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This feature article was written by Dr. Wayne Osbourne, a GP and the Head Practitioner at Treated.com.
I’ve been working in general practice for 13 years now, and I can tell you that STIs are just as much of an issue here in the UK as they are in the United States.
Permit me to share some statistics:
- During 2013, there were 1.4 million chlamydia diagnoses reported to the CDC, the Centers for Disease Control and Prevention in the US.
- During the same year, in England, there were a little over 200,000 new cases reported to NHS, the National Health Service.
While it may seem like a huge disparity in the actual numbers, when you take the respective populations of each country into account (approximately 318 million in the US and 53 million in England), it really isn’t. In fact, the incidence of infection per capita is almost exactly the same:
- In 2013, around 0.4% of people in both England and the US were newly diagnosed with chlamydia.
Although public awareness of STIs is generally on the rise, the social stigmas surrounding them is just as much an issue here as it is in the US. Looking past the emotional distress STIs can cause, perhaps the most damaging effect of this stigmatization is a reluctance to seek treatment.
Sometimes, the less you know (or want to know) about a condition, the less real it can seem, and the simpler it can be to ignore. However, the longer infections linger without being addressed, the more damage they can do – not only to your own health, but to those you come in contact with as well.
The first step in tackling these conditions is to know what you’re up against. Here, I’ve assembled a list of five of the most common STIs affecting people on either side of the Atlantic, along with a guide on how to recognize them, and what diagnosis and treatment may involve.
The term chlamydia is actually a derivative of the Greek word chlamys, meaning ‘to cloak’, due to the infection’s ability to hide itself in the body of the host and remain undetected.
What are the symptoms of chlamydia?
- Pain during urination in both men and women
- Testicular pain or white watery discharge emanating from the penis in men
- Bleeding after sex, heavier periods, vaginal discharge, and lower abdominal pain in women
However, as its name suggests, not everyone who comes into contact with this STI will get symptoms. As many as 80% of women and 50% of men will not notice any symptoms at all. But this doesn’t make the infection any less formidable, as it can still be spread to other people and lead to infertility.
- A potential complication for women is pelvic inflammatory disease, a painful condition which affects the urinary tract, the womb, the ovaries, and can cause infertility.
How is chlamydia transmitted?
- Through any type of unprotected sexual activity where vaginal fluid or semen is exchanged, including: anal, vaginal, or oral penetration; and the sharing of sex toys.
How is chlamydia diagnosed?
- A urine sample is taken, and in some cases a swab from the area affected.
How is chlamydia treated?
- With antibiotics. This may be as a single one-off dose, or a one-week course, depending on the state of infection and which method is most suitable for you.
- Over 95% of chlamydia cases are completely cured with this form of treatment.
This infection was at its most common in the US in the mid 1970’s. But even though the number of infections have since fallen, rate of infection is on the rise – there were over 300,000 cases reported to the CDC in 2013.
What are the symptoms of gonorrhea?
- In women, a green or yellowish vaginal discharge, and heavier periods
- In men, a similar-colored discharge from the penis, sore or inflamed foreskin, and occasionally testicular pain
- The infection causes urinary pain in both sexes, and can also lead to infertility.
Once again, the infection isn’t always outwardly noticeable; 10% of men and 50% of women experience no visible symptoms. This makes it all the more important, if you are sexually active, to get tested regularly.
How is gonorrhea transmitted?
- The same way as chlamydia – through any type of unprotected sexual activity where vaginal fluid or semen is exchanged, including: anal, vaginal, or oral penetration; and the sharing of sex toys.
How is gonorrhea diagnosed?
- A urine sample is taken, and in some cases a swab from the area affected.
How is gonorrhea treated?
- The remedy is simple and non-invasive and is often given as a short or one-off dose of antibiotics.
Herpes (HSV 1 or 2)
What are the symptoms of herpes?
- Recurrent blisters and/or cut-like sores on the genitals or the mouth. In genital cases, these may be accompanied by difficulty passing urine and/or a mild discharge in women.
- The initial infection is usually the most severe. Recurrent outbreaks often cause less noticeable sores and tend to occur with diminishing frequency over time.
- HSV is also commonly asymptomatic.
How is herpes transmitted?
- Through skin-to-skin contact with an infected area. This can occur during vaginal, oral, manual, or anal sex.
- Cold sores, which are usually HSV1, can also be passed on through kissing.
How is herpes diagnosed?
- The condition can be identified by its appearance. Those less certain cases can have a blister swabbed and tested to obtain a definitive diagnosis.
- Blood tests are also available, but they do not indicate location of the infection, just that it is present in the body.
How is herpes treated?
- The bad news is that herpes isn’t curable. But it is fairly straight-forward to manage.
- Creams and tablets containing antivirals can send this virus into a state or remission, and help blisters to clear up.
In 2013 there were over 17,000 cases of (primary and secondary) syphilis reported in the US. While it is not as common as gonorrhea and chlamydia, it has the potential to be much more dangerous if left untreated.
What are the symptoms of syphilis?
There are three stages of syphilis: primary, secondary and tertiary.
- Primary syphilis is characterized by a small sore appearing on the genitals, referred to as a chancre. It may develop between one week and three months after the infection has been contracted and disappear within two to six weeks.
- Secondary symptoms will arise a short time after the chancre has gone. These include a rash, wart-like growths around the vagina or anus, non-specific symptoms similar to flu, such as headache and joint pain, or swollen lymph glands.
- A period of ‘latency’ will follow, where the infection may appear to go away for months, or even years.
- The final stage, or tertiary syphilis, is where the condition gets serious. It can cause severe damage to the nervous system, blood vessels, bones and organs – resulting in stroke, heart problems, dementia, paralysis and, in some cases, death.
How is syphilis transmitted?
- The bacteria responsible can be passed through physical contact with the chancre.
How is syphilis diagnosed?
- A blood test or a physical examination, which may be followed with a swab of a suspected sore.
How is syphilis treated?
- During the primary and secondary stages, syphilis can be completely remedied with antibiotic treatment.
- Tertiary cases will require admission to a hospital, where antibiotics may be administered through a drip.
Genital Warts (HPV)
According to the CDC, there are approximately 360,000 cases of genital warts reported in the US on an annual basis. It is caused by the human papillomavirus, or HPV.
What are the symptoms of genital warts?
- Warts are small skin-colored bumps, which can take on a cauliflower-appearance when present in clusters.
- These develop on or inside the vagina, on or around the penis or scrotum, in the urethra, the anus, or the upper thighs.
How are genital warts transmitted?
- Via skin-to-skin contact. This means that wearing a condom may not prevent the disease from being spread.
How are genital warts diagnosed?
- Through visual identification by a doctor.
How are genital warts treated?
- As it is caused by a virus, genital warts are not ‘curable’. However, medication can help to eliminate their presence, and over time (6 months to 2 years), most people will clear the infection on their own.
- Topical creams containing an antiviral agent are applied directly to the warts. These help to kill off the wart cells, so that healthy skin can grow in their place. Warts can also be surgically removed.
- It may be necessary to continue undergoing treatment for several weeks or months.
The Importance of Testing
As evidenced by the figures above, STIs are much more common that you might think. When you take into account the potential dangers of an untreated infection and the general risk of transmission, getting tested and a correct diagnosis and treatment is the only sensible and responsible course.
Many patients think that testing for STIs is invasive and that treatment will be complicated. However, in most cases, a diagnosis can be ascertained from a simple blood test or urine sample. And treatment in the case of bacterial infections is as easy as a one-off dose of antibiotics. Perhaps more startlingly, though, is the readiness of many people to ignore symptoms or deny that STIs are a possibility.
If you think you have come in contact with any STIs, you owe it to yourself and those around you to not suffer in silence.
Over at Treated.com, I am pleased to announce that we have introduced a new module on my blog, where readers are welcome to ask me questions and get free help and advice. You can also find out more about the nature of STIs on our information pages, including those infections not listed above.
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Dr. Wayne Osbourne is a British-based GP and the Head Practitioner at Treated.com. He has been working in private practice since 2002, and his particular interests lie in sports injuries, elderly medicine, and pediatrics.
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Did this post answer your questions about symptoms, testing, and treatment? Were you surprised by how common some of the infections are in the UK and the US? Did you already know how all of the infections were transmitted? Share your thoughts in the comments section below!