Although syphilis rates have been recently rising among gay men in Australia, syphilis is not particularly common among women. However, it is worth being screened for, as the disease progresses more quickly in the context of immune impairment, and can also become more difficult to treat if you have HIV. It is also easily cured.
Syphilis is caused by bacteria and is passed from person to person through sexual contact, skin-to-skin contact with a syphilis sore, or from a mother to her baby. Women who have sex with men can acquire and transmit syphilis. It is only very rarely transmitted from woman to woman.
Testing for syphilis involves either a blood test, or taking a swab from any sores present on the skin, mouth, vagina, or anus.
Untreated syphilis can develop in three stages:
- The first stage, called primary syphilis; sores appear on the body where the bacteria has entered – such as on the vulva, vagina or cervix. These sores are highly infectious and take two to six weeks to heal
- The second stage, called secondary syphilis; a painless rash can appear, often covering the palms of hands and soles of feet; flat wart-like growths can appear around the genitals and patchy hair loss may occur. In addition, fever, tiredness, and swollen lymph glands can all occur at this stage
- The third or latent stage, called tertiary syphilis; after many years untreated syphilis may start to cause very serious damage to the heart, brain, eyes, other internal organs, bones and nervous system. At this stage syphilis could be fatal
In people with HIV, the disease can progress far quicker, with some cases reported of progression to the tertiary stage occurring within months of infection, so prompt diagnosis and treatment is essential.
Syphilis is treated with antibiotics, usually penicillin, and sexual partners also need to be tested and treated.
Chlamydia is an STI caused by bacteria that infects the cervix in women and can travel upwards through the reproductive organs to the fallopian tubes. It is particularly important to screen for and to treat. It is readily transmissible, highly prevalent in the general Australian population particularly in people under 25 and if left untreated can give rise to serious illness like pelvic inflammatory disease (PID) and can compromise your fertility. Because it is often asymptomatic in both men and women, people often don’t know that they have it. The only way to know for sure if you have chlamydia is to have a test.
This involves either a urine test or taking a cell specimen from the vagina using a swab. This can be done on its own, as part of other testing for STIs, or as an extra test when you have a Pap smear.
Treatment is simple – a course of antibiotics which can either be taken as a single dose or as a longer course. Your doctor will advise you on the best treatment approach for your situation. If you are prescribed the longer course, it is important that you take every tablet and that your partner is treated too if he or she is infected. You and your partner should avoid vaginal, oral and/or anal sex until you have both completed the course of treatment.
Gonorrhoea is caused by bacteria that can be passed from one person to another during sex. The bacteria usually live inside the cells of the cervix (entrance to the womb), the urethra (tube where urine comes out), the rectum (back passage), the throat and occasionally the eyes.
The infection can spread if you have vaginal, anal or oral sex, or share sex toys. Using a condom correctly will reduce your chance of getting or passing on gonorrhoea.
It is also possible to transfer the infection from the genital area to the eyes by fingers, and for a pregnant woman to pass the infection to her baby’s eyes at birth.
About 50% of women, but very few men, will have no symptoms. If you do have symptoms, which might show up from one to 14 days after infection, they include:
- An unusual vaginal discharge which may be thin or watery, or yellow or green
- Pain when passing urine
- Lower abdominal pain or tenderness
A gonorrhoea test involves a sample of cells being taken from the potentially infected area using a swab (a soft, rounded cotton implement similar to a cotton bud), although a urine test can also diagnose it if the infection is in the urethra or cervix.
Treatment consists of antibiotics, frequently a single dose.
In women, gonorrhoea can spread to other reproductive organs causing pelvic inflammatory disease (PID). This can lead to long-term pelvic pain, blocked fallopian tubes, ectopic pregnancy (pregnancy that occurs outside the womb) and infertility. It is estimated that there is a 15% risk of PID with each episode if the gonorrhoea is not treated.
Herpes infections are caused by a virus, either herpes simplex virus type 1 or 2. Herpes simplex 1 is the virus that causes cold sores. This virus can also cause genital herpes, and is now the most common cause of new genital herpes infections in young adults. Genital herpes is also caused by the herpes simplex 2 virus, and this is the most common cause of recurring lesions.
Are you at risk?
Genital herpes is a sexually transmissible infection. Transmission occurs via intercourse, even when no herpes lesions are visible. Condom use for vaginal or anal sex, and the use of barrier protection like dams, can help prevent this although protection is significantly less than 100%.
A number of effective anti-herpes drugs are available by prescription, and there are national guidelines outlining their use. If your regular partner (regardless of HIV status) has genital herpes, he or she should get preventive (sometimes called suppressive) herpes treatment prescribed to stop outbreaks and to lower your risk of infection. Herpes treatment used preventively does not reduce the infection risk to zero.
If your partner has oral herpes (cold sores on the face or around the mouth) it is very important that he or she does not perform oral sex on you from the time that he or she gets the warning ‘tingle’ to the time that the infection has completely cleared up. People who already have antibodies to HSV-1 (regardless of whether they can recall having cold sores in the past) will not contract it again from their partner(s). If you do not have this protection from antibodies however, it is possible for you to get herpes in the genital region from a partner’s oral infection, whether or not he or she has any visible lesions.
These may include:
- Itching and tingling in the genitals
- Painful sores or blisters around the vagina/anus
- Burning/pain when urinating
- Recurring vulvovaginal thrush may also sometimes be caused initially by outbreaks of genital herpes
Herpes and HIV
Outbreaks of genital herpes may occur more often, and be more severe, if your immune system is weakened by HIV. Some women also report herpes lesions that take a very long time to heal.
It is also possible for undiagnosed 69 herpes infections, which have not caused symptoms in the past, to be ‘reactivated’, and cause symptoms. This can happen if your CD4 count gets very low (below 200) and then is subsequently improved by ARV treatment.
Medical educators urge the aggressive treatment of herpes infections in people with HIV. It can be treated with drugs named aciclovir (Zovirax), valaciclovir (Valtrex) or famciclovir (Famvir). These drugs are very safe and have almost no side-effects. However, they do need to be prescribed by a doctor.
Improving your immune system with ARV can greatly reduce your susceptibility to herpes outbreaks. In addition, avoiding triggering factors can all help reduce the recurrence of herpes.
Human Papilloma Virus
Genital warts are an extremely common STI . Warts are caused by the HPV (human papilloma virus ), which has over 200 different strains, but many people who are infected with HPV do not have any symptoms (i.e. actual warts).
Many women who are or who have been sexually active have been infected with one or more strains of HPV (human papilloma virus ).Some strains of this virus have been shown to cause pre-cancerous changes in the cervix.
The most common manifestation of HPV is genital warts, but most people who have HPV have no symptoms. An estimated 80% of all sexually active men and women have been exposed to HPV.
Wart virus infection can occur in three ways:
- Visible warts (warts which are easy to see); these may have either a hard, smooth surface, or a ‘cauliflower-like’ appearance
- Sub-clinical infection; where you cannot see warts on your skin, but the wart virus can be found inside the skin cell using a microscope, and it may still be able to infect other people
- Latent infection; where the wart virus can only be found with special tests that look for wart virus DNA
If you do have visible warts, treatment is:
- Putting cream or a liquid onto the warts. This can be done at home or in
- Freezing (cryotherapy)
- Heat (electrocautery)
- Laser treatment
There are now vaccines (Gardasil, Cervarix) for HPV that have been proven effective in clinical trials of adolescents and women up to the age of 45. However, it is thought that these products would have less utility in people already exposed to the virus , as most positive women have been. The place of these vaccines for women with HIV is still to be determined.