Sexually transmitted infections

Sexually transmitted infections are the main cause of infertility, especially in women.  Many people, young and older have been confused by 'safe sex' messages.... left thinking that if they only use a condom they are completely protected from disease.   Many are then shocked to discover that condoms did not provide 100% protection and that they do indeed have a disease!   Remember that the use of a barrier method to avoid sexually transmitted infections is risk reduction... not risk elimination...  this means it reduces your risk, it doesn't get rid of it altogether.

Below is some  information about the most common sexually transmitted infections.

Genital Herpes

Genital Herpes is not a notifiable disease so it is hard to know how many people are infected.  Estimates say that about 1 in 8 women may be infected with genital herpes.   Genital herpes is caused by a virus, not a bacteria and whilst there are treatments to help alleviate symptoms, there is no cure available.   You do not need to have active sores or blisters to pass this disease onto other people.

You can have genital herpes and not know it as some people do not experience any symptoms.  Even if you do not have symptoms, you can pass the disease onto others.  Some people have a 'primary' episode when they first get this disease which can result in them feeling quite unwell over several days.  The usual stages include:

  • a mild tingling or itching in the affected area which can last up to 24 hours
  • small blisters with swelling and redness which can range from uncomfortable to extremely painful
  • blisters break and from ulcers within a couple of days
  • glands may swell

Some people experience no 'outbreaks' at all, whereas others have them quite frequently.  Genital Herpes affects you when you become pregnant as the virus can be very dangerous if contracted by your child during birth.  If you suffer an outbreak of genital herpes at the time of delivery, you may be required to undergo a caesarian birth.

Whilst there are treatments to relieve the symptoms of Genital Herpes, there is NO cure.  Infection with Genital Herpes also substantially increases your risk of acquiring HIV. (Dept of Health and Ageing, National STI Strategy 2010-2013)

HPV (Human Papilloma Virus)

We do not know how many people are affected by HPV, however we do know that it is very common.  If you have ever had sex, you may be at risk.  It is transmitted by any sort of sexual activity, not just vaginal intercourse.  If you have HPV, you most likely have no symptoms at all.  This virus can be passed on to other people, even when there are no symptoms.  Some people develop warts, commonly in the genital area.  These can be treated, but can often return.

Most cases of HPV are dealt with and cleared by the body on its own, but other people continue to carry the virus for their lifetime.   If you have HPV when pregnant, the virus can be transmitted to your baby during childbirth and can have very serious consequences.

Some types of HPV can lead to some types of cervical cancer.   There is a vaccine available for young women for some of these types of HPV.   The vaccine is relatively new and we do not yet know what the impact of it will be on the incidence of either HPV or cervical cancer.  We also do not know how long the vaccine will work.  If you have had the vaccine, you continue to be at risk of contracting other sexually transmitted infections.

Chlamydia

Chlamydia is a disease of major significance as in the early stages, most people experience no symptoms, yet it is considered to be the leading cause of infertility in women.  Between 10% and 40% of women with untreated chlamydia develop symptomatic pelvic inflammatory disease, which can lead to tubal damage.  This damage is responsible for up to 40% of all female infertility. Women who have had pelvic inflammatory disease are also up to 10 time more likely to experience an ectopic pregnancy than those who have not.

In 2008 there were 58515 notifications of this disease in Australia.  This is an increase of more than 7000 on the previous year.  Women were more greatly affected with almost 35000 cases compared to men at less than 24000.  The highest rates of chlamydia were found in the 20-24 year age bracket making up more than 21000 reported cases.  This was about 7000 more than the next nearest age group which was 15-19.

Treatment is relatively straightforward once diagnosed, however with the majority of people experiencing no symptoms, the danger is that many may experience complications before they become aware of having the disease.  If you do get symptoms, they will generally occur within 2 weeks of becoming infected.

Symptoms can include:

  • crampy lower abdominal pain
  • longer heavier periods
  • pain when urinating
  • vaginal bleeding or spotting between periods
  • pain during or after sex
  • a change in the quality, colour, or smell of vaginal discharge

Chlamydia can be transmitted via vaginal, anal and oral sex.  Correct and consistent use of a condom during every sexual encounter, may reduce your chances of getting chlamydia by about half.

Gonorrhea

In 2008 there were 7675,  reported cases of Gonorrhea, with the age group 15-29 years comprising 4678 of these cases.

Gonorrhea used to be swiftly and easily treated with penicillin.  Today however gonorrhea has become more resistant to cure.   The World Health Organisation has recently advised (April 2010) of an increase in the incidence of multi-resistant gonorrhea in Australia.   Spokesperson for the WHO states that if the pattern continued, it was only a matter of time before gonorrhoea was fully resistant to those medications used to combat it, and goes on to say.. 'We are dealing with a serious issue with the implication that gonorrhoea may beomce untreatable.  This will have a major impact on our efforts to control the disease and will result in an increase in serious health related complications.'

In the early stages up to 80% of women experience no symptoms of this disease and will be unaware that they have an infection at all.  Left untreated gonorrhea can lead to sterility in both men and women.

If symptoms do occur they generally develop within a few days to a week after the bacteria has been contracted.  Symptoms include:

  • crampy lower abdominal pain
  • a yellowish discharge from the penis
  • a change in quality or colour of vaginal secretions
  • bleeding from the vagina
  • pain during or after sex

If you are a female, crampy abdominal pain may be a sign of Pelvic Inflammatory Disease (PID).  PID can interfere with your ability to get pregnant.  Untreated infections can damage your joints, heart or brain.  The infection can be passed onto babies through childbirth.

Gonorrhea can be transmitted by vaginal, anal or oral sex.  Correct and consistent use of a condom during every sexual encounter may reduce your risk of contracting gonorrhea by about half.

What can I do to avoid getting a sexually transmitted infection?

The only 100% effective means of avoiding an STI, is to avoid sexual activity if you are single, this does not just mean sexual intercourse, but any activity incurring skin to skin contact of the genital region, including oral sex.   If you are married or in a long term committed relationship,  and both of you are free of any STI, stay faithful to that partner for the rest of your life.

References:
- Australian Government Second National STI Strategy 2010- 2013 available HERE
- Crosby RA, Diclemente RJ, Wingood GM, et al. Correlates of condom failure among adolescent males: an exploratory study. Prev Med. 2005 Nov-Dec; 41(5-6):873-6. Epub 2005 Oct 27.
- Wald A, Langenberg AG, Krantz E, et al. The relationship between condom use and herpes simplex virus acquisition. Ann Intern Med. 2005;143(10):707-713.
- Shlay JC, McClung MW, Patnaik JL, Douglas JM Jr. Comparison of sexually transmitted disease prevalence by reported level of condom use among patients attending an urban sexually transmitted disease clinic. Sex Transm Dis. 2004;31(3):154-160.
- Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006;354(25):2645-2654
- Westrom L, Eschenbach D. Pelvic inflammatory disease. In: Holmes KK, et al, eds. Sexually Transmitted Diseases. 3rd ed. New York: McGraw-Hill; 1999:783-809.
- Information reviewed and updated:  October 2010.