NOTE: Always check with your local GUM Clinic or local GP before self diagnosis.

Bacterial Vaginosis

What is it?

This is a condition that affects the vagina. Certain bacteria which are present normally may be increased by as much as 1000 times the expected amount.

How does it show itself?

There is usually (but not always) a thin grayish discharge. It tends not to cause any soreness or irritation but can smell a little ‘fishy’, especially after sex or during a period. It sometimes can be confused with thrush.

Is it common?

Yes, very. It is difficult to estimate but perhaps as many as one in three women will get it at some time.

Where does it come from?

We don’t really know. Hormonal changes or the use of antibiotics may play a part. It is more common in those who are sexually active and in some people using the coil for contraception.

Can it be passed on sexually?

There is no strong evidence that this happens and therefore the condition is not classified as a sexually transmitted disease. Partners of women with bacterial vaginosis do not usually require treatment.

Can it be treated successfully?

Yes... though it may return at a later date. The doctor can prescribe an antibiotic (such as metronidazole) which is very effective. This is usually in tablet form.

Side effects?

Sometimes the medication can leave an unpleasant taste temporarily in the mouth and cause mild stomach upsets. Alcohol must be avoided during treatment.

Can bacterial vaginosis be prevented?

There is no strong evidence to point to how bacterial vaginosis can be prevented.

Are there any long term risks?

Most probably not. Bacterial vaginosis is overwhelmingly a mild condition. It is easily treated. It may be involved in other conditions related to a woman’s health but more studies are needed on this.

Balanitis

What is it?

Redness, irritation and soreness of the head of the penis (the glans) is called balanitis. Some men also complain of a discharge under the foreskin which covers the penis. The foreskin may also be inflamed (called posthitis).

Is it common?

It is extremely common and is generally not serious though it can cause a great deal of concern to men and their partners.

Where does it come from?

There are a number of possible causes;

• Poor hygiene. The foreskin should be withdrawn and then the area can be gently washed. This should be done daily to stop matter building up which can cause inflammation.
• Over keen hygiene. Washing too hard under the foreskin or too frequently causes irritation.
• Dermatitis is when the sensitive skin of the glans and foreskin becomes inflamed by the use of chemicals/products such as:
  
  • perfumed soaps and cosmetics
  • washing powders (biological) and fabric softeners
  • chemicals on hands transferred to penis when touching it
  • condoms or their spermicidal lubricant
  • sweat/urine collecting under the foreskin
    
    
• Infection. Thrush (candida) is the most common cause here. This is a yeast germ that women often have though it is not easily passed on from women to men. The yeast germ however can collect under the foreskin. Other germs may also cause a balanitis.
• Reaction to infection. An infection in a partner (male or female) may cause a balanitis in a man.

Can it be treated successfully?

Yes if we can identify what is causing the problem.

• Check for infection by taking swabs and examine the skin. Treatment (such as hydrocortisone) may be given if needed. Partners may also be advised to attend if the balanitis is thought to be due to sexual activity.
• Care should be taken with hygiene. Hands should be washed before and after urinating.
• Avoid scented soaps and cosmetics
• Avoid biological powders/softeners for washing underwear.
• Use condoms without spermicidal lubricants. Non-oxynol-9 is usually the major culprit. Sensitol is better. Check with your local clinic sexual sexual health adviser on the more suitable brands available.

Chlamydia

What is it?

An infection caused by a germ which infects the genitals of men and women. However it can spread beyond this area. Occasionally it may cause an eye infection.

Is it common?

It is one of the most common sexually transmitted infections and the most likely identifiable cause of NSU (Non specific urethritis) in men.

Where does it come from?

It can be very easily passed on through vaginal, anal and perhaps oral sex. Sometimes it only takes close physical contact to spread. There is no evidence to show that it can be passed on from toilet seats, sharing towels or cups. An infected mother can pass it on to her babies eyes at birth. It can also be spread from genitals to eyes on the fingers.

How does it show itself?

Symptoms of infection may show up at anytime. Often this is between 1 to 3 weeks after exposure but the majority of women and a good proportion of men will not realise they have it. Symptoms may not emerge until a long way down the line. Tests done at a GUM clinic usually take one week before the results are available.

Some women may notice:

• an unusual vaginal discharge
• pain when urinating
• However these symptoms are more commonly caused by other conditions.

Some men may notice:

• a discharge from the tip of the penis
• pain when urinating
• swelling of the testicles

Can it do much damage?

It can usually be treated very effectively with antibiotics (such as deteclo, doxycycline and erythromycin) and cured completely. It is important that further tests are done after treatment to see that the infection has cleared. Without proper treatment it can cause long term complications for both men and women one of which could include infertility. Research from a large study in Scandinavia published early 2001 pointed towards a possible link with cervical cancer and some types of chlamydia. This has not been properly established and more investigations are needed.

Can it be prevented?

Like most other sexually transmitted infections a proper and consistent use of condoms (including flavoured ones for oral sex) will reduce the chance of becoming infected.

What about sexual partners?

Because many people may be totally unaware they are infected so it is important that current and recent sexual partners (perhaps over the past 6 months) should be offered the chance to be tested and treated if necessary. However it is an infection that could have been acquired a long time ago. In some cases this could be a matter of years. A sexual sexual health adviser can help you to work out how best to inform partners.

It will take about 1 month for your body to heal from this infection after treatment. During this period you would be strongly advised to avoid any sexual contact and also until a partner has been seen.

Genital Herpes

What is it?

The herpes simplex virus is the cause of cold sores and genital herpes. It can also cause infections around the bottom (anus/rectum), eyes (herpes conjunctivitis) and fingers (whitlows).

How does it show itself?

Initial herpes simplex

This is when it occurs for the first time in the genital area. You may experience `flu-like` symptoms such as fever, tiredness, headache, aches and pains of the lower back and down the legs or in the groin. Small blisters can appear anywhere in the genital region which quickly burst leaving red, punched out ulcers tender to touch and may be painful. Several crops of blisters may appear one after another. Passing urine can be very painful. Left untreated these symptoms will last for 2 to 3 weeks after which the ulcers will heal without leaving a scar.

Recurrent herpes simplex

Not everyone gets further episodes after the first one. In those who do the symptoms are usually much milder and clear up more quickly (within 3 to 5 days). Often there is an early warning tingling sensation before a recurrence happens. This is due to the virus travelling down the nerve to the skin. Recurrences eventually stop altogether for most people although this may take several years to achieve.

Some things that might bring on an episode are:

• feeling run down or under stress
• menstruation (periods)
• damage to the genital area
• sunlight (natural or artificial) on the affected area
• tight clothing
• nylon underwear.

Where does it come from?

There are two types of this virus;

Herpes simplex virus type I - This commonly causes cold sores around the mouth and nose. It can also affect the eyes, genitals and anal areas.

Herpes simplex virus type II - This is responsible largely for sores in the genital and anal region but may also affect the mouth and eyes.

Only laboratory tests will tell what type virus is causing an infection. Genital infection caused by type I is usually milder and less likely to recur than that caused by type II.

How is it spread?

The virus is spread mainly in the following ways:

• sexual intercourse with someone with genital herpes. A condom may not provide adequate protection if skin to skin contact has occurred before or after its use.
• oral sex with someone who has active cold or genital sores.
• it is quite possible to get herpes from sexual contact with someone with the virus but without them having any signs of it being there. Most adults have it in the mouth area.

Much rarer means are:

• self-infection by transferring the virus to other parts of the body via a towel (wet). However the virus can only live for a short period away from the body so this is a very unlikely source of infection .

Symptoms may develop as early as 4 or 5 days after contact with the virus but it could also be several weeks or even months later.

Can it be treated?

Treatments (such as acyclovir) are available to slow down the virus multiplying. At the present time nothing is available to get rid of the virus completely. The drugs work well when herpes is first experienced but appear to have little or no effect if it returns. People who experience it frequently may take continuous treatment to try to reduce this. A GP may be able to prescribe this.

What about sexual partners?

Sexual intercourse and oral sex should be avoided when herpes simplex symptoms are being experienced (i.e. when the virus is active). The virus is often passed on by someone who does not even know they have it so it often helps to be open about a herpes infection. There is a small risk of passing on the infection between episodes so informing a new partner about having herpes is a difficulty to face up to. Some people find it easier to wait until a relationship has developed and strengthened before disclosing this sensitive information whilst at the same time being careful to practice safer sex (using protection).

Anything else?

Cancer of the cervix (neck of the womb) is not caused by herpes infection. It does not affect fertility. It may be possible to pass it on to a baby during pregnancy or delivery. It is therefore recommended that a doctor is informed during pregnancy if the infection has been present.

People often feel very down when told they have herpes. It helps to talk to someone who is both knowledgeable and sympathetic. Apart from the staff at a GUM clinic it may be useful to contact ‘The Herpes Virus Association’ on 020 6099061. 41 North Road, London, N7 9DP. They would be happy to send more information if a SAE is enclosed.

Genital Warts

What are warts?

Warts are caused by a virus called the human papilloma virus and can occur anywhere on the body. When they appear around the sexual parts (genitals) they are known as genital warts. Around the ‘back passage’ they are known as perianal warts.

How do they show up?

Warts can take on a variety of appearances and are best described as fleshy growths. You may have spotted them yourself, or they may have been noticed by a doctor, nurse or your partner. Usually they are not painful although they can sometimes be irritable. It often takes at least several months before warts show up and of course they can be present without you realising it.

Are they common?

A number of skin conditions are seen at GUM clinics and genital warts are seen more frequently than any other.

How do you get them?

Warts can be passed on during sexual intercourse and close body contact. It is therefore important that your sexual partner is checked at a clinic for warts/ and other common infections which can encourage the growth of warts. It is possible to develop them in or around the mouth after oral sex with someone who has genital warts though this is uncommon. It is not unknown for them to be passed from the fingers to the genital area.

What about partners?

It is probably pointless to avoid sexual intercourse until the warts have been cleared. Condoms are usually ineffectual in preventing the spread of warts. However they are usually a very effective means of reducing the risk of other sexual infections and therefore should be considered even after the warts have disappeared. Remember however that warts only need skin to skin contact to be passed on. Current partners may benefit from a check-up too.

Can they be treated?

Yes. A doctor or nurse can quickly and easily treat warts in an out-patient clinic. They will discuss with you the most appropriate treatment for your warts.It is unusual for one application of the treatment to be enough. Generally you will be seen at a clinic at weekly intervals until they have cleared.

Women can still attend for treatment as normal during their menstrual periods.

Everyone is different therefore it is impossible to say how many times you may need to attend. Staff are aware that this may be a problem and will do all they can to help.

It is quite common for them to return after treatment and this does not always mean that a new infection has been caught. The treatment gets rid of the warts but not the virus which stays under the skin.

What treatments are available?

The two most commonly used treatments are paint and cryotherapy.

Paints

The "paints" refer to a substance called Podophyllin dissolved in benzoin and a mild solution of trichloroacetic acid. When applied to warts it is vital it is washed off at a stated time otherwise good skin could be damaged. The doctor or nurse will tell you how long to keep it on for. It is possible to have a reaction to paint. If the skin becomes very sore and painful while the paint is on, wash it off immediately. Check all the paint has been removed, (women use a mirror) keep the area clean and dry, remember not to use creams, lotions or perfumed products. If you are concerned you can always contact your local clinic for help.

Wash the paint off with warm water and unscented soap, pat the skin dry and apply baby powder. The paint treatment is not recommended for use on pregnant women.

Cryotherapy

This is a freezing treatment which can be sprayed onto warts. It does not need to be washed off at a certain time. It is safe to use in pregnancy. Small tender areas may appear on the skin after spraying. Keep the affected areas clean and dry as before. A simple painkiller such as Paracetamol may help. Again staff at the clinic will be happy to advise if you are worried.

Anything else?

Remember to wash the paint off as directed. Warts love moisture so keep the skin clean and dry. Use unperfumed talcum powder or baby powder. Avoid using perfumed soap, oils, bubble baths, creams and lotions.

Many women are anxious to know if having warts can cause cancer of the cervix. This is very unlikely. Smears are therefore usually still only recommended every 3 to 5 years.

Warts in pregnancy can be treated safely, although in some cases treatment is put off until after delivery. Each woman will be assessed individually.

Gonorrhoea

What is it?

An infection (sometimes known as the ‘clap’) caused by bacteria which commonly affects the urethra, cervix, rectum and throat. More rarely it can infect the blood, skin, joints and eyes.

Is it common?

Over the past 20 years the number of infections in Britain has fallen steadily. There is evidence however that it is back on the increase. Although it is seen more commonly in gay men it is by no means restricted to them only.

Where does it come from?

It can be very easily passed on through vaginal, anal and oral sex. Sometimes it only takes close physical contact to spread. There is no evidence to show that it can be passed on from toilet seats, sharing towels or cups. An infected mother can pass it on to her babies eyes at birth. It can be spread to the eyes from the genitals via the fingers.

How does it show itself?

Symptoms of infection may show up at anytime between 1 and 14 days after exposure but many women and some men will not realise they have it. Tests done at a clinic may show it up straight away but often take one week before the results are fully known.

Some women may notice:

• an unusual vaginal discharge which may be thin/watery, or yellow/green
  pain when urinating.

Some men may notice:

• a white or yellow or green discharge from the tip of the penis
• pain when urinating
• irritation or discharge from the anus

Can it do much damage?

It can usually be treated very effectively with antibiotics (such as doxycycline) and cured completely. It is important that further tests are done after treatment to see that the infection has cleared. Without proper treatment it can cause long term complications for both men and women one of which could be infertility.

Can it be prevented?

Like most other sexually transmitted infections a proper and consistent use of condoms (including flavoured ones for oral sex) will reduce the chance of becoming infected.

What about sexual partners?

Because many people may be totally unaware they are infected until lasting damage is done it is important that current and recent sexual partners (perhaps over the past 6 months) should be offered the chance to be tested. A clinic sexual sexual health adviser can help you to work out how best to achieve this.

It will take about 1 month for your body to heal from this infection after treatment. During this period you would be strongly advised to avoid any sexual contact including the time taken for a partner to be seen.

Hepatitis B

Hepatitis B is caused by a virus that attacks the liver and causes it to become inflamed.

How do people catch it?

Hepatitis B can be passed on in the following ways:

• During sex with an infected partner.

• From an infected mother to her newborn baby during delivery.

• Users of injected drugs can infect others through sharing needles.

• By sharing contaminated needles or other drug injecting equipment.

• Through a blood transfusion in a country where blood is not tested for hepatitis B virus. All blood in the UK is tested.

If you have had other types of hepatitis, you can still get hepatitis B. People who have had hepatitis B but haven't recovered fully can remain infectious all their lives.

Symptoms

People may have no symptoms at all but can still pass on the virus to others.

Symptoms can include:

• itchy skin

• weight loss

• a short, mild flu-like illness

• jaundice (yellow skin and eyes)

• loss of appetite

• nausea and vomiting

• diarrhoea.

It is possible to have contracted hepatitis B and not have symptoms for many years until it develops into long-term disease.

Complications

Hepatitis B can cause long term infection that leads to liver disease. This can lead to death from liver cancer or cirrhosis.

How dangerous is Hep B?

Hepatitis B is particularly likely to cause long term infection in babies and children.

It is not known how many people are infected in the UK, but in some cities up to 1 in 100 women who visit antenatal clinics have been found to carry hepatitis B.

Prevention is better than cure

There is a vaccine against hepatitis B. It contains a killed part of the hepatitis B virus and is given in three doses.

All pregnant women are offered screening for hepatitis B. If found to be carriers, or to have acute hepatitis B during pregnancy, their babies are given hepatitis B vaccine starting at birth and hepatitis B immunoglobulin if recommended.

People at high risk of infection with hepatitis B, such as healthcare workers, are also offered the vaccine.

information taken from http://www.immunisation.nhs.uk/article.php?id=392

Hepatitis C

What is hepatitis C?

Hepatitis C is a virus that can seriously damage the liver and affect its ability to function correctly. It is mainly spread through contact with the blood of a person who is infected. Less commonly it can also be passed on via other body fluids

You cannot catch it through everyday contact such as holding hands, hugging, kissing or through sharing toilets, crockery or kitchen utensils.

Disease facts:

• In England, the number of people with chronic (long-term) hepatitis C infection is estimated to be around 200,000
• Most people with hepatitis C do not realise they have the virus because it can take years or even decades for symptoms to appear
• Around one in four people with hepatitis C will get rid of the virus naturally. The remainder will develop chronic infection. Many people with chronic hepatitis C infection will live out a normal lifespan. About one in five of people with chronic infection will eventually develop severe liver damage (cirrhosis), which can lead to liver cancer or liver failure and the need for liver transplantation
• Hepatitis C is not just a disease contracted by people who inject drugs. Anyone whose blood has come into contact with the blood of someone infected with the hepatitis C virus, could be at risk. There are other ways that the virus can be transmitted. (See How to avoid hepatitis C for more information.)
• Hepatitis C can be successfully treated - effective drug treatments are available. (See treatment for more information.)

What are the symptoms?

• Most people do not experience any symptoms when they become infected. Some people may feel briefly unwell and in rare cases may become jaundiced (yellowing of the skin and eyes). Many people with chronic hepatitis C infection will have no symptoms, while others will feel unwell in varying degrees

information taken from http://www.hepc.nhs.uk/

HIV & Aids

What is HIV?

HIV stands for Human Immunodeficiency Virus.

What does it do?

It attacks the body's immune system, making it hard to fight off infections. It targets specific white blood cells known as CD4 cells. The lower a person's CD4 count, the weaker their immune system will be.

What are the symptoms?

Symptoms will vary enormously across individuals. Many will become infected and experience nothing. Others weeks or months after exposure will have a flu like illness, develop an rash, have night sweats or more rarely have a life threatening brain infection. All too often people coming for a test report vague symptoms similar to the above but eventually test negative - is no evidence of infection. a blood test is therefore the only reliable means of detection.

How do you get it?

For someone to become infected, a sufficient amount of HIV must get into their blood. Body fluids which contain enough HIV to infect someone are blood, semen, vaginal fluids including menstrual blood, and breast milk.

Saliva, sweat and urine do not contain enough virus to infect someone. HIV cannot pass through intact external skin, or through the air like a cold or flu virus.

The main ways in the UK of passing HIV on to another person are:

• Sex without a condom - HIV can pass from one person to another through unprotected anal or vaginal sex. A small risk exists with oral sex.
• Injecting drug use - HIV can be passed on by using needles or syringes and other injecting equipment (works) that someone with HIV has already used.
• Mother to baby - a pregnant woman may pass the virus to her baby before or during birth, or HIV can be passed on during breastfeeding.
• Organ transplant, blood transfusion or blood products - Since 1985, all blood and tissue donations and blood products in the UK have been screened for HIV.

What is the HIV test?

The HIV antibody test is the most common method of checking for HIV . It looks for antibodies produced by the body in response to the presence of HIV. When someone becomes infected with HIV, it can take up to three months for their immune system to produce enough antibodies to show up on an HIV test. Very rarely this takes longer - up to six months. The gap between infection and being able to test positive for HIV is known as the window period. Taking an HIV test less than three months after possibly getting infected might not give an accurate result.
However, throughout the window period , the infected person has enough virus in the blood, breast milk or sexual fluids to infect another person even though it wont show on a test.

How can it be prevented?

A proper and consistent use of condoms is the most effective way of reducing risk in the sexually active person. Limiting the number of sexual partners may also help.
Avoiding injecting drugs or not sharing 'works' will prevent the virus from spreading.

Can it be cured?

There is no cure or vaccine for HIV. Some powerful anti HIV drugs are available. Taking these in various combinations can slow down the damage HIV does to the immune system.

What is AIDS?

AIDS is short for Acquired Immune Deficiency Syndrome. An HIV damaged immune system leaves a person open to other illnesses - i.e. tuberculosis, pneumonia and cancers. These would not normally be a threat. Once diagnosed with such an illness the person is often said to have AIDS. It is a term falling out of use. Instead it is increasingly called 'late stage' or 'advanced HIV infection'

Further information

Knowledge is rapidly increasing about the prevention, treatment and care of HIV/AIDS. For further up to date information we recommend you check out our links page for details of other organisations web sites. An excellent place to start would be to contact hertsaid

More info:
Medical Guidelines for Professionals: www.agum.org.uk

Molluscum

What is it?

This is a harmless skin condition caused by a virus.

How does it show itself?

The virus causes spots to appear on the skin. They are usually small, pink or flesh coloured and can sometimes have a small dimple in the centre. When touching them they can feel `waxy.`

Are they common?

Yes.

How do I get them?

The virus is passed on by close body contact including sexual contact. It may be possible to get them from towels and clothing. It is therefore not unusual for other family members to get them or groups of children in a school class or nursery.

From the time from coming into contact with the virus to developing spots varies from approximately two weeks to three months and they may not all appear at the same time.

Can they be treated?

It is possible to treat them with a 5% strength of Aldara. Usually, however, they will be treated with a cold spray called cryotherapy, which freezes them off. Cryotherapy can cause scarring and therefore many doctors advise they be left alone. Eventually they should disappear. If treated you will usually be advised to return to the clinic to see that you have been successfully treated and that no other spots have developed. You may need more than one treatment.

What about partners?

Any sexual partner is welcome to attend a clinic and it would be preferable to avoid sexual contact until the spots have cleared, although this is not essential.

Non-Specific Urethritis

What is it?

Only men get this. It is an inflammation of the tube (urethra) which carries the urine from the bladder to the tip of the penis.

How does it show itself?

Many men notice a discharge coming from the end of the penis with pain, irritation or discomfort on passing urine.

Where does it come from?

It is called "non-specific" because there are a range of different causes.

• Chlamydia. This is a common cause. It is a germ passed between sexual partners but may take weeks, months or even years in some cases to show up. Most women with it may never know they have it. For both men and women it can cause a lot of damage if it is not treated i.e fertility problems.
• Other sexually transmitted infections.
• Reaction to vaginal infections. Some men develop NSU as a response to a simple infection in their partner who may not even know they have one.
• Injury. The urethra is delicate and may be damaged during vigorous sexual activity leading to NSU. Squeezing the penis or using disinfectants etc if worried about having an infection might cause NSU.
• Urine/bladder infection. This is quite an unusual cause of NSU in younger men

NSU may be experienced months or even in some cases years into a relationship.

Can it be treated successfully?

Yes, it usually clears up with a simple course of antibiotics (such as deteclo or doxycycline). Because it is usually caused by germs it is important that sexual partners are checked carefully and treated if necessary, otherwise it could easily return.

Damage to the urethra takes a few weeks to heal and therefore it is best to avoid sexual intercourse until regular partners have been treated and the signs have disappeared. This can only be properly established by returning to the clinic. It may be that a second course of antibiotics are needed. Using condoms before you are given the `all clear` will not provide full protection from becoming re-infected. It may be useful to restrict or even cut out alcohol intake during treatment as it can irritate the urethra.

Pubic Lice (crabs)

What are they?

Crab lice are small insects which live in coarse body hair. This means they can be found not only in pubic hair but also in underarm hair, on hairy legs and chests. Very rarely would they be found on the scalp. They have been known to exist in beards and eyelashes. It is difficult to see them as they are skin coloured and stay still in light. They reach 2mm in length and have large claws which make them look like crabs. They glue their eggs to the hair close to the skin.

How do you spot them?

It may be 2-3 weeks before they cause the skin to itch. The first sign may be a black powder in the underwear. This is their `droppings` (faeces). They live by sucking blood and therefore sometimes minute specks of blood may be seen. `Nits` are the hatched eggs and appear as white dots fixed to the hair.

How do you get them?

It is possible though very unlikely that they could be caught from toilet seats. They don’t fly or jump. Sexual contact is the most common way they are spread though it is possible for them to transfer to another person with other types of body contact. It is occasionally possible for them to be spread by clothing or bedding, which should be washed before further use.

Can they be got rid of?

Yes, quite easily. Creams, lotions (such as Derbac) and shampoos exist which kill off both the `crabs` and their eggs. Normally you will be asked to apply a liquid to the whole surface of skin especially the hairy areas. It is best to leave this on for 12 hours i.e. overnight before washing it off. The lotion has no colour or smell. If sufficient remains to repeat then this should be done one week later. Shampoos need to be used differently. It is important to follow the instructions on the pack or as given by the doctor, nurse or sexual sexual health adviser. The itching may still go on for a further week or so.

Anything else?

Yes. It is vital that any sexual contacts are treated otherwise they will too easily return. It may be also necessary to inform recent previous sexual partners of their need to have a check up.

Scabies

What is it?

This is caused by a tiny little insect/mite. The female burrows into the skin laying 2 to 3 eggs per day which take about 10 days to turn into adult mites.

How does it show itself?

The mites concentrate in special sites. Many are found on the hands and wrists but can be found almost anywhere on the body especially in skin creases. Itching (especially at night) and raw broken skin (lesions) and lumps (nodules) may occur though this may be weeks after the initial contact.

Is it common?

Yes though epidemics break out from time to time. It is frequent in school-age children, but unlikely to be transmitted in schools.

How can you get it?

Close personal contact is usually involved. It is not unusual to find whole families or groups such as in nursing homes and hospitals with it. It can be passed on sexually but unlike other infections (such as gonorrhoea or chlamydia) that only require a short time of sexual contact to be passed on scabies is more likely to be transmitted when partners spend a lengthy period lying next to each other. It is not spread by towels, bedding or clothing and no special precautions need to be taken with these.

Can it be treated successfully?

Yes. A cure is easy to achieve. It involves covering the whole body with a liquid/lotion (such as derbac) which will kill both the mites and their eggs. It should be applied to clean dry cool skin and left on for 24 hours (1 day) and then washed off.

One treatment is normally all that is needed though any itching or rash may persist. Your doctor or pharmacist will be able to advise you about getting an anti-irritant cream such as calamine lotion.

Always re-apply the lotion to the hands after washing during the treatment period.

Anything else?

Yes. It is vital that any close contacts including sexual partners are treated at the same time even if they do not show any signs of it being present. It may also be necessary to inform recent previous sexual partners of their need to have a check-up.

Syphilis

What is it?

Syphilis is a complicated disease (sometimes called the ‘pox’) caused by a bacterium and can show up in many different ways. It can also be present with no symptoms at all. In either case it can still be infectious. Today it is a relatively rare infection in the UK but common in other parts of the world and becoming more common in the USA.

How is it passed on?

It can be spread by intimate close body contact and sexual intercourse, including oral sex.

How does it affect the body?

There might be no signs of the infection, but most commonly there is the appearance of one or more painless sores. These are generally round in shape commonly emerge around the point of genital contact (ie on the penis or vagina/vulva) two to three weeks later. They can last for up to 6 weeks. A painless, non-irritating rash may follow some weeks later, spreading all over the body including the palms of the hands and soles of the feet. Other symptoms of infection may also be present.

After this stage the person infected may experience no further symptoms for many years. In the long run it can have very serious effects on the brain and nervous system. The heart, bones, liver, and skin can be involved too. A mother, if infected, can pass it on to her unborn baby.

Can it be treated?

Yes - the antibiotic penicillin can provide a very effective cure.

Blood tests for syphilis are offered in most GUM clinics on a relatively routine basis. The results take up to about a week to come back. Tests often need to be repeated at future visits because of possible delays in the test showing positive after infection.

Can it be prevented?

Safer sex practices, including the proper and consistent use of condoms will drastically reduce the risk of infection.

Thrush

What is it?

A yeast known as candida lives normally on skin, in the mouth and gut. It can flare up from time to time in some individuals causing thrush.

Is it common?

Yes. At least 3 out of 4 women will experience it at some time. A much smaller proportion will suffer from it on a regular basis. It is much less common in men.

How does it show itself?

The yeast may be present without you knowing it however you may have one or more of the following symptoms.

• Itching, soreness and redness around the vagina and its "lips" (vulva) and "back passage" (anus). Can cause vulvitis.
• Thick, white discharge looking like cottage cheese. Smells yeasty.
• Pain during sex
• Pain when passing water

• Irritation, burning, itching, redness and red patches under the foreskin or on the top of the penis
• Thick, cheesy discharge under the foreskin
• Difficulty pulling back the foreskin
• Discomfort when passing water

What can cause it?

Thrush is more likely to develop when you

• Are pregnant
• Wear tight jeans or nylon underwear
• Are taking certain antibiotics
• Have diabetes
• Are unwell or ill
• Are taking the contraceptive pill
• Have unprotected sex with someone who has thrush

Can it be treated?

It is usually quite easy to treat using pessaries (such as canestan) with or without creams. A pessary is an almond-shaped tablet a women puts high up into her vaginal using a special applicator. On the other hand a pill may be given if pessaries have failed to work.

Can anything else be done?

The following may help in some cases:

• Avoid washing yourself too frequently or using disinfectants and bubble bath in the water
• Stop using soap and clean yourself with just water
• Some women gain relief by inserting a tampon soaked in plain, live yoghurt then removing it. There is not much evidence to prove this works.
• Use pads rather than tampons during a period
• Avoid tight fitting clothing and underwear made from nylon. Stockings are better than tights.
• Women should wash and wipe the genital area from "front to back"
• Inform your doctor if you think you may have developed thrush after taking antibiotics

Anything else?

Sometimes thrush can be passed on through sex so if it keeps returning it may be wise to have any regular partners checked. Having sex during treatment may delay healing so it would help to avoid this until it has cleared up.

Trichomonas

What is it?

This is an infection caused by a tiny parasite found in the vagina and urethra ("water pipe"). It is sometimes called TV.

How does it show up?

There may be nothing to see at all, especially in men. It may be discovered during a routine cervical smear. Commonly 3-21 days after infection the following may be seen:

• A change in vaginal discharge - may increase, become thinner, frothy or yellow/green in colour and develop a musty/fishy smell
• Soreness, inflammation and itching in and around the vagina
• Pain when passing urine
• Pain when having sex

• A discharge from the penis, which may be thin and whitish staining underwear.
• This however is not often seen yet they can act as carriers
• Pain, or a burning feeling when passing urine

Where does it come from?

Almost always from sexual contact i.e when the penis enters the vagina.
It is extremely unlikely to get it from towels, flannels, jacuzzies or hot baths.

Can it be treated?

Yes, very easily with a course of antibiotics (such as metronidazole). It is important to return to a clinic for a follow up appointment to check to see the infection has cleared.

What about sexual partners?

Regular or recent partners should also be seen and treated at the same time. Sex should be avoided until it has been confirmed the infection has been cleared.

Vulvitis

What is it?

An irritation around the entrance of the vagina and its lips (vulva).

How does it show itself?

It usually leads to itching or soreness and there may be an unusual discharge. It can be easily confused with "thrush" which is caused by a yeast germ called "candida". Thrush can however be one of a number of causes of vulvitis.

Is it common?

Yes, very. Some women get it regularly especially if they suffer other skin conditions such as eczema, dermatitis or psoriasis. An allergy to certain drugs or chemicals may exist. A family history of allergy may also be relevant.

Where does it come from?

There could be a number of causes. Here are some of the more common ones:

• Infection. Thrush is the commonest infectious cause. Some women experience this more during pregnancy or after taking antibiotics. It may be passed on from a sexual partner but this is thought to be rare. Other genital infections might cause vulvitis.
• Allergy or chemical irritation. It may be difficult to pinpoint exactly what substance causes a vulvitis. Common things are:
  
  • Feminine deoderant sprays
  • Scented bath/washing products (eg bath salts/bubble baths)
  • Creams used incorrectly (eg antithrush, antiseptics)
  • Disinfectants
  • Contraceptive creams
  • Condoms (especially with spermicidal lubricant)
  • Chlorine in swimming pools
  • Hair shampoo in bath water
  • Chemicals/cosmetics used by a sexual partner on genitals/fingers.
  • Washing powders especially biological ones and fabric softeners.
  • Certain brands of sanitary protection products
  • Menopause. This is a time when many women experience dryness and irritation as hormone levels reduce. Your G.P. may be able to help if this is the case.

Can it be treated successfully?

Yes. It is important to check for the presence of an infection by examining the vulva and taking swabs from the vagina. Treatment (such as hydrocortisone) can then be given if needed. If no infection is found then it will be helpful to stop using products that may be causing the irritation. Underwear may best be washed separately using simple soap flakes.

If condoms appear to be the problem then changing brands may help especially by avoiding ones with nonoxynol-9 lubricant. If it occurs during the menopause a GP may prescribe hormonal creams or replacement therapies. Use of a lubricant such as KY jelly may help with dryness and can be purchased from any chemist.

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