Factsheet 3: Sexually Transmitted Infections, May 2011

Sexually transmitted infections (STIs) are a major cause of ill health and can have serious consequences such as infertility and ectopic pregnancy.

Sexually transmitted infections are usually passed on by sex with an infected person though some can be passed on in other ways as well. They can be caught during oral, vaginal or anal sex. Condoms, used on their own or with another method of contraception, prevent the transmission of most STIs. Dental dams (small squares of latex) can also be used as a barrier during sex involving contact between the mouth and the vagina, or the mouth and the anus.

Most STIs can be easily diagnosed and treated at Genito-Urinary Medicine clinics based in hospitals and screening is becoming more easily available in community settings.[i]

The statistics in this fact sheet are taken from recorded visits at GUMand community settings. As some people with infections may be treated by GPs or, if they have no symptoms, remain undiagnosed, the numbers are likely to be an underestimate.

Chlamydia

Chlamydia, caused by Chlamydia trachomatis, is the commonest sexually transmitted infection and is on the increase. The number of cases of Chlamydia identified at GUM clinics in the UK rose by 71% between 2000 and 2009to 114,686. Almost 103,000 people were also diagnosed with Chlamydia in community settings bringing the total number of diagnoses to 217,570, 7% more than the previous year. Women aged 16-24 and men aged 20-34 are at the greatest risk.

Up to 75% of women and up to 50% of men infected with Chlamydia have no symptoms. Because of this, a substantial number of infections remain undiagnosed. Where there are symptoms, women may have discharge, pain when passing urine, heavy periods or bleeding between periods, low abdominal pain or abdominal pain during vaginal sex. Men may notice discharge from the penis and/or burning when passing urine.

Chlamydia is easily treated with antibiotics. However, left untreated, it can cause pelvic inflammatory disease (PID), which can lead to infertility. New methods of testing for Chlamydia are now available which will allow easier and more widespread screening of the infection.

Gonorrhoea

Gonorrhoea, caused by the gonococcus bacteria, is similar to Chlamydia but less common. The number of cases of gonorrhoea fell during the late 1980s and early 1990s, probably because of the HIV safer sex campaigns. Rates rose again between 1995 and 2002 but then declined until starting to rise again in 2009 when there were 17,001 diagnoses at GUM clinics, a 5% increase on the previous year. The highest rates in women occur at 16-24 years, while for men the highest rates are at 20-34 years.

Symptoms of gonorrhoea are different for men and women. Most women do not have any symptoms. The main symptom for men is a discharge from the penis and burning pain on passing urine. Gonorrhoea passed on during oral sex does not usually cause symptoms. Anal gonorrhoea is more common in men who have sex with men and may cause an irritation or discharge from the anus.

Gonorrhoea is treated with antibiotics.

Genital Herpes

Genital herpes is caused by the virus, Herpes simplex 2. However, Herpes simplex 1, which causes cold sores, can also cause some infection. In 2009 there were 30,126cases of genital herpes diagnosed at GUM clinics in the UK. Rates of new infection rose by 71% between 2000and 2009. New cases of herpes are most common among men and women aged 24-35.

Symptoms of herpes are usually tingling or itching on or around the genital area followed by the appearance of small painful blisters. Other symptoms include general flu-like symptoms such as headache, backache or a temperature and burning sensation when passing urine.

People with herpes are most infectious when they have sores or blisters. Tests for herpes can only be done during an episode of blisters.

No cure is yet available for herpes but an anti-viral drug (aciclovir) can reduce the severity and length of the first episode. Most people will only have one or two attacks of herpes but some may have more regular recurrences.

Genital Warts

Genital warts, caused by some strains of the human papilloma virus, are the second commonest sexually transmitted infection seen in GUM clinics with 91,257 cases diagnosed in 2009. The highest rate of infection occurs among men aged 20-34 and women aged 16-34.

Warts can take a year or more to develop after infection with the wart virus. Warts are not always visible, especially if they occur inside the vagina, particularly on the cervix, or in the anus. If warts are not present, the virus cannot be tested for.

Warts can be treated by applying ointments or paints, freezing, or surgical removal under local anaesthetic.

Non-specific genital infections (NSGI)

Non-specific genital infections is a large group of different infections. They include vaginitis (inflammation of the vagina), urethritis (inflammation of the urethra), cystitis (inflammation of the bladder) and proctitis (inflammation of the rectum). NSGI may be caused by Chlamydia, particularly in men. 93,456 people were diagnosed with NSGIs at GUM clinics and in community settings in 2009.

Symptoms of NSGI include discharge from the vagina, urethra or anus, inflammation around the genital area, and pain or burning sensation when passing urine. Sometimes there are no symptoms.

NSGI can be treated with antibiotics.

Syphilis

Caused by the bacterium, Treponema pallidum, there were 2,211 new cases of syphilis in 2009. Symptoms are a painless sore, usually on or near the vagina or penis, but sometimes in the mouth or anus. This is followed by a rash on the body and flu-like symptoms. Although syphilis is now not very common in the UK rates have increased sharply since 1995 with several outbreaks in particular areas of the country.

Syphilis can be treated with antibiotics. If it is left untreated, it can cause heart problems and dementia. If contracted in pregnancy it can cause still birth or congenital infection.

HIV & AIDS

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)

AIDS is a collection of specific illnesses and conditions that occur because the body’s immune system has been damaged by HIV. There are estimated to be 86,500 people living with HIV in the UK, around a quarter of whom are undiagnosed. In 2010 there were 6,750 new diagnoses of HIV. 26,791 AIDS cases had been reported in the UK to the end of 2010.

HIV can be transmitted by four main routes:

through unprotected vaginal or anal intercourse;
through the sharing of needles, or other injecting equipment;
from an infected mother to her baby, during pregnancy, birth or through breastfeeding;
by infected blood, although since 1985 all blood in the UK has been screened, so this is not a major transmission route inthe UK.

HIV infection is concentrated in adults between 20-44. In the UK HIV infection has mainly been transmitted between men who have sex with men although since 1999 the number of new cases acquired through heterosexual sex has outnumbered those acquired through homosexual sex. Where HIV has been transmitted in heterosexual sex, it is mainly when one partner comes from or has lived in countries where the major route of HIV transmission is through sex between men and women. A smaller number of people have acquired HIV through heterosexual sex with a high-risk partner such as an injecting drug user.

HIV is preventable and treatable, but not curable.

Hepatitis B

Hepatitis B is caused by the Hepatitis B Virus (HBV). HBV is much more infectious than HIV and can be transmitted through sexual contact and contact with blood or blood stained saliva and urine.

There is no specific treatment for Hep B but there is a vaccine against the virus available at GUM clinics.

Most people with Hep B recover completely after rest, but in some cases there may be long term liver damage.

Trichomoniasis

Trichomoniasis is caused by tiny parasites infecting the vagina and urethra. There were 5,671 new cases in 2009. Women have symptoms of discharge, itching and irritation but men usually have no symptoms.

Trichomoniasis is not a serious condition but as it is often diagnosed with gonorrhoea, it can be a warning signal for a more serious infection.

Treatment is with antibiotics.

Candidiasis (Thrush)

Thrush is caused by a yeast, Candida albicans. This is often present in the vagina but can multiply and cause symptoms. For women these include a thick, white vaginal discharge, itching, soreness and swelling of the vulva and pain when passing urine. In men, the penis may become sore, itchy and inflamed.

Thrush is not necessarily sexually transmitted. It can be triggered by antibiotics and some forms of contraceptives.

Women can treat thrush with vaginal pessaries and anti-fungal cream. The application of live yoghurt can also be effective. Men should treat thrush with anti-fungal cream.

Pubic Lice

These are very small, crab like creatures which live in the pubic hair. They can cause severe itching.

Pubic lice are not necessarily sexually transmitted but can be passed on through close body contact or sharing towels and bed linen.

Treatment is with special solutions. Left untreated, the lice may spread to other parts of the body, including chest hair and eyelashes, although this is uncommon.

Scabies

Scabies is caused by Sarcoptes scabei. Symptoms include widespread, severe itching.

Like pubic lice, scabies may be passed on through close body contact, not necessarily sexual.

Treatment is with a special lotion.

References

Health Protection Agency, Selected STI diagnoses made at GUM clinics in the UK and England: 2000-2009, HPA 2010
Health Protection Agency. Total number of STI diagnoses made at GUM and Community Settings in the UK and England 2000-2009
in the UK and England 2008-2009, HPA 2010
Health Protection Agency. Total number of STI diagnoses and other episodes of care seen at GUM clinics in the UK and England 2000-2009, HPA 2010
Health Protection Agency, HIV in the United Kingdom: 2010 report, HPA 20
Health Protection Agency. United Kingdom; New HIV Diagnoses data to end December 2010. Tables No. 2:2010.Table A & Table 1

Factsheet 3: Sexually Transmitted Infections, May 2011

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Factsheet 3: Sexually Transmitted Infections, May 2011

[i] Information about local services is available from Brook’s Young People’s Information Service by telephoning 0808 802 1234