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Wellness Education
 

SEX: Sexually Transmitted Infections (STIs)

When concerned about your sexual health and wellness, you can't go wrong knowing some background information about some of the most common STIs.

Bacterial Vaginosis (BV)

How is it Transmitted?
Certain factors have been identified that increase the chances of developing bacterial vaginosis, though the role of intercourse is yet to be determined. Having multiple or new sexual partners, vaginal douching, and cigarette smoking can all increase the risk. Bacterial vaginosis can still develop in women who have not had sexual intercourse.

Symptoms
Vaginal discharge and odor. Some women experience an unpleasant fishy odor with vaginal discharge. The discharge is usually thin and grayish white. The discharge is often more noticeable after sexual intercourse. The amount of vaginal discharge that is considered normal varies from woman to woman. Therefore, any degree of vaginal discharge that is abnormal for a particular woman should be evaluated.

Many women with bacterial vaginosis have no symptoms at all.

Diagnosis
Diagnosis entails a pelvic exam so that the physician can see the appearance of the vaginal lining and cervix. The exam may include a manual exam of the ovaries and uterus. The cervix is examined for tenderness, which might indicate a more serious infection.

Examining the vaginal discharge under the microscope can help distinguish bacterial vaginosis from yeast vaginitis (candidiasis) and trichomonas (a type of sexually transmitted infection). A sign of bacterial vaginosis under the microscope is an unusual vaginal cell called a clue cell. Clue cells are believed to be the most reliable diagnostic sign of bacterial vaginosis. In addition to clue cells, women with bacterial vaginosis have fewer of the normal vaginal bacteria, called lactobacilli. A vaginal pH greater than 4.5 is also suggestive of bacterial vaginosis.

Finally, the doctor may perform a "whiff test" with potassium hydroxide (KOH) liquid. When a drop of KOH testing liquid used in the "whiff test" contacts a drop of the discharge from a woman with bacterial vaginosis, a certain fishy odor can result.

Treatment
BV is treated with of antibiotics. Recurrence of bacterial vaginosis is possible even after successful treatment. More than half of those treated experience recurrent symptoms within 12 months. It is unclear why so many recurrent infections develop. With recurrent symptoms, a second course of antibiotics is generally prescribed.

Chlamydia

How is it Transmitted?

  • Unprotected vaginal, anal or oral sex with someone who is infected
  • Mother to baby during vaginal childbirth

Symptoms

  • Women: increase in vaginal discharge, cystitis (an inflammation of the lining of the bladder), need to urinate more frequently, or pain whilst passing urine, pain during sexual intercourse or bleeding after sex, mild lower abdominal pains, irregular menstrual bleeding
  • Men: white/cloudy and watery discharge from the penis, burning sensation and/or pain when passing urine

Diagnosis
Usually entails genital examination and urine sample, for both men and women.

Treatment
Short and sweet: just a short course of antibiotic tablets.

Genital Herpes, a.k.a. Herpes Simplex Virus

How is it Transmitted?
There are eight types of human herpes virus. It is the herpes simplex virus types I and II (known as HSV-1 and HSV-2) that are responsible for genital herpes. HSV-2 is more frequently transmitted by sexual contact and is one of the most prevalent STIs worldwide.

An estimated 80% of people infected with HSV-2 are not aware they have the virus. This is because genital herpes will often produce mild symptoms or no symptoms at all.

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, oral sex (HSV-1 or HSV-2), and even 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.

Symptoms
If symptoms occur, they usually appear 2 to 7 days after exposure and last 2 to 4 weeks. Symptoms include:

  • itching or tingling sensations in the genital or anal area
  • small fluid-filled blisters that burst leaving small painful sores
  • 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.

Diagnosis
Diagnosis usually includes an examination of the patient’s genital area, samples from any visible sores, an internal pelvic exam (for women), a urine sample

Treatment
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 that reduce the severity of an outbreak. The antiviral tablets work by preventing the herpes simplex virus from multiplying.

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.

HPV

How is it Transmitted?
Human Papilloma Virus (HPV) is a virus that can cause genital warts. 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.

Symptoms
HPV infection without warts will generally be symptomless and most infections clear on their own without ever causing any problems. Most HPV infections fall under this category.

Genital warts appear as white or flesh-colored, smooth, small bumps, or larger, fleshy, cauliflower-like lumps. 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.

Warts can appear on or around the penis, the scrotum, the thighs or the anus. In women 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 colored vaginal discharge. Warts may occur singly or in groups. The warts may itch, but they are usually painless. In severe cases, it is possible for warts to spread from the genitals to the area around the anus, even if anal intercourse has not occurred.

Diagnosis
At your bi-annual pelvic exam and Pap smear, the medical provider will take a tiny scraping of tissue from the cervix and test for HPV. If you test positive, they'll discuss with you the nature of your infection

A doctor or nurse can usually tell whether you have genital warts just by looking closely at the affected area. If warts are suspected but are not obvious, the doctor may apply a weak vinegar-like solution to the the genital area; this turns any warts white and therefore makes them more visible.
To check for hidden warts, the doctor may carry out an internal examination of the vagina, cervix and/or anus.

Treatment
Most HPV infections clear on their own without intervention. More serious infections, like those associated with cervical cancer, may be followed up with a colposcopy and cervical biopsy.

A colposcopy is a vaginal wash, sometimes made from vinegar, that helps the medical provider see the infected tissue. The biopsy involves taking a sample of tissue from the cervix to test for abnormal cells. The biopsy is not just diagnostic, it's also therapeutic. The removal of cells draws the attention of the immune system, which busily gets to work clearing the infection.

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.

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 which is painted on to the wart(s) by a doctor or nurse and must be washed off 4 hours later
  • 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.
  • 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 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 cauterizes the blood vessels. Electrocautery is used only after other treatments have failed.
  • Surgical excision – the doctor will perform minor surgery to remove the wart under local anesthetic.

Gonorrhea

How is it Transmitted?
Gonorrhea is passed on through sex, including vaginal, anal, and oral, and can sometimes be transmitted by a person using their mouth and tongue to lick or suck another person's anus or 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.

Symptoms
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. 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.

Symptoms can include:

  • Women: 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: white or yellow discharge from the penis, burning sensation or pain whilst passing urine, irritation and/or discharge from the anus.

Diagnosis
A doctor or nurse will examine the genital area and samples will be taken from any infected areas, using a cotton wool swab or sponge. Women will also be given an internal pelvic examination, similar to a pap test. A sample of urine may be taken.

Treatment
The patient will be given an antibiotic in tablet, liquid or injection form.

 

Syphilis

How is it Transmitted?
Syphilis can be transmitted through any direct contact with a syphilis sore.

Symptoms
Primary Stage: One or more painless ulcers (known 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. The usual locations for chancres are on the vulva or on the cervix in women, on the penis in men, and around the anus and mouth (both sexes). Ulcers take between 2 and 6 weeks to heal, but if the infection is not treated at this point it will progress to the secondary stage.

Secondary Stage: A secondary stage 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
  • 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

During this stage syphilis is very infectious. Treatment at any time during the first two stages of syphilis will cure the infection.

Latent and tertiary stages: 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 then the infection can be cured. However, any heart or nervous-system damage that occurred before the start of treatment may be irreversible.

Diagnosis

  • 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 urine sample is taken

Treatment
Treatment of 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.

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.

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