Sexually Transmitted Infections

Sexually active adolescents are particularly at risk of acquiring a sexually transmitted infection. This is due to a number of reasons, including having sex with multiple partners, failure to use condoms consistently, limited antibodies to STIs, and the "It can't happen to me" attitude (1). Anyone who is sexually active is at risk of contracting an STI. As many STIs do not have obvious symptoms, the best way to prevent them is by always practising safe sex.

STIs have a range of symptoms and can cause a wide variety of problems including mild irritation, serious illness and infertility.

Viral STIs

HIV/AIDS

The human immunodeficiency virus (HIV) is a virus that damages the body's immune system, making it unable to fight off infection. A person infected with HIV is said to be HIV positive. HIV causes acquired immune deficiency syndrome (AIDS). AIDS is the name given to the group of illnesses or symptoms that are the result of the human immunodeficiency virus. A person who has one or more serious HIV-related illnesses or whose immune system has decreased to an identified level, is said to have AIDS (2).

The number of new HIV diagnoses has dropped over the last decade. In 2006, the National Centre in HIV Epidemiology and Clinical Research received notification of 998 new HIV diagnoses (3). This is compared to 1418 new diagnoses in 1991 (4). The number of women diagnosed with HIV is comparatively small with most new cases occurring in the male homosexual or bisexual population. Among men newly diagnosed with HIV infection in 2002-2006, 88% reported a history of male homosexual contact (5). The vast majority of women contract the virus through heterosexual contact, in particular through heterosexual contact in a country which has a high HIV prevalence or with a partner who comes from a country with a high HIV prevalence. At the end of 2006 26 267 diagnoses of HIV infection had occurred in Australia (6).

HIV is spread when the blood, semen or vaginal fluid of an infected person gets into the bloodstream of an uninfected person. This transmission can happen via unsafe/unprotected vaginal or anal sex, sharing needles, receiving an infected blood supply or through pregnancy and possibly childbirth. (All donated blood is now checked before being given to someone else).

Men and women infected with HIV suffer from similar HIV-related illnesses including chronic diarrhoea, bacterial infections, tuberculosis, pneumonia and cancer of the lymph nodes. Women are, however, also affected by a range of conditions specific to their gender. These illnesses are primarily reproductive tract infections, in particular, recurrent thrush infections.

Presently, there is no cure for HIV/AIDS, but new drug therapies and lifestyle improvements can help a HIV positive person remain symptom free for long periods of time. It is estimated that in the average time from infection with HIV to developing AIDS is 8-10 years (7).

The only safeguard against HIV/AIDS is prevention: always practising safe sex and using clean needles and syringes. The only way of knowing if someone is HIV positive is by having a blood test. It can take up to three months for the antibodies to develop once HIV has entered the bloodstream.

Genital herpes

Genital herpes is a common STI caused by the herpes simplex virus. There are two types of herpes simplex virus. Type I generally causes cold sores around the mouth and face and Type II generally causes genital herpes. Type I and II are interchangeable in that Type I may be transmitted onto the genitals. An increasing number of genital herpes cases are from Type I which is most likely due to an increase in the practice of oral sex, particularly among young people. It is estimated that up to one in eight people carry the virus that causes genital herpes (8).

Symptoms of the genital herpes vary and may be extremely mild in some people and severe in others. The virus causes painful and itchy blisters which burst, leaving ulcers or scabs which then heal over. The appearance of the blisters is often accompanied by flu-like symptoms. In women, genital herpes blisters usually occur on the outer and inner lips of the vagina. They can also occur inside the vagina, the urethra, the clitoris, the cervix, the area between the vagina and anus and on the thighs or bottom.

Following the initial outbreak, the virus moves to the nerves in the base of the spine where it remains dormant. Periodically, the virus again becomes active, causing a recurrence of symptoms. The frequency of these recurrences differs greatly between individuals and for some people are triggered by certain factors (menstruation, high levels of stress, fatigue, poor health, sun exposure). Therefore, maintaining good general health and well-being and a strong immune system is important. Several anti-viral drug treatments are also now being used to treat genital herpes. These drugs either reduce the length of an attack or reduce the frequency of attacks.

Genital herpes can be transmitted through skin-to-skin-contact with the infected ulcers/blisters, mucus or secretions (9). The virus may also be transmitted even when the infected person is displaying no symptoms (is free of any ulcers or blisters). Therefore, the best way to prevent contracting the herpes virus is to always practise safe sex, with the use of condoms. However, it is important to remember that condoms do not provide absolute protection against the virus as blisters or ulcers can occur in places which are not covered by a condom.

Hepatitis B and C

Hepatitis is a virus which causes inflammation of the liver and can lead to cirrhosis of the liver or even liver cancer. Hepatitis B can be transmitted by infected blood, semen, mucus, vaginal secretions, saliva or breast milk entering the body of another person. Symptoms include weakness, fatigue, fever, vomiting as well as jaundice (yellowing of the skin and eyes). However, the disease can also be asymptomatic (experience no symptoms). The majority of people with Hepatitis B recover completely, but some people will become chronic carriers which means that they are infectious for the rest of their lives. In 2006, 295 newly acquired infections of Hepatitis B were notified in Australia (10).

Hepatitis C is transmitted through blood contact (needle sharing or needle-stick injuries, razor blades, unsterile tattooing or body piercing equipment). Sexual transmission rate is very low, but sex during menstruation or anal sex may increase the risk (11). In 2006, 431 newly acquired infections of Hepatitis C were notified in Australia (12). The majority of Hepatitis B and C transmissions are from injecting drug use.

While there is no specific treatment for hepatitis, antiviral drug therapy can assist the body to fight the virus. Alcohol and fatty foods should be avoided following an infection as they place extra strain on the liver.

Genital human papillomavirus (HPV)

More than 70 types of the human papillomavirus (HPV) have been identified, with over 30 of these able to infect the genitals (13). It is estimated that 30-40% of sexually active people in the developed world are infected with genital HPV, with most being unaware they are infected (14). While some strains of genital HPV cause genital warts, others increase the risk of cervical cancer. HPV is transmitted through direct skin-to-skin contact, usually through sexual activity. As in the case of genital herpes, the use of condoms to prevent HPV may not be effective if the infected areas are not covered by the condom.

In women, genital warts may appear on the vulva, vagina, cervix, anus, or urethra. A person, however, may not know that they are infected if the warts are not visible (very small or inside the vagina or anus). Other people may remain asymptomatic. The virus may be activated due to lowered immunity levels (due to another illness, genetics, smoking, pregnancy, and lifestyle factors such as poor nutrition, stress, depression and inadequate sleep) (15). Treatment involves the removal of the warts through the application of chemicals, ablation (freezing, burning or laser) or immunotherapy (use of a cream which enhances the body's immune response).

HPV is the major risk factor for cervical cancer. However, not all women with HPV develop cervical cancer and so it is thought that other factors (eg. smoking) need to be present in addition to HPV (16). Vaccines against some strains of HPV are now available in Australia. Women aged 12-26 can be vaccinated for free through the National HPV Vaccination Program (17).

Bacterial STIs

Chlamydia

Chlamydia trachomatis (chlamydia) is the most common form of bacterial sexually transmitted infection in Australia. More than half (53%) of the cases diagnosed in 2006occurred in those aged 20-29 (18). In the past nine years the rate of reported chlamydia increased dramatically, from 9 206 cases in 1997 to 47 030 cases in 2006 (19). Of the diagnoses in 2006, approximately one quarter occurred in Queensland (20).

Transmission of chlamydia occurs through vaginal, oral or anal sex. It can also be transmitted from mother to baby during birth. Approximately 60% of women and 10% of men will experience no symptoms (21). Symptoms for women include unusual vaginal discharge, pain during sexual intercourse, changes in menstrual bleeding or pain in the lower abdomen. Chlamydia can be diagnosed by a swab test or a urine test.

Chlamydia is potentially a very serious STI for women, as it is responsible for 30-40% of cases of pelvic inflammatory disease (PID). Chlamydia-related PID occurs when the chlamydial infection spreads from the cervix and urethra to the upper reproductive tract (uterus, fallopian tubes and ovaries). PID can cause scarring and adhesions which result in pelvic pain, ectopic pregnancies and infertility. Fortunately, chlamydia is easily treated with antibiotics if diagnosed in the early stages.

Gonorrhoea

Gonorrhoea is transmitted through oral, vaginal or anal sex and can also be spread to the throat during oral sex with an infected person. Symptoms include pain when urinating, pelvic pain and a heavier than usual vaginal discharge. However, as with chlamydia, many women will not display any symptoms. If left untreated, gonorrhoea can cause pelvic inflammatory disease (PID). Diagnosis of gonorrhoea involves taking swabs and treatment consists of a course of antibiotics. In 2006, there were 8 550 diagnoses of gonorrhoea, with 1 560 in Queensland (22).

Syphilis

Syphilis is spread by sexual contact and from mother to baby during pregnancy. The first sign is the appearance of a painless sore in the area of sexual contact. The sore may go unnoticed if it is small or in an internal area. This sore may take up to three months to occur, and will heal within a few weeks. The next stage, which may happen days or months later, involves a spotty rash occurring on the chest, face, palms or soles of the feet. This secondary stage is highly infectious and can last from three months to a year. If the infection is left untreated it can progress to a third stage. In this stage the syphilis infection causes damage to the central nervous system and the brain. Diagnosis of syphilis involves a blood test.

Treatment for syphilis is simple and involves high doses of penicillin or other antibiotics. In 2006, there were 815 cases of syphilis diagnosed in Australia, with 165 in Queensland (23).

Other STIs

Trichomoniasis

Trichomoniasis is caused by a small parasite, Trichomonas vaginalis and is almost always sexually transmitted. The main symptom is a frothy vaginal discharge which has an unpleasant odour (although nearly half of women infected with trichomoniasis will not experience symptoms). Treatment involves either oral antibiotics or a vaginal cream.

Pubic lice and scabies

Pubic lice are creatures similar to head lice which infest the pubic hair causing intense itching. Marks or bites around the pubic area and small eggs attached to the pubic hair are indicators of pubic lice. Treatments are available from chemists without a doctor's prescription.

Scabies is caused by a tiny mite that burrows under the skin, causing itchy red lumps on the skin. Scabies mites can be treated by applying lotions which are available from chemists. Pubic lice and scabies are spread by sexual and other intimate contact.

References

This student factsheet is one of a series produced by Women's Health Queensland Wide. They have been developed in response to students' most frequently asked question and reflect a range of topics examined by high school and tertiary students. It has been reviewed by our Editorial Committee. This factsheet is designed for student assignment purposes and, therefore, may not be an appropriate source of information for personal use.

For further information sources on this topic see our Internet resources for assignments page

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Last Modified: October 30, 2007