STDs (Sexually Transmitted Diseases)

What are sexually transmitted diseases (STDs)?

Sexually transmitted diseases (STDs) are diseases that are mainly passed from one person to another during sex. There are at least 25 different sexually transmitted diseases with a range of different symptoms. These diseases may be spread through vaginal, anal and oral sex. Most sexually transmitted diseases will only affect you if you have sexual contact with someone who has an STD. However there are some infections, for example scabies, which are referred to as STDs because they are most commonly transmitted sexually, but which can also be passed on in other ways.

What are sexually transmitted infections (STIs)?

Sexually transmitted infection (STI) is another name for sexually transmitted disease (STD). The name STI is often preferred because there are a few STDs, such as chlamydia, that can infect a person without causing any actual disease (i.e. unpleasant symptoms). Someone without symptoms may not think of themselves as having a disease, but they may still have an infection that needs treating.

How can you tell if you have a sexually transmitted disease?

You may become aware that you have an STD because of symptoms, or it may be that a sexual partner tells you they have an STD which they might have passed on to you. Some sexually transmitted diseases can be transmitted by an infected person even if they don't have any symptoms. Certain STDs can also be transmitted from a pregnant woman to her unborn child. If you think you might have been exposed to an STD then you should go to see a doctor. Many sexually transmitted diseases can be easily cured, but if left untreated, they may cause unpleasant symptoms and could lead to long-term damage such as infertility. It is important that anyone diagnosed with an STD informs everyone they have had sex with within the past year (or everyone following the partner they believe may have infected them).

What are common STD symptoms?

STD symptoms vary, but the most common are soreness, unusual lumps or sores, itching, pain when urinating, and/or an unusual discharge from the genitals.
Crabs or Pubic Lice

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Enlargement of Phthirus pubis, the pubic or crab louse.

Chlamydia
Chlamydia is a disease caused by the bacteria Chlamydia trachomatis. It is most commonly sexually transmitted.

Causes, incidence, and risk factors

Chlamydia infection is the most common sexually transmitted disease in the United States. Sexually active individuals and individuals with multiple partners are at highest risk.

Symptoms
As many as 1 in 4 men with chlamydia have no symptoms. In men, chlamydia may produce symptoms similar to gonorrhea. Symptoms may include:

Burning sensation during urination Discharge from the penis or rectum Testicular tenderness or pain Rectal discharge or pain

Only about 30% of women with chlamydia have symptoms. Symptoms that may occur in women include:

Burning sensation during urination Painful sexual intercourse Rectal pain or discharge Symptoms of PID, salpingitis, liver inflammation similar to hepatitis Vaginal discharge

See also: Chlamydia in women

Signs and tests

The diagnosis of chlamydia infection involves sampling of the urethral discharge in males or cervical secretions in females. If an individual engages in anal sexual contact, samples from the rectum may also be needed. The sample is sent for a fluorescent or monoclonal antibody test, DNA probe test, or cell culture. Some of these tests may also be performed on urine samples.

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Treatment
The usual treatment for chlamydia is antibiotics, including tetracyclines, azithromycin, or erythromycin. You can get chlamydia with gonorrhea or syphilis, so if you have one sexually transmitted disease you must be screened for other sexually transmitted diseases as well. All sexual contacts should be screened for chlamydia. Sexual partners must be treated to prevent passing the infection back and forth. There is no significant immunity following the infection and a person may become repeatedly infected. A follow-up evaluation may be done in 4 weeks to determine if the infection has been cured.

Expectations (prognosis)
Early antibiotic treatment is extremely successful and may prevent the development of long-term complications. Untreated infection, however, may lead to complications.

Complications
Chlamydia infections in women may lead to inflammation of the cervix. In men, chlamydia infection can lead to inflammation of the urethra called urethritis. An untreated chlamydia infection may spread to the uterus or the fallopian tubes, causing salpingitis or pelvic inflammatory disease. These conditions can lead to infertility and increase the risk of ectopic pregnancy. If a women is infected with chlamydia while pregnant, the infection may cause infection in the uterus after delivery (late postpartum endometritis). In addition, the infant may develop chlamydia-related conjunctivitis (eye infection) and pneumonia. See: chlamydial pneumonia

Calling your health care provider

Call your health care provider if you have symptoms of chlamydia. Because many people with chlamydia may not have symptoms, sexually active adults should be screened periodically for the infection.

Prevention
All sexually active women up through age 25 should be screened yearly for chlamydia. All women with new sexual partners or multiple partners should also be screened.
A mutually monogamous sexual relationship with an uninfected partner is one way to avoid this infection. The proper use of condoms during intercourse usually prevents infection.

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SYPHILIS
Introduction
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidium. The infection is usually sexually transmitted, in which case it is called venereal syphilis. It may also be passed from an infected mother to her unborn child, in which case it is known as congenital syphilis. Syphilis has been uncommon since penicillin become widely available in the 1950s, although global syphilis statistics show that an estimated 10 million new infections still occur each year.1 2
The past decade has seen a rise in new cases of the almost forgotten historic disease syphilis, particularly in 3 certain risk groups. Alexandra Geusau and Stefan Whrl, Medical University of Vienna

Syphilis symptoms
The symptoms of syphilis are the same in men and women. They can be mild and difficult to recognise or distinguish from other STDs. Symptoms may take up to 3 months to appear after initial infection. Syphilis is a slowly progressing disease that has several stages. The primary and secondary stages of syphilis are very infectious.
Primary stage of syphilis

One or more painless ulcers (know as chancres) appear at the place where the syphilis bacteria entered the body. On average, this will be 21 days after sexual contact with an infected person. Chancres may be difficult to notice and are highly infectious. The usual locations for chancres are:
On the vulva (outside the vagina) or on the cervix (neck of the womb) in women. On the penis in men. Around the anus and mouth (both sexes).

Without treatment, the ulcers take between 2 and 6 weeks to heal. If the infection is not treated at this point then it will progress to the secondary stage.
Secondary stage of syphilis

If the infection has not been treated, the secondary stage of syphilis will usually occur from 3 to 6 weeks after the appearance of chancres. The symptoms often include:
A flu-like illness, a feeling of tiredness and loss of appetite, accompanied by swollen glands (this can last for weeks or months). A non-itchy rash covering the whole body or appearing in patches. Flat, warty-looking growths on the vulva in women and around the anus in both sexes. White patches on the tongue or roof of the mouth. Patchy hair loss.

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During this stage syphilis is very infectious and may be sexually transmitted to a partner. These symptoms will usually clear up within a few weeks, but may re-occur for years. Treatment at any time during the first two stages of syphilis will cure the infection.
Latent and tertiary stages of syphilis

If a person infected with syphilis has not received treatment during the first two stages of the disease then it will progress to the latent stage. The person will no longer experience any symptoms of the earlier stages, but their infection can still be diagnosed with a blood test. If left untreated, the infection may develop into symptomatic late syphilis, also known as the tertiary stage. This usually develops after more than 10 years and is often very serious. It is at this stage that syphilis can affect the heart and possibly the nervous system. If treatment for syphilis is given during the latent stage the infection can be cured. However, any heart or nervous-system damage that occurred before the start of treatment may be irreversible.

How syphilis is passed on

Syphilis can be transmitted through direct contact with a syphilis sore. The methods of transmission are:
By having vaginal, anal or oral sex with someone who has the infection. From a mother to her unborn baby.

Syphilis cannot be passed on by sharing baths, toilets, towels or eating utensils.

Where to go for help

If you have any symptoms or you are worried you may have been infected with syphilis, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can. Some countries also have specific sexual health clinics that can help you directly.

The diagnosis of syphilis

To find out if someone has syphilis, a doctor will usually carry out the following examinations and tests:
A blood sample is taken and sent to an STD testing laboratory. A specimen of fluid is taken from all sores using a cotton swab and examined under a microscope. The genital area is examined for any primary signs of syphilis. The rest of the body is also checked. Women are given an internal examination to check for sores. A sample of urine is taken.

None of the examinations should be painful, but they may be slightly uncomfortable. The blood samples taken by the doctor are examined in a laboratory under a microscope to confirm a diagnosis. Various tests can be used on the blood sample. The most common and least expensive looks for antibodies.

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The examinations and tests can be done as soon as a person thinks they might have become infected with syphilis. If the result is negative then it is usually recommended that the person retests at a later time, as it can take up to 3 months for the immune system to produce the antibodies that are detected by the test.

Treatment for syphilis

Treatment for syphilis usually consists of a two-week course of intramuscular penicillin injections or, in some cases, antibiotic tablets or capsules. If the patient has had syphilis for less than a year then fewer doses will be needed. If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, then the doctor should be informed so that alternative medication can be prescribed. It is important that the full course of treatment is completed. If treatment is interrupted then it may be necessary to start again from the beginning. The patient will be asked about their sexual partners as it is important they are informed and tested as soon as possible. It is strongly advised to avoid any oral, vaginal or anal sex whilst having treatment, especially if the patient is in the early infectious stages of syphilis. Contact with any sores or rashes carries a risk of syphilis transmission. After the treatment is completed the patient will be asked to attend the clinic at regular intervals for blood tests to check that the syphilis has gone. Once a person has been treated and confirmed cleared of syphilis, any future blood tests (e.g. for immigration reasons) will still be positive, because the body retains antibodies against the bacteria. Doctors can give the person a certificate explaining that they have been treated and no longer have syphilis. Treatment is only capable of killing the syphilis bacteria and preventing further damage. It cannot repair damage already done to organs, or prevent re-infection if the person is exposed to the bacteria again.

Prevention
Although using a condom reduces the chances of becoming infected with syphilis, it is not entirely effective. A condom may not cover all of the sores or rashes in the affected areas, and direct skin contact may result in transmission. If a person has sex regularly with multiple partners, then it is advisable for them to get frequent STD check-ups. A person can become re-infected with syphilis even if they have had effective treatment for a previous infection: past infection with syphilis does not make a person immune.

Congenital syphilis
Syphilis can infect a baby in the womb if the mother's infection is not treated. This is know as congenital syphilis. If a baby becomes infected then there is a high risk of stillbirth or miscarriage. A newborn baby may not display any obvious symptoms of syphilis, but may develop serious complications within weeks if the disease is not treated.

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In many countries, blood tests for syphilis are given to all pregnant women when they visit antenatal clinics. Women may also be offered other tests for other STDs, such as an HIV test when pregnant. If a woman is found to be infected with syphilis, treatment can safely be given during pregnancy with no risk to the unborn baby.

GONORRHEA
Introduction
Gonorrhea is a sexually transmitted infection caused by the bacterium Neisseria gonorrheoae. Gonorrhea affects both men and women and can infect the cervix, urethra, rectum, anus and throat. Gonorrhea is one of the most common sexually transmitted diseases (STDs) and the global gonorrhea statistics show that an estimated 62 million cases of gonorrhea occur each year, affecting more women than men. Gonorrhea is easily curable but if left untreated it can cause serious health problems such as pelvic inflammatory disease (PID), which can lead to abdominal pain and ectopic pregnancy in women. Untreated, gonorrhea can also lead to infertility, meningitis and septicaemia.

Gonorrhea symptoms
Symptoms of gonorrhea infection may appear 1 to 14 days after exposure, although it is possible to be infected with gonorrhea and have no symptoms. Men are far more likely to notice symptoms as they are more apparent. It is estimated that nearly half of the women who become infected with gonorrhea experience no symptoms, or have non-specific symptoms such as a bladder infection. Gonorrhea symptoms can include:
Women A change in vaginal discharge; it may appear in abundance, change to a yellow or greenish colour, and develop a strong smell. A burning sensation or pain whilst passing urine. Irritation and/or discharge from the anus. Men A white or yellow discharge from the penis.

A burning sensation or pain whilst passing urine. Irritation and/or discharge from the anus.

How is gonorrhea passed on?

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These pictures are intended to give information for educational purposes and are not a replacement for medical diagnosis. If you are worried you might have an STD it is essential to seek medical advice, even if your symptoms do not look like these pictures. See more STD pictures Gonorrhea is passed on through penetrative sex, including:
vaginal sex anal sex oral sex - oral sex can either transmit gonorrhea from the genitals to the throat of the person giving the stimulation, or it can pass an infection from the throat to the genitals of the person receiving stimulation.

Less often it can be transmitted by:

a person using their mouth and tongue to lick or suck another person's anus; a person putting fingers into the vagina, anus or mouth of someone infected with gonorrhea, then touching their own mouth, genitals or anus without washing their hands in between.

Where to go for help

If you have any symptoms or you are worried you may have been infected with gonorrhea, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can.

Tests for gonorrhea

To test for gonorrhea an examination of the genital area will be carried out by a doctor or nurse and samples will be taken, using a cotton wool swab or sponge, from any infected areas - the cervix, urethra, anus or throat. Women will also be given an internal pelvic examination, similar to a smear test. A sample of urine may be taken. None of these tests are painful, but they may cause minor discomfort. If a person has had anal sex, it is important they tell the doctor so that a swab can be taken from the rectum. They should also tell the doctor if they have had oral sex so swabs can be taken from the throat.

Gonorrhea diagnosis and treatment

Samples taken during the examination will be sent to a laboratory to be tested for the bacterium Neisseria gonorrheae and will usually be available within a week. This may vary depending on which country the patient is in. Some sexual health clinics have rapid testing services to provide immediate results. In these clinics the doctor will check the sample for gonorrhea bacteria under a microscope to confirm an infection straight away. Treatment is easy and essential. The patient will be given an antibiotic in tablet, liquid or injection form. If the patient is allergic to any antibiotics, or if there is any possibility that they may be pregnant, it is very important that the doctor is informed as this may affect treatment options. Once a course of treatment is started it is important to complete it, even if symptoms diminish, to ensure the infection is cured.

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The doctor or health advisor will discuss the gonorrhea infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with as they will also be at risk of having gonorrhea and should be tested. The patient should not have penetrative sex until they have returned to the clinic and it is confirmed that the infection is gone. The doctor or health adviser will inform the patient which sexual activities are safe.

Follow-up
Once the patient has completed the course of treatment for gonorrhea, they should return to the clinic or their doctor for a check-up. Some types of gonorrhea are resistant to certain antibiotics. Further tests will be done to ensure the infection has cleared. If it has not then different, usually stronger, antibiotics will be prescribed.

Complications
Women Gonorrhea can cause Pelvic Inflammatory Disease (PID), an inflammation of the fallopian tubes (the tubes along which an egg passes to get to the womb), which increases the future risk of ectopic pregnancy (a pregnancy outside the womb) or premature birth. If a woman is pregnant and has gonorrhea when giving birth, the infection may be passed on to her child. The baby could be born with a gonoccocal eye infection, which must be treated with antibiotics as it can cause blindness. It is better for the woman to get treatment before giving birth. Men Gonorrhea can cause painful inflammation of the testicles and the prostate gland, potentially leading to epididymitus, which can cause infertility. Without treatment, a narrowing of the urethra or abscesses can develop after time. This causes considerable pain and problems whilst urinating.

Once gonorrhea has been successfully treated it will not come back unless the person becomes reinfected.

Prevention
Using a latex condom consistently and correctly during sex can reduce the chances of getting or passing on gonorrhea.

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Hepatitis B
Hepatitis B is similar to hepatitis A in its symptoms, but is more likely to cause chronic longterm illness and permanent damage to the liver if not treated.
How hepatitis B is spread

The hepatitis B virus (HBV) is very common worldwide, with more than 350 million people infected. Those with long term HBV are at high risk of developing liver cirrhosis or liver cancer. Hepatitis B is most frequently passed on through the exchange of bodily fluids with an infected person. HBV is estimated to be 50 to 100 times more infectious than HIV.1 HBV can be spread in the following ways:

By unprotected (without a condom) penetrative sex (when the penis enters the anus, vagina or mouth) with someone who is infectious. Also by sex that draws blood with someone who is infected. By sharing contaminated needles or other drug-injecting equipment. By using non-sterilised equipment for tattooing, acupuncture or body piercing. From an infected mother to her baby, most commonly during delivery. Immunisation of the baby at birth prevents the transmission of hepatitis B. Through a blood transfusion in a country where blood is not screened for blood-borne viruses such as HBV.

Hepatitis B cannot be spread through sneezing, coughing, hugging or coming in contact with the faeces of someone who is infected.
Signs and symptoms of hepatitis B

Many people who become infected with HBV experience mild symptoms or no symptoms at all, but they may still carry the infectious virus and pass it on to others. When symptoms do appear they are similar to those of hepatitis A and may include:

A short, mild, flu-like illness; nausea, vomiting and diarrhoea; loss of appetite; weight loss; jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces); itchy skin.

If symptoms become severe then a person with hepatitis B may be admitted to hospital. Most adults infected with the hepatitis B virus fully recover and develop life-long immunity. Between 2% and 10% of individuals infected as adults will become chronic carriers, which

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means they will be infectious to others and can develop chronic liver damage. Infected children, especially newborn babies, are much more likely to become chronic carriers. If a person lives with hepatitis B infection for a number of years then they may develop the following complications:

chronic hepatitis liver cirrhosis liver cancer

Where to go for help

If you have any symptoms or you are worried you may have been infected with hepatitis B, you should discuss your worries with a doctor. They may be able to run tests themselves, or else will refer you to someone who can. Some countries have specific sexual health clinics that can help you directly.
What does a positive test result mean?

A positive test result could indicate either of the following:

A past infection. This means the patient has already been in contact with hepatitis B and their immune system has succeeded in fighting off the virus. The patient will then have a natural immunity to the virus. The patient is a carrier. This means the patient is carrying HBV and can pass it on to others. The person may not display any symptoms but could be at risk of developing chronic liver disease.

A doctor may perform a number of different types of test to distinguish between current and past infections, and to estimate how infectious a patient with a current infection may be.
What does a negative test result mean?

This result generally means the patient has never been infected with HBV and therefore has no natural immunity against the virus. If the person suspects they may have been recently exposed to HBV, the doctor may advise them to take a repeat test to confirm their negative status, and may also advise immunisation against hepatitis B.
Treatment for hepatitis B

In most countries a patient with a positive test result will be referred to a specialist who will carry out further tests to determine the degree to which hepatitis B may be affecting the liver, and what may be the best treatment options. In these tests a small sample of liver tissue may need to be taken (a liver biopsy).

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In the majority of patients with active HBV, symptoms will not be severe and treatment will not be required. The patient will be monitored and after a few months the patients immune system should fight off the virus, giving the patient natural immunity. In around 5% of adults, 30-50% of young children (aged 1-4), and 90% of infants, HBV infection will become chronic. The virus is more deadly to the young and those that are infected at birth have a 25% chance of developing a life-threatening liver-related illness. Antiviral medication is given as treatment to those with chronic symptoms to help prevent further liver damage. These medications may be injected or given in pill form. Examples are Interferon Alpha, Lamivudine and Baraclude. Treatment usually lasts 6 months, during which time the patient will be carefully monitored. Regardless of whether the infection is producing symptoms or not, the patient will be advised to avoid alcohol, get plenty of rest and maintain a healthy diet.
Hepatitis B immunisation

Three immunisation injections are given over a period of 3-6 months. A blood test is taken once the course of injections is completed to check they have worked. Immunity should last for at least 5 years.
Follow-up

A patient with an active infection will be advised to have regular blood tests and physical checkups to monitor the virus, even if they are not receiving treatment. All carriers of HBV should expect to be referred to specialist services. The doctor or nurse may advise the patient to avoid alcohol, fatty foods and follow a low-salt diet. They will also describe any precautions necessary to ensure the patient avoids infecting others with the virus, such as not sharing toothbrushes or shaving equipment. It is important to use a condom for penetrative sex to prevent passing on the virus. Sexual partners of the patient should be tested and immunised against HBV (if not already infected).

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Herpes simplex viruses (HSV)

Genital herpes is caused by infection with herpes simplex virus (HSV). There are two types of HSV, HSV-1 and HSV-2, both of which belong to a wider group called Herpesviridae. Another well-known virus in this group is varicella zoster virus, which causes chicken-pox and shingles. In general:

HSV-1 is acquired orally, causing cold sores. HSV-2 is acquired during sexual contact and affects the genital area.

Although genital herpes used to almost always be caused by HSV-2 infection, HSV-1 is accounting for an increasing number of cases of genital herpes in developed countries.1 Only around 10-25 percent of people infected with HSV-2 are aware they have genital herpes.2 This is because genital herpes will often produce mild symptoms or no symptoms at all (asymptomatic infection). As a result, many cases of genital herpes go undiagnosed and frequently people unknowingly pass the virus on to their sexual partners.

Genital herpes symptoms and signs

If symptoms do occur, they will usually appear 2 to 7 days after exposure and last 2 to 4 weeks. Both men and women may have one or more symptoms, including:

Itching or tingling sensations in the genital or anal area; small fluid-filled blisters that burst leaving small painful sores (see STD pictures); pain when passing urine over the open sores (especially in women); headaches; backache; flu-like symptoms, including swollen glands or fever.

Subsequent outbreaks are usually milder and last for a shorter period of time, usually 3 to 5 days. The sores are fewer, smaller, less painful and heal more quickly, and there are no flu-like symptoms. Subsequent outbreaks, or primary outbreaks in people who have had the virus for some time but have previously been asymptomatic, usually occur during periods of stress or illness when the immune system is functioning less efficiently than normal.

How is genital herpes passed on?

Genital herpes is passed on through skin contact with a person infected with the virus, most frequently during sex. The virus affects the areas where it enters the body. This can occur during:

vaginal sex anal sex

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oral sex (HSV-1 or HSV-2) kissing (HSV-1 only)

Herpes is most infectious during the period when itchy sores start to appear on the skin during an outbreak. But even if an outbreak causes no visible symptoms or breaks in the skin, there is still a risk of the virus being passed on to another person through skin contact.

Where to go for help

If you have any symptoms or you are worried you may have been infected with an STD, you should discuss your worries with a doctor. They may be able to run tests or offer you treatment themselves, or else will refer you to someone who can. Some countries have specific sexual health clinics that can help you directly. Check you local telephone directory to see if you have a clinic near you.

Testing for genital herpes

A herpes test will usually involve the following examinations, which are carried out by a doctor or nurse.

A clinical examination will be done of a patients genital area. A sample will be taken, using a cotton wool or spongy swab, from any visible sores. Women may be given an internal pelvic examination (similar to a smear test). A sample of urine may be taken.

If the patients symptoms have already disappeared, or if there were no symptoms to begin with, a blood test can be taken to look for the virus. As in HIV testing, the herpes test works by searching for antibodies that the immune system produces to fight the virus. This means that the test is not effective until 3 months after exposure, as the body can take up to 3 months to produce an immune response. It is possible to have more than one sexually transmitted infection at the same time, so it is advisable to have a full check-up. Samples taken during an examination are sent to a laboratory for testing, and the result is usually available within 2 weeks, although this varies between countries.

Treatment for genital herpes

There is no cure for the herpes simplex virus and treatment is not essential, as an outbreak of genital herpes will usually clear up by itself. A doctor may however prescribe a course of antiviral tablets to reduce the severity of an outbreak. The antiviral tablets work by preventing the herpes simplex virus from multiplying.

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Once the initial outbreak of herpes is over, the virus hides away in the nerve fibres adjacent to the infection site, where it remains dormant, causing no symptoms. It is possible for the dormant virus to be 'reactivated' in some people, in which case it travels back down the nerve to the skin surface. Recurrences of genital herpes vary from person to person in frequency. Some will never experience an outbreak again, whilst others may have milder recurrences more than 6 times a year. Because these recurrent infections are milder, they often do not require treatment. When receiving treatment for genital herpes, the doctor or health advisor will discuss the genital herpes infection and answer any questions. They will also want to know about any partners the patient has had sexual contact with within a recent period, as they will also be at risk of having genital herpes and should be tested.

Help during an outbreak

If you are suffering from an outbreak of genital herpes, there are several things you can do that may help make it easier to cope with:

Take pain-killers (aspirin/paracetamol) for any pain. Gently bathe the sore areas with a salt solution (half a teaspoon of salt to half a pint of warm water) twice a day: it is soothing and helps the sores to dry out. Wear loose clothing so that the air can get to the sore areas. Place an ice-pack wrapped in a clean cloth or towel on the affected area. If passing urine is painful, try urinating in a bath of water, or pour water over yourself while urinating. Drink plenty of fluids, such as mineral water and soft drinks, to help neutralise the urine (it is important not to hold back from passing urine as this can cause further problems). Avoid sunbathing and using sunbeds. Get plenty of rest.

Taking care of yourself and your partner

During an outbreak of genital herpes, the sores are highly infectious and the virus can be passed on to others by direct contact. To prevent this from happening, you should avoid:

Kissing when you or your partner have cold sores around the mouth; having oral sex when you or your partner have oral or genital sores; having any genital or anal contact, even with a condom or dental dam, when you or your partner has genital sores; using saliva to wet contact lenses if you have sores around your mouth.

Remember - wash your hands with soap before and after touching the sores.

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Although the likelihood of transmitting genital herpes to your partner between outbreaks is much reduced, there is still some risk. Having genital herpes does not mean the end of your sex life. Ask your doctor or clinical health advisor for advice. Remember, a condom will only protect against herpes infection if it covers all the sores. Herpes can also be transmitted by non-penetrative sex.

Complications
HIV and genital herpes

Those with suppressed immune systems are likely to have more frequent and severe recurring episodes of genital herpes. They may also have more asymptomatic outbreaks (where the virus travels up the nerve to the surface of the skin but causes no blisters) during which time the virus can be passed on. A genital herpes infection increases the risk of becoming infected with HIV by up to three times in both men and women.3 This is due to the breaks in the skin caused by HSV, that facilitate entry of HIV.
Pregnancy and genital herpes

Having herpes does not affect a woman's ability to become pregnant. However, if herpes is transmitted in the first 3 months of pregnancy there is a small risk of a miscarriage. A first episode of herpes during pregnancy carries a greater risk of transmission to the baby. Becoming infected towards the end of pregnancy may cause the baby to be born early. Though transmission of herpes from a mother to her newborn is rare, if it does occur, it can pose a serious risk to the baby. If left untreated, the infection can cause damage to a newborn's internal organs, skin, and central nervous system and may even prove fatal. Prompt testing and treatment with acyclovir of any baby thought to be at risk is therefore essential. However, most women who have an outbreak (or even several outbreaks) of genital herpes during pregnancy have a normal delivery and a healthy baby.

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GENITAL WARTS
Introduction
Genital warts, caused by some types of HPV (human papillomavirus), can appear on the skin anywhere in the genital area as white or flesh-coloured, smooth, small bumps, or larger, fleshy, cauliflower-like lumps (see genital warts pictures). There are more than 100 different subtypes of HPV, and around 30 of them specifically affect the genitals. Other HPV subtypes cause warts to grow on different parts of the body, such as the hands. Not everyone infected with HPV will develop genital warts. Some people will be infected with a strain that does not produce warts, or they will remain asymptomatic (i.e. no warts will appear), even though the virus is present in the skin or mucous membranes around the genital area, or on the cervix in women. Those who do go on to develop genital warts will usually notice them 1 to 3 months after initial infection.

What are the symptoms of genital warts?

If symptoms do appear then the infected person may notice pinkish/white small lumps or larger cauliflower-shaped lumps on the genital area. Genital warts can appear on or around the penis, the scrotum, the thighs or the anus. In women genital warts can develop around the vulva or inside the vagina and on the cervix. If a woman has warts on her cervix, this may cause slight bleeding or, very rarely, an unusual coloured vaginal discharge. Warts may occur singly or in groups. The warts may itch, but they are usually painless. Sometimes genital warts can be difficult to spot. In severe cases, it is possible for genital warts to spread from the genitals to the area around the anus, even if anal intercourse has not occurred. Occasionally, people can confuse skin problems caused by other STDs (such as genital herpes, syphilis or molluscum) with genital warts. Other people may become very worried because they mistake perfectly normal and non-infectious lumps and bumps for genital warts. Conditions that may be confused with genital warts include:

Pearly penile papules - small white or skin-coloured bumps that, when numerous, appear in a ring around the edge of the head of the penis. More rarely, similar papules may be found on the vulva. Angiokeratomas - bright red or purple spots that look a little like blood blisters. Sebaceous glands (also known as 'Fordyce spots') - hard white, yellowish or skin-coloured little bumps that may be found all over the skin of the penis and scrotum in men, and the vulva in women. Sebaceous glands produce a substance called sebum, which keeps the skin healthy. Pimples or spots - caused by blocked sebaceous glands. Pimples and spots can form just as easily around the genital area as they do on the face, and may become sore and inflamed in a similar way.

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All of the above are common, non-infectious skin manifestations that are not sexually transmitted. Any doubt about lumps and bumps on the genitals can usually be resolved by a visit to a doctor or sexual health clinic.

How is HPV passed on?

Genital HPV is transmitted by genital skin-to-skin contact, or through the transfer of infected genital fluids. This is usually during vaginal or anal sex, but it is also possible to pass it on through non-penetrative sexual activity. In rare circumstances, a woman can pass HPV on to her baby during vaginal child birth.

"I think I may have genital warts"

If you have any symptoms or are worried you may have been infected with an STD, there are a number of places you can go for help.

You can visit your doctor, who may be able to tell whether you have genital warts just by looking closely at the affected area. If you would prefer, they will probably be able to refer you to a specialist clinic to get tested. Some countries also have specific sexual health clinics that can test for a range of STDs.

If genital warts are suspected but are not obvious, the doctor or nurse may apply a weak vinegarlike solution to the genital area; this turns any warts white and makes them more visible. To check for hidden genital warts, the doctor may carry out an internal examination of the vagina, cervix and/or anus. If a person suspects they have been exposed to HPV, but does not yet have symptoms, their doctor may be able to take a swab to test for high-risk strains of the virus (this isn't available in all countries). In women, this may be performed alongside a cervical Pap smear test (see below). Not everyone diagnosed with HPV will develop warts, and patients may be asked to come back for another examination at a later date if nothing is yet visible.

Treatment for genital warts

There is no treatment that can completely eliminate genital warts once a person has been infected. Often outbreaks of genital warts will become less frequent over time, until the body naturally clears the virus and the warts disappear of their own accord. However, in some people the infection may linger.

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A doctor can give patients various treatments to clear genital warts, but they may reappear even after treatment. Genital warts are caused by a virus, not a bacterium, so antibiotics will not get rid of them. Common treatments include:

Podophyllin resin a brown liquid that removes genital warts by stopping cell growth. Podophyllin resin and podofilox lotion is painted on to the wart(s) by a doctor or nurse and must be washed off 4 hours later (or sooner, if the area is irritated). It has to be applied by a medical professional to avoid damaging the healthy tissue around the wart and may have to be applied several times to work effectively. Podopfilox lotion/gel can be applied to the wart(s) by the patient at home. The usual schedule is twice a day for 3 days, followed by 4 days without any lotion. This cycle is repeated for 4 weeks. It has few side effects and is well-suited for treatment at home. Cryocautery (also called cryotherapy) uses liquid nitrogen to freeze more persistent warts every 1 to 3 weeks for a short period. Laser treatments this approach, which uses an intense beam of light, can be expensive and is usually reserved for very extensive and tough-to-treat warts. Electrocautery an electrical current is used to super-heat a needle which burns the wart cells and cauterises the blood vessels. A local anesthetic is used to prevent any pain and the procedure is usually carried out at a doctor's surgery. Electrocautery is used only after other treatments have failed. Surgical excision the doctor will perform minor surgery to remove the wart under local anesthetic.

The doctor or nurse should give the patient advice about having sex whilst receiving treatment. There are some non-prescription treatments available for genital HPV, but it is advisable to always seek medical advice. Never try to treat genital warts by yourself. It is important that a woman who is pregnant, or trying to become pregnant, informs her doctor. Podophyllin treatment could harm the developing baby and an alternative treatment should be used.
Follow-up

It is important to return regularly for treatment until all of the genital warts have gone so the doctor or nurse can check progress and make any necessary changes in your treatment. Sometimes treatment can take a long time. The majority of people whose genital warts initially disappear will get a recurrence. In the majority of cases, the immune system keeps the virus under control and eventually destroys it a few years after the initial infection.

Taking care of yourself and your partner

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If you have genital warts, following these suggestions will make an outbreak easier to deal with, and will help protect your partner.

Use condoms when having sex. But remember that condoms will only prevent the transmission of genital warts if they cover the affected areas. Talk to your doctor or nurse for more advice on safer sex. Make sure that your partner has a check-up too, as they may have warts that they haven't noticed. Keep your genitals clean and dry. Don't use scented soaps and bath oils or vaginal deodorants, as these may irritate the warts.

HPV and cervical Pap smear tests

Some types of the human papilloma virus (notably types 16 and 18) have been linked to changes in cervical cells that can lead to cancer. This is why it is important that all sexually active women have a regular cervical Pap smear test. A smear test is performed by opening the vagina using a speculum (a metal instrument that gently stretches the entrance and the walls of the vagina) and taking a small sample of cells from the cervix with a special swab. The cells will then be looked at under a microscope. If any changes to the cells are noted, the woman may be asked to repeat the test or will be referred for treatment that can prevent the cells from developing into cervical cancer. It is important to note that cell changes (also called cervical dysplasia) DO NOT indicate that a woman already has cancer. Most of these changes will go away on their own, or with treatment. However, it is very important to monitor the cell changes closely, as there is a risk that they may turn precancerous if they do not clear. A woman who has received an abnormal Pap smear result may sometimes be given a colposcopy to look at cells on the cervix. A colposcope is a kind of small microscope with a light which is used to view the cervix. The scope magnifies the cervix so the doctor can see any changes or problems. The doctor may take a small sample of cells (called a biopsy), which will be looked at in a laboratory. The colposcopy may feel slightly uncomfortable. If the patient has a biopsy taken then they may have a dull ache like a mild period cramp, with slight bleeding. Treatment to remove abnormal cells on the cervix will usually consist of cryocautery (freezing the cells using a special cold probe), electrocautery (heating the cells with electricity) or using laser treatment to 'zap' the cells. None of these procedures should be painful, but they may lead to dull aching (like period pains) and watery vaginal discharge that may last several weeks. A woman who has had visible genital warts in the past is not necessarily at any greater risk of cervical cancer, as genital warts tend to be linked to non-cancer causing subtypes of HPV.
Pap smear tests of the anus and rectum

The subtypes of HPV that can lead to cervical cancer may also pose a risk for men and women who have regular anal sex. Though few countries offer regular screening for anal and rectal

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cancer, many doctors recommend that people who have frequent anal sex (such as gay or bisexual men) should still receive a regular Pap smear test of the rectum and anus. As with cervical cell changes, early detection and treatment can help to prevent cancer from developing.

Is there a vaccine against genital warts?

Two vaccines are currently used to prevent cervical, vulvar and vaginal cancers, and genital warts caused by some of the major subtypes of HPV. Gardasil marketed by Merck, was first approved by the Food and Drug Administration (FDA) for use in the United States of America in June 2006.1 The vaccine is now approved in over 100 countries. Gardasil has also been found to provide protection for men against anal disease caused by some types of HPV.2 The other FDA approved vaccine, Cervarix (marketed by GlaxoSmithKline), is used in the UK's HPV vaccination programme for girls run by the National Health Service. The vaccines are not recommended for pregnant women and a very small number of people may not be able to have the vaccine due to specific medical reasons. The vaccines may also be less effective in women who are already sexually active, as they may have already been infected with HPV. HPV vaccines do not protect against all cervical cancers, so it is important for women to continue attending cervical Pap smear tests.

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AIDS

What is AIDS?
AIDS stands for: Acquired Immune Deficiency Syndrome

AIDS is a medical condition. A person is diagnosed with AIDS when their immune system is too weak to fight off infections. Since AIDS was first identified in the early 1980s, an unprecedented number of people have been affected by the global AIDS epidemic. Today, there are an estimated 34 million people living with HIV and AIDS worldwide.

What causes AIDS?

Acquired Immune Deficiency Syndrome, shortened AIDS, is caused by HIV. Some people may refer to AIDS as advanced HIV infection. HIV is a virus that gradually attacks immune system cells. As HIV progressively damages these cells, the body becomes more vulnerable to infections, which it will have difficulty in fighting off. It is at the point of very advanced HIV infection that a person is said to have AIDS. If left untreated, it can take around ten years before HIV has damaged the immune system enough for AIDS to develop.

What are the symptoms of AIDS?

A person is diagnosed with AIDS when they have developed an AIDS related condition or symptom, called an opportunistic infection, or an AIDS related cancer. The infections are called opportunistic because they take advantage of the opportunity offered by a weakened immune system. It is possible for someone to be diagnosed with AIDS even if they have not developed an opportunistic infection. AIDS can be diagnosed when the number of immune system cells (CD4 cells) in the blood of an HIV positive person drops below a certain level.

Is there a cure for AIDS?

Worryingly, many people think there is a 'cure' for HIV, the virus that causes AIDS - which perhaps makes them take risks that they otherwise wouldn't. However, there is still no cure for
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HIV. The only way to ensure that you avoid AIDS is to be aware of how HIV is transmitted and how to prevent HIV infection. However, people can take antiretroviral treatment, which suppresses the HIV virus. This can prevent them from reaching a point where they are diagnosed with AIDS. Also, in some cases, it is possible for a person who has an AIDS diagnosis to regain a strong immune system with antiretroviral therapy. However, once somebody is diagnosed with AIDS, officially they keep this diagnosis for life even though in reality an opportunistic infection may be cured or the number of immune system cells (CD4 cells) in their blood may increase to recommended levels.1

How many people have died from AIDS?

Since the first cases of AIDS were identified in 1981, more than 30 million people have died from AIDS. An estimated 1.8 million people died as a result of AIDS in 2010 alone. Although there is no cure for AIDS, HIV infection can be prevented, and those living with HIV can take antiretroviral drugs to prevent or delay the onset of AIDS. However, in many countries across the world access to prevention and treatment services is limited. Global leaders have pledged to work towards universal access to HIV prevention and care, so that millions of deaths can be averted.

How is AIDS treated?

Antiretroviral treatment can significantly prolong the lives of people living with HIV. Modern combination therapy is highly effective and someone with HIV who is taking treatment could live for the rest of their life without developing AIDS. An AIDS diagnosis does not necessarily equate to a death sentence. Many people can still benefit from starting antiretroviral therapy even once they have developed an AIDS defining illness. Better treatment and prevention for opportunistic infections have also helped to improve the quality and length of life for those diagnosed with AIDS. Treating some opportunistic infections is easier than others. Infections such as herpes zoster and candidiasis of the mouth, throat or vagina, can be managed effectively in most environments. On the other hand, more complex infections such as toxoplasmosis, need advanced medical equipment and infrastructure, which are lacking in many resource-poor areas. It is also important that treatment is provided for AIDS related pain, which is experienced by almost all people in the very advanced stages of HIV infection.

Why do people still develop AIDS today?

Even though antiretroviral treatment can prevent the onset of AIDS in a person living with HIV, many people are still diagnosed with AIDS today. There are four main reasons for this:

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In many resource-poor countries antiretroviral treatment is not widely available. Even in wealthier countries, such as America, many individuals are not covered by health insurance and cannot afford treatment. Some people who became infected with HIV in the early years of the epidemic before combination therapy was available, have subsequently developed drug resistance and therefore have limited treatment options. Many people are never tested for HIV and only become aware they are infected with the virus once they have developed an AIDS related illness. These people are at a higher risk of mortality, as they tend to respond less well to treatment at this stage. Sometimes people taking treatment are unable to adhere to, or tolerate the side effects of drugs.

Caring for a person with AIDS

In the later stages of AIDS, a person will need palliative care and emotional support. In many parts of the world, friends, family and AIDS organisations provide home based care. This is particularly the case in countries with high HIV prevalence and overstretched healthcare systems. End of life care becomes necessary when a person has reached the very final stages of AIDS. At this stage, preparing for death and open discussion about whether a person is going to die often helps in addressing concerns and ensuring final wishes are followed.

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