>Genital herpes

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.
Only around 10-25 percent of people infected with HSV-2 are aware they have genital herpes. 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 is transmitted?

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)
• 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 patient’s 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 patient’s 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.
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.
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. 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.

>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 12 million new infections still occur each year.

“The past decade has seen a rise in new cases of the almost forgotten ‘historic disease’ syphilis, particularly in certain risk groups.” Alexandra Geusau and Stefan Wöhrl, 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.

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 transmitted

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.
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.
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:


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:


       In 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.

       In Men

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

Route of transmission of gonorrhea

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.
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

      In 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.

       In 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 condom during sex can reduce the chances of getting or passing on gonorrhea. Latex condoms are proven to be over 99% effective when used consistently and correctly.