Sexually Transmitted Diseases

Sexually transmitted infections (STIs) can affect you at any age, whether you're straight or gay, in a long-term relationship or with a casual partner. Symptoms don't always show up immediately, so you could have been infected recently or a long time ago. It is important to ensure that you always practice safe sex by using a condom. If you haven't practised safe sex, you can have a confidential check-up and treatment if needed, at a genitourinary medicine (GUM) or STI clinic. Call NHS Direct for details of your nearest clinic.

Chlamydia
Around 10per cent of men and 14 per cent of women in the UK are carrying Chlamydia. There may be an intense burning sensation when passing water possibly with a white discharge but it generally causes few problems for men other than this discomfort yet can be disastrous for women as it is the single biggest cause of:

• Infection of the Fallopian tubes (pelvic inflammatory disease),
• Infertility,
• Ectopic pregnancy (a potentially lethal condition where the baby attaches to the wall of the Fallopian tube instead of the wall of the womb),

As with all other STIs, condoms provide almost total protection. Unlike some, it is treatable with antibiotics and early diagnosis can limit its impact considerably.

Hepatitis B
Although Hepatitis B is one of the more deadly sexually transmitted diseases, there is now a protective vaccine to prevent it yet the number of infected people is rising steadily.

Obviously, most people will not require immunisation, but depending upon your lifestyle it may be wise to consult your GP. Like HIV it is transmitted through bodily fluids and it only requires a tiny fraction of a drop of blood to transmit the disease. For this reason it can be caught from sharing a toothbrush or kissing when there is bleeding from the gums. Worse still, the virus can survive a week or more in the dried state and so can be picked up from a razor or toothbrush.

Genital Herpes
Number three in the league table for STIs and roughly 50% of infected people who never have another attack but it is impossible to completely get rid of the virus. Herpes Simplex Virus (HSV) comes in two forms, HSV I and HSV II.

• Both infect the same places and are likely to infect parts of the body where two types of skin meet together
• Both forms can infect the corners of the mouth, the outer parts of the genital areas and even the anus
• Both cause crusted blisters and then ulcers that weep a thin, watery substance. This substance is highly infectious.

Coming in attacks which can last for months and then disappear for years, or even never return, you are definitely infectious during the presence of the sores. Even when sores are not present, it might be possible to pass on the infection. Stress and coincidental illness can bring on these attacks. For some people, the condition will pass unnoticed, with only tiny ulcers on the genitals to show its presence.

Treatment
Anti-viral drugs can be applied directly to the affected skin or taken orally. They are most effective if used before the sores break out. This is signalled by a tingling, itchy, painful sensation in the affected area. They are only effective during the first attack in some people and have not been shown to have any impact on subsequent attacks. Condoms with a spermicide appear to offer greater protection than those without. You need to arrange your sex life around the condition if you are having an attack as this means you are highly infectious. Otherwise, the use of condoms gives maximum protection for your partner.

Genital warts
We simply do not know how many people have genital warts but at least one in eight people attending GUM clinics has genital warts. It may be a factor in causing cervical cancer in women and rectal cancer in gay men.

Papilloma viruses, which cause warts, can affect any part of the skin. The virus can be transmitted by physical contact including sexual intercourse. Like the warts commonly seen on people's hands, they can vary in size from tiny skin tags to large fungating masses like cauliflowers. While the latter are hard to miss, the less obvious form can be prevented from causing infection only by covering the area completely.

Treatment
There are lotions applied directly to warts, which will cause them to disappear. Use a condom to prevent catching them in the first place.

Syphilis
Once almost extinct in the UK, is on the big increase. It is caused by a microscopic parasite and highly infectious. Most people are unaware of the infection but if it is not treated it can develop over a number of years into a condition that can affect the brain. Women show few signs of the infection in the early stages except for small ulcers around the vagina so it can go unnoticed by the woman or by their partner during intercourse. Condoms give almost 100% protection and penicillin injections will cure it when caught early.

Trichomoniasis
This microscopic parasite lives in the urinary tract and usually causes pain when passing water but can be completely symptomless. When it has no effect on the male partner but the female partner complains of a smelly green discharge from the vagina, tests may show its presence in the man. A course of the antibiotic metronidazole will get rid of it but you must not drink alcohol as it will make you very sick.
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Gonorrhoea
Commonly known as the clap from the French word clapoir meaning sexual sore it is not rare causing a yellow/white discharge from the penis and vagina, along with pain on passing water. The infected anus may have a similar discharge. Most of the symptoms of infection will start within 5 days of infection and include a vague ache of the joints and muscles. Although these can disappear after a further 10 or so days, the person remains infectious. It can cause reduced fertility if not treated.
Although antibiotics are usually effective condoms provide almost 100% protection from infection in the first place.

HIV & AIDS
Early stages of infection generally go unnoticed and it needs an antibody test from a blood or saliva sample to confirm the presence of the virus. The appearance of the antibodies can take months and is known as seroconversion. A vague non-specific illness similar to flu or glandular fever sometimes follows the infection at around 6 to 7 weeks later. A variable period of time, years even, can then pass completely symptom free. The occurrence of oral thrush, persistent herpes (cold sores) or strange chest infections which clear only slowly with treatment are ominous signs of the body's declining ability to fight off other infections.

Causes
Body fluids are often cited as the carrier of the virus. Actually this can be narrowed down to blood, semen and saliva. Although the risk of infection from saliva is extremely small it makes sense to avoid obvious risks such as oral sex without adequate protection. The main routes of infection are:

• Sexual transmission via blood from small cuts either in the mouth (oral sex), vagina, anus or penis. Sexual orientation is not exclusive with both gay and straight men at risk
• Blood transfusion in countries with poor medical resources is still a risk and you can buy a travel kit from your GP
• Sharing dirty needles or even razor blades.

Prevention
According to the World Health Organisation (WHO) up to 90 per cent of those people infected in the World contracted HIV through heterosexual sex of whatever form. Dental dams, male and female condoms particularly those containing the spermicide non-oxynol-9 give a high degree of protection. Use stronger condoms such as Durex Extra Safe, Mates Extra Strong, HT Specials or Gay Safe. This will protect both you and your partner.

Although extra lubrication is often required, do not use an oil-based lubricant such as Vaseline, baby oil, margarine or butter. They will damage the condom. There are water-based lubricants available such as KY Jelly or Foreplay. If you are not sure, ask the chemist, they sell thousands of them and will not be embarrassed to give advice

Your choice for treatment
You can attend either your own doctor or the local genitourinary medical clinic (GUM), which is located at one of the major hospitals in your area. Confidentiality is all-important at these clinics. You will need to be honest to the doctor who asks you questions, as it can be impossible to work out what is wrong without the correct information. You can give a false name or remain anonymous if you feel more comfortable, although there is no chance of the fact of your attendance going any further, even to your GP, let alone any diagnosis that may be made.

Certain tests may be needed to make an accurate diagnosis, although it may be fairly obvious on your first visit and the treatment may start immediately with no return needed. It is worth remembering that the doctors and nurses who staff these clinics are professionals who see you as simply a person who, like any other patient, needs treatment.