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Sexually transmitted infections (STI)

What is an STI?

Sexually transmissible infections (STIs) are common around the world including Australia and are passed on from one person to another by sexual contact. Some are relatively harmless and easily treatable/ curable, whilst others are serious, incurable and may cause long-term and chronic complications. Anyone who has unprotected sexual contact can contract an STI; they do not discriminate on the basis of age, sex, marital status, sexual preference, race, colour or social class.
Sexually transmissible infections include gonorrhoea, syphilis, genital herpes or warts, scabies, pubic lice (crabs), chlamydia, hepatitis and HIV/AIDS. Detailed Victorian statistical information is available from the Victorian Department of Human Services Better Health Channel.

How do I catch an STI?

  • Vaginal sex - the man's penis in the woman's vagina
  • Anal sex - the man's penis in the partner's anus (partner can be male or female)
  • Oral sex - the man's penis in the partner's mouth, or the partner's mouth or tongue in the woman's vagina

How can I avoid an STI?

To avoid an STI:

  • avoid having sex (see above) or any genital contact
  • use condoms and water based lubricant or dental dams every time you have vaginal, anal or oral sex
  • use other forms of sexual contact, e.g. masturbation, kissing, hugging, massaging, touching (some of these activities pose a small risk of passing on some STIs)
  • avoid sharing sex toys
  • minimise the number of different partners you have sexual contact with
  • practice safe injecting practices if using intravenous drugs
  • be vaccinated against hepatitis A and B.

Will I know if I have an STI?

Not necessarily. There are a large number of STIs with many different signs / symptoms and some STIs (including chlamydia, hepatitis B and C, genital warts and herpes) show no signs or symptoms. If present, signs and symptoms can include:

  • unusual vaginal or penile discharge
  • genital irritation, pain or bleeding
  • bleeding during or after sex (for example spotting)
  • pain during or after sex
  • sores, blisters, scratches or lesions around the genital or anal area or mouth
  • feeling feverish or unwell or experiencing pelvic or lower abdominal pain
  • burning or stinging sensation when passing urine.

What is involved in STI testing?

An STI screen involves

  • taking a medical and sexual history
  • examination and testing (urine, swabs, blood)
  • education and advice.

In some cases STI testing may comprise of urine testing only for males and females depending on a person's history and presenting symptoms.  On average, an STI screen can be done 2-10 days after a 'risk' contact, although for some STIs a waiting time of approximately three months may be necessary (for example HIV testing).

Common STI's

Genital warts

There are over 150 types of wart virus (HPV) in existence. It is estimated that up to two in every three people carry HPV. Genital warts are often carried and passed on asymptomatically, and it is estimated that it can take anywhere between three weeks to eight months or more for warts to appear after initial infection. Some types of HPV virus have been linked with an increased risk of cervical cancer in women.

Like genital herpes, the wart virus once contracted cannot be cured, only treated. Even with treatment the recurrence rate is up to 25%. HPV can cause outbreaks of visible or invisible warts (undetectable to the human eye). If present, the warts might occur as painless, small cauliflower like lumps on the genital or anal area and occasionally in the mouth, vagina and cervix. Otherwise the person usually feels well.

The wart virus is spread easily by any kind of sexual contact (including touching), via direct contact with a partner's infected skin or mucous membrane, whether warts can be seen or not. There is no reliable diagnostic test for genital warts, however a pap test may pick up wart virus on the cervix.

Treatment does not eradicate the virus and recurrences can occur. Options for external genital warts include freezing the warts with liquid nitrogen which is well tolerated and safe, applying a chemical paint to the warts over a period of time or applying a specially prescribed cream. These treatments must be done with extreme care and depending on the type of treatment administered only by an appropriately qualified health professional.

Prevention is again far better than cure. The National HPV vaccine is available for women aged 18-26 year and provides protection against four strains of wart virus - two which cause 7 out of 10 cervical cancers and 2 which cause 9 out of 10 cases of genital warts.

Genital warts are easily passed on from one person to another due to their highly infectious nature. Apart from the vaccine, condoms and dental dams are the only tool we have to decrease risk of spread, however they are not completely risk free as they only cover parts of the genital and anal area. It is also important for sexually active women to have two-yearly pap smears.

Chlamydia

Chlamydia is one of the most common sexually transmissible infections in Australia, especially among young people (aged 20-29 years), infecting the neck of the womb (cervix) in women and the urethra (urinary tube) in men. It can also infect the throat and anus of males or females.

Chlamydia is of serious concern because it can remain undetected and if untreated, can be a major cause of long-term complications including pelvic inflammatory disease and associated decreased fertility.

Symptoms in women
Women often have no signs or symptoms. If symptoms are present, they may include:

  • unusual vaginal discharge
  • vaginal pain or bleeding with or after sex
  • a burning sensation when urinating.

Symptoms in men
Men may have no signs or symptoms either. If symptoms are present, they may include:

  • white or clear discharge from the penis
  • stinging during urination.

Chlamydia is easily spread by unprotected vaginal or anal sex with someone who has chlamydia and can also be spread via oral sex. Diagnosis is via a swab (from the cervix or penis) or a simple urine test whilst treatment consists of a simple course of antibiotics. Partners should also be treated.

Hepatitis B

Hepatitis B is a common and potentially serious disease, which predominantly affects the liver. Hepatitis itself means inflammation of the liver and can be caused by a number of factors including viruses, medications and disease (such as glandular fever).

In Australia the incidence of hepatitis B has increased significantly with an estimated 150,000 plus people infected with the virus. The highest incidence of the virus (approximately 40%) occurs in the 20-24 age group. It is impossible to know if someone is infected with hepatitis B and often individuals themselves do not realise they are carrying the hepatitis B virus.

Hepatitis B is present in blood, semen, vaginal fluid, saliva and breast milk and is easily spread by activities such as unprotected sex, tattooing, body piercing, intravenous drug use and blood contact where skin is broken (for example during contact sport and/or in first aid situations). The virus is extremely virulent and contagious (it is thought that only 0.00004ml of blood is needed to pass the infection on), surviving outside the body for up to seven days.

Hepatitis B may cause no symptoms. The person may be well and unaware they carry the virus. If symptoms do occur they may include fever, weight loss, loss of appetite, abdominal pain, fatigue, nausea and vomiting and yellowing of the skin and mucous membranes. These symptoms can range from mild to debilitating enough to require extensive time off work or study and possible hospitalisation for a period of time.

Complications of hepatitis B are of concern. Although most people recover from the illness and do not continue to carry the virus, up to 10% of adults and 90% of children become what is known as a 'chronic carrier'. This means the virus remains in the body and can be passed on for life, increasing the risk of liver complications, including scarring or cancer later in life.

There are some reasonably good treatment options but currently no cure for hepatitis B infection. The answer lies in prevention via hepatitis B vaccination and prevention strategies including protected sex and safe injecting practices. Hepatitis B vaccination is available from Deakin Medical Centre on your Campus.

How to use a condom

  1. Always use an unused condom. Buy reputable brands and check the expiry date before purchase and use of single condoms. Store condoms in a dry, cool place away from direct light and heat.
  2. Open the packet carefully, don't use teeth or sharp nails. Do not test the condom first.
  3. Squeeze the tip of the condom to expel the air and roll the condom carefully down the shaft of the erect penis before any genital contact.
  4. Use additional water-based lubricant (small amount).
  5. After ejaculation the penis should be carefully withdrawn holding the base of the condom whilst the erection is still present.
  6. Dispose of the used condom thoughtfully and carefully. They block the sewerage system, so dispose of in a rubbish bin.

Taking it further

Please note: Whilst care has been taken to ensure that external web sites are credible sources of information, no responsibility can be taken for their content. Web-based health information does not replace the need to see an appropriate health care professional.

  • Family Planning Victoria - a range of educational and referral information on sexual health topics including contraception and sexually transmitted infections (STI).
  • Let Them Know - to help people diagnosed with chlamydia tell their sexual partners. Resources include anonymous email and SMS facilities. Developed by the Melbourne Sexual Health Centre
  • STI Testing, Prevention and Treatment - Australian Government site providing useful resources for young people including condom cards and new fact sheets.
  • Drama DownUnder - information about the most commonly experienced sexually transmitted infections (STIs) experienced by gay men
  • Melbourne Sexual Health Centre - specialises in providing diagnosis, testing and education relating to sexually transmissible infections
  • Herpes.com.au - information and advice about genital herpes
  • Hepatitis Australia - resource for people affected by hepatitis C and those who support them
  • Hepatitis C Council of Victoria - represents and provides services and useful information to people with hepatitis C, their carers, partners, family and friends
  • HIV, Hepatitis and STI Education and Resource Centre - free community resource for Victorians, providing fact sheets, librarian assistance, newsletters and presentations
  • Victorian AIDS Council (VAC) - aims to improve the social, mental, emotional and physical health and wellbeing of the Victorian HIV positive communities

Getting help

  • Make an appointment with Deakin Medical Centre
  • Geelong Sexual Health Clinic, telephone 5221 4735
  • Victoria AIDS Council/Gay Men's Health Centre, telephone 9865 6700 or 1800 134 840

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13th September 2011