September 20, 2020

STI’s (Sexually Transmitted Infections)

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Dr Lynn Dawber is a South African national with the International Medical Group from New Zealand where she has been practicing for a number of years.

Sexually transmitted infections (STIs) such as chlamydia and gonorrhoea are increasingly prevalent among young people and patients are often asymptomatic. STI’s can have various long term effects or complications including infertility in men and women; urethral strictures (narrowing of the urethra) in men; and chronic lower abdominal pain in women.

  • The only way to completely prevent STIs and other sexual health issues is to remain abstinent. However by modifying risky behaviours, sex can be made safer.
  • Younger people could be encouraged to express sexual feelings in other ways e.g. massage, mutual masturbation
  • If a person chooses to have sex, consistently and correctly using condoms (or other barrier contraception) is a key safer sex behaviour
  • Even in a monogamous relationship, it may be appropriate to recommend condom use until both partners have had a sexual health check
  • Condoms should always be used for anal sex to protect against STIs and other infections

Condoms provide protection against most but not all STIs

  • Condoms should be used for vaginal, anal and oral sex. If used properly, they protect against STIs that are transferred through contact with genital secretions such as gonorrhoea, chlamydia, trichomonias, syphilis, HIV and hepatitis B and C. Protection against diseases such as human papilloma virus, herpes simplex virus, scabies and pubic lice depends on the site of the sore/ulcer or infection and whether this is covered by the condom.
  • There are a variety of products available in sizes 49 – 60 mm, regular, extra strength or shaped. Choice of product is based on personal preference and self selection of size, however extra strength products are recommended for use during anal sex. It is not necessary to use spermicidal condoms – they are no more effective in preventing pregnancy and can cause vaginal irritation.
  • Non-latex condoms are available for those with a severe latex allergy.
  • Condoms should be stored in a cool, dry place and kept away from sunlight. Expiry dates should be checked before use. Only water based lubrication should be used (e.g. KY jelly). Do not use Vaseline, oils (e.g. baby oil) or body lotions.
  • Condoms protect against eight different infections and pregnancy.
  • Other barrier methods
  • Female condoms/femidoms/vaginal liners are available and offer the same level of protection against STIs as a regular condom for vaginal sex. They are made from polyurethane, with an inner ring to aid insertion and an outer ring that rests on the female genital area. Female condoms can be disinfected after use with household bleach, washed in detergent, dried and re-used approximately
    five times.
  • An oral dam (also known as a dental dam) is a thin square of latex that is placed over the vagina or anal area during oral sex. These can be purchased from family planning clinics and some pharmacies or alternatively a cut open latex glove may be used.

Symptoms indicating a possible STI

  • A recent change in vaginal discharge or urethral discharge
  • Vulval or genital skin problems
  • Peri-anal/anal symptoms
  • Lower abdominal pain
  • Dysuria (Pain/Burning when urinating)
  • Changes in menstrual cycle, irregular bleeding or post-coital bleeding
  • See your GP if you have any concerns. The earlier these infections are treated, the better the outcomes. But prevention is always better than cure.

Treating STI’s

General points:

  • If one STI is present, always consider others.
  • Testing and treatment of partners should ideally be done simultaneously.
  • Sexual abstinence is important until the course of treatment is completed or for seven days if single dose treatment.

 

Testing and treatment of sexual partners is important. All sexual contacts within the past three months (or last contact if greater than three months ago) should be traced and advised to seek testing and/or treatment.

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