Sexually Transmitted Infections

Sexually transmitted infections (STIs) are infections that are spread primarily through person-to-person sexual contact. There are more than 30 different sexually transmissible bacteria, viruses and parasites. Several, in particular HIV and syphilis, can also be transmitted from mother to child during pregnancy and childbirth, and through blood products and tissue transfer. Some of the commonest sexually transmitted pathogens can be divided into those caused by bacteria, viruses and parasites.

In developing countries, STIs and their complications rank in the top five disease categories for which adults seek health care. Infection with STIs can lead to acute symptoms, chronic infection and serious delayed consequences such as infertility, ectopic pregnancy, cervical cancer and the untimely death of infants and adults.

Signs and Symptoms of Sexually Transmitted Infections

The following signs and symptoms may be present after an STI but remember most are silent:

• Urethral discharge
• Genital ulcers
• Inguinal swellings (bubo, which is a swelling in the groin)
• Lower abdominal pain
• Painful intercourse
• Scrotal swelling (men)
• Vaginal discharge (women)
• Neonatal eye infections (newborn)

Symptoms of Sexually Transmitted Infections
Many sexually transmitted infections often exist without symptoms. For example, up to 70% of women and a significant proportion of men with gonococcal and/or chlamydial infections may experience no symptoms at all. Both symptomatic and asymptomatic infections can lead to the development of serious complications.

Sexually Transmitted Infections and HIV
The presence of an untreated ulcerative or non-ulcerative (those STIs which cause ulcers or those which do not) infection increases the risk of both acquisition and transmission of HIV by a factor of up to 10. Thus, prompt treatment for STIs is important to reduce the risk of HIV infection. Controlling STIs is important for preventing HIV in people at high risk, as well as in the general population.

Sexually Transmitted Infections and Women’s Health
STIs are the main preventable cause of infertility, particularly in women. Between 10% and 40% of women with untreated chlamydial infection develop symptomatic pelvic inflammatory disease. Post-infection tubal damage is responsible for 30% to 40% of cases of female infertility. Furthermore, women who have had pelvic inflammatory disease are 6 to 10 times more likely to develop an ectopic (tubal) pregnancy than those who have not, and 40% to 50% of ectopic pregnancies can be attributed to previous pelvic inflammatory disease. Infection with certain types of the human papillomavirus can lead to the development of genital cancers, particularly cervical cancer in women.

Sexually Transmitted Infections and Pregnancy
Untreated sexually transmitted infections are associated with congenital and perinatal infections in neonates, particularly in the areas where rates of infection remain high.

In pregnant women with untreated early syphilis, 25% of pregnancies result in stillbirth and 14% in neonatal death an overall perinatal mortality of about 40%. Syphilis prevalence in pregnant women in Africa, for example, ranges from 4% to 15%. Up to 35% of pregnancies among women with untreated gonococcal infection result in spontaneous abortions and premature deliveries, and up to 10% in perinatal deaths. In the absence of prophylaxis, 30% to 50% of infants born to mothers with untreated gonorrhoea and up to 30% of infants born to mothers with untreated chlamydial infection will develop a serious eye infection (ophthalmia neonatorum), which can lead to blindness if not treated early. It is estimated that, worldwide, between 1000 and 4000 newborn babies become blind every year because of this condition.

What causes Sexually Transmitted Infections?

Common Bacterial Infections
• Neisseria gonorrhoeae (causes gonorrhoea or gonococcal infection)
• Chlamydia trachomatis (causes chlamydial infections)
• Treponema pallidum (causes syphilis)
• Haemophilus ducreyi (causes chancroid)
• Klebsiella granulomatis (previously known as Calymmatobacterium granulomatis causes granuloma inguinale or donovanosis).

Common Viral Infections
• Human immunodeficiency virus (causes AIDS)
• Herpes simplex virus type 2 (causes genital herpes)
• Human papillomavirus (causes genital warts and certain subtypes lead to cervical cancer in women)
• Hepatitis B virus (causes hepatitis and chronic cases may lead to cancer of the liver)
• Cytomegalovirus (causes inflammation in a number of organs including the brain, the eye, and the bowel).

Parasitic Organisms
• Trichomonas vaginalis (causes vaginal trichomoniasis) Candida albicans (causes vulvovaginitis in women; inflammation of the glans penis and foreskin [balano-posthitis] in men).

Screening for Sequally Transmitted Infections

It is now possible to screen for many of the common STIs based on an internet ordered home sample urine test or blood test kit using a laboratory technique called PCR with results via confidential text or email.

Urine Test Kits will screen for
• Chlamydia
• Gonorrhoea
• Mycoplasma
• Ureaplasma
• Gardnerella
• Trichomona
• Herpes Simplex I/II

Blood Test Kits will screen for
• HIV
• Hepatitis B
• Hepatitis C
• Syphilis

Screening for Sexually Transmitted Infections
Most STIs are silent or may present with symptoms some time after the infection occurred. This makes it impossible to tell if you, a partner or potential partner is carrying a silent STI. The most reliable way of avoiding an STI is to always practice safer sex and when embarking on a new relationship to consider screening for STIs before embarking on a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Prevention of Sexually Transmitted Infections
The most effective means to avoid becoming infected with or transmitting a sexually transmitted infection is to abstain from sexual intercourse (i.e., oral, vaginal, or anal sex) or to have sexual intercourse only within a long-term, mutually monogamous relationship with an uninfected partner. Male latex condoms, when used consistently and correctly, are highly effective in reducing the transmission of HIV and other sexually transmitted infections, including gonorrhoea, chlamydial infection and trichomoniasis.

Where Can I Find Out More About Testing and Treatment?

If you are worried about or think you might you might have an STI, have recently been exposed to the risk of an STI or wish to discuss screening, testing and treatment you should do so now as early advice, testing and treatment is important.

NHS: Testing is free on the NHS from genitourinary medicine clinics, sexual health clinics, many Family Planning Association and contraception clinics, your GP and pharmacies. You can find a clinic to help with STIs by phoning directory enquiries and asking for genitourinary medicine, sexually transmitted disease or venereal disease or locate one using our NHS Genitourinary Medicine Clinic page in the Sexual Health Section of our website. You can also contact NHS Direct on 0845 4647.

PRIVATE: You can have confidential private testing and treatment or screening via an internet ordered home sample urine test or blood test kit. Telephone 0345 2303386 or use the Confidential Text Service 07786202070.