Sexually transmitted diseases (STDs)

These are infections which are transmitted through sexual intercourse.

Chlamydia

Chlamydia is the commonest curable STD in developed world. It is caused by a germ called C. trachomatis. It is a major cause of pelvic inflammatory disease (PID), infertility and ectopic pregnancy. Most women with Chlamydia don’t know they have it and one half of the infected men don’t know they are infected. When symptomatic, men may have the following symptoms: painful frequent urination, penile discharge, painful testicles, pain when opening bowels with diarrhoea, and painful swollen joints. Symptomatic women may have vaginal discharge, painful intercourse, heavy, irregular periods, lower abdominal pain and painful joints.

Gonorrhoea

Gonorrhoea is caused by a germ called Neisseria gonorrhoeae, and occurs worldwide. Most men with gonorrhoea will have symptoms but about 40% of females may not know they have it as they may not have symptoms.

Symptoms usually occur within 3-5 days when if you are a man you start to notice yellow (pussy) discharge from your penis and urination becomes painful and frequent. This may progress and involve your testicles causing painful, swollen tender testicles.

When symptomatic, infected women may notice increased /altered / yellow (pussy) vaginal discharge. They may also experience frequent and painful urination and vaginal soreness. Occasionally, a woman with gonorrhoea may have irregular vaginal bleeding or heavy periods. They may experience painful sexual intercourse and lower abdominal pain.

Trichomonas

Trichomonas is caused by a germ called Trichomonas vaginalis. It is most common in females between 18 and 35 years. Although it is usually sexually acquired, sexual intercourse is by no means, the only way of acquiring it. In women it causes frothy and offensive yellow/green discharge with vaginal itching. In addition, there may be painful and frequent urination, vaginal soreness and painful intercourse.

Up to 50% of men with Trichomonas may not know they have it as they have no symptoms. Symptomatic males may experience mild penile discharge (clear/grey) and some degree of painful urination.

Genital Warts

Genital wart is caused by human papilloma virus (HPV). It is the most common viral sexually transmitted infection in the UK. It is most common in young women and men under 24 years. The lesions usually cause no symptoms but they can sometimes become painful, itchy, and can bleed when traumatised.  

Genital Herpes

Genital herpes is mostly caused by infection with herpes simplex virus type II, but can also be caused by type I (transferred via cold sores). Symptoms start 3 days to 2 weeks after exposure initially as itch and tingling, redness and fluid filled rash (vesicles). By day 8 or 9, the vesicles break up into ulcers that are wet and exquisitely painful. During this time the patient experiences painful urination, urethral/penile/vaginal discharge, headache, muscle pain, general malaise. The ulcers start to heal from day 10 and by day 14 healing is usually complete although the patient may develop another flare.

Hepatitis B

Hepatitis B is caused by hepatitis B virus. The complete virus particle is known as the Dane particle. It can also be transmitted through non-sexual routes.

Persons who may be at increased risk Hep B infection include:

Drug abusers using shared or unsterile needles

Persons with multiple sexual partners

Sexual partners of Hep B carrier

Babies born to Hep B mothers

Blood transfusion – if donor is not properly screened

Haemodialysis patients

Family members of infected patients – from sharing things such as toothbrushes, razors

Health-care workers – occupational hazard from sharps injuries

Persons who are institutionalised - prisoners, mentally handicapped - especially Down's syndrome. Carers are also at risk.

HIV/AIDS

AIDS is a consequence of infection with human immunodeficiency virus, HIV. HIV causes a slowly progressive but fatal disease. HIV can be acquired through sexual intercourse as well as by intravenous administration and other exposure to human body fluids. Initially, the patient shows no symptoms and infection may not be recognised. After 2-6 weeks, seroconversion occurs the virus is dissemination throughout the body. The patient then develops systemic illness characterised by: fever, swollen glands (lymphadenopathy), joint pain, muscle pain, sore throat, skin rash. This seroconversion illness usually settles in less than two weeks. With dissemination the virus attacks the defence system of the body and destroys the body’s immunity leading to full blown AIDS.

Syphilis

Syphilis is caused by a germ called treponema pallidum. Syphilis is becoming increasingly common. It is characterised by a minor early illness with a more serious late manifestations after a variable inactive (latent) period. The disease is divided into three stages - primary, secondary and tertiary stages. Secondary and tertiary stages are becoming rarer as people have become more aware and adequate antibiotic treatment of the early stage - the latter two becoming rarer with the development of adequate antibiotic control.

The first stage (primary syphilis) is characterised by the occurrence of a painless hard ulcer (chancre) developing in the genital area between 9 to 90 days after exposure. The glands in the groin area swell up but they are painless. After 3 to 10 weeks, the chancre heals and the infection progresses into the second stage.

The second stage (secondary syphilis) can be difficult to diagnose as the clinical picture is non-specific. It is characterised by a combination of: fever, sore throat, malaise, joint pains. There may also be generalised skin rash (with exception of face – rose pink), eye redness, hair loss, severe headache, chest pain, swollen glands, mouth and genital ulcers, thick palms and soles. The features of secondary syphilis generally settle after a few months. The disease then enters a period of late latency after one year. This period may continue for many years before the late stages of syphilis become apparent.

The third stage (tertiary syphilis) is characterised by the development of lesions called gummata. These lesions most commonly affect skin, bone, and mucosal surfaces. Latterly, they affect the cardiovascular and neurological systems, a stage which is often referred to as quaternary syphilis.

Other STDs

Chancroid

Chancroid is endemic in Africa, Asia and South America and is caused by a germ called Haemophillus ducreyi. It causes genital ulcers which are characteristically very painful and the groin glands also swell up and become painful.

Granuloma inguinale

It is caused by a germ called Calymmatobacterium granulomatis. It causes red raised rash which become painless ulcers in genital and groin areas.

Lymphogranuloma venerum

Lymphogranuloma venerum is caused by a germ called Chlamydia trachomatis (L1,L2,L3) and is endemic in Africa, India, SE Asia, South America and the Caribbean. It characteristically causes painful large glands in the groin.