Gonorrhoea and other STIs – all you need to know

Sexually transmitted infections (STIs) are on the rise, so if you’re having sex – whether you’re 17 or 70 – it’s time to think about getting an STI test. It’s a subject that most of us just won’t talk about but sadly, STIs don’t care about your sexual history – you can get an infection on your first or 100th time having sex, so it’s crucial to know the facts. In these modern times, the health experts suggest we need to add a couple of STI checks to our annual medical checks.

Here are some all-important questions for you:

Have you ever been tested? Has your partner? If not, why not? Would you go for a chlamydia test? Are you too embarrassed to talk about STIs and contraception with your partner? Have you ever felt uncomfortable asking your partner to use a condom? Have you ever been pressured into not using one?

With the number of recorded STIs increasing, it’s time to banish our blushes and get used to talking about the tricky subject of sex and infections. Any sexually active person may be exposed to an STI and, like a regular health check-up, we need to start adding an STI test to the list.

We’re all a bit more liberal about sex these days and while the number of STIs is greatest among the under-25s, thanks to relationship breakdown and divorce those between 35-60 are increasingly susceptible.

In the past 20 years, there has been a rapid rise in sexually transmitted infections in Ireland. In 1995, just over 3,000 STIs were diagnosed; by 2013 it was 12,753, so it’s time to change our attitude to testing. A survey by insurer Aviva Health in 2013 found that 70 per cent of people surveyed had never had an STI test.

Are STIs all that serious?

The reality is that having an STI will not ruin your life. Most can be cured, and even chronic STIs like HIV can be managed when caught early. The key is to know your stuff – some STIs have no symptoms and if left untreated can result in infertility, in both sexes.

The good news is that testing and treatment for most STIs is simple and painless. Some of the most common STIs can be treated with a once-off dose of antibiotic. The problem is that some people are leaving it too long to get checked. Dr Andrea Holmes, a consultant in genitourinary medicine, says we can no longer afford to stay silent about our sexual health. "We should not be targeting just young people for education about safe sex and STIs," she says.

Despite the myth that our sex lives end at the first sight of a grey hair, many people over 70 are still enjoying a healthy libido, perhaps with new partners. “Times have changed, and the problem is that most sexual health promotion is aimed at younger people, leaving many older people unaware that they are also at risk of STIs,” says Holmes.

Holmes believes we all need to think about testing. “In the wider public, there is a lack of knowledge about how STIs spread, and about how to identify tell-tale symptoms, which exacerbates the problem.”

In the case of chlamydia, for example, a man or woman could have no symptoms and be totally unaware they are infected unless they test. “People can carry it for a long time and potentially pass it on without even knowing they have it,” she says. “But it can be serious in the long term. Chlamydia can lead to reduced fertility and chronic pelvic pain.”

Can I talk to my doctor?

Your doctor will not be shocked if you raise the subject of STIs, says Holmes. “We are always pleased to see people taking a proactive approach, so it’s great to be able to pluck up the courage and ask to be tested. I wish it was the norm rather than the exception, because it would end a lot of the embarrassment around the issue. It’s time to be more grown-up on the subject.”

Holmes says the stigma around STIs has to go: “People are often afraid or unwilling to talk openly about it. They may feel guilty and embarrassed, and some may leave it quite late before seeking help. It would be great to reverse that situation and be able to openly discuss these issues.”

STIs: THE FACTS

Genital Human Papillomavirus (HPV): HPV infects the skin, causing abnormal cell changes that can lead to cervical cancer.

How you get it: Oral, vaginal and anal sex.

Treatment: There's no cure, but the immune system clears most cases within a year or two. Follow-up smear tests, as recommended by your doctor, catch signs of pre-cancers before they turn into something serious.

Pubic Lice ('Crabs'): These tiny insects infest the pubic hair, suck your blood and lay eggs. Experts say crabs are waning, thanks to the recent increase in below-the-belt shaving and waxing.

How you get them: Sexual activity, but it can also be passed through contact with linens and clothes.

Treatment: OTC creams and lotions kill the insects and their eggs.

Genital Warts: These cauliflower-ish bumps, which can turn up on the anus, and inside and outside the vagina, are caused by a less serious strain of HPV that isn't associated with cancer. They're itchy, but usually painless.

How you get it: Sexual intercourse and groin-to-groin contact.

Treatment: Warts can be removed with freezing, creams or surgery. Without this the wart, and the wart virus, can clear on their own within a couple of years. Smoking slows down wart clearance.

Herpes: A virus grouped into two types (HSV-1 and HSV-2), herpes can cause painful outbreaks of ulcers on the mouth, vagina, penis, rectum and butt cheeks, which make you more vulnerable to other STIs. In rare cases, herpes leads to viral meningitis and can be passed to a baby during childbirth.

How you get it: Oral, vaginal and anal sex can cause genital herpes and a person could potentially get type 2 on their mouth if they gave someone oral sex or kissed someone with type 2 on their lips.

Treatment: It's incurable, but a daily pill can lessen outbreaks.

Gonorrhoea ('the Clap'): Gonorrhoea is a bacterial infection that can cause pelvic pain, inflammation and vaginal discharge, but sometimes has no symptoms. It can lead to pelvic inflammatory disease and infertility if left untreated.

How you get it: Oral, vaginal and anal sex.

Treatment: Doctors prescribe a combination of injectable and oral antibiotics.

Chlamydia:

Most people notice no symptoms, but you could experience pelvic pain, burning during urination, and vaginal or urethral discharge. Without medication, chlamydia can cause pelvic inflammatory disease and infertility.

How you get it: Oral, vaginal and anal sex.

Treatment: Easily cured with a once-off dose of antibiotic.

Syphilis ('the Pox'): A bacterial disease said to have plagued Beethoven and van Gogh, syphilis can damage the heart and nervous system if left untreated. The telltale symptom is a painless sore or sores. It may progress to a red pock-like rash.

How you get it: Contact with a syphilis sore during kissing and vaginal, oral or anal sex.

Treatment: Antibiotics can cure it.

Super Gonorrhoes: Like other bacteria, gonorrhoea is mutating: a new strain is resistant to four of the antibiotics once used to cure it.

How you get it: Oral, vaginal and anal sex.

Treatment: New treatment guidelines, an injectable drug and an oral dose of a second antibiotic are working.

Hep B: A virus that affects the liver and often leads to chronic liver disease. Symptoms are fatigue, fever, jaundice, dark urine, nausea and abdominal pain. Can lead to liver failure or cancer.

How you get it: Oral, vaginal and anal sex as well as sharing needles, razors or toothbrushes with an infected person.

Treatment: The immune system sometimes fights off the infection within six months of exposure. Chronic cases are treated with lifelong medication and by cutting back on alcohol.

HIV: Human immunodeficiency virus (HIV) attacks the immune system and initially may feel like a bad case of the flu. The advanced stage is acquired immunodeficiency syndrome (Aids). If diagnosed early after infection, medications can stop progression to Aids.

How you get it: Vaginal and anal sex and sharing needles; less commonly, oral sex, contact with open wounds.

Treatment: There's no cure, but long-term medicines control the virus and allow people to live long, healthy lives.

How do I get an STI test? The Irish Family Planning Association recommends that all people who are sexually active attend for a full STI screening twice each year. STI screening is free of charge and confidential at HSE clinics (you can get a full list here: http://www.hivireland.ie/hiv/testing/free-hiv-sti-testing-centre-locator) or contact a private clinic and self-refer.

Dr Andrea Holmes is attached to the Guide clinic at St James’s Hospital in Dublin and runs a private practice in the Bon Secours hospital in Galway.