Key points
- STIs don’t always have symptoms but can cause severe health problems, if left untreated.
- Regular sexual health checks are important if you are sexually active.
- All treatment at NHS sexual health clinics is confidential and free of charge for anyone.
Sexually transmitted infections (STIs) can be caused by bacteria, viruses or parasites. More common STIs include:
- chlamydia
- genital and anal warts (caused by the human papillomavirus, or HPV)
- gonorrhoea
- Lymphogranuloma venereum (LGV)
- mycoplasma genitalium, a bacterial infection
- hepatitis A, B and C
- herpes (caused by the herpes simplex virus, or HSV). This can cause both oral (on the mouth) and genital infection
- syphilis
- parasites such as pubic lice (sometimes called crabs) and scabies
- shigellosis, an illness caused by the bacteria Shigella, and other illnesses that cause diarrhoea
- trichomoniasis, an infection caused by a very small parasite.
Although STIs other than HIV can seem a minor issue, they can cause unpleasant symptoms. If left untreated, some can cause severe health problems. In the very long term, some can cause irreversible damage to your health or, in extreme cases, be fatal.
Some sexually transmitted viral infections, such as herpes simplex virus (HSV, normally just called herpes) and HPV, cannot be cured, although their symptoms can be reduced or treated.
Hepatitis A, B and C can all be passed on during sex (hepatitis B is especially infectious). They can all make you seriously ill if they are left untreated.
Sexual health check-ups
If you are sexually active, it is important to have regular sexual health check-ups. For people considered to be at high risk of STIs (because they have had sex without a condom with a new partner, have multiple partners, or been diagnosed with an STI), the recommendation is to have a check-up every three months.
Many HIV clinics share a building with a sexual health clinic and many HIV clinics include sexual health screening as part of their routine HIV care. You can choose which sexual health clinic you go to. It does not have to be the one nearest your home or the one linked to your HIV clinic.
Visits to sexual health clinics usually involve seeing a healthcare provider who will ask you about the kind of sex you are having and whether you have any symptoms of an STI before examining you. It is important to be honest about the types of sex you have had, so you can be given the appropriate tests. Sexual health clinics are very used to seeing all the communities affected by HIV in the UK. Most people are happy with their treatment at sexual health clinics, but if you are not treated in a professional and non-judgemental manner, you have a right to raise this or make a complaint.
Tests and examinations for STIs vary, often depending on whether you have symptoms. They might be done in the clinic. Or they may give you a kit and ask you to take your own swabs and samples which you then post to a laboratory for analysis.
Samples may be taken from the tip of your penis (only if you have symptoms) or from inside your vagina. If you have oral or anal sex, you will be asked for samples from the mouth, throat and anus. You may also be asked for a urine sample and a blood sample. These swabs and samples are then sent to a laboratory to look for evidence of infection and may be examined under a microscope for rapid detection.
Some results can be given to you at your visit, but it may be necessary to wait for a text message, a telephone call from the clinic, or to come back a week or so later for some other results.
All treatment at NHS sexual health clinics is confidential and free of charge (even if you are not normally entitled to free NHS care). The clinic will need a record of your postcode for administration purposes. Your GP will not be informed without your consent.
If it turns out that you have an STI, you may be offered the opportunity to see a sexual health adviser. Sexual health advisers can give you information about STIs and how to avoid them and can help you contact your sexual partners, if this is possible or practical, so they can also be tested and treated. This helps prevent infections from spreading in the wider community and can help reduce the chance of you becoming re-infected.
In the UK, some GPs or practice nurses offer sexual health screens. Free chlamydia testing and treatment is widely available for people under the age of 25. Many pharmacies also work with local sexual health clinics to provide screening and treatment.
STI postal testing kits that can be ordered online and used at home, with samples sent back to a laboratory for testing, may also be available in your area.
Vaccinations against STIs
There are vaccines available for:
- hepatitis A
- hepatitis B
- human papillomavirus (HPV), which can cause genital and anal warts, as well as several types of cancer.
Your clinic can advise you on whether you need vaccination against hepatitis A. Unless you have natural immunity, the hepatitis B vaccine is recommended for all people with HIV.
The British HIV Association recommends that the following groups of people living with HIV should have the HPV vaccine: women up to the age of 40, gay and bisexual men up to the age of 40, and heterosexual men up to the age of 26.
Common symptoms
There are some common symptoms of STIs. These include:
- a discharge from your vagina, penis or anus. This may be discoloured – for example, milky, yellowish or like mucus – or may have blood in it
- pain or a burning feeling when you urinate (pee) or needing to urinate more often than usual
- pain while you are having sex
- abnormal stomach pains
- pain or swelling around your anus or testicles
- generally feeling unwell
- for herpes: numbness, itching and tingling, followed by bumps that become small, fluid-filled blisters
- for syphilis: small sores, spots or ulcers on the penis or around the mouth, vagina or anus at the site of infection; a rash on your torso, arms, palms or soles of feet
- for hepatitis A, B and C: symptoms can include jaundice (a yellowing of skin and eyes), nausea and vomiting, and tiredness
- for genital warts: lumps and bumps around the genital area and anus
- for parasites, especially scabies: itching around the genitals or in other concealed places, such as between the fingers or toes, or behind the knees
- diarrhoea with blood and rectal pain.
However, many people have no symptoms at all when they first get an STI, or their symptoms are so mild they don’t notice them. Regular sexual health checks are important because they can diagnose STIs even if you have no symptoms. Many STIs can go on to cause serious, long-term health problems if they are not diagnosed and treated, including causing infertility. Hepatitis B and C can become chronic (long-term) conditions and lead to serious liver damage while syphilis can affect organs such as the brain and heart.
Treatment
Antibiotics can cure bacterial infections such as chlamydia, gonorrhoea and syphilis, and also the parasitical infection, trichomoniasis. Antibiotics may be given as tablets or by injections, depending on the STI you have.
Antiviral drugs can be used to treat (but not always cure) some viral infections. Herpes cannot be cured and the virus stays in nerve cells for life, although most of the time it may not cause symptoms. You may have episodes from time to time, especially if you have a weakened immune system. Your immune system may suppress HPV, the genital warts virus, but this may take a long time and for some people never happens. There are various treatment options to get rid of visible warts.
Drugs to treat hepatitis C can provide a cure, but they don’t protect you from being infected again.
Topical treatments, such as lotions, can clear infestations of parasites such as scabies or pubic lice. You should also wash clothing, towels and bedding at high temperatures.
It is important to finish the whole course of any drugs prescribed and to go to any follow-up appointments you are advised to have. You may be advised not to have sex (even with a condom) until any treatment is finished, and sometimes for a while after that. This will ensure you get the correct treatment and are completely cured of the STI, if that is possible.
Any sexual partners you have had since the time you may have been infected should also go for a sexual health check, as they may also need to be treated, even if they have no symptoms.
Transmission and prevention of STIs
STIs can be transmitted through anal, oral and vaginal sex, and by sharing sex toys.
Some can also be passed on through rimming (mouth-to-anus contact), kissing or other close physical contact. Parasites can be passed on by sharing towels or bedding. Some STIs (including hepatitis A) and other infections (for example, gut infections such as giardia) can be caused by contact with infected faeces (excrement, shit), such as during rimming or fisting. Hepatitis A can also be transmitted through contact with infected faeces in contaminated food, for example, shellfish.
Hepatitis B is passed on by contact with the blood, semen, saliva, or vaginal fluids of a person with hepatitis B. It is easily passed on during sex without a condom and to a baby during childbirth. It is many times more infectious than HIV. Hepatitis C is normally passed on through blood-to-blood contact. It is also passed on through sex among gay men having anal sex without using condoms. Other factors that seem to be associated with sexual transmission of hepatitis C are group sex, fisting, sharing sex toys, injecting or snorting drugs, anal administration of drugs and the presence in either person of other STIs, especially syphilis or LGV infection.
Using condoms during anal or vaginal sex, using a condom or dental dam for oral sex, and not sharing sex toys can protect you against most STIs. If you are fisting, to protect yourself against hepatitis C, wear latex gloves and do not share pots of lubricant. With some STIs, using a condom or dental dam will reduce the risk of infection, but not protect you completely.