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Genitourinary diseases
Written by Dr Angela Robinson, consultant in sexual health
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
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 men:
Occasionally, chlamydia can cause inflamed joints - this is more common in men.
How is it treated?
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
What are the symptoms?
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?
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:
Gonorrhoea
What are the symptoms?
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?
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
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?
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?
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)
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 also suffer complications such as swelling of the testicles (epididymitis). Occasionally, joints can also become inflamed.
How it is it treated?
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')
What are the symptoms?
How is it treated?
Other information
Pelvic inflammatory disease (PID)
What are the symptoms?
Pelvic infection can be confused with other emergency problems, such as appendicitis, so make sure you get help if you have any of the symptoms. There are many different causes of abdominal pain and PID can be difficult to diagnose. A doctor should examine you to try to find out the cause of the abdominal pain, but they might still have to make a 'best guess' at the diagnosis. If you are quite unwell, you might need further investigations such as a laparoscopy (a small telescope examination through the tummy wall that allows the doctor to look at the uterus and tubes). This investigation is usually done only if the diagnosis is in doubt or if you have not responded to standard therapy. If symptoms are severe, some women with PID need to stay in hospital.
How is it treated?
After a single episode of pelvic infection, you have a small chance of becoming infertile from blocked Fallopian tubes (about 1 in 10 women have trouble getting pregnant). After a second episode, the risk of infertility is much higher. Also there is a greater chance of being left with continuing discomfort in the abdomen. So, you must ensure your partner gets treated to avoid re-infection.
Scabies
Scabies presents itself as a skin problem caused by scabies mites that burrow into the skin to lay eggs under the skin surface. The eggs hatch into larvae and grow into adults that then lay eggs again. The itching is due to an allergic reaction to the mites. Mites prefer particular areas of skin such as wrists, finger webs or genitals but can burrow anywhere.
What are the symptoms?
How is it treated?
The itch may continue for up to a month after satisfactory treatment. This is due to continuing allergy rather than continuing infestation. There is no need to use more treatment but a course of antihistamines can dampen down the itch until it eventually goes away.
There are often outbreaks in families. If one person within the house has scabies, other members should also be treated. Sexual partners must be treated.
Thrush (candida)
What are the symptoms?
How is it treated?
Some of the treatments are now available over the counter. However, the first time you have vaginal discharge that you think is thrush, it is important that you get a correct diagnosis by having an examination and preferably some tests.
Some women get thrush recurrently. For these women, it may be more convenient to buy over-the-counter medication. However, if you have recently changed sexual partner or think you may be at risk of sexually transmitted infections, you should have a check-up.
Women can transmit the yeast to their male partners, especially if the man has a foreskin. It has not been proven that such men can infect women - women are much more likely to get a recurrence of their own thrush. Some women are particularly prone to thrush when taking antibiotics - if this is the case, ask for an anti-thrush treatment alongside the antibiotics.
Trichomoniasis
What are the symptoms?
How do you treat it?
As TV is sexually transmitted, partners must take treatment. Men usually have no symptoms, although occasionally they get stinging on passing urine. If your partner is not treated, you are at risk of getting re-infected.
Genital warts
Genital warts are transmitted by close contact between the genitals of an infected person and those of a non-infected person, usually during sex. The wart virus can be caught and then lie dormant in the skin without causing any problems. Later, the wart virus may start to divide and produce a wart. This can take from six weeks to many months, or even years. Because the time from catching the virus to getting warts is very variable, a previous partner could have infected you a long time before warts appear.
What are the symptoms?
How are they treated?
Unfortunately, warts come back after treatment in about 30 per cent of patients. It is not because you have re-caught the infection but because the wart virus remains in the skin. Eventually your body should develop immunity to the wart virus and the warts will go away.
Warts commonly co-exist with other sexually transmitted infections, so you must have a check-up to exclude other infections.
While you have warts you are infectious. Condoms offer some protection but obviously they cover only the penis and there are other areas of the skin that come into contact during sex.
Less common genitourinary diseases
What are the symptoms?
What is the treatment?
Syphilis
If not treated when first caught, the infection goes through three stages. In all stages, the infected person may not have any symptoms. Therefore, blood tests are taken routinely for syphilis screening in antenatal clinics and GUM clinics.
What are the symptoms?
Second stage: as the sore is healing, the second stage of syphilis occurs, two to six months after contact with an infected person. The symptoms are 'flu-like' with headache, fever, sore throat and swollen glands. Usually a rash appears on the body that can affect the hands and feet.
Later stages:
What is the treatment?
Previous and present partners should have a blood test for syphilis. The organism can be transmitted up to two years after contracting the infection. After two years of having the infection, you are unlikely to transmit it to a sexual partner.
Human immunodeficiency virus (HIV)
HIV is present in body fluids including blood, semen, and vaginal and cervical secretions so it can be transmitted by sharing body fluids: through sexual intercourse, sharing needles, blood transfusion, etc. The virus is not just an infection of gay men but can be transmitted through vaginal sex. Anal sex is particularly risky, and transmits the infection more easily than vaginal sex. The virus is less likely to be transmitted through oral sex than penetrative sex but transmission can occur, especially if there is bleeding from the gums, or mouth ulcers are present. Although the virus is found in saliva, kissing has not been found to transmit infection. HIV is not passed on through everyday social contact such as sharing plates, cutlery, towels, etc.
What are the symptoms?
Eventually, most people with HIV will develop AIDS if left untreated. AIDS consists of numerous infections and other illnesses that involve many different body organs.
How it is it treated?
There are many different medicine combinations, all of which have some side effects. Further information is available from helplines and websites. HIV is a life-threatening infection and the only way to protect yourself is by using a condom. You will also reduce the risk by knowing whether your partner has HIV. Tests are readily available from GUM clinics.
In women:
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).
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.
Often women have no symptoms but the following may indicate infection:
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.
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.
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.
Men can have NGU without knowing - if symptoms are present they are tingling or burning during urination, and urethral discharge.
A course of antibiotics - usually doxycycline
for one week to cover chlamydial infection - can cure the problem.
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.
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.
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. You may have noticed a change in your vaginal discharge and/or abnormal bleeding over the preceding weeks. This bleeding can be between periods (spotting) or your periods can be heavier, longer or more irregular than normal.
If PID is likely, a course of antibiotics should be taken to treat the most common cause of PID,
An insecticide lotion (such as malathion) should be applied from the neck downwards over the whole skin surface and kept on for 12 to 24 hours before washing. A repeat application may be necessary, depending on the product used.
The most usual symptom is itching that can be very intense and can affect the anus as well as the vulva. A lot of women notice an increase in vaginal discharge. This can vary from thin and watery with white flecks in it to thick 'cottage-cheese-like' discharge. You may notice a smell that is different to normal although not unpleasant. The vulva can become red and swollen in a bad attack. As you urinate the urine may sting as it touches the lips of the vulva.
Simple measures like washing in slightly saltly warm water can reduce the itchiness and soreness until you can get to see a doctor. For women, treatment is a choice of antifungal pessaries or cream, both of which are inserted into the vagina (eg clotrimazole), or antifungal medicine taken by mouth (eg fluconazole).
In women, the usual symptoms are a yellow or greeny discharge that smells unpleasant. There is often a lot of discharge, which can be frothy. Itching and irritation of the skin of the vulva are very common with TV. Symptoms can start within a few days of catching the infection or can take a few weeks to develop.
Antibiotics are required - you should get these from your doctor.
Warts often go unnoticed because they do not produce many symptoms and are difficult to see. Occasionally they itch or bleed. Sometimes you can feel them as lumps that are gritty to the touch. Some warts are flat and others are more fleshy. Warts can be found on any part of the genital skin including around the anus even if you have never had anal sex.
Many different treatments are available, which include applying solutions directly onto the wart, freezing, burning or surgically removing the warts. It is important to consult your doctor before applying any solutions. Sometimes the solutions can cause the skin to become sore. Keep the area clean by washing in very dilute salt water (1 teaspoon to a pint of water).
Symptoms usually appear about two weeks after you have had sex with an infected person. You get painful ulcers, usually several at a time. You may also notice lumps in the groin, which are swollen glands (lymph nodes).
You need to take a one to two week course of antibiotics. It is very important to attend a GUM clinic so that proper tests can be taken to make sure that you get the right treatment.
First stage: often a single small sore or ulcer is present on the vulva, although the anus can also be affected. There are usually swollen glands in the groin. The sore appears up to 12 weeks after contact with an infected person and lasts approximately six weeks. It can heal without any treatment.
A prolonged course of antibiotics, usually by injection, is required for 10 to 21 days depending on the stage of infection. After treatment, regular check-ups at yearly intervals are advised.
There is no cure or vaccine available for HIV infection. Some treatments are available that can slow down the production of new virus and delay the development of AIDS.
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