This section contains a brief explanation of how common sexually transmitted infections (STIs) are passed on, their symptoms and their treatment.

Sexually transmitted infections can be caused by bacteria, viruses or parasites.

Bacterial infections can be cured with antibiotics, antiviral drugs can be used to treat some viral infections and lotions can clear infestations of parasites such as scabies or pubic lice (sometimes called crabs).

Bacteria called Chlamydia trachomatis cause chlamydia.

Transmission and avoiding infection

The bacteria can be transmitted during anal, oral and vaginal sex if no condom is used, and can affect the anus, penis, cervix, throat and eyes. They can be transmitted to a baby during birth, resulting in eye and chest infections. Also see the entry on LGV (which is caused by specific types of Chlamydia trachomatis), below.

Chlamydia can be avoided by using a condom during vaginal or anal sex, using a condom or dental dam during oral sex and not sharing sex toys.

Symptoms

Symptoms of chlamydia normally occur between one and three weeks after infection. However, many people who have chlamydia are unaware that they have it. It is thought that as many as 75% of women and 50% of men with chlamydia have no symptoms.

Where symptoms do occur, in men they usually consist of a milky discharge from the penis, particularly in the morning, and a burning sensation when urinating. The testicles can swell and be very painful. Women with chlamydia may notice a milky discharge from the vagina and/or lower abdominal or back pain, or pain when having sex. There may be vaginal bleeding during sex and bleeding between periods, or pain when urinating.

If a person has been infected anally, there may be soreness around the anus and a discharge.

If chlamydia is left untreated, it can lead to pelvic inflammatory disease (PID) in women, which can cause ectopic pregnancy and infertility. Men can also become infertile as chlamydia can cause epididymitis, an inflammation of the epididymis (the tube connecting the testes with the vas deferens); in rare cases, the blood supply to the testicles can be cut off. Men and, more rarely, women may develop Reiter’s syndrome, a reactive condition, leading to arthritis, urethritis and eye inflammation.

Diagnosis

Chlamydia is diagnosed by taking a swab from the penis, cervix, anal area or vagina. The swabs can be a little uncomfortable but are usually very quick to take. Some clinics will examine a urine sample for evidence of infection with chlamydia.

It can, however, take at least a week for tests to show if chlamydia is present. It is important to contact your clinic for the result of your test, so that you can be given treatment if the infection has been detected.

Treatment

Chlamydia is treated with antibiotics. Normally this consists of a seven-day course of doxycycline, or a single dose of azithromycin. It’s important to take all your tablets to ensure that the infection is eradicated from your body. It's also important to ensure that your partner receives treatment before you have sex again. Symptoms may persist for a few days after taking azithromycin, as the antibiotic takes time to work.

You will be advised not to have sex (even with a condom) until your treatment period is finished. This is to prevent reinfection with chlamydia.

Genital and anal warts are caused by the human papillomavirus (HPV). HPV is one of the most common sexually transmitted infections in the UK.

Transmission and avoiding infection

The virus can be transmitted during unprotected anal, vaginal or oral sex, or simply by close physical contact. Condoms may reduce the risk of transmission, but this is not always the case.

Symptoms

Genital warts look just like the warts that may appear on other parts of the body – usually small lumps on the skin with a slightly rough texture. Some people who contract the wart virus do not have visible warts or do not notice them. Warts may appear anywhere in the genital area.

Some forms of HPV are associated with an increased risk of cervical or anal cancer, and this risk might be increased further in people with HIV.

Diagnosis

Genital warts are diagnosed by visual and manual examination of the genital and anal area.

Cervical screening is a procedure designed to detect pre-cancerous cellular changes (called dysplasia) in a woman’s cervix – before the cancer develops. Cervical screening is sometimes also referred to as a Pap smear or a cervical smear. It involves taking a small sample of cells from the cervix. When these cells are examined in the laboratory, it is possible to see if there are any changes in the cells that suggest a risk that cancer could develop in the future.

HIV-positive women are recommended to have a cervical screen soon after they are first diagnosed with HIV, six months later, and then once a year. If you are not automatically offered screening at these points, it’s important you ask your healthcare team to arrange them. Do not wait to be invited for screening by your GP or family planning clinic. If they are unaware of your HIV status, they will assume you only require the standard screening offered every three years.

The value of screening the anal canal for pre-cancerous cells is being studied. You may find some HIV clinics start to offer anal screening as a matter of routine practice in the future.

Treatment

Infection with the genital wart virus can be cured by your own immune system, although this can take a long time. There are various treatments to remove any visible warts, including using a chemical to remove them, freezing, laser surgery or a self-applied cream. These procedures may feel a little uncomfortable.

Vaccines against the types of human papillomavirus thought to cause anal and cervical cancer and genital warts have been developed. At the moment, the vaccine against the cancer-causing strain is only provided to girls in their early teens. The vaccine that protects against genital warts is only available privately.

Studies are underway to see if the vaccines are safe and have any benefit for people with HIV. Some private doctors are providing the vaccine to people with HIV, but it is expensive and unlikely to be of benefit if you already have the strain of HPV prevented by that vaccine. If you are considering paying for the vaccine, talk to your HIV doctor about the benefits and disadvantages.

Gonorrhoea is a bacterial, sexually transmitted infection.

Transmission and avoiding infection

Gonorrhoea can be passed on during anal, vaginal, oral, and mouth-to-anus (rimming) sex. Gonorrhoea can affect the anus, penis, cervix and throat.

Untreated gonorrhoea can make a person with HIV more infectious. Having gonorrhoea can also make it more likely that an HIV-negative person will be infected if they are exposed to HIV.

Gonorrhoea can be passed on from mother to baby during childbirth (in a vaginal delivery), and can cause infection in the baby's eyes, with a high risk of blindness if left untreated. It can also spread through the bloodstream, causing sepsis (a severe reaction to infection in the body) and, possibly, meningitis.

Gonorrhoea can be avoided by using a condom during vaginal or anal sex, using a condom or dental dam during oral sex and not sharing sex toys.

Symptoms

In men, symptoms usually consist of a yellowish discharge from the penis and burning when passing urine. The testicles may also hurt and swell.

Symptoms in women can include a burning sensation when passing urine and a discoloured or bloody discharge from the vagina. If the infection is rectal, both men and women may notice a mucus-like, or bloody, discharge from the anus, pain in the anus, or pain when having anal sex. Gonorrhoea in the throat usually has no symptoms.

Symptoms of gonorrhoea usually appear between two and ten days after infection, but it can take up to three weeks. However, some people may not realise they have the infection, as symptoms may not always be present, or may be very mild.

If left untreated, gonorrhoea can cause more serious health problems, including pelvic infections in women that can result in pain, infertility, and ectopic pregnancy, and testicular problems and narrowing of the urethra in men.

Untreated gonorrhoea can spread to the bloodstream, leading to fevers, and can also affect the joints, causing arthritis and swelling. It may also cause skin problems and a form of meningitis.

Diagnosis

There are several ways to test for gonorrhoea. If you have symptoms, a swab may be taken from the tip of the penis, the anus, urethra, throat or cervix. The swabs can be a little uncomfortable. A urine sample may be taken if you have no symptoms, and sent off for analysis. In someone with symptoms, it is usually possible to tell immediately from examination of the swabs if gonorrhoea is present in the genital area, but gonorrhoea in the throat can only be diagnosed later.

However, whatever the site of infection, it can take up to seven days for testing to provide conclusive results. It is important, therefore, to contact your clinic for the result of your test.

Treatment

Gonorrhoea is treated with antibiotics. Because gonorrhoea can be resistant to some antibiotics, swabs will be sent to the laboratory to check the sensitivity to the antibiotic you are given.

It is very important not to have anal, oral or vaginal sex for seven days after treatment, as you may be reinfected with gonorrhoea, or pass the infection to your partner. Your recent sexual partners should be seen by a sexual health clinic for testing and treatment.

Hepatitis A is a virus that affects the liver.

Transmission and avoiding infection

Hepatitis A is transmitted through contact with infected faeces (excrement, shit), normally in contaminated food, for example, shellfish.

It can be passed on during sex, particularly oral-anal contact (rimming). There have been outbreaks of hepatitis A among gay men in several cities in recent years. Once you have had hepatitis A, you cannot get it again, but some people do have relapses.

Good personal hygiene can prevent the transmission of hepatitis A – washing your hands after going to the toilet and before preparing or eating food.

Vaccination

Unlike most infections considered in this section, a vaccination against hepatitis A is available and everyone living with HIV is recommended to have it if they do not already have natural immunity to the infection. The vaccination consists of two injections, given six months apart, and gives immunity for about ten years. These vaccinations are usually given at GP clinics rather than sexual health clinics.

Symptoms

Hepatitis A can cause a short-term mild illness, and symptoms can include a yellowing of the skin and eyes (jaundice), extreme tiredness, weight loss, vomiting, diarrhoea, dark urine and pale stools. Symptoms can be made worse by drinking alcohol, tea or coffee and eating fatty food. People normally get better in a couple of weeks.

Diagnosis

A blood test can show present or prior hepatitis A infection. Sexual health clinics do not routinely test for hepatitis A, but you may have been screened at your HIV clinic.

Treatment

Treatment for hepatitis A consists of rest, drinking fluids, and avoiding alcohol and recreational drugs. It's also important not to take paracetamol while you are recovering from hepatitis A. Hepatitis A can last longer and be more severe in people living with HIV or weakened immune systems. If you get hepatitis A, it might be necessary for you to stop taking anti-HIV drugs for a time. This is because the liver does most of the work of breaking down drugs in the body, and when it is inflamed, it doesn’t work so well, and this can make any side-effects your treatment causes worse.

For more information, see the booklet HIV and hepatitis in this information series.

Hepatitis B is a type of viral hepatitis, causing inflammation of the liver.

Transmission

Hepatitis B is passed on by contact with the blood, semen, saliva, or vaginal fluids of an infected person. It is easily passed on during unprotected sex and from a mother to her baby during delivery. It is many times more infectious than HIV.

Hepatitis B can be avoided by using a condom during vaginal or anal sex, using a condom or dental dam during oral sex and not sharing sex toys.

Vaccination

People with HIV, unless naturally immune, are recommended to receive hepatitis B vaccination. This consists of a course of three injections, given over several months. People with HIV can lose their immunity to hepatitis B if their immune system weakens, and should have their level of immunity checked regularly.

Symptoms

When someone first becomes infected with hepatitis B, they may develop jaundice (yellowing of the eyes and skin), lose their appetite, have pain in the abdomen, malaise, nausea, vomiting, muscle and joint aches or fever. These symptoms can be very serious or, in very rare cases, even fatal. However, most people do not notice any symptoms.

Early in the infection, most people will develop protective immunity. However, in about 10% of adults, hepatitis B continues to reproduce in the body long after infection. These people become chronically infected with hepatitis B, meaning that they will be infectious for the rest of their lives, although they may not experience any symptoms themselves. Some chronic hepatitis B carriers eventually develop chronic liver inflammation and have, therefore, increased risk of liver disease (cirrhosis) or cancer of the liver.

HIV-positive people who develop hepatitis B are more likely to become chronically infected with hepatitis B than people without HIV.

Levels of hepatitis B in the body fluids of HIV-positive people may be higher than those seen in HIV-negative people. This is because their immune systems are not so efficient at clearing the hepatitis B from the body – so HIV-positive carriers of hepatitis B may be more infectious than their HIV-negative counterparts.

Diagnosis

Blood tests can detect the presence of hepatitis B antibodies, which show that you have been exposed to, and have cleared, the virus. If you have been exposed and have not developed any protective antibodies, then fragments of the virus itself, called hepatitis B surface antigen (HBsAg), will persist in your blood. This means that you are a chronic carrier and are capable of infecting other people. A sub-group of carriers also test e-antigen positive and this means that their hepatitis infection is highly infectious to others.

Treatment

During the initial period of infection with hepatitis B, it's important to take lots of rest, drink plenty of fluids, and to avoid alcohol and recreational drugs.

If you are HIV-positive and have chronic hepatitis B infection, then you must receive care from a doctor skilled in the treatment of both HIV and hepatitis.

Several drugs are currently available for the treatment of hepatitis B. Some anti-HIV drugs are also active against hepatitis B.

If you are co-infected with hepatitis B, you should talk to your doctor about how it might affect your anti-HIV treatment options.

For more information, see the booklet HIV and hepatitis in this patient information series.

Hepatitis C is a type of viral hepatitis, causing inflammation of the liver.

Transmission and avoiding infection

Hepatitis C is normally transmitted by blood-to-blood contact. However, there has recently been an increase in the number of HIV-positive gay men who have tested positive for hepatitis C, with the only risk factor being unprotected sex.

Other factors that seem to be associated with sexual transmission of hepatitis C are group sex, injecting or snorting drugs, anal administration of drugs and the presence in either person of other sexually transmitted infections, especially syphilis or LGV infection.

When used correctly, condoms can reduce the risk of sexual transmission of hepatitis C. If you are fisting, wear latex gloves and do not share pots of lubricant. Do not share sex toys. This should reduce the risk of hepatitis C being passed on.

There is no vaccine for hepatitis C. Unlike hepatitis A and B, having hepatitis C once does not mean you are then immune from getting it again. It is possible to be reinfected with the hepatitis C virus.

Symptoms

The effects of infection with hepatitis C vary. Less than 5% of people who contract the virus develop acute hepatitis symptoms such as jaundice and nausea at the time of infection, and a significant minority may experience no symptoms at any stage. For those who do, common symptoms include extreme tiredness and depression.

Diagnosis

A blood test for antibodies to hepatitis C can tell you whether you have been exposed to the virus, but as these tests can give false negative results (especially in the early stages of infection), a PCR (viral load) test may be used to confirm infection.

Liver function tests may give an indication of whether hepatitis C has damaged your liver, but to be sure of this, doctors will normally do one of two tests. The first of these is a liver biopsy, in which a small sample of liver tissue is removed for examination. The second, now available at many centres, involves a simple blood test or a type of scan (FibroScan).

In people with HIV, the diagnosis of hepatitis C can be more difficult, as the infection may not show up on their antibody tests.

Treatment

As with hepatitis B, treatment should be provided in a clinic with experience of managing HIV and hepatitis C co-infection.

The goals of treatment are to ‘cure’ hepatitis (to eradicate the hepatitis C virus from the body), to normalise liver enzymes (a marker of liver function), to improve liver inflammation, to prevent progression to cirrhosis or liver cancer and to reduce transmission of the virus.

Treatment for hepatitis C is not lifelong and usually lasts 24 or 48 weeks. Antiviral drugs are approved for hepatitis C. The British HIV Association recommends that hepatitis C be treated with a combination of pegylated interferon and ribavirin.

Side-effects may be very severe, though they tend to lessen as treatment goes on, and include high fevers, joint pain, hair loss, depression and low white cell count.

It is important that sperm from a man on ribavirin treatment is prevented from starting a pregnancy and that ribavirin is not allowed to reach an unborn child. Couples who have been treated with ribavirin should avoid pregnancy (and unprotected sex) for at least six months after the completion of treatment.

Treatment for hepatitis C doesn’t always work. The best results are seen in people who are treated soon after they are infected with the virus.

If you are co-infected with hepatitis C, then you are especially encouraged to start HIV treatment when your CD4 cell count is around 350.

For more information, see the booklet HIV and hepatitis in this information series.

Herpes is caused by a common virus called herpes simplex virus (HSV).

An episode of herpes involves painful sores or ulcers that can affect the mouth, genitals or anus.

Once you are infected, the virus stays in nerve cells for life. You may not know that you are infected with HSV. Most of the time it is dormant and causes no symptoms. From time to time flare-ups can occur, especially if you have a weakened immune system. Even among people who do not have HIV, stress, a common cold or exposure to strong ultra-violet light (for example, during a holiday) can cause an episode of active herpes.

There are two main types of HSV, both of which can cause oral and genital infection. HSV-1 usually causes oral herpes or cold sores – tingling or painful spots on the edge of the lip where it meets the skin of the face. These can occasionally develop on the nostrils, on the gums or on the roof of the mouth. It can also cause genital infection.

Painful genital or anal ulcers, sometimes accompanied by fever, headache, muscle ache and malaise can be caused by both HSV-1 and HSV-2. Herpes lesions often start as numbness, tingling or itching. This feeling indicates that the virus is travelling up a nerve to the skin. There it causes small bumps that rapidly develop into small, inflamed, fluid-filled blisters. These burst and crust over, and typically take one or two weeks to heal in people whose immune systems are functioning well.

Transmission and avoiding infection

The virus can be passed from person to person by contact between the ulcers and mucous membranes, for example by kissing and anal, vaginal or oral sex.

You should avoid sexual contact during an active episode of herpes.

Herpes may also be transmitted when sores are not present. The virus can still be present and be shed from the skin or, more likely, from mucous membranes. This is known as ‘asymptomatic shedding’. HIV-positive people may experience such shedding more frequently. Condoms do not always protect against HSV as a condom won’t cover all the affected areas.

Having genital herpes increases the risk of passing on HIV (and for someone who doesn’t have HIV, genital herpes increases the risk of becoming infected with HIV).

In people with HIV, herpes episodes can be frequent, severe and long lasting. Sometimes the lesions can become infected with other bacteria or fungi. As well as causing large oral and genital lesions, herpes can occasionally affect the throat and the eyes.

Diagnosis

HSV is diagnosed by detecting the virus from a swab taken from a lesion, or by using a fluorescent screening test. Herpes in the oesophagus (gullet) or colon may be examined using fibre-optic instruments.

Treatment and preventing recurrence of episodes

Herpes infections are treated with aciclovir (Zovirax). Other treatments for herpes include valaciclovir, known by the brand name Valtrex, and famciclovir (Famvir).

Aciclovir taken in tablet form (200 to 800mg five times a day for five to ten days) can reduce the severity of episodes of oral herpes and genital or anal lesions. It can be given as an intravenous drip for very severe cases. Aciclovir has very few side-effects.

Aciclovir may also be taken on a daily basis to reduce the frequency and severity of subsequent episodes of herpes (400mg twice daily).

Aciclovir cannot eliminate HSV, so herpes episodes may recur. Aciclovir cream is available from chemists to treat cold sores; however, many doctors question how effective it really is. Some people find that salt baths, ice packs (wrapped in a towel), lidocaine gel, painkillers and rest help relieve symptoms.

LGV (lymphogranuloma venereum) is a form of chlamydia.

LGV was once termed a ‘tropical infection’, occurring mainly in Africa, Asia, South America and parts of the Caribbean. With the introduction of antibiotics in the 1940s, LGV became very rare in the UK and Europe.

However, outbreaks of LGV have been reported in gay men in the Netherlands, France, Germany, the US and Sweden. In the UK, measures have been introduced to detect and monitor infections.

Transmission and avoiding infection

The outbreak of LGV in Europe has mostly involved gay men, many of whom have also been HIV-positive, and often had another sexually transmitted infection such as gonorrhoea, syphilis, herpes, hepatitis B or C. It is thought to be linked to certain sexual behaviours – those more likely to cause tissue damage, such as fisting.

However, LGV can affect both men and women, regardless of their HIV status. LGV can affect the penis, vagina and anus, and can be passed on during anal, oral and vaginal sex.

Condoms are very effective at preventing the transmission of sexually transmitted infections, including chlamydia, of which LGV is a form. 

If you are fisting, wear latex gloves and do not share pots of lubricant with other people. This should reduce the risk of LGV and other sexually transmitted infections being passed on.

Symptoms

LGV can cause very unpleasant symptoms. In the recent outbreak, the most common symptom was pain and inflammation in the anus and rectum (proctitis). In some cases, this was accompanied by swollen glands in the groin, and often by a discharge of mucus or blood from the rectum, as well as a change in bowel habit.

If left untreated, LGV can cause general swelling of the lymph glands and genitals, and ulcers. It can also affect the bowels.

Diagnosis

If you go for a general sexual health check-up, you will be screened for a number of sexually transmitted infections. If you are found to have chlamydia in the rectum, the clinic should send the sample for tests to see if it is LGV.

If you are concerned that you might have LGV, make sure that you tell the doctors or nurses at the clinic you are attending.

Treatment

LGV can be cured using a 21-day course of the oral antibiotic doxycycline. This antibiotic is also used to treat other sexually transmitted infections (and some other infections), but in shorter courses.

You should avoid sexual activity during treatment, and any recent sexual partners should also be treated.

Transmission

Non-specific urethritis (NSU) is an inflammation of the urethra, the tube that through which urine (and in men, semen) passes. This inflammation can be caused by a sexually transmitted infection, such as chlamydia. However, very rarely it can have a different cause, such as friction during sex or irritation caused by soap.

Symptoms

Symptoms of NSU normally develop within a week or so of infection. Where NSU is caused by some irritants, such as soap, symptoms can occur almost immediately. However, many people with NSU show no symptoms at all.

When symptoms do occur, they normally consist of pain or a burning sensation when passing urine, more frequent urination and a white or cloudy discharge that may be particularly noticeable first thing in the morning.

Diagnosis

In men, NSU is diagnosed by taking a swab from the penis. This can be very briefly uncomfortable. In many cases it will be possible to tell instantly if NSU is present, but it can take up to a week for tests to show if chlamydia is present.

NSU is more difficult to diagnose in women. Usually, swabs will be taken from the genitals (e.g. the vulva, vagina or cervix) to see if an STI is present.

Treatment

NSU is treated with antibiotics, usually either a seven-day course of doxycycline or a single dose of azithromycin. It is important to take all your tablets to ensure that the infection has been eradicated from your body. Symptoms may persist for a few days after taking azithromycin, as the antibiotic takes time to work.

You will be advised not to have sex (even with a condom) until your treatment period has finished. Any partners, wherever possible, should also receive treatment, even if they have no symptoms.

Pubic lice, also called ‘crabs’, are small parasites that resemble crabs because of their claws, which allow them to hold on to hair. Although crabs are particularly fond of pubic hair (body hair near the genitals and anus), they can live in hair in other parts of the body, particularly the armpits, and even in the eyebrows and eyelashes, although this is uncommon.

Transmission

Crabs are normally picked up and passed on during sex, though any form of intimate bodily contact can be enough to pass them on. They can also be picked up from sharing towels, bedding or clothing, but this is less common.

Symptoms and diagnosis

Some people notice the infestation within hours, but others do not become aware that they have crabs for several weeks. Crabs are very small and can be very difficult to see, but symptoms usually include an intense itching in the groin, and some people notice the lice eggs firmly attached to pubic hair. Small spots of blood may appear on underwear or sheets.

Treatment

Lotions for eradication of crabs – such as malathion (Derbac-M) – are available from chemists, without prescription, or free of charge from sexual health and GUM clinics. It is important to follow the instructions properly, as improper use could mean that you fail to clear the infestation, and using too much could provoke an allergic reaction. Do not use Derbac-M or similar lotions after a hot bath.

Once you start treatment, it is important to wash all the clothes, towels and bedding you have used since you were infected with crabs – on a hot cycle. You should also ensure that your partner, or anyone else with whom you have had intimate bodily contact or shared a bed, and anyone else in the household, has been treated at the same time as you, to avoid reinfection.

Scabies is a skin infection caused by a mite that burrows under the skin, causing intense itching, usually most noticeable at night.

Transmission

It is easy to pick up the scabies mite, through prolonged skin contact with an infected person, or by sharing towels or bedding.

Symptoms

The mites themselves are invisible to the naked eye, but their burrowing often leaves red 'track marks' in the skin. These are often seen in the webs of the fingers, on the backs of the hands, around the tummy, on wrists, elbows, armpits, the genitals, breasts, buttocks and feet.

People whose immune systems aren’t fully functioning (and having HIV is only one possible cause of this) may develop a widespread rash with thick scaling and intense itching. This is called crusted, or Norwegian, scabies.

Treatment

The same lotions used to treat pubic lice infections are also effective against scabies mites, although it may be necessary to leave the lotion on the body for longer (usually 24 hours). It should be applied to the whole body, except the face and scalp, and needs to be reapplied to the hands after washing.

After treatment, the itch can get worse temporarily. In this case, hydrocortisone cream can be applied, and the itch should not be scratched.

Do not use scabies treatment after a hot bath.

Clothing, towels and bedding should be washed on a hot cycle to avoid infecting others or yourself. As with pubic lice, it is important that anyone who has been in intimate contact with you treats him/herself at the same time as you, to avoid reinfection.

Neither scabies mites nor pubic lice can pass on HIV. People with long-standing pubic lice and scabies infections can feel generally unwell (which is the origin of the term ‘lousy’) and, if left untreated, scabies can cause severe skin irritation.

Syphilis is a bacterial infection. The number of cases in the UK and many other countries has increased dramatically in recent years. There are two main stages of the disease: early and late infection. In the early stage, the infection is highly contagious.

Transmission and avoiding infection

Syphilis can be contracted easily during unprotected anal, oral or vaginal sex. It can also be transmitted by close physical contact. Syphilis can also be transmitted from mother to baby.

The risk of getting syphilis can be reduced by using a condom during vaginal or anal sex, using a condom or dental dam during oral sex and not sharing sex toys.

Untreated early syphilis can make a person with HIV more infectious. An HIV-negative person who has syphilis is much more likely to be infected with HIV if they are exposed to it.

Symptoms

Syphilis can cause a range of symptoms or none at all. In the early stage of the disease, symptoms may be easily missed. Syphilis can progress more quickly and severely in people with HIV, and may present slightly different symptoms.

Shortly after becoming infected with syphilis (primary syphilis) a small sore, spot or ulcer (called a chancre) may appear at the site of infection, usually on the penis, or in or around the anus, vagina or mouth. Often the chancre does not hurt, heals quickly, and can be accompanied by swollen glands.

Secondary syphilis can cause a rash on the body, palms and soles, swollen glands, fever, muscle pain, headache, ringing in the ears, and, in rare cases, meningitis. The rash and sores are highly infectious. Secondary syphilis normally develops within six months of exposure.

When these symptoms disappear, the condition becomes latent syphilis. Latent syphilis can still be passed on during the first year of this stage, usually through sexual or close physical contact. However, after a couple of years, it is difficult to pass the infection to others, even though you remain infected.

If left untreated, tertiary syphilis can develop, sometimes years later. This stage can cause damage to the heart, the brain, the bones and the skin. Without treatment, syphilis can cause death.

Diagnosis

A general sexual health check-up will include a blood test for syphilis, and any sores will be swabbed. Many HIV clinics now test for syphilis as part of their routine HIV care. It can take up to three months for the body to develop evidence of syphilis infection, so a test taken shortly after exposure may not detect infection.

There is some evidence to suggest that tests for syphilis are not as reliable in HIV-positive people.

If brain involvement is suspected, a lumbar puncture (often called a ‘spinal tap’) may be carried out to assess the extent of disease.

Treatment

Syphilis is usually treated with penicillin injections. People who are allergic to penicillin are given a course of doxycycline tablets. To ensure that the syphilis is completely cured, it is vital to have all your prescribed injections or take all your tablets and to attend for follow-up blood tests. To avoid infecting other people with syphilis, or being reinfected with the bacteria, it is important to avoid sex altogether until treatment has been completed and you have been given the all clear.

Any recent sexual partners should also be tested and treated.

Follow-up blood tests will be carried out at intervals to ensure the infection has gone. This is particularly important in people with HIV as the syphilis infection is more likely to recur.

Trichomonas vaginalis is a common sexually transmitted infection caused by a tiny parasite.

Transmission and avoiding infection

Trichomonas is spread by unprotected sex. You can avoid infection by using a condom during vaginal or anal sex, using a condom or dental dam during oral sex and not sharing sex toys. Women should also use a dental dam when rubbing their genital area (vulva) against their female partner’s vulva.

Symptoms

In women, symptoms can include a heavy vaginal discharge, vaginal itching, lower back pain, pain during sex and a frequent need to urinate. Often men have no symptoms, but when they do, a discharge from the penis, a burning pain when urinating and an increased need to urinate are most common.

Diagnosis

Swabs taken from the vagina or penis are examined for the presence of trichomonas under a microscope, and it is often possible to tell immediately if infection is present. Swabs can also be cultured, with results available in a week.

Treatment

Trichomonas is treated with antibiotics. It is important to take all prescribed tablets to ensure that the infection has been eradicated from your body. You will be asked to return a week later for a test to see that you have been cured. You will be advised not to have sex (even with a condom) until your treatment period has finished and any recent partners have received treatment. This is to prevent reinfection.

Other infections can also be transmitted during sex. Any sex that involves contact with faeces, even in microscopic amounts, such as rimming, anal sex or fisting, can lead to infection with gut infections such as giardia and cryptosporidiosis. These can cause bad diarrhoea and vomiting which needs to be treated with antibiotics.