Genitourinary diseases
Genitourinary diseases
Written by Dr Angela Robinson, consultant in sexual health
What are 'genitourinary' diseases?
These are conditions usually caused by infections that can affect the genital area and urinary system.
- Some infections are caught from another person, usually during sex.
- Other cases are caused when organisms (bacteria or yeast), which are usually present in small numbers, overgrow and cause symptoms.
- Some genitourinary (GU) diseases are caused by bacteria that do not cause problems in their usual home in the body, but do if they get into another place.
These diseases are often managed best at a genitourinary medicine (GUM) or sexual health clinic.
Who is at risk of sexually transmitted infections?
Young people are at greatest risk of sexually transmitted infections.
- They are very unlikely to have been exposed to any sexually transmitted infections before they start having sex, so they have no chance to build up immunity (when the body can fight off an infection by itself).
- In young women, the cervix (neck of the womb) is immature and is easier to infect. In general, women are more likely to be infected by a man than vice versa.
- Younger people may have more partners or change partners more frequently than older generations. Sexual behaviour is the most important influence on whether you get a sexually transmitted infection. If you have sex with someone who is infected then you are likely to get the infection yourself. The more partners you have the more likely you are to have sex with someone who is infected.
How do I know if I've got an infection?
Some infections, particularly those that are sexually transmitted, can produce no symptoms at all. But they might lead to complications that cause symptoms that prompt you to seek help. Even if sexually transmitted infections do not cause symptoms, they can still be transmitted to sexual partners.
- Some infections cause very similar symptoms. For example, vaginal discharge in a woman can be due to non-sexually transmitted infections such as thrush, but can also be due to sexually transmitted infections. Non-specific symptoms of change in vaginal discharge and pain on passing urine cannot tell you the type of infection. To make a diagnosis, tests usually need to be taken. Similarly in men, urethral discharge (from the tube in the penis) can be caused by more than one infection.
- Sometimes symptoms occur but disappear rapidly. This does not necessarily mean that the infection has gone away. Often the infection remains hidden in the body and, if it is sexually transmitted, the infection can be passed on to a sexual partner.
What are the commonest GU diseases?
Below is a list of the commonest diseases encountered in the United Kingdom:
* Note: These diseases are not usually sexually transmitted, but sex can make the symptoms worse, or sometimes even initiate symptoms.
Less common GU diseases
The conditions listed below are sexually transmitted and can be very common in some parts of the world. Therefore, if you have sex without a condom abroad you are at risk of getting infected. Some of these diseases are increasing in the UK, particularly HIV and syphilis.
- Chancroid.
-
HIV.
-
Syphilis.
- Other causes of genital ulcers: donovanosis, lymphogranuloma venereum.
Common genitourinary diseases
Bacterial vaginosis (BV)
BV is caused by an overgrowth of bacteria that normally live in the vagina in small numbers. Although this condition is not strictly speaking sexually transmitted, BV is uncommon in virgins. The more sexual partners you have had, the more likely you are to get it. Sexual intercourse may produce symptoms or worsen the symptoms. Products that affect bacteria in the vagina can cause the condition or encourage recurrences, including products added to baths (bubble baths, antiseptics), douches, or forgetting to remove tampons.
What are the symptoms?
Sometimes women do not have any symptoms, and the condition is found only when they have a check for sexually transmitted diseases or a smear test. If symptoms are present they are usually:
- a greyish white discharge with an offensive fishy smell.
- a burning sensation or soreness is more common than itching although this can also occur.
- there is usually no redness of the genital skin.
Often the diagnosis is missed by a GP, either because thrush is presumed to be the cause and the woman is not examined, or because the correct tests are not taken. Make sure you tell the doctor all your symptoms when you attend surgery and don't presume that you have a condition such as thrush. At least you can then discuss with your doctor the likely causes of your symptoms.
How is it treated?
The condition can resolve by itself but often antibiotics from a doctor are generally needed. Washing the genital area in mild salt water (1 teaspoon per ½ litre of water) can reduce the soreness and amount of bacteria present on the vulva (external female genital area) and in the vagina. Unfortunately even with antibiotic treatment the condition can recur. Treating the sexual partner makes no difference.
Occasionally male partners of women get infection under the foreskin that gives a strong smell and excess smegma, which may need treatment.
Chlamydia trachomatis
Infection with bacteria called Chlamydia trachomatis can cause different GU conditions, including pelvic inflammatory disease in women and non-gonococcal urethritis in men. The infection is often called 'chlamydia', although there are other types of chlamydia that affect other parts of the body (eg, lung and heart).
-
Chlamydia trachomatis is sexually transmitted and is the second most common sexually transmitted infection in the UK.
- In women, the bacterium can infect the cervix and/or the urethra (urine tube). It can also spread up into the uterus (womb) and Fallopian tubes (which conduct eggs from the ovaries to the womb), where it causes complications of pelvic infection (pelvic inflammatory disease - see PID).
- Pelvic infection with Chlamydia trachomatis can lead to infertility (see PID).
. Sometimes doctors do not have the facilities to test for this infection, and if they do, some of the tests are unreliable. Get checked out at a GUM clinic if you suspect you have this infection.
What are the symptoms?
In women:
- often women have no symptoms.
- there may be a change in the quality and quantity of vaginal discharge.
- there is sometimes stinging on passing urine.
- lower abdominal pain is often the first symptom of pelvic infection (see PID).
In men:
- Urethral discharge and/or stinging on passing urine or mild irritation at the end of the penis (see non-gonococcal urethritis). Most often, no symptoms are present.
Occasionally, chlamydia can cause inflamed joints - this is more common in men.
How is it treated?
Antibiotics from a doctor are essential. These can be either single-dose treatment with azithromycin or a course, usually a tetracycline antibiotic for a week).
If one partner in a sexual relationship is infected, it is very important that the other partner is seen and treated to prevent complications and avoid re-infection.
Cystitis
This is a term that means inflammation of the bladder, and is another name for lower urinary tract infection. It occurs more in women than men and the usual cause is infection with bacteria that are normally found in the rectum (back passage). When these bacteria get into the urethra and then the bladder they cause symptoms.
What are the symptoms?
- There is pain, stinging and burning when passing urine, sometimes only at the beginning or end.
- There may be a desire to pass urine but only a small dribble comes out. Afterwards there can still be the feeling that you need to pass urine.
- Sometimes the urine has blood in it which gives it a red colour (you should always consult your doctor if this happens).
Remember that there are other causes of these symptoms apart from a bladder infection (eg chlamydia) and the only way to make a definite diagnosis is to have some tests taken.
Men rarely get bladder infections.
Often, cystitis in men can indicate some abnormality within the lower urinary tract that needs further investigation.
How is it treated?
Products are available over the counter from the pharmacist that alter the acidity of the urine. An attack of cystitis can be stopped by using this medication and drinking plenty of fluid (3L a day) to keep the bladder flushed out.
If the symptoms do not settle within a few hours then go to your doctor. A urine sample might be sent off for further tests and a course of antibiotics is usually prescribed.
During a severe episode, it is often more comfortable to pass urine while in the bath. This tends to avoid the severe stinging.
Some women are prone to get repeated attacks of cystitis. To avoid these:
- try to drink plenty of fluid (not tea, coffee, or diet drinks).
- do not put off going to the toilet.
- make sure that you completely empty your bladder when you pass urine.
- some women find drinking cranberry juice helps. A severe attack can be stopped by taking an over-the-counter preparation to reduce urine acidity as soon as there is any symptom.
. Gonorrhoea
This is a sexually transmitted bacterial infection caused by Neisseria gonorrhoeae. It is less common than chlamydia, the incidence of gonorrhoea increased by about 30 per cent between 1998 and 1999, particularly in teenage males.
What are the symptoms?
Often women have no symptoms but the following may indicate infection:
- a change in vaginal discharge, particularly a change in the colour from the normal colour of 'off-white' to yellow.
- pain on passing urine.
- abdominal pain.
- like chlamydia, gonorrhoea can get into the uterus and Fallopian tubes and cause pelvic infection, with longer-term consequences of infertility.
Men may have urethral discharge and pain on passing urine. Sometimes no symptoms are present but gonorrhoea tends to cause urethral discharge more frequently than chlamydia.
How is it treated?
A single dose of antibiotics prescribed by a doctor. Commonly, ciprofloxacin
or a penicillin called amoxicillin
are prescribed by GUM clinics. It is important to have a repeat test after you have taken the course to make sure that you have been cured of gonorrhoea.
As gonorrhoea is sexually transmitted, it is vital that your present sexual partners get treated to avoid re-infection and subsequent complications. To avoid spread of infection, other recent sexual partners should also be contacted and treated.
Genital herpes
Herpes simplex virus is the cause of genital herpes and of cold sores. There are two types of virus, type one and type two; both can affect the genital area.
Genital herpes is sexually transmitted but full penetration is not required to transmit infection. Close contact is all that is necessary when ulcers are present (though occasionally the infection is transmitted when ulcers have not occurred). The virus can be transmitted through oral sex, especially men to women.
Your partner does not necessarily need to have an attack of oral herpes (cold sore) to transmit the infection to your genitals but this makes it more likely. .
What are the symptoms?
The first sign can be a tingling in the skin followed by small blisters that burst quickly to form ulcers which then scab over. The ulcers are usually extremely painful and lumps in the groin (swollen lymph nodes) are noticeable in most patients. In a first attack, there are often several ulcers and you can feel unwell. An attack can also begin with pain on passing urine and a change in vaginal discharge, sometimes with back and leg pain.
In a first attack passing urine can sometimes be extremely painful. By doing this in bath water it can be more comfortable. Very occasionally you might find it difficult or impossible to pass urine. Attend a doctor immediately if this is the case.
Once you have had an attack of genital herpes, the virus stays within the body and can cause recurrences. The symptoms in a recurrent attack are usually much less than the first attack, with one or two small ulcers and splits in the skin. Occasionally, you can get a more severe recurrence if you are very run down.
How is it treated?
A first attack of genital herpes is not a condition that you should self-treat. You should go straight to a doctor, preferably within a GUM clinic, as soon as you notice any ulcers. The earlier in an attack you start a course of antiviral medicine, usually aciclovir, the quicker the current ulcers will heal and the more new ulcers will be prevented.
In recurrent attacks, there is usually no point in giving treatment because the five-day treatment course usually reduces the symptoms by only 12 to 24 hours. Keep the genital skin clean by washing in mild salt water (a teaspoon full of salt to a pint of water). This will avoid 'superinfection' of the ulcers with skin bacteria.
If there are multiple episodes of recurrence, antiviral medication can be taken regularly (twice a day) to prevent further attacks. This is usually given for six months in the first instance.
Genital herpes cannot be cured, which unfortunately means that it can be transmitted to sexual partners at any time. Avoid sex if you have any symptoms that suggest a recurrence. Condoms can cut down the risk of transmission but do not eliminate it. Herpes simplex virus can less commonly shed from the skin surface without ulcers being present (asymptomatic shedding) so you cannot rely on symptoms to avoid transmitting the infection.
Non-gonoccocal (non-specific) urethritis (NGU or NSU)
NGU is an inflammation of the urethra (urine tube) in men that is NOT caused by gonorrhoea. The commonest cause is Chlamydia trachomatis. However, in about half of affected men no specific infection is found - hence the term 'non-specific urethritis' (NSU).
The infections that cause NSU are usually transmitted by vaginal or anal sex although oral sex can sometimes transmit infection. .
What are the symptoms?
Men can have NGU without knowing - if symptoms are present they are tingling or burning during urination, and urethral discharge.
Men can also suffer complications such as swelling of the testicles (epididymitis). Occasionally, joints can also become inflamed.
How it is it treated?
A course of antibiotics - usually doxycycline
for one week to cover chlamydial infection - can cure the problem.
If a man has this condition, his female partner should be checked and treated. It is often not possible to detect a specific infection in women. But women need treatment because some bacteria that cause NGU in men can lead to pelvic infection in women. Also, if the woman is not treated then the man can get re-infected.
Pubic lice ('crabs')
Lice are small insects that are particularly adapted to living on pubic (genital) hair because the width of their gripping 'legs' are the same width as the pubic hair. This means that pubic lice cannot infect head hair but can be found on other body hair such as chest and armpit hair. You need close contact to transmit pubic lice, not necessarily full penetrative sex.
What are the symptoms?
Lice cause itching of the hair in the pubic region, especially at night. Sometimes you can see the lice moving and when the eggs are laid you can see specks that look like dandruff stuck onto the hairs. Lice live by sucking blood so sometimes you can see blood spots on your underwear.
How is it treated?
You need specific insecticide treatment in the form of shampoo or lotion applied to the pubic area and other hairy areas. The shampoo or lotion kills the lice and eggs. You can buy this treatment at the chemist but follow the instructions carefully. Normal washing in soap and water does not work. Shaving the hair can also get rid of the lice provided all the affected areas are shaved.
Other information
Although lice can be self-treated, sexually transmitted infections are often transmitted together. If you catch pubic lice you should be checked for other infections.
Pelvic inflammatory disease (PID)
This condition that affects women is usually a result of a sexually transmitted infection that is present in the vagina or the cervix but goes up into the uterus and Fallopian tubes causing inflammation. It is often a complication of untreated infection, particularly chlamydia and more rarely gonorrhoea, which can be present for months before resulting in this complication.
What are the symptoms?
The symptoms can vary from mild to severe. Pain in the lower abdomen that is often crampy and like period pains, especially if made worse by sex, can indicate PID. The pain can come and go and the tummy may be tender to the touch. Sometimes you can feel tired and unwell and have a temperature.
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