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Tis the silly season to be sure and never is there a more promiscuous time of year than this. It seems that unwanted gifts of the infective nature, borne out of a little passion and an intoxicated evening are around in epidemic proportions. These diseases can turn a silly affair into a serious matter very quickly indeed. Ever experienced that gut sinking feeling when you have a sneaking suspicion that a little itch or lump or pain is some kind of Sexually Transmitted Disease (STD)? Then again, many STDs have no warning signs at all. So, how would you really know if you have an STD and what should you do about it? For answers to these questions and more, read on .....
Common STD’s - The range of different types of Sexually Transmitted Diseases around is as long and extensive as a month’s shopping list and all STD’s come at a cost to your health. Some of the more common STDs are bacterial vaginosis, balanitis, chlamydia, crabs (pubic lice), genital warts, gonorrhoea, hepatitis B, hepatitis C, herpes, HIV (human immunodeficiency virus), molluscum contagiosum, non-specific urethritis, scabies, syphilis, thrush (candidiasis) and trichomoniasis. Let’s tackle them one by one and see how we detect and treat these diseases, as well as what their long term effects may be.
BACTERIAL VAGINOSIS
Many bacteria live happily and healthily in the vagina. They are called vaginal flora. In bacterial vaginosis there is a loss of the normal flora, and a huge overgrowth of other organisms which cause the problem - often an unpleasant fishy smell and discharge. Doctors aren’t entirely sure if this is exclusively sexually transmitted or not as it only seems to affect women. They do know this infection can develop soon after sexual intercourse and is often connected to poor hygiene and having several different partners.
Signs - You can have bacterial vaginosis without even knowing you’ve got it. You might notice a strong odour coming from the vagina. The odour might smell worse after unprotected sex (vaginal sex without a condom). Sometimes a doctor might notice the smell during an examination, even though you haven’t noticed anything. The other sign can be a discharge that is a watery, pearl grey colour. Sometimes a woman has it combined with other STD’s.
Testing - It is diagnosed by a doctor on examination after taking a swab of the vaginal secretions.
Treatment - The doctor can prescribe tablets or vaginal creams to clear it up. Sometimes it does come back and you need to be treated again. It is important to avoid alcohol while on the tablets and for at least three days afterwards. There is an unpleasant interaction between the tablets and the alcohol and you can feel very ill if you combine them.
Prevention - It’s best to practice safe sex (condoms). Get tested straight away if you think you have bacterial vaginosis and don’t have sex until you know you’re clear.
VAGINAL THRUSH
Candida is the yeast organism causing thrush. It lives naturally in the bowel and in small numbers in the vagina, but in certain conditions it can multiply. Some things - like sexual intercourse, taking the pill and antibiotics, pregnancy or diabetes - can sometimes cause the yeast to grow more than it should. This is when we call it thrush. For women, thrush in the vagina can cause a lot of discomfort.
Signs - The woman has an itchy discharge. The discharge can be thick, clumpy or like little curds. The vulva may be red and swollen. Some women feel a stinging or burning when passing urine. Similar signs can be caused by other medical conditions so you need to get it checked out by your clinician. Thrush can also occur in the mouth (particularly in babies), on rashes (eg nappy rashes) and on the nipples of breast feeding mothers. Thrush can be passed onto a sexual partner, however it is not exclusively sexually transmitted. Men can also get thrush, it normally occurs on uncircumcised men. The symptoms are similar to women - soreness and itchiness. To reduce the chances of getting thrush, it is important to keep the penis clean by washing under the foreskin. In men thrush is treated with an anti-fungal cream.
Testing - The sure way to tell if you have it is for an internal examination and a laboratory test performed by your clinician.
Treatment - Prompt treatment will clear this up fairly quickly. This is usually a cream or pessaries. Pessaries are large tablets that are placed in the vagina and dissolve there to get the yeast under control. There are also natural, some women find inserting yogurt (natural lactobacillus type, not sweetened or fruit flavoured!) into the vagina gives relief from the itching. The coolness helps relieve discomfort and the bacterium in the yogurt reduces symptoms. Bathing with a mix of vinegar and water also helps some people. Use 1 part vinegar to 5 parts water. Male sexual partners are wise to use antifungal cream especially in the uncircumcised male.
Prevention
- Always wipe from front to back after using the toilet. This is because the yeast lives naturally in the anus and can spread from the anus to the vagina if you wipe the other way.
- Wash the anal-vulva area daily.
- Avoid tight fitting pants.
- Cotton underwear is healthier that nylon or synthetic materials.
- Eat a balanced diet.
- Don’t use douches.
CHLAMYDIA
Chlamydia is fairly common, especially with young people who are sexually active. It is passed on during sexual contact. It is caused by a bacterium called chlamydia trachomatis. It affects both women and men. Chlamydia often has no symptoms, particularly in men, but can have very serious consequences if left untreated, in particular sterility in women.
Signs - Chlamydia is sneaky in that most times there are no symptoms at all. If a person does have symptoms it is a vaginal discharge for women, abnormal periods, pain during sex, maybe a lower bellyache, or pain when urinating. Men could have a yellow or whitish discharge from the penis and urinating has been described as passing “broken glass” or burning.
Testing & treatment - The good news is that chlamydia can be treated very effectively with medication prescribed by your doctor. The way to find out for sure if chlamydia is present is to have a doctor take a swab or have a blood test. It is very important that both partners are tested and treated. Remember that the person who passes on chlamydia may not even have any symptoms and if they aren’t told will continue to pass it on.
Prevention-Don’t have sex if you know you have chlamydia - get it treated first. Chlamydia can be prevented by practising safe sex (condoms).
CRABS
Crabs are tiny little lice that cause a lot of itching around the genitals, in the pubic hair and other coarse body hair. They’re called crabs because they have little crab like legs that they use to hang on to the pubic hair. They are usually spread by close body contact. However they can live off the body for several hours, clinging to towels, underwear and even sheets and blankets. They are different to head lice and do not live in head hair - though they sometimes can live in beards!
Signs - Usually the first sign is being very itchy. They bite the skin and there can be red itchy lumps or scratch marks on the skin. If you look closely you can see them. They are light brown or grey. They might look like little freckles at first - until you see them go walkies!
Treatment - To get rid of crabs a special lotion from a chemist shop is used. Everyone who has had intimate contact with a person with crabs needs to be treated. Clothes, bedding and towels will need to be washed in hot water.
Prevention - Any close contact with crabs can infect you; so can using someone else’s towel or sleeping in their bed if they have crabs. The only sure way is not to have close contact with anyone who has crabs.
GENITAL WARTS
Genital warts are a very common sexually transmitted disease. An estimated one in every six sexually active people carry the virus. The genital wart virus is different from the wart virus that people get on their hands and feet. The genital wart virus can cause warts so tiny you can hardly see them, while others are quite big and noticeable. Some people have the genital wart virus, but you can’t see the warts. The warts might not come out for months or even years after the sexual contact. Warts can still be passed on even if you can’t see them or they look like they’re gone, because the virus is still hanging around. Warts themselves are not painful but genital warts need to be taken seriously because the wart virus can lead to cervical cancer in some women.
Signs - The only sign of having warts is when you see them. They are painless; some might be very small, others might clump together and have a cauliflower kind of look. You could find them around the genital area or anus. Women have them most often on the vulva (the outer folds of the genitals) and men have them most often on the penis - but they can be in other places too.
Tests - A doctor can tell you if a lump or bump is a genital wart by looking. You can have the wart virus (it’s proper name is human papilloma-virus or HPV) without getting any warts. Sometimes this will show up as “abnormal cells” in a Pap smear in women if the virus is in the cervix. This is a medical test that every woman who is sexually active, should have regularly. If you get this outcome from a test, it’s important to have follow-up treatment because in a small number of women, these cells could develop into cancer.
Treatment - So how do you get rid of those warty growths? A doctor can give you treatment such as freezing them off or painting a special lotion on to the warts. If they’re really difficult to get rid of you can have them removed with laser treatment in hospital. The virus can remain in the body and be passed on to a sexual partner even though the warts are gone. Don’t try to treat them yourself. It is really easy to burn the skin around the wart and cause other problems.
Prevention - Condoms will protect the covered areas, but not areas outside of the condom.
GONORRHOEA
Gonorrhoea has been around for thousands of years. Even though it’s been around that long, not all of us know just what it is. Gonorrhoea is a disease of the genital area caused by bacteria that are passed on during vaginal sex, anal sex or oral sex. If passed on during sex it can leave a nasty infection. A woman can pass gonorrhoea on to her baby at birth.
Signs- Men
The most common sign for men that gonorrhoea has got a hold is a yellow discharge from the penis. A male could also get a burning feeling when urinating. Some men might not have any signs.
Women
In women there usually are no signs but some women could have a vaginal discharge, irregular periods or lower belly pain. Gonorrhoea can lead to pelvic inflammatory disease (PID) and infertility in women. It can also lead to infertility in men.
Tests - To test for gonorrhoea a swab is taken. The swab is like a cotton bud but is longer and only has cotton at one end. It is wiped over the relevant part of the body to take a sample of the discharge or fluid. It is important that partner(s) are traced, tested and treated.
Treatment - Medication prescribed by a doctor will clear up the problem. A doctor should assess the problem so that you can get the right treatment. Another test should be done 5 – 10 days later to make sure it’s completely cleared up. As with other STDs, you shouldn’t have sex until you know it’s cleared up.
Prevention
- It’s best to practice safe sex. You could use a condom when having sex.
- Get tested straight away if you think you have gonorrhoea, don’t have sex until you know you’re clear and don’t pass it on..
HEPATITIS B
Hepatitis B is a virus that affects the liver. Hepatitis B can be passed on through blood to blood contact and through sexual contact. A blood test will show whether or not a person has hepatitis B.
How is Hepatitis B Passed on? - Hepatitis B can be passed on in a number of ways.
- It can be passed on through blood to blood contact eg unclean/shared needles (drugs, tattoos etc).
- It is also spread by sexual contact.
- It can also be passed on from a mother to her baby at or around the time of the baby’s birth.
Signs - Some people have no symptoms at all while others become ill with some or all of the following.
- Have a fever.
- Jaundice - Yellow discolouration shows most on the skin and whites of eyes and in the urine.
- Feel sick (nausea).
- Have a lack of energy.
- Loss of appetite.
Once people have had the illness, most get better, and can’t pass it on. However, some people are carriers - they do not get rid of the virus from their bodies and can pass it on. Carriers might not even know they ever had hepatitis B and may only be able to tell through a blood test. Carriers are at risk of liver disease later in life.
Prevention.
- Avoid blood to blood contact with others. Remember that a person who is a hepatitis B carrier may not even know. There may not be any symptoms at all. Ways to avoid blood to blood contact include:
- No sharing of any injecting equipment including needles, spoons, swabs, filters or tourniquets .
- Don’t share razors, toothbrushes or even combs, anything that could carry and hold a speck of blood.
- If you are having a piercing or tattoo, ensure the worker uses sterile techniques - ask questions - do they use new sterile disposable needles? Do they sterilise all equipment? Has the worker completed a health department approved sterilisation course? Look around - is the place clean? Can you see the special yellow sharps disposal units - this gives one indication that the worker follows health standards.
- Use condoms for safer sex.
- You can get a vaccination to prevent getting hepatitis B
Testing - A blood sample is used to test for hepatitis B.
Treatment
- There is no cure for hepatitis B. Most people recover after being unwell for several weeks (sometimes months).
- It is important to rest, eat a healthy diet and avoid alcohol.
- Liver function tests should be done regularly.
HEPATITIS C
As for Hepatitis B, however there is no vaccination for Hepatitis C
To be continued….SO HOLD ON TO THAT CONDOM!
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com”.
