Having multiple sex partners increases the risk of contracting sexually transmitted diseases. Picture: Jennifer Bruce Having multiple sex partners increases the risk of contracting sexually transmitted diseases. Picture: Jennifer Bruce
‘One in two sexually active people in South Africa will get a sexually transmitted infection (STI) by age 25,” says Professor Elna McIntosh, who is the president of the South African Society of Sexual Health Advisers, Educators, Researchers and Therapists (Sassert) and the director of the Disa Sexual and Reproductive Health Care Clinic in Sandton.
“There are over 20 STIs that affect men and women, including syphilis, gonorrhoea, herpes and HIV,” she explains. “STIs are contracted during sexual contact and are caused by a variety of organisms that fall into four main categories: bacterial, fungal, parasitic and viral.”
Men and women who have several sexual partners and who do not use condoms are at greater risk of infection.
The problem is that many people do not know they have an STI or do not want to admit they have one, irrespective of the mildness or seriousness of the infection. In some cases, STIs show no obvious signs or symptoms; in other cases people do not know what their symptoms mean – which is why getting tested regularly at your doctor or clinic, and particularly after risky sexual behaviour, is vital.
Many people also do not want to tell their partner/s that they have an STI, or they have lost contact with their partner/s, which is a serious problem because treating the partner/s of STI patients is necessary to stop infections from spreading.
“Most STIs can be successfully managed; others can be cured. It is critical to seek help as soon as possible because if left untreated STIs can cause long-term health problems. Infertility in both men and women is the most common problem caused by STIs,” says McIntosh.
Women can also experience problems during pregnancy such as miscarriages and premature births, and mothers with STIs can infect their unborn and newborn children, causing growth problems, severe eye and other infections, growth abnormalities, blindness and deafness.
People with STIs also become more susceptible to other potentially life-threatening STIs such as HIV. In the same way, people with HIV are more susceptible to other STIs. Proper treatment of STIs can reduce HIV transmission.
There is a tendency for people who think that they have an STI to self-medicate. This can lead to them taking the wrong medication or the wrong doses of the medication, which can encourage the growth of treatment-resistant germs.
The wrong herbal medications can lead to life-threatening allergic reactions.
It is far better to put your health ahead of your embarrassment and go to your doctor or clinic where your case will be treated with the strictest confidentiality.
Be open and honest about your sexual health history and let your doctor or health professional know if you or your partner have any signs or symptoms, including painful urination, bumps, sores or cuts on your sexual organs and/or unusual discharge.
Your doctor will be able to narrow down which tests to perform.
The only way to be sure about your STI status is to get tested.
Herpes is the most common STI seen at the Disa Clinic that has also seen an increase in HPV and chlamydia over the years. The clinic offers a “well woman screen” which includes a pap smear, breast check and contraceptive consultation for R400.
“As long as people are having sex we’ll always have STIs,” says Dr Michael Laurino from the Health4Men Centre in Soweto. Funded by USAid through the Anova Health Institute, the centre’s focus is on men who have sex with men, but historically it has opened its doors to all men, and treatment is free.
“Men are comfortable coming to us because we are comfortable about talking about sex and STIs in a way that other clinics might not be,” Laurino adds.
“We see about 300 men a month and we’re seeing an increase in herpes, gonorrhoea and syphilis.
“This is worrying because it suggests that people are not using condoms and are putting themselves and their partners at risk of HIV and other STIs.
“We’re also picking up another worrying trend among young people where there is a perception that HIV is an ‘older generation’ issue.
“Because of this, many are failing to use condoms and acquiring STIs, including HIV.”
In this feature we’ll explore the main list of STIs with Dr Sumayya Ebrahim, a practising gynaecologist at the Park Lane Clinic in Joburg who has a passionate interest in educating the public about health issues, health choices and treatments.
We are not including HIV here as it gets far more coverage than all the other STIs.
Chlamydia
Chlamydia is a bacterial infection that can manifest in men and women as a vaginal or urethral discharge, with or without a burning sensation during urination.
Chlamydia is easily treated with antibiotics. If you have chlamydia, your sexual partner/s also need to be treated, irrespective of whether they have symptoms to prevent re-infection.
If the chlamydia is chronic or untreated, it can lead to infertility in women.
Women can also infect their newborn babies, and it can manifest in newborn babies as an infection such as conjunctivitis (infection and inflammation of the lining of the eye) or pneumonia.
Human papillomavirus (HPV)
HPV is a highly prevalent virus with over 100 subtypes, several of which cause genital warts. Others can lead to cervical, penile and anal cancer.
HPV is transmitted from skin-to-skin contact. Genital warts are either cauterised or have topical medication applied to destroy them. This does not mean you are rid of the virus, which remains in the body. HPV can be managed and kept under control, but as with all ST viruses, to date there is no cure. Women must have regular pap smears because if HPV is present, it will show cellular changes associated with HPV infection which can lead to cervical cancer. Anal pap smears can also be done for men and women to show up any cellular changes that can lead to anal cancer.
Vaccines can protect against the main cancer-causing strains of the virus if given early on in life before any sexual activity is initiated.
Syphilis
Syphilis is a bacterial infection that most commonly presents itself as a painless pimple or papule that develops into a sore or ulcer.
The ulcer can either be visible and present on the penis or vagina or it can be less visible if it presents on the cervix.
The ulcer can heal by itself and disappear without a scar within three to eight weeks.
But syphilis remains in the body and attacks can recur and be transmitted to a partner or baby. Syphilis can be successfully treated with an antibiotic. If left untreated it can lead to secondary syphilis in men and women, which is characterised by fevers, headaches, generalised body pain, generalised skin rashes, lesions and ulcers in the genital area, ulcers in the mouth, hair loss and severely swollen glands.
Secondary syphilis can lead to tertiary syphilis, which is when it becomes extremely serious and can affect your heart and mind.
Neurosyphilis or syphilis that affects the mind can present as fever, meningitis, stabbing pains in the legs, forgetfulness, irritability, delusions, tremors or dementia. It can still be treated at this stage but some of the symptoms may not be reversible. Syphilis can also be transmitted to your unborn child.
Genital herpes
Genital herpes is a highly prevalent virus that usually presents as a cluster of painful blisters or a tingling sensation in the genital area.
Oral and genital herpes are the same family and you can transmit the infection from the mouth to the genitals and vice versa.
Herpes cannot be cured but it can be controlled with an antiviral tablet or cream. Without treatment, the cluster of blisters will often reappear when you are stressed, overtired or your immune system is low. If your immune system is low and you have HIV, the blisters can cover your whole body, cause meningitis and be life threatening.
A woman with herpes blisters on her genitals at the time of labour can transmit herpes to her baby, in which case doctors will recommend a Caesarian section.
Gonorrhoea
Gonorrhoea, also known as “drop”, is a bacterial infection that generally manifests in men and women as an offensive discharge, and pain during urination.
Men can also have pain in the scrotum and women can have bleeding between their periods. It can be cured with antibiotics. If it is not treated in time, it can lead to lowered fertility in men and infertility in women.
Gonorrhoea can also be passed from the mother to her unborn baby who may be born with an infection such as conjunctivitis.
Trichomoniasis or trichomonas vaginalis (TV)
This is one of the main causes of vaginal discharge (offensive) with inflammation in the vaginal area, itching and burning. It is more common in women.
It is caused by a parasite and can be cured with an antibiotic.
Hepatitis
Hepatitis is a virus and there are several types, such as A, B & C, all of which can be sexually transmitted through contact, especially hepatitis B, which is highly infectious.
This virus can also be transmitted through blood transfusions and contaminated needles (more common with hepatitis C) and contaminated food and water (more common with hepatitis A).
Hepatitis manifests as jaundice, nausea, vomiting, diarrhoea and a general feeling of ill health. You may need to be hospitalised.
Long-term hepatitis B and C is associated with liver cancer. People with hepatitis B may also have HIV.
Hepatitis can also be transferred from mother to baby.
Hepatitis vaccines are available for types A and B, but not yet for C.
Crabs or pubic lice
Crabs or pubic lice are lice in the pubic hair: the mature lice are brown or bluish in colour and the size of pinheads. Intense itching causes you to scratch and the scratches can become infected. You can see the lice or nits (eggs) in the pubic hair under a microscope. Treatment is easy – either a lotion or medicated solution.
Molluscum contagiosum
This is an infection caused by the pox virus that can be, but is not exclusively, sexually transmitted.
It manifests in “crops” of itchy little papules or raised bumps on the skin with a clear or creamy-white material in the centre that you can squeeze out.
They can appear anywhere including the genital area. Doctors may cauterise or freeze them, or apply a tincture of iodine or phenol, but they will also go away on their own.
Thrush (candidiasis)
Thrush is a common fungal infection that can be sexually transmitted (which is why it is included in the list), but which frequently manifests as a result of non-sexual causes, such as after antibiotic usage and when your immune system is run down. It commonly occurs in women as a white, inoffensive discharge, accompanied by vaginal itchiness.
Men can get thrush if they don’t wash under their foreskins as thrush thrives on sweaty dark areas. Men with thrush can get a skin reaction on their penis - areas of redness, itching, irritation, soreness and discharge from beneath the foreskin.
Thrush is treated with antifungals either orally or topically with creams.
Both/all partners need to be treated.
l Professor Elna McIntosh presents Kaya FM’s sexual wellness show every Wednesday night from 8pm to 9pm. For more information contact.
l Disa Health Care, Joburg
Professor Elna McIntosh
Phone: 011 787 1222
E-mail: [email protected]
www.safersex.co.za
l The Heath4Men Centre, Soweto
Dr Michael Laurino
E-mail: laurino@ anovahealth.co.za
Phone: 011 989 9756
www.health4men.co.za