risk of reinfecting each other.

It is crucial that any recent sexual partners are tested and treated as this will help stop the spread of the infection. If left untreated, Chlamydia can spread to other areas of your body and potentially lead to long-term health conditions such as pelvic inflammatory disease (PID), inflammation of the testicles and infertility.

How chlamydia is spread

Chlamydia can be spread through unprotected vaginal, anal or oral sex. Equally, sharing sex toys that haven't been washed or covered with a condom or genital touching (even if there is no penetration, orgasm or ejaculation) can spread Chlamydia.

Chlamydia cannot be passed on through casual contact, so if you kiss or hug your partner you will not get infected. It cannot spread through sharing baths, towels, swimming pools, toilet seats or cutlery either!

Gonorrhoea

Gonorrhoea is a bacterial STI. Around 10% of people with penises and 50% of people with vaginas who have Gonorrhoea have no noticeable symptoms. It is therefore important to get tested as regularly as possible.

Symptoms usually appear within two weeks of being infected but could start much later. It's important to get tested as soon as possible if you have had unprotected sex with a new partner as Gonorrhoea can lead to more serious long-term health problems if it's not treated, including pelvic inflammatory disease in people with vaginas or infertility to anyone.

Most common symptoms

  • Bleeding between periods
  • Green or yellow discharge from the vagina or penis
  • Pain when peeing
  • No symptoms

Treatment

The treatment for gonorrhoea is usually a single antibiotic injection and a single antibiotic tablet. With effective treatment, symptoms should improve within a few days. Commonly, people with gonorrhoea are asked to attend a two-week follow-up appointment to have another test to ensure the infection has cleared up. You should not have sex until after the second test as you may still be infected, and this means the infection could spread. Unfortunately, catching Gonorrhoea and going through treatment does not give you immunity to catching it again. It's best to play it safe and use condoms and dental dams!

How gonorrhoea is spread

Gonorrhoea is very easily passed between people through unprotected sex such as vaginal, oral or anal sex and sharing vibrators or dildos that haven't been protected within a condom. Pregnant people can pass the infection to their unborn baby - without treatment permanent blindness can be caused by Gonorrhoea.

The bacteria that causes Gonorrhoea cannot survive outside of the human body for long, so sharing a bath, towels, toilet seats, cups, plates or cutlery will not increase your risks of catching it, equally, Gonorrhoea cannot be spread through kissing or hugging.

Trichomoniasis

Trichomonas is a sexually transmitted infection, which is caused by a tiny organism (a living cell) called Trichomonas vaginalis. It is common for symptoms to appear within four weeks, but they could flare up months after contracting the infection. Diagnosing trichomoniasis usually requires a medical examination of the genitals followed by laboratory testing of a swab taken from the penis or vagina, you are unable to test yourself at home for this infection.

Most common symptoms

Can be varied depending on what type of genitalia you have.

People with penises may experience:

  • Discharge from the penis which is commonly thin and white in colour
  • Pain, soreness and swelling around the foreskin or head of the penis
  • Needing to pee more frequently than usual
  • Pain when peeing and/or ejaculating

People with vaginas may experience:

  • Burning, swelling and redness in the pubic area and sometimes in the upper thigh area
  • Abnormal discharge from the vagina - thick, thin or frothy which can be yellow or green in colour
  • Itchy discomfort and swelling around the opening of the vagina
  • Pain when peeing and/or having sex

Treatment

Trichomoniasis is very unlikely to clear up on its own, instead, it's best to seek medical advice and access antibiotics to treat the infection. People with trichomoniasis are commonly treated with metronidazole that is taken twice a day for five to seven days. As with any antibiotic treatment, it’s really important to complete the entire course, do not stop taking the medication when you begin to feel better or notice your symptoms improve. Again, avoid having any sexual contact during treatment as you may be at risk of spreading the infection or reinfecting yourself.

How trichomonas is spread

The most common way for Trichomoniasis to spread is through all forms of unprotected sex and sharing sex toys. Anyone can be infected with Trichomoniasis regardless of how many sexual partners they may have had. The infection cannot spread through hugs or kisses, sharing cutlery or plates or through using the toilet. If left untreated, complications although unlikely may arise. People with vaginas are most at risk of complications and this can also relate to pregnancy. Being infected with Trichomoniasis whilst pregnant may cause premature birth and low birthweight.

Genital herpes

Genital herpes is caused by a virus called herpes simplex (HSV). There are two types of herpes simplex virus, HSV-1 which usually causes cold sores and HSV-2 which usually causes genital herpes. Sexual contact is the primary transmitter for the spread of genital herpes. The most widely known symptoms of genital herpes are blisters, the appearance of blisters is called an outbreak. After coming into contact with the virus, symptoms (an outbreak) may appear after four to seven days but might not start until months or years later. Again, this highlights the importance of getting tested regularly. Once you have the virus, it stays in your body, there is currently no cure for genital herpes, but medication and treatment can ease any symptoms.

Most common symptoms

  • Small, painful blisters or sores around the genitals, buttocks and anus
  • The blisters may become ulcerated (open sores) and ooze fluid
  • Flu-like symptoms including body aches, headaches and fever
  • Itching or tingling around the genitals 
  • Swollen lymph glands
  • Pain when peeing
  • No symptoms

Treatment

If you are being treated for genital herpes for the first time it is common to be prescribed antiviral medicine which can be used to stop the symptoms getting worse, and a cream to soothe the pain. It's important to start taking this medicine within five days of the symptoms appearing, and if the blisters don't clear up it is advised to go back to the sexual health clinic to investigate this further.

As stated, genital herpes will stay in your body, this means those with the virus may experience reoccurring outbreaks. Outbreaks can settle by themselves but prescribed antiviral medicine can shorten an outbreak by one to two days if administered as soon as the symptoms begin. Some people never have outbreaks or have at least milder outbreaks than their first. Equally, some people who suffer with six or more outbreaks in a year may benefit from regular antiviral medicine.

Tips for treating outbreaks at home

  • Wash your hands thoroughly before touching the affected area
  • Clean the affected area with saltwater, this will prevent infections within the blisters
  • Soothe the pain with an ice pack wrapped in a sterile flannel - ensure this flannel is disposed of or washed immediately
  • Apply Vaseline or painkilling cream, such as 5% lidocaine to reduce the pain when peeing
  • Make sure you wash your hands after touching the affected area
  • Pour water over your genitals when peeing to ease the pain
  • Try not to touch any blisters, unless you are applying the medicated cream
  • Avoid wearing tight clothing as this could irritate the blisters
  • Do not have vaginal, anal or oral sex whilst the blisters are active, this includes sharing sex toys
  • Always protect your sexual partners, you can pass the virus on even if you have no symptoms

How genital herpes is spread

Genital herpes is very contagious, it can spread through skin-to-skin contact with an infected area (cold sore), this includes vaginal, anal and oral sex. Even if there are no visible sores or blisters the infection can still transfer through, for example on someone's fingers that touch your genitals or sharing sex toys. You cannot catch genital herpes from objects such as cutlery or cups as the virus dies very quickly away from the skin.

Babies can be born with herpes if contracted through vaginal delivery, it is common for ulcers to appear on the face, body and genitals. Severe complications may arise in new-born babies such as blindness, brain damage and death. It is important to inform your doctor/midwife if you contract genital herpes and are pregnant, steps can be taken to reduce the risk of transmission through the use of caesarean section.

Genital warts

Genital warts are a common STI caused by the human papillomavirus (HPV). They can affect both people with penises and vaginas, but those with vaginas are far more vulnerable to complications. Genital warts can be treated, but they can come back unless the underlying infection is also treated. There is no cure for genital warts, but over time that body can fight off the virus! You cannot test yourself at home for genital warts, it's best to visit a sexual health clinic where a doctor can diagnose the warts through observation.

A doctor may look at your genitals and anus using a magnifying lens, they may also need to look inside your vagina if you have one, or inside your anus or urethra (where you pee). It is unlikely that the doctor would be able to tell how long you have had the infection or where you contracted it.

Most common symptoms

  • Small fleshy growths or lumps on the genitals or around the anus
  • Itchiness or bleeding from the genitals or anus
  • No symptoms
  • Change to the flow of pee that doesn't go away, for example, if the flow is directed sideways

Treatment

Genital warts cannot be treated without a prescription from a doctor. There are three varying types of treatment for this infection; the treatment offered will depend on what type of warts are apparent and where they are located. Creams or liquids can be prescribed to treat the warts, this can sometimes be done at home, but it may be necessary to have a doctor apply the cream for you. This is because the treatment can be painful, causing irritation and burning sensations.

The second form of treatment is surgery, where a medical professional will use a laser to remove the warts, again this procedure is painful and can leave scarring.

The last treatment is freezing, a medical professional will carefully freeze and then remove the warts. This is likely to be part of on-going treatment and may take a few tries. This procedure is also reported to be painful.

How genital warts are spread

The virus that causes genital warts can be passed between partners whether warts are visible or not. The most common transmission is through vaginal or anal sex without using a condom or by sharing sex toys such as a clitoral vibrator. The virus spreads through any close genital contact, so this means you can contract genital warts simply by touching or rubbing genitals, regardless of penetration or whether you or your partner cum.

It is rare for genital warts to spread through oral sex but it's not impossible. Genital warts cannot be spread through kissing or sharing items such as towels, cutlery and cups.

Pubic Lice

Pubic lice are tiny parasitic insects that live in coarse body hair, such as pubic hair. They are sometimes known as 'crabs' as they have two large front claws similar to a crab that cling to pubic hair. Symptoms of pubic lice will be the same regardless of your genitalia and can take several weeks to show post-infection. Adult pubic lice and lice eggs are very small (2mm long) and are visible in coarse hair. They are a yellow-grey or dusky red colour and have six legs. The lice lay their eggs, also called nits, in sacs that stick to hair and are a pale brownish colour. Once the eggs are hatched, the remanence of the empty exacts are white in colour.

A pubic lice infestation is not usually serious, but there are opportunities for minor complications such as infections from starching. Getting tested for pubic lice is really simple, either book an appointment with your GP or attend a sexual health clinic. If you go to an STI clinic, your best bet is to get a full STI screening just to be on the safe side.

To diagnose pubic lice a medical professional will examine you (potentially with a magnifying glass), they may need to touch the area with a gloved finger to look in-between the pubic hair.

Most Common Symptoms

  • Itching in the affected areas, usually at night, the itching is caused by an allergic reaction to the lice' salvia  
  • No symptoms
  • Inflammation and irritation caused by scratching
  • Black powder in your underwear
  • Blue spots or small spots of blood on your skin, such as on your thighs or lower tummy (caused by lice bites)

Treatment

A GP or a pharmacist will be able to assist you with the treatment of pubic lice. Common treatment includes insecticide cream, lotion or shampoo. With any lice treatment, it is recommended to repeat the treatment days later just in case new lice have hatched after the first treatment. Sometimes, treatment doesn’t work, this isn't anything to be scared of, it simply means you need to try an alternative treatment. Don’t underestimate these little things - they are known to build resistance to certain treatments.

How pubic lice is spread

Contracting pubic lice is not something to be ashamed of, it doesn't mean you have poor personal hygiene or are unclean. The most common transmission for pubic lice is bodily contact with an infected person. The lice are unable to jump or fly and therefore crawl from one hair to another. The lice feed off blood to survive and will therefore not leave one body unless there is another body nearby. There is no method of contraception to prevent the spread of pubic lice, even a condom will not protect you.

Lice can spread without any penetrative sex, for example through hugging and kissing. In rare cases, pubic lice have been known to spread through sleeping in a bed together, sharing clothes and even sharing towels. If you are diagnosed with pubic lice, you are responsible for informing anyone you have had close bodily contact with in the last three months, as they should receive treatment even if they have no symptoms.

Scabies

Scabies is a common and highly contagious skin disease caused by tiny and almost invisible insects commonly called the human itch mite. Contracting scabies has nothing to do with personal hygiene, it does not mean you are dirty or unclean.

If you have never had scabies before it can take up to six weeks to appear, whereas it may only take up to four days if you have had scabies before. When the mites first enter your body, they burrow under the skin so you may not notice them at all. If you are experiencing symptoms such as itching you will need to go to your GP or local sexual health clinic. The dialogistic test for pubic lice is simple and painless. A medical professional will scrape the affected area to collect a sample, this sample will be sent to the lab to be examined under a microscope to ensure the correct diagnosis and treatment is given.

Most common symptoms

  • Intense itching at nighttime, commonly leading to interrupted sleep
  • No symptoms
  • Red spotty rash
  • Itching and pain around the genitals
  • Skin lesions such as bumps or tiny blisters in-between the fingers, on the elbows, stomach and upper thighs
  • People with vaginas may find their nipples become infested

Treatment

Treating scabies is easy and effective, your GP or medical professional at a sexual health clinic will advise treatment through either a cream or a lotion. Both are simple to apply and have no tell-tale odour. While scabies will disappear after 24 hours, the itch may last for two or three weeks. Anyone you have had close contact with, for example, sexual partners, should all be examined and receive treatment even if they have no symptoms. This is necessary to prevent re-infection.

How scabies is spread

Scabies is classed as an STI as it often spreads through sexual skin-to-skin contact. Scabies can also be spread by sharing clothes, sharing a bed or even by using someone else's towel. Scabies has been known to be transmitted through furniture if an infected person’s skin has touched, for example, a sofa. This is why it's so important that everyone in your home receives treatment even if they have no symptoms.

Syphilis

Syphilis is a bacterial infection that is usually spread through sexual contact with someone who has the infection. Syphilis can cause serious problems if left untreated, it can spread to the brain and other body parts. If you have had unprotected sexual contact with someone, I urge you to get tested as soon as possible. Symptoms of syphilis are not always obvious; they can disappear on their own, but the infection will remain unless you receive treatment. Usually, symptoms appear two to three weeks after contracting the infection but could start earlier or much later.

Your body cannot build immunity to Syphilis, you can catch it more than once. Treatment for Syphilis is only available by medical prescription, this means you must get tested to receive treatment - you cannot buy it yourself.

Syphilis can be diagnosed via a blood test and collecting a sample of fluid from any sores using a swab (similar to a cotton bud). The best place to get tested for Syphilis is at a sexual health clinic. You cannot ever be fully protected from Syphilis, but you can reduce the risk of transmission through the use of internal or external condoms, dental dams and not sharing sex toys.

Most common symptoms

  • Small and painless blisters or sores on the penis, vagina anus and/or mouth
  • Blotchy red rashes on the palm of the hands and soles of the feet
  • Flu-like symptoms including swollen glands in your neck, armpit or groin, headaches, a fever, fatigue and joint pains
  • No symptoms (or symptoms that come and go)
  • Small growths, similar to genital warts, on the vulva, if you have one and around the anus

Treatment

A strong dose of antibiotics will be injected into the buttocks to kill the infection. Most people will only need one dose of the injection, although it is recommended to have three injections at weekly intervals if you have had Syphilis for a long time. For those who are unable to have an injection, oral antibiotics can be prescribed. The course will usually be two to four weeks depending on how long you have had the infection.

How Syphilis is spread

Syphilis is mainly spread through close contact with someone who has an infected sore. This contact usually happens during vaginal, anal or oral sex, or by sharing sex toys with someone who's infected. Anyone who is sexually active is potentially at risk of contracting Syphilis. Pregnant people with syphilis can pass the infection to their unborn baby, if you are pregnant you will be offered free screening to detect the infection. Syphilis can also be spread by sharing needles or through blood transfusion.

In the UK blood donations are thoroughly tested so it would be very unlikely to spread this way. Syphilis cannot be spread by using the same toilet, clothing, cutlery or bathroom as an infected person.

HIV

Human Immunodeficiency Virus (HIV) is a virus that damages cells within your immune system. HIV compromises and weakens the immune system; this means an individual with HIV will be more suspectable to infections and diseases. Two in five people in the UK newly diagnosed with HIV are diagnosed late – this means they’ve been living with undiagnosed HIV for a number of years. There is no known cure for HIV, but medical advancements have meant that people with the virus are able to live long and healthy lives.

Acquired immune deficiency syndrome (AIDS) is a term used to describe a number of potentially life-threatening infections and illnesses that occur due to a compromised immune system severely damaged by HIV. AIDS cannot be spread from one person to another, but HIV can.

When caught early, administering effective treatment means that most people will not develop AIDS. The first symptoms of HIV may appear after two to six weeks of infections, but not everyone with HIV has symptoms. For those who do, it is common for them to last for one to two weeks. These symptoms will then disappear, there may be no further symptoms for many years even though the infection remains in your body. The only way to find out if you have HIV is through an HIV test - this involves giving a blood sample from your arm which is sent to a lab to be tested or pricking your finger to give results in a few minutes.

Most common symptoms

  • Seroconversion illness - flu-like symptoms including fever, headaches, muscle aches, fatigue and swollen glands in the neck, groin and armpits
  • Night sweats
  • Weight loss
  • Sore throat
  • Red rash on the body

Emergency HIV Treatment

If you have been exposed to the virus, post-exposure prophylaxis (PEP) medicine can stop you from becoming infected after the virus has entered your body. For PEP to be effective, treatment must start within 72 hours of contact with the virus, ideally, treatment should start within 24 hours.

PEP is only recommended following high-risk exposure, such as unprotected vaginal or anal sex with someone known to be positive. PEP is a powerful course of drugs and is very expensive to prescribe. The medication now used for PEP is a single tablet called Truvada and two tablets of Raltegravir. Common side effects of the tablets include nausea, headaches or tiredness. You can gain access to PEP from a sexual health or genitourinary medicine (GUM) clinic or a hospital with an A&E department. PEP is not normally available at GPs.

The main message I want to convey here is PEP is not a 'morning-after pill' for HIV. There is no guarantee that taking PEP will stop you from getting HIV.

PEP is an emergency measure that is to be used as a last resort, for example, if a condom split during any form of sex. Taking PEP will not offer protection from any STI.

How to take PEP

PEP must be taken exactly as instructed and for 28 days. 

  • Do not skip a dose or fail to complete the full month as this makes it less likely to work
  • Do not double a dose if you miss one
  • If you do miss a dose and you remember in less than 24 hours, take the next one as soon as you remember
  • If you miss more than 48 hours of PEP it will be discontinued

Treatment

If you have tested positive for HIV, regular blood tests will be used to monitor the progress of the infection. There are two important blood tests, firstly HIV Virial Load Test - this measures the amount of HIV virus within the bloodstream. Secondly, CD4 Lymphocyte Cell Count - this test measures how HIV has affected your immune system. From these tests, a doctor will advise on which antiretroviral medicine should be administered.

HIV is treated with antiretroviral medications, which work by stopping the virus from replicating in the body. This allows the immune system to repair itself and prevent further damage. HIV is very adaptable and can quickly become resistant to treatment, it is, therefore, usual to combine and vary treatments. It is common for someone receiving treatment for HIV to be taking between one to four pills a day. The aim of treatment is to maintain the level of HIV in your blood as close to zero as possible, so it can’t harm your immune system. When the level of the virus is so low that a test can’t detect it, this is known as an undetectable viral load and is the best result you can get from treatment. This helps keep you healthy and means you can’t transmit the virus to anyone else.

How HIV is spread

HIV lives in blood and other body fluids. For HIV to pass from one person to another, one of these fluids containing HIV has to enter your bloodstream. Bodily fluids such as semen, vaginal fluids, including menstrual blood, breast milk, blood and the lining inside the anus contain enough HIV to transmit to another person.

In the UK, the most common transmission of HIV is through unprotected vaginal or anal sex. There is a lower risk of transmission through oral sex, but it is still possible for HIV to be passed this way. Other common transmitters of HIV are sharing needles, blood transfusion, pregnancy and childbirth. Fluids such as urine, sweat and saliva are unable to infect people as they do not contain enough HIV. This means HIV cannot be passed through using toilet seats, kissing, spitting, sneezing sharing baths, towels or cutlery, mouth-to-mouth resuscitation or contact with broken/healthy skin.

If the person you had sex with is living with HIV and has an undetectable viral load, you will not need PEP as it won’t be possible for the virus to have been transmitted.

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To wrap it up

The most important thing to remind yourself about STIs is they do not define you.

Contracting an STI, whether it's curable or treatable, doesn't make you any less of a person. You are not dirty or unhygienic for having an STI, and it certainly does not mean you should be labelled negatively amongst peers. Anyone who has sex can get an STI, whether it's your first time or 100th time and regardless of your sexuality.

It's time we challenge the negative stigma surrounding STIs and promote safer sex by encouraging regular testing and the use of latex or polyurethane (internal & external) condoms or dental dams every time you engage in sexual activities.

STI related shame greatly undermines testing, treatment and tracing as individuals are more likely to put off getting a test. Take pride, be responsible for your sexual health, get tested regularly and ensure your partners to do the same!

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