STI's and treatments

• Herpes is a common STI.
• It is caused by a virus, which is transmitted by skin-to-skin contact during genital or oral sex.
• It usually occurs on the Genitals, but may also occur on the mouth, or other sites
• The virus is usually silent, but may cause blisters or sores on the skin in a few people.
• Apart from causing discomfort, it usually does little harm. Some people become very distressed by this common infection, especially if they look at some of the misinformation that is frequently found on the internet
• There are two types of Herpes Virus both of which can cause genital herpes, HSV 1 and HSV 2.
• When a person initially catched HSV they have a "first outbreak", this can be extremely painful, cause a flu like illness and difficulty in urinating. You should seek help for pain relief and advice.
• HSV is tested for by taking a swab from as "fresh" a lesion as possible. So it is important to come for a swab as early as possible in the outbreak to increase the chance that the virus will be picked up so that a definitive diagnosis can be made.
• After the first episode subsequent outbreaks are less severe as the body has "learnt" to make antibodies against the virus.
• It is difficult to predict at first how frequently outbreaks may occur, some people never have an outbreak again however for others it may be more frequent.
• At the GUIDE Clinic free and confidential testing and treatment is provided.
• Antiviral tablets are given to shorthen the severity and duration of an outbreak but these need to be taken as soon as possible after an outbreak occurs.

• Urethritis is inflammation of the urethra, the tube in the center of the penis where you pee from.
• Urethritis commonly affects men and may have no symptoms. It is only discovered by a microscopic examination of the secretions.
• In some cases, it may cause symptoms of stinging, burning or pain passing urine. There may be a discharge from the tip of the penis, which may stain underwear. If anyone has these symptoms, it is essential to have a full screening examination with a full set of tests.
• Urethritis in men may be caused by Chlamydia or Gonorrhoea. These bugs are reliably detected by the ultrasensitive tests now available. Often, we do not find the precise cause, and the condition is called Non-Specific or Non-Gonococcal Urethritis (NSU or NGU). Some of the bugs that cause NGU have been identified in research studies, but are not detected in normal clinical practice. The good point is that the condition responds to the right antibiotic. Sometimes the inflammation can be caused by non-infectious causes such as trauma, sex and masturbation. Also irritants such as soap may aggravate symptoms.

• Chlamydia is a very common infection that mainly infects the penis, cervix, anus and throat
• Most people who have Chlamydia have no symptoms so they do not know they have it. It is only discovered when they are tested
• 70% of women with Chlamydia are asymptomatic and 50% of men.
• Chlamydia infects 1 in 10 under 25 year olds, the only way to be sure you don't have it is to get tested
• If left untreated it may lead to pelvic inflammatory disease in women and epididymoorchitis in men.

• PID is caused by inflammation or infection of the tubes and ovaries in the pelvis.
• It may be caused by a STI.
• If untreated, it can result in infertility or Ectopic pregnancy

• Gonorrhoea is a bacteria that infects the penis, cervix, anus and throat
• The most common symptom is a discharge from the penis, which usually is obvious, burning, and comes on quickly
• Gonorrhoea in the cervix, anus or throat is usually silent, - no signs or symptoms. You have it without knowing
• It is easily treated with the right antibiotic. Unfortunately, today there is great concern about antibiotic resistance in gonorrhea because of inappropriate antibiotic usage so it is important to get adequately treated in a specialist GUM centre such as the GUIDE Clinic.

This is a very common complaint amongst woman. It would be a rare woman who never has experienced this at some time or other.

Whilst it is unpleasant and uncomfortable, it is unusual to be caused by a Sexually Transmitted Infection. Whilst that does not rule out an STI, and anyone who has had these symptoms after a risk encounter would be wise to be screened, they are usually caused by either Candida or Bacterial Vaginosis. These are not Sexually Transmitted Infections.

• The fungus, Candida albicans is normally present in the vagina.
• If it overgrows, or the vagina becomes allergic to it, then it causes irritation, itch and discharge.
• Overgrowth often occurs after a course of broad-spectrum antibiotics.
• Tight, occlusive, or synthetic underwear or clothes can aggravate the area, and bring it on.
• It is easily treated with appropriate tablet or pessary. It may recur if the conditions that brought it on are not dealt with. Salt-water baths help
• Candida can be passed to male partners causing them to have a rash on their penis which is easily treated

• The normal, healthy vagina contains many different types of bacteria.
• In BV the balance of the different types of bacteria is changed, leading to an overgrowth of some and a decrease in others. This usually results in a change to a woman's vaginal discharge.
• The vaginal secretions loose normal acidity. There is odour. This may be more pronounced after sex
• BV is not usually sexually transmitted, but is associated with sexual activity. It is easily treated with tablets or cream. It often recurs. Salt-water baths help

• Genital warts are very common: they are hard irregular growths on the genital skin.
• They are caused by a virus, the Human Papilloma Virus (HPV). This virus is so common that almost everybody catches it at some time or other. It is sexually transmitted, an STI.
• The virus causes the skin cells to overgrow into a wart
• Only very few of those who catch the virus grow warts, approx 10%.
• Very often only one partner displays the signs of warts while the other partner is likely to carry the virus they may not realise it or develop warts.
• It is a superficial infection of the skin, and in more than 80% of cases is cleared by the immune system, however this may take 2-3 years.
• The wart virus is transmitted by skin-to-skin contact during sex.
• There are more than 160 different strains. Some cause cancer, especially cancer of the cervix, anus or throat. But the types that cause cancer are different than the types that cause genital warts.
• It is treated by destruction of the overgrowth of skin cells by freezing and chemicals. No treatment gets rid of the virus HPV, that will be done by your own immune system over time. The treatments get rid of the warts, but the virus which is still present can make the warts return, this is most likely to occur in the first 3 months after treatment, in 50% of patients.
• A woman with genital warts is at no higher risk of cervical cancer than a woman that does not, and therefore she does not need any more frequent or earlier screening for cervical cancer.
• Condoms do not fully protect against the transmission of HPV.

• Syphilis is transmitted during sexual contact with a person who has this infection.
• It is highly infectious, and is commonly transmitted by oral sex, and even kissing.
• Today, it is especially common in Men who have Sex with Men.
• Syphilis is on the rise and we are seeing more and more every week
• Very often someone who has syphilis will not know and it is only picked up on a blood test. If left untreated Syphilis can have serious health consequences.
• There are no reliable symptoms, hence why it is often called, "The Great Pretender". But obvious syphilis signs are a painless sore otherwise known as a chancre that can appear on the genitals, mouth, nipple, anus or at any point of sexual contact. Very often this clears up and is unnoticed. Another common symptom is a generalised, asymptomatic red blotchy rash over the body, which sometimes just clears up and so is passed off as a viral rash.
• Syphilis is easily treated so it is important to get tested regularly incase you have picked it up and are unaware.

• HIV is a viral infection that breaks down the body's natural defenses against infections by weakening the immune system. It can lead to Acquired Immune Deficiency Syndrome (AIDS)
• HIV is in the blood, vaginal secretions and semen of a person with the virus and is passed on by vaginal or anal sex without a condom or by sharing drug-injecting equipment.
• It is very treatable today unlike many years ago when it was first discovered and therefore it is advisable to test for HIV if you think you have been put at risk
• Early Diagnosis is essential to prevent the destruction of the Immune System and reduce spread of the infection.

After a high risk exposure you may be asked to return for "window period bloods" after 12 weeks, as in some cases the HIV will not show up in the blood test until then.

• PEP may prevent infection with HIV developing, . 2 or 3 antiretroviral HIV drugs are taken for 28 days
• They must be started within 72 hours of possible exposure to HIV infection, if they are to have any chance of working - the sooner the better.
• To be at risk of HIV you need to have had risky contact (e.g. penetrative sex, sharing a syringe) with a person who has HIV.
• If you are unsure of the HIV status of the risk contact it is helpful, but not always possible, to have their blood checked urgently to see if they have HIV, if they do not then PEP will not be necessary.
• If you need PEP outside of GUIDE Clinic opening hours then it is important to get an emergency 4 day supply of PEP from your local emergency department within 72 hours. Then come to the GUIDE Clinic at their next opening.

There are so many causes of rashes on the genital area and it is best to seek expert advise if you are concerned. Causes include, candida, fungal rashes, eczema, psoriasis, scabies, syphilis, herpes, drug rash, and many many more.

Most are easily treated so there is no point in sitting at home worrying about it, it is best to get the appropriate diagnosis and treatment.

All treatment at the GUIDE Clinic is free. Most STIs are easily treated. It is important to get treated early to avoid complications and passing on the infection to others.

At the GUIDE Clinic there is a wealth of expertise in the area of STis.

Health advisors will work with you to find the best and most confidential way to let contacts of your STI know that they should get tested also and treated if necessary.