In this section learn more about common sexual health topics. We have split this section into sexually transmissible infections and those that are not sexually transmissible but affect the genital tract.
SEXUALLY TRANSMITTED INFECTIONS
STIs are infections that can be passed from one person to another during unprotected sexual or close genital-to-genital (intimate) contact. STIs can infect various parts of your body depending on your sexual practises. This can include the penis, vagina, vulva, cervix, anus, skin and throat.
Some people are at greater risk of STIs than others. This includes those who have unprotected sexual contact with casual partners (the more partners, the greater the risk) or with a partner who has casual unprotected intercourse. It is riskier when you or your partner travel outside of Australia and engage in unprotected sex with others, or if you/your partner has injected drugs. Men who have unprotected sex with other men are also at higher risk.
Getting regularly tested for STIs is important because many STIs can have no symptoms, so there is a chance that you or your partner could be infected without knowing it.
Chlamydia is a common bacterial infection that is sexually transmitted in both men and women. Condom use reduces your likelihood of infection. Most chlamydia infections do not cause any symptoms (asymptomatic). However, symptoms can include discharge, irregular bleeding (especially after sex), or burning when you pee. The tip of the penis might be red. There might also be discharge from the tip of the penis.
Yearly testing for chlamydia is recommended for people aged 30 and under, who have sex. More frequent testing is recommended in higher risk groups. Testing for chlamydia is easy. It can be done on a swab from the cervix, anus or with a urine sample. Treatment is simple and effective with antibiotics. However if symptoms do continue, sometimes a longer course of treatment is required. If left untreated chlamydia can cause fertility problems, as well as ongoing pelvic and testicular pain.
If you have chlamydia there is a high chance your partner(s) has it too. All your current sexual partners should be tested and treated. Remember – using a condom every time will help reduce the risk of chlamydia. It is important not to have sex for 7 days (even with a condom) after you and your partner are treated. It is recommended to have a repeat chlamydia test 3 months after treatment to ensure you have not been re-infected (one month if anal chlamydia was detected).
Genital herpes is caused by two related viruses (Herpes simplex virus 1 and 2 (HSV-1 & HSV-2)). The virus initially enters the body through tiny abrasions in skin and then enters nerve cells within the skin – where it can persist for life. Your immune system keeps the virus under control. However when it is weakened, the virus can re-emerge and cause symptoms.
For some people, they will have no symptoms at all. For others, especially with their first infection, they may have very painful ulcers, flu-like symptoms and pain with urination. Future recurrences are not usually as severe and typically are small blisters or ulcers. The blisters can occur in the genital region but also the thighs, buttocks, and anus. Virus can be shed to others at these times. People who have cold sores (again same virus!) around their mouth can also pass this infection to their partner – either with direct mouth/mouth kissing or through oral sex.
A swab from an ulcer or blister can be taken and sent to the laboratory to assess for viral DNA. Bloods tests for Herpes infection are not recommended as they lack sensitivity and specificity.
Genital herpes are treated with antiviral medications. These are very effective and very safe. Recurrences can be treated with short courses of therapy, started at the very first sign of symptoms. Frequent recurrences can be suppressed by taking a continuous daily dose of as little as 1 tablet daily. Suppressive therapy also has the advantage of reducing transmission to sexual partners.
There are a number of things you can do to prevent infection. Use a condom at all times helps to reduce the likelihood of coming into contact with the virus. Having fewer partners reduces this risk too. Avoid direct skin-skin contact with a partner who has an active lesion although it is important to know that virus may be present before a lesion is seen. A partner who has genital herpes may choose to take suppressive treatment to reduce the likelihood of spread to others.
A virus called Human Papilloma Virus (HPV) causes genital warts. It is another common STI which often shows no symptoms and does not require treatment, however sometimes HPV can cause genital warts (and is also responsible for some cancers in the genital region). Genital warts vary in size and shape but are often a cauliflower-type appearance.
There are a number of subtypes of HPV. Some are linked with genital cancers such as HPV 16 and 18. Others are linked with genital warts such as HPV 6 and 11. Most sexually active people will be exposed to HPV during their lifetime. Most of these people will clear HPV infection spontaneously (they do not require treatment and they may in fact not even realise they have had this infection). Spread of this virus is by direct skin-to-skin contact. Warts can appear within several weeks to months of exposure.
Genital warts are diagnosed clinically (by looking at them). If you have a new lesion or growth that you are concerned about, see your GP for a sexual health check up. Genital warts can be treated successfully in a number of ways.
HPV infection can be prevented with Gardasil vaccination. This helps prevent infection with the common subtypes of HPV that cause warts as well as genital cancers. The vaccine is provided free in Australia to all year 7 students. In 2018, the government has also funded a program to provide free Gardasil vaccination to all men aged under 26 who have sex with men.
Gonorrhoea is an STI that infects the penis, cervix, anus, throat and eyes. Rarely it can spread to the bloodstream causing fever, joint pain and skin lesions. It is spread by unprotected intercourse.
Men with gonorrhoea (in the penis) usually have symptoms, while infection in the anus and throat is usually asymptomatic. When present, symptoms can include a yellow or white discharge from the penis, discomfort with passing urine, redness at the opening of the penis and sometimes discharge and discomfort in the anus. Symptoms usually develop within 1-3 days of infection.
Most women with gonorrhoea do not have any signs or symptoms of infections. However it can cause a vaginal discharge, irregular bleeding, discomfort with urinating and pelvic pain. If the anal canal is infected, this can also cause discomfort and discharge. The time to develop symptoms in women varies. Like some other STIs, if left untreated it can cause future fertility problems.
To test if you have gonorrhoea, a urine sample or swab from an appropriate body site is taken by your health professional. It is treated with antibiotics and symptoms usually ease within 1 day of treatment. If symptoms continue for more than a week after treatment, then it is important to see your doctor again. Sex should be avoided for one week after completing treatment, this includes even with a condom.
Hepatitis means inflammation of the liver. An estimated 232 000 people are living in Australia with Hepatitis B infection. Hepatitis B infection can have serious health effects. The Hepatitis B virus is found in blood and to a lesser degree other bodily fluids such as semen, vaginal secretions and saliva.
You can get Hepatitis B from the following activities:
- Mother to child: from a mother with Hepatitis B to her baby during pregnancy and delivery
- Unsafe vaginal or anal sex (not wearing condoms)
- Sharing equipment used for injecting drug use
- Skin piercing and tattoos with equipment that is not cleaned and sterilized properly
- Sharing razor blades or toothbrushes with someone who has the virus
- The blood from a person with Hepatitis B coming into contact with an open cut or wound of a person who does not have the virus
All blood and blood products produced for medical purposes in Australia are carefully screened for Hepatitis B and other blood-borne viruses.
A blood test can be performed to determine if you have been infected with Hepatitis B. Many people who become infected with Hepatitis B show no signs of infection. Children are less likely to have symptoms than adults. If symptoms are present they often last only a few weeks and may include loss of appetite, nausea, vomiting and tiredness. In more severe cases additional symptoms of pain in the liver and joints, fever, and yellowing of the eyes and skin known as jaundice can occur.
Most adults infected with Hepatitis B completely recover and do not become infected again. However, about 5% of adults who become infected with the Hepatitis B virus develop long term (chronic) Hepatitis B infection. Chronic infection means the virus stays in the bloodstream for a person’s entire life. A person with chronic Hepatitis B may ‘carry’ (and transmit) the virus for life without showing any signs or symptoms and may not know they have it. Chronic infection increases the risk of a person developing cirrhosis and cancer of the liver in later life.
Immunisation is the best protection against Hepatitis B and is recommended for everyone. Practice safe sex by using condoms every time you have anal or vaginal sex. For adults a full course of Hepatitis B vaccination consists of 3 doses over six months. All 3 doses are required to give 90% protection.
Mycoplasma genitalium (MG) is a bacteria that infects the urethra, cervix and anus. It is passed on through unprotected intercourse. Men can have pain with passing urine and a discharge from the penis. Women may be asymptomatic or might have pain during intercourse, abnormal vaginal discharge or bleeding or pain with urinating. Testing for MG can be done on a urine sample or swabs from vagina, cervix, anus or urethra. Antibiotics are used to treat the infection. You should abstain from intercourse (or use condoms 100% of the time) until you and your partner have tested negative for MG following treatment. This follow up testing is done one month after completion of antibiotics.
Crabs or pubic lice infest hair – commonly pubic hair, but also armpits, eyebrows, eyelashes and facial hair. The infection causes no serious harm. They are usually transmitted through skin-to-skin contact, sexually. Itching is the main symptom, often worse at night. Diagnosis is made by seeing the lice or eggs. Treatment involves topical creams/lotions such as permethrin. Sexual partners should also be treated. Bedding and clothing should be washed well. Shaving pubic hair can also be helpful. Permethrin should not be applied to eyelashes. If this area is affected, speak to your health professional.
Syphilis is an STI caused by a bacterium called Treponema pallidum. Syphilis can be contracted through oral, vaginal or anal intercourse with a person who has syphilis. It is transmitted through skin-to-skin contact with an infected area. Using condoms greatly reduces your chance of contracting syphilis. It can also be transmitted from mother to baby in utero.
Not everyone will have signs or symptoms of syphilis. Those that do might have a hard painless sore on the genitals, or other sites of sexual contact such as mouth or anus. This is called Primary Syphilis. A sore can appear 10 days to 3 months after infection making it difficult sometimes to know when you caught syphilis. The sore usually heals itself without treatment. However, if you have not had treatment, you are still contagious to others. Secondary syphilis can occur 2-4 months after infection and can last many weeks. There may be a red rash on hands, feet and torso. People may feel tired and have fevers. This can continue for up to 2 years if not treated. When the rash is present, people are highly contagious. Latent syphilis occurs when syphilis is not treated in primary or secondary stages. Most people are asymptomatic. It can cause serious problems in some by spreading to the brain and heart. This stage is not infectious but is harder to treat.
Testing for syphilis can include a swab if a sore is present or a blood test. Syphilis is treated with antibiotics. Treatment is straightforward but further testing to ensure it has worked is important. All sexual partners in the last few months should be tested if you have syphilis.
This is a genital infection that commonly affects older women. Many women will have no symptoms but those that do, can experience a green frothy vaginal discharge, vaginal odour, itching and burning. Men can have penile discharge and pain when they urinate. Most will also be asymptomatic. Trichomonas can be transmitted by having unprotected intercourse. It is diagnosed with a vaginal or penile swab if discharge is present, otherwise a urine sample can be taken. It can be treated with antibiotics. It is important that all sexual partners are treated, even if asymptomatic.
This is the name given to the inflammation of the urethra, (the tube that connects the bladder to the outside of your body). People with urethritis can have pain whilst passing urine, and also experience discharge. The most common causes of urethritis are chlamydia, gonorrhoea and Mycoplasma genitalium. When someone has symptoms of urethritis but their tests for these 3 causative agents are negative – they are said to have non-specific urethritis. Other causes can include adenovirus and herpes. Treatment is usually with antibiotics. Symptoms should improve in a few days and it is important to treat all sexual partners. Intercourse should be avoided for 7 days after the treatment. If symptoms do not resolve, it is important to see your doctor again.
PRE EXPOSURE PROPHYLAXIS (PrEP)
For our patients who are at risk of HIV infection, our GPs at Royal Park Medical are able to prescribe PrEP (pre-exposure prophylaxis) to help minimise the risk of infection. After an initial assessment appointment, those eligible for PrEP will be seen monthly for their ongoing prescriptions.
Certain groups in our community are at higher risk of certain infections. Gay and bisexual men are at increased risk of meningococcal disease and hepatitis and more likely to spread the infection to others in their social and sexual group. As are individuals who inject drugs. The Victorian Government has funded some vaccinations for MSM and IV drug users.
Until 31 December 2018, all men who have sex with men (MSM) who live in Victoria, and all men and women who have injected drugs in the past 12 months and live in Victoria, can access a free, 2 dose vaccine course of hepatitis A, Havrix 1440®.
The free meningococcal ACWY vaccine, Menactra® program has been extended and is now free for all MSM until 31 December 2018.
The human papillomavirus 3 dose vaccine course, Gardasil®, is now free for all MSM aged up to 26 years of age until 31 December 2018.
The hepatitis B vaccine, Engerix B®, remains free to all MSM and all men and women who inject drugs as a long-term approach to protect against liver disease and liver cancer.
For any questions, speak to your health professional.
NON SEXUALLY TRANSMITTED INFECTIONS
Balanitis is an inflammation of the glans or head of the penis. Symptoms include; pain, redness, itchiness and sometimes a discharge from under the foreskin. It is most common in uncircumcised men. Causes include skin disorders, infection, poor hygiene, uncontrolled diabetes and overuse of soaps. Preventing balanitis includes washing under the foreskin and head of the penis daily with warm water and soap free wash. Drying the tip of the penis following washing helps. During urination, pull the foreskin back so urine does not pool under it. Wash and dry the penis after sex and masturbation. If you experience balanitis frequently, or if your foreskin is too tight to roll back easily, see your doctor.
BACTERIAL VAGINOSIS (BV)
The healthy vagina contains many different types of bacteria. In BV, there is a change in the balance of these bacteria. This may result in an unpleasant or fishy odour and/or discharge. The actual cause of BV remains unclear but appears more common in sexually active women. It is not clear if BV is transmitted through sex, or whether sexual activity itself causes BV.
Women are more likely to develop BV if they do not use condoms regularly, have a female partner, douche (overwash the vagina with soap and other products) and have a change in sexual partner.
Testing for BV includes a history from the patient, examination and microbiological findings such as on a vaginal swab. It can be treated with antibiotics. Many women will experience a recurrence of BV. Currently there isn’t a way to avoid getting BV. However condoms may help avoid it, as well as not douching.
Thrush is caused by an overgrowth of a yeast within the vagina. It is extremely common with 95% of women having thrush at some point in their lives. There are many types of yeast causing thrush, the commonest being Candida albicans. This is different to the yeast found in food and beer.
The vagina has a small number of yeast, which is normal. It is when they overgrow that you can experience symptoms such as itch, vulval discomfort and discharge. The vulva and vagina can become red and swollen. Thrush can occur for no apparent reason but it is more likely to happen if pregnant, you have diabetes, you have recently had antibiotics, with sweaty moist skin (so take off those sweaty gym clothes promptly!). Thrush is not an STI but partners can sometimes have redness and irritation in their genital region after unprotected intercourse.
Thrush is diagnosed clinically by your doctor. Sometimes this may require a vaginal swab. Treatment is with antifungal creams, pessaries or tablets. Sometimes a second treatment is needed to control symptoms. Most women avoid intercourse whilst they have thrush due to discomfort.
TELLING YOUR PARTNER
If you have been diagnosed with an STI you must tell your partner(s).
If you have difficulty notifying a partner, we can help you do that whilst keeping your identity confidential. You can also go to www.letthemknow.org.au for assistance. For gay men and men with male sexual partners, you can also use www.thedramadownunder.info/notify
This information is intended to support, not replace, discussion with your doctor or healthcare professional. The authors have made considerable effort to ensure the information is accurate, up to date and easy to understand. Royal Park Medical accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen.