The Clinic.

Sexually transmitted infections : The Shared Infections Section

I was going to put some graphics to show you what they look like but I was so horrified when I found some that I didn't stop itching for days. If you want to have a look, and you’re not squeamish, head over to LINK

There are many types of STI's (They used to be referred to as STD'S ). Having an STI is nothing to be ashamed of as they have been around since wo/man popped onto the planet.

STI's are a reality for individuals who are sexually active…..

BUT think on..... If you leave yourself open to the risk of catching an STI by not using a condom, then what makes you think that you are not going to be at risk of contracting HIV if you don't use a condom?

If you can get it into your head, that if you do all you can to protect yourself from Sti's, then you have gone a long way to protecting yourself from HIV.

If you have an Sti, It is very important to get seen by a professional as soon as possible.

Having an Sti puts the body's immune system under strain, which makes it more likely that you are more susceptible to HIV

A few of the familiar STI's are:-
Chlamydia
Syphilis
Herpes
Genital Warts
Urethritis
Gonorrhoea
( More commonly referred to as the Clap)
Hepatitis A, B and C
and not forgetting, HIV

The most important thing to remember is that anyone who has sex can get any of them - whether your young, old, gay, hetro, or lesbian, rich or poor and any colour race or nationality
The Good News is that most are treatable, if they are detected early on. BUT some can cause seriouse long term problems if left untreated


The Signs to look for.


People who have a sexual infection sometimes get symptoms which show ther's something wrong.

BUT OFTEN THEY DON'T

Some infections have no clear signs. Others have symptoms that come and go even though the infection stays (dormant). Sometimes you can have more than one infection at a time.

So if you have had unprotected sex and think that you might have caught an infection then it is really important to get medical advice straight away. Even if you have no obvious symptoms.

SOME OF THE WARNING SIGNS TO LOOK OUT FOR INCLUDE
An unusual discharge from the penis or vagina.
Rashes.
Itchiness.
Sores.
Blisters.
Pain in the genital area.
A burning sensation when having a pee.
Peeing more than ussual.


BUT REMEMBER -you can't always tell if you or your partner have a sexual infection as neither of you might have symptoms.

IF IN DOUBT CHECK IT OUT.

WHERE TO GO FOR HELP
1.For Ysbyty Gwynedd :-
Menai Unit, Ysbyty Gwynedd
Penrhos Road
Penrhosgarnedd
Bangor
LL57 2PW
01248 385385 (contraception) or 01248 384054 (screening) Monday to Friday 9.30am-11.30am

You can either go to the STI/GUM clinic or to your own GP. The Gum clinic is totally confidential and even your GP won't be informed without your consent.

Link to NHS Service Finder WALES website

Link to NHS Service Finder Engaland website

There is at the moment a higher than normal incidence of STI's presented at Bangor GUM Clinic.... They are "VERY BUSY" and this is down to the increase in syphilis, gonorrhea and clymidia outbreaks. And this is the case amongst men and women, across western Europe. Manchester is rife with syphilis at the moment and this strain is thought to be passed about more through oral sex. It appears that the incubation period for this strain is longer than normal, which could also account for the increase in number of cases. While in the syphilis phase and treatment stage you should refrain from 'all' sex, even with a condom, until you have had the all clear.

Any discharges, rashes, itches should ring your alarm bells, Better safe than sorry, get to that clinic. Syphilis is one of the most nasty of STI's, and if left untreated can kill you. The 'it's 2 days later and a discharge' does not apply to this one, as it can be up to 3 months and even more before any indication that there is something not quite right. BUT in some cases there are no symptoms, but it's in you multiplying and causing damage.


Unprotected sex is any form of anal, oral or vaginal sexual contact which does not involve the use of a condom (male or female)

Many sexually transmitted diseases infections (STIs) can be passed on by having unprotected sex. Also it must be stressed that some STI's can be passed on by kissing, with tongues to the back of the throat job, that heavy10/10 snogg. So don't tongue any stranger...

Unprotected penetrative anal and vaginal sex.

The insertion of the penis into the body of another person carries the greatest risk of STIs, however, infections can also be transmitted through oral sex (mouth to genitals), and oral-anal sex (mouth to anus), also called 'rimming.' For oral sex, some people choose flavoured condoms but these shoul not be used for penetration ( anal sex). For anal sex, it is very important that condoms are used with plenty of water-based lubricant, you should never use oil based lubricants as these weaken the rubber in condoms.

Unprotected sex with HIV-negative and untested people
If you are HIV-positive, using condoms during sex with people who know that they are HIV-negative or are unsure of their HIV status will protect them against HIV and protect both of you from STIs. Even if you are taking anti-HIV drugs and have an undetectable viral load in your blood, you may still have enough virus in your semen or vaginal fluids to pass on HIV. You should also be aware that in some countries you are legally required to disclose your HIV status to sexual partners.

Sex with other HIV-positive people
If you are HIV-positive and having sex with another person who is also HIV-positive, many health promotion experts and HIV and sexual health doctors will recommend that you still continue to use condoms. There is growing evidence that it is possible to be super-infected with a new strain or strains of HIV, which may either be more aggressive than or resistant to anti-HIV drugs. This could lead to the failure of treatments that might otherwise have been effective. This applies to both men and women.


Unprotected sex puts you at risk of other sexually transmitted infections. This applies to both men and women.


Sexually transmitted infections :- 'Herpes, Chlamydia, Gonorrhoea, Syphilis, Genital Warts, Hepatitis B, and Hepatitis C.

Bacterial STIs, such as gonorrhoea, and chlamydia can be treated just as easily and successfully in most people with HIV as in people who are HIV-negative, provided that they are diagnosed and treated. Failure to get prompt treatment can lead to infertility and in some cases damage to the internal organs. Syphilis, particularly in people with severely damaged immune systems can be harder to diagnose and cure and can be more aggressive when the immune system is damaged. There have been syphilis outbreaks, particularly amongst gay men, across western Europe and North America in the past few years and gay men with HIV have been disproportionately affected. In eastern Europe, and much of the rest of the world, syphilis predominately affects heterosexuals and is also linked to increased risk of HIV infection, along with other treatable ulcerating diseases such as chancroid and donovanosis.

Viral STIs. Genital herpes and genital warts, are not curable, even in people who are HIV-negative. Although both these infections will respond to treatment, they can reoccur and can be harder to control if you have a severely damaged immune system. Genital herpes is linked to an increased risk of HIV transmission, especially when ulcers are present. Some strains of the virus which cause genital warts have been linked with the development of genital cervical and anal cancers.

The liver viruses hepatitis A and B and (less easily C,) can also be passed on sexually and can be more complicated in people with HIV. Hepatitis can cause liver damage which can limit HIV treatment options and make you very unwell in its own right. There are vaccines for hepatitis A and B (but not C), which should be available at your GUM or HIV treatment centre. Gay men in particular are advised to be vaccinated against hepatitis A and B. After you have been vaccinated it is important to have your immunity to hepatitis A and B checked regularly, as the vaccines do not offer permanent protection.

Some of the opportunistic infections which affect people with HIV can be passed on through sex. Karposi's sarcoma is thought to be passed on sexually through a form of herpes virus. Both HIV-positive and negative people can be affected by gut infections such as Giardia, amoebas (small parasites which live in the gut and cause diarrhoea), cryptosporidium and microsporidium which can be passed on through oral-anal contact or any sexual activity which leads to contaminated faeces getting into the mouth. These infections can cause very severe diarrhoea which is particularly severe in people with badly damaged immune systems.

Having an active, untreated STI increases the amount of HIV in the genital fluids, making HIV easier to pass on if you have unprotected sex. It is recommended that all sexually active people have regular sexual health check-ups. Many HIV treatment centres have sexual health clinics attached, which in the UK offer free and confidential testing and treatment.

If you decide that you want to have sex then the chances are that you'll want to reduce the risk of unwanted transmission of sexual infections. If you have someone in mind then discuss sex with them, and 'talk condoms use' don't beat around the bush, be bold.

If you use a reliable protection/barrier method, a CONDOM, then the risk of transmission is low.

You both share the responsibility for this but it is always a good idea to always carry your own supply of condoms and lube. You can get nice little discrete holders/ kits these days that can be kept in your pocket or bag.

So if you are likely to be in a situation where you may have sex - maybe during/after parties, pubs, clubs raves - make sure that you have your condoms with you.

Saying that you want to use a condom can be one of the most difficult things to say in the heat of the moment. But you could be surprised, s/he may also find it difficult and would welcome the lead from you.

You might not have discussed having sex with a new partner, so you bringing the subject up might make you think, that s/he will think, that your up for it and are easy. Try not to think like this, you might get carried away with the passion of the moment and and end up penetrating your partner or getting penetrated. Always be prepared for condom use and have your condoms and lube handy - within reach.

Even if you leave them in your pocket or bag you will still have them near you.... If you can't bring yourself to talk about the condom then just get them in sight & within easy reach, on the bed, on the sideboard, on the cistern, so that you can grab them if needed.

Alcohol and drugs can lower your inhibitions. You might not think so, but even a little alcohol can affect the way you behave and you could end up doing something that you will regret later, 10 shots and 12 Vodkas and a bit of head gear and you will be, away with the fairies, so get condom use into your head before you get there.

 

The prostate

is a male sex gland located underneath the bladder. It is about the size of a walnut and fits around the tube (the urethra) that carries urine out of the bladder The prostate produces a thick white fluid that forms part of your semen.

Prostate Cancer:- is the most common cancer in men in the UK.

It affects about 186men per 100,000 and there are 1,504,228 males (all age groups) in Wales Prostate cancer accounts for a quarter of all new cancer cases in men in the UK. In 2011 in the UK around 41,700 men were diagnosed with prostate cancer, that's more than 110 every day. Over the last 35 years prostate cancer rates in Great Britain have more than tripled, although much of the increase is due to increased detection through widespread use of the PSA test. More than a third of prostate cancer cases are diagnosed in men aged over 75 years. In Europe, around 417,000 new cases of prostate cancer were estimated to have been diagnosed in 2012. The UK incidence rate is 17th highest in Europe. Worldwide, more than 1.11 million men were estimated to have been diagnosed with prostate cancer in 2012, with incidence rates varying across the world. prostate cancer usually but not always affects older men - 95% of all cases are between the ages of 45 and 80

Causes

We do know that the risk is increased if there is a family history of the disease. But in most cases, we simply do not know what causes prostate cancer.

Signs and Symptoms


One of the problems related to prostate cancer is that, in it's early stages, it often does not cause any symptoms. When they do occur they may include any of the following problems.

* Difficulty or a delay in urinating.

* Stopping or starting, or a weak stream or urine.

* Urinating more than usual.

* Pain when urinating, or blood in urine.

* Sometimes:- Pain or stiffness in the lower back and hips

These symptoms can also be caused by other conditions such as non-cancerous enlarged prostate gland or kidney infection.

Action

It is vital that you do go and see your GP as soon as possible if you are suffering from any of these symptoms, so that the cause can be diagnosed and any relevant treatment administered.

Testing and Screening

Early diagnosis of prostate cancer is extremely important for successful treatment. Once the cancer has become advanced and has spread, it becomes much more difficult to cure.

Prostate Cancer Test.

Rectal examination

Your GP can actually feel the size of your prostate gland. However a large prostate does not necessarily indicate prostate cancer.

PSA Blood Test

Tests the level of 'prostate Specific Antigen' in the blood. A high reading suggests prostate cancer but could be caused by another condition.

Biopsy;

A tiny sample of tissue is taken using a probe and the tissue is then sent for analysis.

Ultrasound;

A small probe is inserted up the rectum and a scan is take to determine the size of the prostate.

Bone scan;

can be taken to determine whether there is any cancer that has spread to the bones near the prostate.

None of these tests are individually conclusive indicators of prostate cancer.

Treatments

Some prostate cancers are so slow growing that no treatment is needed. Instead a policy of 'watchful waiting' is adopted so as to monitor the condition. When more active treatments are required there are currently four main options;-

Surgery:

The entire prostate is removed in an operation called a 'prostatectomy'.

Radiotherapy:

High energy rays are used to destroy the cancer cells.

Hormone treatment:

Drugs can be used to lower the level of testosterone in the blood which has the effect of showing or stopping the growth of the cancerous tumour. However some prostate tumours develop the ability to grow without testosterone.

Brachytherapy:

A treatment where radioactive seeds are implanted directly into the tumour.

All these treatments can cause side-effects and carry long-term risk of impotence.

Testicular Cancer :

Cancer of the balls, is the most common cancer to affect men between 20-35 years old. The incidence of testicular cancer has doubled in the last 20 years and currently over 1,600 new cases are diagnosed each year.

According to a recent MORI poll carried out by the institute of Cancer research

only 14% of young men check their testicles regularly.

Yet this method of early detection is both simple and effective.

:Thanks to advances made at the institute of testicular cancer, testicular cancer is easily treated if caught at an early stage and is nearly always curable. If diagnosed early enough the recovery rate can be as high as 96%

Causes

We urgently need to find out what causes testicular cancer and why cases are increasing so dramatically.

Signs and symptoms

Regular self-examination will help you become more aware of the normal feel and size of your testicles so that if anything happens you will be able to spot the difference early on.

How to carry out a testicular self-examination:-

You should perform these simple steps regularly. A thorough examination may be easier after a warm bath or shower as the scrotum skin relaxes.

*. Most lumps found on the testicles are benign non-cancerouse) but any changes in size, shape or weight should be checked by your GP.

*. Support the scrotum in the palm of your hand and become familiar with the size and weight of each of your testicles.

*. Examine each testicle by rolling it between your fingers and thumb. Gently feel for lumps, swelling, or changes in firmness.

*. Remember that each testicle has an epididymis at the top which carries sperm to the penis. Don't panic if you feel this - It's normal.

If you do notice any of the following symptoms, go and see your GP as soon as you can.

A lump in either testicle

Any enlargement of the testicle.

A feeling of heaviness in the scrotum.

A dull ache in the abdomen or groin.

A sudden collection of fluid in the scrotum.

Growth or tenderness of the upper chest.

Don't just wait and hope that these symptoms go away-

GO AND GET CHECKED OUT by your Doctor. Most lumps are not cancerous, but the earlier you find out, the earlier you can get the necessary treatment.

What Happens Next

If your Doctor thinks that you might be suffering from testicular cancer, s/he is likely to recommend one or more of the following options.

Referral to a surgeon.

A Blood Test

Biopsy.

An X-ray.

An Ultrasound Scan.

These tests are firstly to determine whether you have testicular cancer and secondly, to discover to what extent it has spread.

Treatments

If caught early and the cancer has not spread, treatment will ordinarily be the surgical removal of the cancerous testicle. If the cancer has spread, this will usually be followed by a three to four month course of chemotherapy.

THE FUTURE

If you are treated for testicular cancer, it is likely that both your fertility and you sex life will recover after the end of your treatment.

If you have a testicle surgically removed, you should have the option to have a prosthetic replacement fitted. The remaining healthy testicle tends to be able to produce enough sperm to compensate for the loss.

There is also no existing evidence that there are any risks to children fathered by men who have been treated for testicular cancer.

We do not know if a history of undescended testes at birth, or of testicular cancer in the family increases the risk of developing the illness.

So make sure that you tell your family about your treatment and make them aware of the fact about testicular cancer.

Facts and figures taken from the EVERYMAN Action agains male Cancer appeal leaflets. This is run by The Institute of Cancer Reasearch. WEBSITE

...The Sexually Transmitted Infection's List

Sexual Health Testing Clinics (GUM)

The GUM (Genito-Urinary Medicine) or sexual health clinic is the place to go if you want a sexual health check up, HIV test or if you have symptoms which you think might be caused by a sexually transmitted infection. Worried about STIs? The NHS has local testing clinics that are free and confidential.

GUM SERVICE FOR ALL

• GUM Service Gwynedd (For Men and Women) • Please contact 01248 384 054 for enquiries and appointments for all centres.

CLINICS AND OPENING HOURS

ARFON

Menai Unit

Ysbyty Gwynedd
Ffordd Penrhos Road
Bangor
LL57 2PW
Tel : 01248 385 385

Every Tuesday : 5.00 pm – 7.00 pm
Every Thursday : 10.00 am – 12.00 pm
Every Thursday : 6.00 pm – 7.30 pm

Hafan Iechyd

Doc Fictoria
Caernarfon
LL55 1TH

01286 684 101

Every Monday : 10.00 am – 11.30 am
Every Monday : 6.00 pm – 7.30 pm
From June onwards : 1:30 pm – 5.30 pm

MEIRIONYDD

Health Centre

Blaenau Ffestiniog
LL41 3DW
Tel : 01766 831 281

Every Wednesday : 3.30 pm – 6.00 pm

Out Patient’s Department

Ysbyty Dolgellau
Dolgellau
LL40 1NT

Tel : 01341 422 043

First Monday of the month : 5.30 – 7.30 yr hwyr

DWYFOR

Ysbyty Bryn Beryl

Pwllheli
LL53 6TT
Tel : 01758 701 122

Every Friday : 9.30 am – 11.30 am

Out Patient’s Department

Ysbyty Alltwen
Tremadog
LL49 9AQ

Tel :01766 510 015

Every Tuesday : 1.30 pm – 3.30 pm

Chlamydia is a germ which infects the genital area, and sometimes the throat and eyes. One of the main causes of Non-specific urethritis (NSU)

Signs and symptoms

These are the same for both men and women:
•Often nothing until the Chlamydia spreads.
• Pain or stinging when peeing.
• Discharge from the penis, vagina or anus.
• Inflamed and painful anus, vagina.

Somethimes it affects the eyes and throat - Can cause swollen joints if left untreated and can lead to infertility.

How it's passed on:-

Unprotected sexual contact.

Treatment

• Chlamydia can be successfully trated with the use of antibiotics.
• 2 to 3 visits to the clinic.

Using a condom will reduce the risk of infection.

In-Depth:- Chlamydia - the silent epidemic

Written by Dr Angela Robinson, consultant in sexual health.

What is chlamydia?

Chlamydia is a sexually transmitted disease caused by a tiny bacterium Chlamydia trachomatis. If you haven't heard of chlamydia, you're in good company. The vast majority of the UK population hasn't heard of it either. More worrying is that those most at risk of this infection and its serious complications are also the least likely to know about it, let alone take appropriate action.


Why should I know about it?

Chlamydia is the most common, treatable, sexually-transmitted infection. It often presents no symptoms in men or women unless it leads to complications - when treatment can sometimes be too late to stop permanent damage.

In some women, infection can damage the fallopian tubes (which conduct eggs from the ovaries to the womb), which stop working properly and can become completely blocked.

Sometimes, infection leads to pain in the lower abdomen that is often mistaken for some other problem rather than pelvic infection.

Chlamydia is the most common, preventable cause of infertility in women. When the fallopian tubes are blocked, no pregnancy is possible naturally. One option is in vitro fertilisation (IVF) but this is usually not available on the NHS and has variable success rates (usually no more than 20 per cent of women end up with a baby).

Occasionally, women with damaged tubes do get pregnant but the pregnancy can develop in the tubes rather than the womb. This is called an ectopic pregnancy. The tube can split apart causing serious pain and bleeding. This is an emergency as the bleeding can be life threatening.

Men can also run into trouble. Chlamydia is the commonest cause of acutely inflamed testicles (epididymitis) in men under 35 and a well-recognised cause of joint problems in some young men.

Why don't I know about it?

In the UK, we have one of the best networks of clinics in Europe to diagnose and treat sexually-transmitted infections (genitourinary or sexual health clinics). But, women often have no reason to suspect they have chlamydia so do not seek advice at one of these clinics. Apart from sexual health experts, many doctors do not have sufficient knowledge and training to suspect that symptoms can be caused by chlamydia and to do an appropriate test. More importantly, health-care professionals are often unaware of how common the problem is and that it does not usually cause symptoms.

An education campaign for professionals is badly needed. Some clinicians find it difficult to talk about sex or to put their patients at ease. Most general practitioners are so pushed for time that the thought of embarking on a discussion about a sexually-transmitted infection is a bridge too far.

The best place to get help and advice is from the health advisors who are part of the team working in sexual health clinics. To find your nearest clinic, check the phone book or contact the Association of Genitourinary Medicine or the LoveLife programme of Health Promotion England.

How is chlamydia diagnosed?

Until five years ago, testing for chlamydia in women involved taking a swab taken from the cervix (neck of the womb) during a speculum examination (using an instrument to hold open the vagina similar to a smear test). More recently, new tests have been developed that are done on urine samples, or on swabs that a woman inserts into the vagina herself, which is then put into a container and sent to the laboratory. These new tests avoid the need for an intimate and uncomfortable examination and makes testing much easier for women.

Previously for men, the only sample that was satisfactory was from a swab put into the urethra. Now a test can be done on urine, although this is not as reliable as one done on a swab. A urine test is easy and doesn't hurt!

Unfortunately, the new tests are twice as expensive as the old ones and the government has not provided the extra money to adopt the newer tests. Some clinics, hospitals and general practices have found resources to use the newer tests.

How do I know if I should be tested?

Chlamydia is almost always transmitted through sexual intercourse and the likelihood of having the infection depends on your sexual behaviour. The more partners you have, the more likely you are to be exposed to infection. However, you only need to have unprotected sex with one person who happens to have the infection and you can catch it. You don't have to be promiscuous to get chlamydia.

The infection is most common and most likely to cause serious complications in younger women. If you are under 25 and sexually active, you have a 1-in-10 chance of having chlamydia, so it may be worth getting checked out. Your risk is even higher if you are under 20 and have had unprotected sex. If you are over 25 and have had two partners within a year, or recently changed partner your risk is also increased.

Not so much is known about risk of infection in men. The highest risk group in men is between 20 and 30 years.

What are the symptoms?

Some women may have symptoms such as cystitis, change in vaginal discharge, mild lower abdominal pain. These are very 'non-specific symptoms' and can be caused by other infections and diseases. If you go to a GP or family planning doctor with these symptoms, make sure you have a chlamydia test taken. This test is not routinely carried out when you have a smear test. Many women are under the illusion that this is the case and are falsely reassured. If you are unable to get the test from these health care settings, then find where your nearest genitourinary medicine (sexual health) clinic is situated and go and have a check up. This is really important if you are under 25 or if you have recently changed sexual partner and the symptoms coincided or came a few months after the change in partner.

In men, chlamydia is the commonest cause of urethral discharge from the penis. Sometimes chlamydia can cause mild irritation at the end of the penis, which disappears after two or three days. Many men suffering some discomfort will wait to see if it goes away. Unfortunately, the discomfort may disappear but the infection can still be present. They can, therefore, transmit it to a sexual partner and also risk the complication of swollen testicles. Chlamydial infection can affect sperm function and fertility in men.

Remember: If in doubt go and have a test taken.

How can I avoid getting infected?

Condoms are effective in preventing spread of the infection. Obviously there is no point in one half of a sexual partnership getting treated for sexually-transmitted infection unless the other half also gets treated. Otherwise the untreated partner just gets re-infected. Getting repeated infection can cause far worse consequences from the point of view of fertility in women.


What about 'the Public Health'?

Over the past few years, there has been more publicity given to chlamydia infection and its consequences. However, between 1998 and 1999 in England reports from the genitourinary medicine clinics suggest at least a 20 per cent increase in chlamydia. In other Western European countries, particularly Scandinavia, Denmark and Holland, chlamydial infections have decreased over the last 15 years, in some instances to almost zero. There has been a dramatic decrease in women being admitted to hospital with pelvic infection and in the number of ectopic pregnancies in some countries. Meanwhile in the UK, ectopic pregnancies have shown no reduction and the data collection for pelvic infection is so unreliable as to be almost useless. But what is available suggests very little change over the last few years.


Why is it that other countries have made some inroads into controlling the chlamydial epidemic, whereas the reverse is true in the UK?

There are many contributing factors - sexually-transmitted infections are discussed in school-based sex education programmes, wide-spread availability of tests, high profile public education campaigns, attention has been paid to educating practitioners who may deal with the consequences of chlamydial infection (particularly obstetricians and gynaecologists). In Sweden these initiatives were started more than 20 years ago. Now the new tests have been introduced in most Western European countries and the USA. In the UK, the previous government, following increased publicity about chlamydia, set up a working group in 1996 to discuss whether we should screen for this infection and whether it would be cost effective to do so. The report was published two years later. We are now two years further on and awaiting the result of a pilot study in the Wirral and Portsmouth before decisions are made about whether to go to national screening. Meanwhile, most tests currently used for detecting chlamydia are inaccurate. Although some educational initiatives have been started for both professionals and public, these are piecemeal.

The UK situation is pretty dire. It might not be clear which is the best way to undertake screening, how to ensure that sexual partners get treated, but the first step along the way must be to inform the people who are at risk.

So what can we do?

If you have concerns, then act on them and get yourself checked out. Make sure that your friends have heard about the infection and its consequences. Encourage them to get checked up if they think they may be at risk. Make sure that your sexual partner gets treated if you are infected and if possible encourage your ex-partners to also get checked as this infection can stay unrecognised for months, if not years. Use condoms and before you stop using them, make sure you and your partner get a sexually-transmitted-infection screen.

We could do with some patient power. If you ask for a test and your GP is unable to provide it, then demand may hopefully lead to a change in resource. Surely it makes more sense to spend money trying to prevent the complications of chlamydial infection by detecting it early rather than spending large amounts of money on the complications? Your local Public Health department at your Health Authority may be a place to lodge any problems you may have encountered.

It is about time that we grasped the nettle and accepted that about half of under 16 year olds are having sex. Many do not use any contraception when they first start having sex and those that have been given contraception do not use it consistently. With a high teenage pregnancy rate you would also expect a high chlamydia rate. The drive to have sex is considerable and sex is usually pleasurable. It is unrealistic to expect adolescents going through emotional turmoil to make sensible, rational decisions. But knowing the potential consequences of your actions is one step on the way to weighing up the risks and benefits and being able to make an informed decision. And knowing where to go if you are concerned is essential to get help promptly.

And as well as thinking about your own situation, don't forget the health and safety of your own children. Discussing sex isn't easy for everyone but surveys suggest that kids like to hear about sex and relationships from a parent in preference to anyone else.

Where to go for help

• Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections(STI) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GP (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)


• Your own GP.

Link to NHS website

Pubic lice are tiny parasitic insects which live in coarse body hair. They are yellow-grey and about 2mm long. They can be found in pubic hair and underarm hair, on hairy legs, abdomens and chests, eyelashes and occasionally in eyebrows and beards.

Signs and symptoms
These are the same for both men and women:
• Itching in the infected areas.
• Black powder in underwear caused by droppings from the lice.
• Brown eggs (nits) on pubic or other hair.
• It is sometimes possible to see the lice on the skin Pubic lice cannot travel up into the hair on the head (although you can also have head lice). Pubic lice travel by crawling from hair to hair; they cannot fly or jump.


How pubic lice are passed on
Pubic lice are usually sexually transmitted. However, they can be transferred just by close physical contact with someone who has them. In some cases pubic lice can be transferred by sharing sheets and towels.

Where to go for help
• Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections (STI) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GP (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
• Your own GP.
• Your pharmacist, who can sell you a treatment over the counter.


Diagnosis and treatment
• A doctor can diagnose pubic lice by giving you a physical examination and by taking your medical history.
• Pubic lice may be taken from the skin and examined under a microscope.
Pubic lice are easily treated using a special shampoo or lotion. Clothing and bedding should be washed to avoid reinfection. Even after successful treatment, itching may continue for a few weeks. The doctor can prescribe tablets or lotions to help with this.
Your sexual partner should also be checked and treated. Until treatment is completed, you can pass on pubic lice. The doctor is likely to advise you to avoid having sexual contact with anyone during treatment.

Follow-up
It is advisable to return for a check-up following treatment. This is usually in one week's time.
It is possible to have more than one sexually trans- rnitted infection at the same time. For this reason a full check-up is always recommended. NHS sexual health (GUM) clinics routinely test for a number of sexually transmitted infections.


Ripped off from :- Health Education Authority 1997
Produced by the Health Education Authority on behalf of Health Promotion Wales HPW-5-08158 4197

Genital herpes is caused by the herpes simplex virus (HSV). There is no cure for herpes. The virus can affect the mouth, the genital area, and the skin around the anus. There are two types of this virus, either of which can infect these parts of the body, but:
* Type 1 usually causes sores on the nose and mouth, known as cold sores,and (rarely) in the eyes.

* Type 11 causes sores in the genital and anal area.

But the Type 1 virus is now more common in the genital and anal areas, perhaps because more people are having oral sex.

Signs and symptoms.

Both men and women may have one or more symptoms, including:
•an itching or tingling sensation in the genital or anal area.

•small fluid-filled blisters. These burst and leave small sores which can be very painful. In time they dry out, scab over and heal. With the first infection they can take between 2 and 4 weeks to heal properly

•pain when passing urine, if it passes over any of the open sores

•a flu-like illness, backache, headache, swollen glands or fever. At this time the virus is highly infectious.

Recurrent infections are usually milder. The sores are fewer, smaller, less painful and heal more quickly, and there are no flu-like symptoms.

How herpes is passed on.

Herpes is passed on through direct contact with an infected person. The virus affects the areas where it enters the body. This can be by:

• kissing (mouth to mouth)

• penetrative sex (when the penis enters the anus, mouth or vagina)

• oral sex (from the mouth to the genitals)

Where to go for help

•Your local sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections (STI) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GP. (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)

• Your own GR

• The Herpes Association - for information and support for people who have herpes - tel. 0171 609 9061.

The tests for genital herpes

•A clinical examination of your genital area is carried out by a doctor or a nurse.

•A sample is taken, using a cotton-wool or spongy swab, from any visible sores.

•Women may be given an internal pelvic examination.

•A sample of urine is taken.

As with any suspected sexually transmitted infection, it is possible to have more than one infection at the same time, so it is advisable to have a full check-up.


NHS sexual health (GUM) clinics routinely test for a number of sexually transmitted infections.


Diagnosis and treatment

Samples taken during your examination are sent to a laboratory for testing, and the result is available usually within 2 weeks.
Tablets are available which reduce the severity of HSV infection. These are only effective when taken within 72 hours of the start of the symptoms. There is also a cream which controls the symptoms. Recurrent infections often do not require treatment.


If you have been told you have herpes you may be asked to see a health adviser who will explain about the infection and answer your questions. The health adviser will also ask you about your sexual partner(s), as it is important that they have a check-up.

Help during an attack

When you are suffering from herpes, there are several things you can do to help you feel better.

•Take pain-killers (aspirin/paracetamol) if you have any pain.

•Keep the affected area as dry and clean as possible. Gently bathing the sore areas with a salt solution (half a teaspoon of salt to half a pint of warm water) may help: 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.

•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 episode of herpes, the blisters and 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 mouth or genital sores

•having any genital or anal contact, even with a condom or dental dam, when you or your partner have genital sores

•sharing towels and face flannels

•using saliva to wet contact lenses if you have sores around your mouth

Remember - wash your hands with soap after touching the sores.

Between outbreaks of herpes rashes, the chance of passing on the infection is much reduced, although it may occasionally occur. However herpes does not mean the end of your sex life.

Ask the advice of the clinic health adviser.

Genital warts are highly contagious, very common and can recur.

Genital warts are a sexually transmitted infection caused by a virus called the human papilloma virus (HPV). Genital warts are the most common complaint diagnosed at sexually transmitted diseases clinics in the UK, accounting for around a fifth of all diagnoses. During the late 1990s, there was a rising incidence of genital warts in the UK, affecting both men and women. Younger people tend to be more frequently affected, anyone who is sexually active may be exposed to the genital wart virus.
Some forms of the genital wart virus can lead to cervical or anal cancer. This risk is higher in people with HIV because there is more chance that the wart virus will become re-activated due to loss of immunity.

Signs and symptoms

Genital warts look just like warts which may appear on other parts of the body – usually small nodules with a slightly rough texture. (Pinky lumps, varying in size). Some people who contract the wart virus do not have symptoms, however, or else do not notice the presence of warts. In women, warts may appear on the inside or outside of the vagina, or on the neck of the cervix, or around the anus. In men, warts may appear on the tip or shaft of the penis, or around the anus.
Some forms of the genital warts virus are associated with an increased risk of cervical or anal cancer. However, these are not the commonest form of the virus. Strains 16, 18, 31, 33 and 35 are more strongly associated with the development of genital cancers.
These are the same for both men and women:
• on penis scrotum (The sac holding the testicles) or anus
• Lumps can become large and fleshy.

How they are passed on
The genital wart virus can be contracted during unprotected anal, vaginal or oral sex. It can also be transmitted by close physical contact with the genital warts themselves, as these may shed the wart virus.

Diagnosis

Genital warts are diagnosed by visual and manual exam-ination of the genital and anal area.
A Pap smear is a procedure designed to detect pre-cancerous cellular changes called dysplasia early, before cancer develops. Most women know the Pap smear as a ‘cervical smear'. Pap smears involve taking a small scraping of cells from the cervix. When these cells are examined under a microscope, it is possible to see if there are any changes in the cells which suggest there is a risk that cancer could develop in the future.

HIV-positive women are recommended to have Pap smears when they are first diagnosed with HIV, six months later, and then at least once a year. Screening of the anal canal for pre-cancerous cells is under investigation, and some people recommend that gay men with anal warts should receive regular assessment.

 

Treatment .............. ( Regular visits to the clinic)

Infection with the genital wart virus cannot be cured.

• A special liquid is painted on to the warts, which burns them

• They can be frozen off

  • Laser surgery or a new immune stimulating cream.
  • These procedures may feel a little uncomfortable.

EARLY treatment is advised.

Prevention

• Warts are caused by a virus and the best way to avoid infection is to avoid contact with them is to

Use a condom will reduce the risk of infection

Where to go for help
• Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections (STI) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any clinic anywhere in the country - you don't have to go to a local one - and you don't have to
be referred by your GP (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
• Your own GP.

Gonorrhoea is a bacterial infection. It is sexually transmitted and can infect the anus, rectum, cervix, urethra and throat.

Signs and symptoms
It is possible to be infected with gonorrhoea and have no symptoms. Men are far more likely to notice symptoms than women.

Women
Symptoms can include:
• a change in vaginai discharge. This may increase, change to a yellow or greenish colour and develop a strong smell.
• a pain or burning sensation when passing urine
• irritation and/or discharge from the anus

Men
Symptoms may include:
• a yellow/green or white pussy discharge from the penis and/or anus.
• irritation and pain and/or pussy discharge from the anus.
• inflammation of the testicles and prostate gland

• Sore throat, and possibly no symptoms until it spreads further.

How gonorrhoea is passed on
By penetrative sex (when the penis enters the anus, mouth, or vagina )
and less often by:
• rimming (where a person uses their mouth and tongue to stimulate another person's anus)
• inserting your fingers into an infected anus, mouth or vagina, and then putting them into your own without washing your hands in between.

Where to go for help
•Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections (STI) or
venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GR (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
• Your own GP.

The tests for gonorrhoea
•An examination of your genital area is carried out by a doctor or a nurse.
•Samples are taken, using a cotton-wool or spongy swab, from any places which may be infected - the cervix, urethra, anus or throat.
•Women are given an internal pelvic examination.

•A sample of urine may be taken.
None of these tests are painful, but may sometimes be uncomfortable.
If you have had anal sex, it is important to tell the doctor so that a swab can be taken from your rectum. Also tell the doctor if you have had oral sex.

Diagnosis and treatment
Samples taken during examination are looked at under a microscope to check for infection. In some clinics, the result is available immediately. A second sample is sent to a laboratory for testing, the result of which is available usually within one week.
Treatment is easy and essential. You will be given an antibiotic in tablet, liquid or injection form.
If you are allergic to any antibiotics. or if there is any possibility that you may be pregnant, it is important that you tell your doctor. It is important to complete your course of treatment.

If you are told you have gonorrhoea, you may be asked to see a health adviser who will explain the infection to you and answer your questions. The health adviser will also ask you about your sexual partner(s), so that they can get a check-up and treatment if necessary.
You should not have penetrative sex until you have returned to the clinic and been given the all-clear by the doctor. The doctor or health adviser will tell you about which sexual activities are safe.

Follow-up
Once you have completed your course of treatment you should return to the clinic or GP for a check-up. Some types of gonorrhoea are resistant to certain antibiotics, especially if you acquired the disease abroad. Further tests will be done to make sure that the infection has cleared. If it has not, you will be prescribed a different antibiotic.
Complications


Women
If left untreated gonorrhoea can lead to pelvic inflammatory disease (PID). This is inflammation of the fallopian tubes which can cause fever, lower abdominal pain and backache. Sex may be ncomfortable. PID can cause a woman to become infertile or have an ectopic pregnancy. Factsheet on PID are available at clinics.

Men
Gonorrhoea can cause inflammation of the testicles and the prostate gland, which causes pain. Without treatment a narrowing of the urethra or abscesses can develop. Once gonorrhoea has been successfully treated, it will not come back unless you become reinfected.

Remember, after treatment, using condoms during sex can reduce your risk of getting or passing on sexually transmitted infections.

Ripped off from :- Health Education Authority 1997
Produced by the Health Education Authority on behalf of Health Promotion Wales HPW-5-08158 4197

Hepatitis is inflammation of the liver. This can he caused by alcohol and some drugs, but usually it is the result of a viral infection. There are many types of virus which can cause hepatitis. Each of these viruses acts differently.


The hepatitis A virus (HAV) is a common infection in many parts of the world. It is possible to become infected through eating or drinking contaminated food or water. The virus is found in faeces. It can be passed on if even a tiny amount of faeces from a person with hepatitis A comes into contact with another person's mouth.This means the virus can also be passed on sexually through practices such as rimming. Personal hygiene, with careful hand washing, can minimise the risk of the virus being passed on.

Signs and symptoms
People may have no symptoms at all, but they can still pass on the virus to others. Symptoms may include:
•a short, mild, flu-like illness
•nausea and vomiting
•diarrhoea
•loss of appetite
•weight loss
•jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces)
•itchy skin
Some people may need to be admitted to hospital.

Where to go for help
• Your own GR
• Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections (STI) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any NHS clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GR (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
• A hospital Accident and Emergency department.

The tests for hepatitis A
Your GP or doctor at an NHS sexual health (GUM) clinic can diagnose hepatitis A by carrying out blood tests. You will be asked questions to try to discover the source of the infection.

What does a positive test result mean?
It could show:

  1. Past infection. This means that you have been in contact with the hepatitis A virus and your body has cleared it. You now have a natural protection against future infection with the hepatitis A virus.
  2. Current infection. By the time most people have developed symptoms of hepatitis A they will be less infectious to others, but in the weeks before this there will have been a risk of passing on the infection. Your doctor will ask you questions to find out if others have been at risk of hepatitis A. Those who have been in contact with the virus and have become infected may be given an injection to reduce the severity of the symptoms.
    Most of the symptoms of hepatitis A settle after a few weeks, although some people can feel tired for a number of months after infection. There is little likelihood of chronic liver damage and no chronic carrier state (where a person remains chronically infected).

What does a negative test result mean?
This result means that you have never been in contact with hepatitis A and have no natural protection against it.
If you are thought to be at risk of hepatitis A infection, the doctor may advise you to be immunised.

Diagnosis and treatment
Infection with hepatitis A is usually mild, but occasionally causes severe inflammation of the liver, requiring admission to hospital.
immunisation
For hepatitis A you are given a single injection in the arm which gives you protection for a year. A second booster injection at 6-12 months gives you protection for up to 10 years. Most hepatitis A immunisations are given to people who are travelling to parts of
the world with a high incidence of hepatitis A.
These injections are available from your GR
Immunisation is also recommended for those whose sexual practices are likely to put them at risk.

Follow-up
If you are infected with hepatitis A, you should limit the amount of alcohol you drink. The doctor may also offer you dietary advice.
Your doctor will advise you about any precautions necessary to ensure that you avoid infecting others with the virus.

Further information
For further information, contact the British liver Trust, tel. 01473 276 328 (Mon-Fri, 2pm-Spm), or write to Hepatitis Education Prevention and Support (HEPS),
PO Box 7627, London NW6 6WB, or f ax 0 1 71 244 6514.

Ripped off from :- Health Education Authority 1997
Produced by the Health Education Authority on behalf of Health Promotion Wales HPW-5-08158 4197

Hepatitis is inflammation of the liver. This can he caused by alcohol and some drugs, but usually it is the result of a viral infection. There are many types of virus which can cause hepatitis. Each of these viruses acts differently.

The hepatitis B virus (HBV) is very comrnon worldwide. It is very infectious.

The virus can be spread in the following ways:
•by unprotected (without a condom) penetrative sex (when the penis enters the anus, mouth or vagina ) with someone who is infected. Also by sex which draws blood with someone who is infected
•by sharing contaminated needles or other drug- injecting equipment
•by using non-steriiised equipment for tattooing, acupuncture or body piercing
•through a blood transfusion in a country where blood is not tested for the hepatitis B virus. All blood for transfusion in the UK is tested.

Signs and symptoms
People may have no symptoms at all, but they can still pass on the virus to others. Symptoms may include:
•a short, mild, flu-like illness
•nausea and vomiting
•diarrhoea
•loss of appetite
•weight loss
• jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces)
•itchy skin
Some people may need to be admitted to hospital.

Most adults infected with the hepatitis B virus fully recover and develop life-long immunity. Between 2% and 10% of individuals infected as adults will become chronic carriers, which means they will be infectious to others and can develop chronic liver damage. Infected children, especially new-born babies, are much more likely to become chronic carriers.
if a person continues to be infected over a number of years with the hepatitis B virus, they could develop the following complications:
• chronic hepatitis
• liver cirrhosis
• liver cancer

Where to go for help
•Your own GP.
•Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections (STI) or venereal diseases (VI)). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any NHS clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GR (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
• A hospital Accident and Emergency department.
if appropriate, these services may refer you to a hepatologist or specialist gastroenterologist.

The tests for hepatitis B
Your GP or doctor at an NHS sexual health (GUM) clinic can diagnose hepatitis B by carrying out blood tests. You will be asked questions to try to discover the source of the infection.


What does a positive test result mean?
It could show:

  1. Past infection. This means that you have been in contact with HBV and your body has rejected it.
    You now have a natural protection against the virus.
  2. Carrier. This means that you carry HBV and can pass
    it on to others. You are at risk of chronic liver disease and may be referred to a specialist centre for further.

A positive result can be confirmed by further tests and referral to a specialist. To find out how much hepatitis B may be affecting the liver, and what may be the best treatment for this, a small sample of liver tissue may need to be taken (a liver biopsy).


What does a negative test result mean?
This result means you have never been in contact with HBV and have no natural protection against it. If there is a chance you have been recently exposed to the virus, your doctor may advise you to have a repeat test and be immunised against hepatitis B.

Diagnosis and treatment
Many people do not require treatment, as the inflammation of the liver may not be severe. if you need treatment for liver inflammation, you will be referred to a specialist centre for a full assessment.


Immunisation
Three injections are given over a period of 3-6 months. A blood test is taken once the course of injections is completed to check that they have worked. Immunity should last for at least 5 years.
The injections are available at your local NHS sexual health (GUM) clinic, or from your GP.


Follow-up
If you are diagnosed as having an active infection with hepatitis B, you will be advised to have regular blood tests and physical check-ups. All carriers should expect to be referred to specialist services.

If you are infected with hepatitis B, you should limit the amount of alcohol you drink. The doctor may also advise you to avoid fatty foods and follow a low-salt diet.

If you have hepatitis B, you should use a condom for penetrative sex to prevent passing on the virus.
Your partner should also be immunised against hepatitis B ( if not already infected).

Your doctor will advise you about any precautions necessary to ensure that you avoid infecting others with the virus, such as not sharing toothbrushes or shaving equipment.

Remember, using condoms can reduce your risk of getting or passing on sexually transmitted infections.

Further information
For further information, contact the British liver Trust, tel. 01473 276 328 (Mon-Fri, 2pm-Sprn), or write to Hepatitis Education Prevention and Support (HEPS), PO Box 7627, London NW6 6WB, or fax 01 71 244 6514.

Ripped off from :- Health Education Authority 1997
Produced by the Health Education Authority on behalf of Health Promotion Wales HPW-5-08158 4197

Hepatitis is inflammation of the liver. This can be caused by alcohol and some drugs, but usually it is the result of a viral infection. There are many types of virus which can cause hepatitis. Each of these viruses acts differently.

The hepatitis C virus (HCV) can be spread in the following ways.

•by sharing contaminated needles or other drug- injecting equipment. If you have ever shared drug- injecting equipment, you may want to be tested for hepatitis C
•by using non-sterilised equipment for tattooing, acupuncture or body piercing
•by unprotected (without a condom) penetrative sex (when the penis enters the anus or vagina) with someone who is infected. Also by sex which draws blood with someone who is infected. This is not a common way of becoming infected with hepatitis C
•on rare occasions, from an infected mother to her baby, mainly during delivery.
•through a blood transfusion in a country where blood is not tested for the hepatitis C virus. All blood for transfusion in the UK is tested.

Signs and symptoms
People may have no symptoms at all, but they can still pass on the virus to others. Symptoms, though not common, may include:
•a short, mild, flu-like illness
•nausea and vorniting
•diarrhoea
•loss of appetite
•weight loss
•jaundice (yellow skin and whites of eyes, darker yellow urine and pale faeces)
•itchy skin
Some people may need to be admitted to hospital.


Current evidence suggests that only about 20% of individuals who have been infected with the hepatitis C virus appear to clear the virus from the blood, whilst about 80% will remain infected and can pass on the virus to others. If a person continues to be infected over a number of years with the hepatitis C virus, they could develop the following complications:
• chronic hepatitis
• liver cirrhosis
• liver cancer

Where to go for help
• Your own GR
•Your local NHS sexual heaith (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections (STI) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any NHS clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GR (Non-NHS sexual health clinics do not always offer the full range of services which are available at NHS sexual health clinics.)
• A hospital Accident and Emergency department.

The tests for hepatitis C
Tests for the hepatitis C virus (HCV) have only been available since 1989.
Your GP or doctor at your local NHS sexual health (GUM) clinic can diagnose hepatitis C by carrying out blood tests. You will be asked questions to try to discover the source of the infection.

What does a positive test result mean?
It means that you may be a carrier of the hepatitis C virus and can pass it on to others.
The first test given will be a test for antibodies to the hepatitis C virus (anti-HCV). If this test is positive, it means that you have been exposed to the hepatitis C virus and that your body has responded by producing antibodies. This test does not indicate whether or not you are still infected. You will normally be referred on to a specialist for a further test to try to find out if this is the case.

The specialist will carry out another blood test to look for the hepatitis C virus (HCV-RNA). Although some people do clear hepatitis C, most people remain chronically infected and are therefore infectious to others. To find out how much hepatitis C may be affecting the liver, the specialist will also perform liver function tests (LFT) and may also take a small sample of liver tissue (a liver biopsy). The results of the LFT andlor liver biopsy help the specialist decide whether you would benefit from treatment or not.

Clearing the virus does not mean you are immune to reinfection.

What does a negative test result mean?

This result probably means that you have never been in contact with the hepatitis C virus.
However, as the tests rely on the detection of anti- bodies to HCV, and the antibodies can take some months to develop, your doctor may advise you to have a repeat test if there is a chance you have been recently exposed to the virus.
At present there is no vaccine available to protect against hepatitis C.

Follow-up
If you are diagnosed as having an active infection with hepatitis C, you will be advised to have regular blood tests and physical check-ups. All carriers should expect to be referred to specialist services.
If you are infected with hepatitis C, you should limit the amount of alcohol you drink. The doctor may also advise you to avoid fatty foods and follow a low-salt diet.

Transmission of the hepatitis C virus by penetrative sex does occur, although it is not common. If you are infected it is advisable to use a condom for penetrative sex to ensure that you do not pass on
the virus to your partner(s).

Your doctor will advise you about any precautions necessary to ensure that you avoid infecting others with the virus, such as not sharing toothbrushes or shaving equipment.

Remember, using a condom can reduce your risk of getting or passing on sexually transmitted infections.

Further information
For further information, contact the British liver Trust, tel. 01473 276 328 (Mon-Fri, 2prn-Spm), or write to Hepatitis Education Prevention and Support (HEPS), PO Box 7627, London NW6 6WB, or fax 0171 244 6514, or call Mainliners Heipline on 0171 582 5226.

Ripped off from :- Health Education Authority 1997
Produced by the Health Education Authority on behalf of Health Promotion Wales HPW-5-08158 4197

Scabies is the most common sti - Sexualy Transmitable Infection in Britain. It is caused by a mite that cannot be seen

Signs and symptoms
These are the same for both men and women:
•Eczema - like rash
•Itchy red patches on the body and Scratching at night

How they are passed on
Scabies can be easily passed on through any close contact, including sharing towels or clothing. Partner shoul be treated too.

Treatment .............. (1 visit to the clinic)

• Scabies can be treated with a special lotion from the chemist or clinic ( follow the instructions carefully)

Where to go for help
• Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infection (STI) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any clinic anywhere in the country - you don't have to go to a local one - and you don't have to
be referred by your GP (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
• Your own GP.

Syphilis is not a common infection in the UK, But it is on the increase. it is a bacterial infection and is usually sexually transmitted.

Signs and symptoms
The signs and symptoms are the same in both men and women.
They can be difficult to recognise and may take up to 3 months to show after having sexual contact with an infected person.

Syphilis has several stages.
The primary and secondary stages are very infectious.

Primary stage
one or more painless sores appear at the place where the bacteria entered the body. These sores can appear anywhere on the body but mainly:

  1. on the penis and foreskin in men, and around the anus and mouth (both sexes)
  2. on the cervix (neck of the womb) in women and vulva (lips of the vagina), the clitoris and around the opening of the urethra. The sore (or sores) is very infectious and may take from 2 to 6 weeks to heal.

Secondary stage
if the infection remains untreated the secondary stage may occur during the next 2 years.


The symptoms include:
• 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
• a flu-like illness, a feeling of tiredness and loss of appetite, accompanied by swollen glands (this can last for weeks or months)
• white patches on the tongue or roof of the mouth
• patchy hair loss
When these symptoms are present syphilis is very infectious and may be sexually transmitted to a partner.
Treatment at any time during these first two stages of syphilis will cure the infection.

latent stage
This occurs at any time after the first 2 years. During this time syphilis is rarely transmitted sexually. If left untreated over a period of years the disease develops. It is at this late stage that syphilis can affect the heart, joints and possibly the nervous system.
If treatment is given during the latent stage the infection can be cured. However, if there has been heart or nervous-system damage before treatment is started this may be irreversible.

How syphilis is passed on

Syphilis can be transmitted by:
• having unprotected anal or viginal sex with someone who has the infection

Where to go for help
• Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections(STI) or venereal diseases (VD). Or phone your local hospital and ask for the ,special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GR (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)

  • Your own GR


The tests for syphilis
At the clinic the following tests will normally be made:
• A blood sample is taken.
• If you have a sore, a specimen of fluid is taken from this and looked at under a microscope.
• Your genital area and whole body are examined by the doctor.
• Samples are taken, using a cotton-wool or spongy swab, from any sores.
• Women are given an internal examination.
• A sample of urine is taken.
None of these tests should be painful, but they may be slightly uncomfortable.

Diagnosis and treatment
Samples taken during the examination are looked at under a microscope to cheek for infection. Samples are sent to a laboratory for testing. The result is usually available within one week.
If you are told that you have syphilis a health adviser will explain the infection to you and answer any questions you may have. You will also be asked about your sexual partner(s), so that, if necessary, they can get treatment too.
If it is suspected that you have the early infectious stages of syphilis, you should not have oral, anal or vaginal sex. You should also not have any kind of sex involving contact between your partner and any sores or rashes you may have until the treatment is completed.


Treatment for syphilis is usually a 2-week course of penicillin injections or, in some cases, antibiotic tablets or capsules.
if you are allergic to any antibiotics, or if there is any possibility that you may be pregnant. it is important that you tell your doctor.
It is important that you finish any course of treatment. If treatment is interrupted, it may be necessary to start again from the beginning.
once you have completed your treatment, you will be asked to attend the clinic at regular intervals for blood tests.

Once syphilis has been successfully treated, it will not come back unless you become reinfected. However your blood test will be positive in any future tests (e.g. for immigration reasons). Make sure you get a certificate from your clinic explaining about your treatment.

Remember, after treatment, using condoms during sex can reduce your risk of getting or passing on sexually transmitted infections.

Ripped off from :- Health Education Authority 1997
Produced by the Health Education Authority on behalf of Health Promotion Wales HPW-5-08158 4197

Thrus - Candidiasis is an yeast infection which can be present on the skin

Signs and symptoms
These are the same for both men and women:
•Itching, and rash or inflammation on the penis / vagina, anus or in the moth and throat.
•Sticky white patches on the skin or in the mouth.

•Pain during sex and when passing water

How they are passed on
Thrush is a yeast infection, it can be easily passed on through any close contact, not necasserily sexual.

Treatment .............. (1 visit to the clinic)

• Creams and tablets from the clinic ( follow the instructions carefully)

Where to go for help
• Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infection (STI) or venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any clinic anywhere in the country - you don't have to go to a local one - and you don't have to
be referred by your GP (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
• Your own GP.

Non-specific urethritis (NSU) is an inflammation of a man's urethra. This inflammation can be caused by several different types of infection, the most common being chlamydia.

Signs and symptoms

The symptoms may include:
• pain or a burning sensation when passing urine
• a white/cloudy fluid from the tip of the penis. This may be more noticeable first thing in the morning
• feeling that you need to pass urine frequently
There may be no symptoms, but this does not mean that you cannot pass the infection on to your partner(s).

How NSU develops
NSU is almost always caused through sexual infection. Very rarely it can result from:
• excessive friction during sex or masturbation
• an allergic reaction, such as to bubble baths or washing powders
• excessive alcohol consumption

Where to go for help
•Your local NHS sexual health (GUM) clinic. You can find details of your nearest NHS sexual health clinic in the phone book under genito-urinary medicine (GUM), sexually transmitted infections (STI) or
venereal diseases (VD). Or phone your local hospital and ask for the 'special' or GUM clinic. You will get free, confidential advice and treatment. You can go to any clinic anywhere in the country - you don't have to go to a local one - and you don't have to be referred by your GR (Non-NHS sexual health clinics may not always offer the full range of services which are available at NHS sexual health clinics.)
• Your own GR
Don't pass urine for at least 2 hours before attending the clinic or doctor's surgery.

The tests for NSU
• A physical examination of your genital area by a doctor or nurse.
• Samples are taken, using a cotton-wool or spongy swab, from the penis or urethra.
• A sample of urine is taken.
None of these tests should be painful, but they may be uncomfortable.

Diagnosis and treatment
Samples taken during the examination are looked at under a microscope to check for infection. In some clinics, the result is available immediately. A second sample is sent to a laboratory for confirmation of the infection. The result is usually available within one week.


Treatment is easy.

You will be given antibiotic tablets. If you are allergic to any antibiotics, it is important that you tell your doctor.
It is important that you finish any course of treatment. If treatment is interrupted, it may be necessary to start again from the beginning.
Your Partner should also attend the clinic for a check-up.

Follow-up
It is important to return for a check-up after you have completed the treatment to ensure that the infection has gone.
You should not have penetrative sex (when the penis enters the anus,vagina or mouth), not even with a condom, until you have returned to the clinic and been given the all-clear by the doctor.

Complications
•NSU may recur. Serious complications are rare. If they do occur you may experience:
•inflammation of the testicles
•reduced fertility
•Reiters syndrome - which causes inflammation of the eyes, joints and urethra, and sometimes sores on the penis or soles of the feet

Remember, after treatment, using condoms during sex can reduce your risk of getting or passing on sexually transmitted infections.

Ripped off from :- Health Education Authority 1997
Produced by the Health Education Authority on behalf of Health Promotion Wales HPW-5-08158 4197

What if I think I have been recently exposed to HIV?

If you have put yourself at risk of HIV infection within the last 72 hours, then go to your local sexual health centre or Accident & Emergency and request PEP.

If you manage to start PEP treatment within 72 hours, it will help prevent HIV infection if you complete the course of treatment.

Don't second guess whether you should need it or put it off, every hour lapsed makes PEP less effective, click HERE for your local sexual health centre. (Type in your postcode and then click "select test or service" and on next page tick the box PEP

PEP

PEP is a course of HIV medication which you can take if you have been at risk of HIV infection. The course of HIV medication lasts for a month and, if taken within 72 hours of putting yourself at risk, may be able to prevent you from becoming infected with HIV.

PEP stands for Post Exposure Prophylaxis – in other words it is a form of protection (against HIV) that you can take after you have taken a risk or had a condom break on you.

Post Exposure Prophylaxis (PEP)

The aim of this information is to answer some of the questions that you may have, if you think that you may have recently been sexually exposed to HIV (Human Immunodeficiency Virus).

What is PEP?

PEP (Post Exposure Prophylaxis) is a combination of drugs that should prevent HIV infection after possible HIV exposure.

Post – After.

Exposure - A situation where HIV has a chance to get into someone’s body.

Prophylaxis – A combination of drugs that can stop infection happening.

What is my risk of developing HIV infection?

The most important thing to remember is that at least one person that you had sex with needs to have been HIV positive for HIV to be transmitted.

HIV is not transmitted every time a HIV positive person and a HIV negative person have sex.

The risk of transmission occurring depends on the type of sex you have had, with whom and the number of times you have done it.

Lots of different things can make it more likely for HIV to be transmitted;

these include having another sexually transmitted infection, bleeding during sex and the person who already has HIV being at an infectious stage of HIV.

Taking Post Exposure Prophylaxis, (PEP) within 72 hours may reduce the risk of HIV being transmitted.
What do you mean by sexually exposed to HIV?

When we say sexually exposed to HIV, we mean that you have had sex that could cause you to come into contact with HIV.

The most likely route of sexual transmission is vaginal or anal sex where a condom wasn’t used or a condom broke.

Oral sex is less likely to be a route of HIV transmission compared to unprotected vaginal or anal sex. There are other ways that HIV can be transmitted such as sharing injecting equipment, if you are concerned about these you should speak to a professional.

Will PEP prevent me from developing HIV infection?

PEP can offer some protection; however it can’t be a 100% guaranteed that it will stop you from becoming HIV positive.

What drugs will I be prescribed?

You will be given a course of anti HIV drugs which work on different parts of the HIV virus to stop HIV multiplying and to help your immune system to fight off the possible infection.

Where can I get PEP from?

At the Sexual Health Clinic or Accident & Emergency Department.

We recommend that you go to your Sexual Health Clinic during their working hours. You do not need an appointment for this. They will try and see you as soon as possible, as every hour counts. If it is the evening or weekend or you can’t go to your Sexual Health Clinic then please go to your nearest Accident & Emergency Department.

There is an on call GU Medicine or Infectious Diseases Registrar (and consultant if necessary) who can be contacted via the hospital switchboard if the Accident & Emergency Department needs to contact them about PEP.

Not all Accident & Emergency departments are aware of PEP. PEP is not available from your GP or at any pharmacies.

How soon after I have been at risk should I start taking PEP and how long do I have to take it?

PEP should be taken within 72 hours of possible HIV exposure.

The sooner you start the more effective it is.

You will need to complete the month long course of treatment unless the Doctor advises you to, e.g. if your sexual partner’s HIV status is known after HIV testing etc.

Will I get PEP treatment every time I ask for PEP?

When you are seen by a health professional, they will ask you a few questions about what you know about your sexual partner(s) background and the type of sex you have had to find out if it is suitable to prescribe PEP.

They will refer to their BASHH guidelines and discuss the next recommended course of action with you.

What are the side effects of Post-Exposure Prophylaxis (PEP) drugs?

On occasion some people experience side effects which are commonly feeling sick and/or diarrhoea. If you do experience these, medication can be prescribed to minimise the side effects.

Your blood will need to be monitored because occasionally the tablets can affect your kidneys and/or liver. If you have any concerns about side effects, please discuss with your doctor or nurse.

Are there any drugs that I am currently taking that will interact with PEP?

Many drugs can interact with PEP. For this reason, you need to tell the doctor who prescribes PEP for you, about any prescription, over the counter, alternative medication or recreational drugs that you are currently taking.

What tests will I need?

If you take PEP you will need some blood tests before you start the course, during the treatment and then afterwards.

These are explained more fully below:
• Blood taken straight away to check that you are not already HIV positive. Your doctor or nurse may talk to you about testing for other infections at this time.
• Blood taken during the PEP course to check your body’s functions to see if there are any issues.
• Blood taken after the course of PEP to check that HIV infection has not developed.

How can I protect myself and my partners in the future?

A condom and water or silicone based lubricant, used properly, are the most effective way of preventing HIV transmission during sex, i.e. ensuring that the condom is on the penis before vaginal or anal sex occurs.

We recommend that you have regular sexual health checks as not all sexually transmitted infections have symptoms but they can increase HIV transmission.

Reference: ripped off from Yorkshire Mesmac Website

North Wales Sexual Health Help Line

Telephone : 01745 443301

Monday to Friday 9.00 am – 4.30 pm

Childline

Tel:- 0800 1111

Childline Sexual Health Information

Sexually transmitted infections (STIs) Fact sheet N°110

Updated November 2013

Key facts

More than 1 million people acquire a sexually transmitted infection (STI) every day.

Each year, an estimated 500 million people become ill with one of 4 STIs: chlamydia, gonorrhoea, syphilis and trichomoniasis.

More than 530 million people have the virus that causes genital herpes (HSV2).

More than 290 million women have a human papillomavirus (HPV) infection.

The majority of STIs are present without symptoms. Some STIs can increase the risk of HIV acquisition three-fold or more.

STIs can have serious consequences beyond the immediate impact of the infection itself, through mother-to-child transmission of infections and chronic diseases.

Drug resistance, especially for gonorrhoea, is a major threat to reducing the impact of STIs worldwide.

What are sexually transmitted infections and how are they transmitted?

STIs are caused by more than 30 different bacteria, viruses and parasites and are spread predominantly by sexual contact, including vaginal, anal and oral sex.

Some STIs may be spread via skin-to-skin sexual contact. The organisms causing STIs can also be spread through non-sexual means such as blood products and tissue transfer. Many STIs—including chlamydia, gonorrhoea, hepatitis B, HIV, HPV, HSV2 and syphilis—can also be transmitted from mother to child during pregnancy and childbirth.

A person can have an STI without having obvious symptoms of disease. Therefore, the term “sexually transmitted infection” is a broader term than “sexually transmitted disease” (STD). Common symptoms of STDs include vaginal discharge, urethral discharge in men, genital ulcers, and abdominal pain.

Eight of the more than 30 pathogens known to be transmitted through sexual contact have been linked to the greatest incidence of illness. Of these 8 infections, 4 are currently curable: syphilis, gonorrhoea, chlamydia and trichomoniasis. The other four are viral infections and are incurable, but can be mitigated or modulated through treatment: hepatitis B, herpes, HIV, and HPV.

Scope of the problem

STIs have a profound impact on sexual and reproductive health worldwide, and rank among the top 5 disease categories for which adults seek health care.

More than 1 million people acquire a sexually transmitted infection every day. Each year, an estimated 500 million people acquire one of four sexually transmitted infections: chlamydia, gonorrhoea, syphilis and trichomoniasis. More than 530 million people are living with HSV2. More than 290 million women have an HPV infection, one of the most common STIs.

Estimated new cases of curable sexually transmitted infections (gonorrhoea, chlamydia, syphilis and trichomoniasis) by WHO region, 2008 STIs can have serious consequences beyond the immediate impact of the infection itself.

Some STIs can increase the risk of HIV acquisition three-fold or more.

Mother-to-child transmission of STIs can result in stillbirth, neonatal death, low-birth-weight and prematurity, sepsis, pneumonia, neonatal conjunctivitis, and congenital deformities. Syphilis in pregnancy leads to approximately 305 000 fetal and neonatal deaths every year and leaves 215 000 infants at increased risk of dying from prematurity, low-birth-weight or congenital disease.

HPV infection causes 530 000 cases of cervical cancer and 275 000 cervical cancer deaths each year.

STIs such as gonorrhoea and chlamydia are major causes of pelvic inflammatory disease, adverse pregnancy outcomes and infertility.

Prevention of STIs

Counselling and behavioural approaches

Counselling and behavioural interventions offer primary prevention against STIs (including HIV), as well as against unintended pregnancies. These include:

comprehensive sexuality education, STI and HIV pre- and post-test counselling; safer sex/risk-reduction counselling, condom promotion; and interventions targeted at key and vulnerable populations, such as adolescents, sex workers, men who have sex with men and people who inject drugs.

In addition, counselling can improve people’s ability to recognize the symptoms of STIs and increase the likelihood they will seek care or encourage a sexual partner to do so. Unfortunately, lack of public awareness, lack of training of health workers, and long-standing, widespread stigma around STIs remain barriers to greater and more effective use of these interventions.

Barrier methods

When used correctly and consistently, condoms offer one of the most effective methods of protection against STIs, including HIV. Female condoms are effective and safe, but are not used as widely by national programmes as male condoms.

Diagnosis of STIs

Accurate diagnostic tests for STIs are widely used in high-income countries. These are especially useful for the diagnosis of asymptomatic infections. However, in low- and middle-income countries, diagnostic tests are largely unavailable. Where testing is available, it is often expensive and geographically inaccessible; and patients often need to wait a long time (or need to return) to receive results. As a result, follow up can be impeded and care or treatment can be incomplete.

The only inexpensive, rapid blood test currently available for an STI is for syphilis. This test is already in use in some resource-limited settings. The test is accurate, can provide results in 15 to 20 minutes, and is easy to use with minimal training. Rapid syphilis tests have been shown to increase the number of pregnant women tested for syphilis. However, increased efforts are still needed in most low- and middle-income countries to ensure that all pregnant women receive a syphilis test.

Several rapid tests for other STIs are under development and have the potential to improve STI diagnosis and treatment, especially in resource-limited settings.

Treatment of STIs

Effective treatment is currently available for several STIs. Three bacterial STIs (chlamydia, gonorrhoea and syphilis) and one parasitic STI (trichomoniasis) are generally curable with existing, effective single-dose regimens of antibiotics.

For herpes and HIV, the most effective medications available are antivirals that can modulate the course of the disease, though they cannot cure the disease.

For hepatitis B, immune system modulators (interferon) and antiviral medications can help to fight the virus and slow damage to the liver.

Resistance of STIs—

in particular gonorrhoea—to antibiotics has increased rapidly in recent years and has reduced treatment options. The emergence of decreased susceptibility of gonorrhoea to the “last line” treatment option (oral and injectable cephalosporins) together with antimicrobial resistance already shown to penicillins, sulphonamides, tetracyclines, quinolones and macrolides make gonorrhoea a multidrug-resistant organism.

Antimicrobial resistance for other STIs, though less common, also exists, making prevention and prompt treatment critical.

STI case management

Low- and middle-income countries rely on syndromic management, which is based on the identification of consistent groups of symptoms and easily recognized signs (syndromes) to guide treatment, without the use of laboratory tests. This approach, which often relies on clinical algorithms, allows health workers to diagnose a specific infection on the basis of observed syndromes.

Syndromic management is simple, assures rapid, same-day treatment, and avoids expensive or unavailable diagnostic tests. However, this approach misses infections that do not demonstrate any syndromes - the majority of STIs globally.

Vaccines and other biomedical interventions

Safe and highly effective vaccines are available for 2 STIs: hepatitis B and human papillomavirus (HPV). These vaccines have represented major advances in STI prevention. The vaccine against hepatitis B is included in infant immunization programmes in 93% of countries and has already prevented an estimated 1.3 million deaths from chronic liver disease and cancer.

HPV vaccine is available as part of routine immunization programmes in 45 countries, most of them high- and middle-income. HPV vaccination could prevent the deaths of more than 4 million women over the next decade in low- and middle-income countries, where most cases of cervical cancer occur, if 70% vaccination coverage can be achieved.

Research to develop vaccines against herpes and HIV is advanced, though no viable vaccine candidates for either infection have yet emerged. Research into vaccines for chlamydia, gonorrhoea, syphilis and trichomoniasis is in earlier stages of development.

Other biomedical interventions to prevent some STIs include adult male circumcision and microbicides.

Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60% and provides some protection against other STIs, such as herpes and HPV.

Tenofovir gel, a microbicide with the potential to allow women to actively avert HIV acquisition, reached “proof of concept” stage in clinical trials in 2010. Further clinical research to support regulatory approval of its safety and effectiveness is underway.

Current efforts to contain the spread of STIs are not sufficient

Behaviour change is complex

Despite considerable efforts to identify simple interventions that can reduce risky sexual behaviour, behaviour change remains a complex challenge. Research has demonstrated the need to focus on carefully defined populations, consult extensively with the identified target populations, and involve them in design, implementation and evaluation.

Health services for screening and treatment of STIs remain weak

People seeking screening and treatment for STIs face numerous problems. These include limited resources, stigmatization, poor quality of services, and little or no follow-up of sexual partners.

In many countries, STI services are provided separately and not available in primary health care, family planning and other routine health services.

In many settings, services are often unable to provide screening for asymptomatic infections, lacking trained personnel, laboratory capacity and adequate supplies of appropriate medicines.

Marginalized populations with the highest rates of STIs—such as sex workers, men who have sex with men, people who inject drugs, prison inmates, mobile populations and adolescents—often do not have access to adequate health services.

WHO response

WHO develops global norms and standards for STI treatment and prevention, strengthens systems for surveillance and monitoring, including those for drug-resistant gonorrhoea, and leads the setting of the global research agenda on STIs.

Our work is guided by Millennium Development Goals 4, 5 and 6, the global strategy for the prevention and control of STIs adopted by the World Health Assembly in 2006 and the 2010 United Nations Secretary-General’s Global Strategy for Women's and Children's Health, which highlights the need for a comprehensive, integrated package of essential interventions, including information and services for the prevention of HIV and other sexually transmitted infections.

WHO works with countries to:

Scale-up effective STI services including:

STI case management and counseling syphilis testing and treatment, in particular for pregnant women hepatitis B and HPV vaccination.

Promote strategies to enhance STI-prevention impact including:

integrate STI services into existing health systems promote sexual health measure the burden of STIs monitor and respond to STI antimicrobial resistance.

For more information contact: WHO Media Centre LINK

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