London’s STI crisis revealed: a doctor shares her guide to STIs

Gonorrhoea is a bacterial infection that is passed from one person to another by sexual contact (vaginal, oral and anal), as the bacteria is mainly found in discharge from the penis and vaginal fluid. It can also be passed by sharing sex toys that have not been washed or have not been covered with a condom each time they’re used.

The infection can go unnoticed for long periods of time because many people experience no symptoms at all (around half of infected women and 1 in 10 infected men). However, if you do notice symptoms then this will normally be a thick discharge (from the penis/vagina) and pain when urinating. Women may also notice bleeding between periods.

Because Gonorrhoea is caused by a bacteria (as opposed to a virus), the infection is curable using antibiotics. Once you have tested positive for Gonorrhoea, you will also need to contact your recent sexual partners to ensure they are tested too, and treated if they are also infected.

Although Gonorrhoea is curable, it’s better to try and prevent its spread. Use condoms whenever you have sex (including oral) and make sure to follow proper hygiene measures when using sex toys (particularly if you’re sharing them).

The most common, but unknown STI – HPV

When people think of sexually transmitted infections, they often think of Chlamydia, Gonorrhoea and HIV. But actually, the most common STI is one that people with forget or don’t know very much about and that’s HPV.

HPV (human paillimovirus) is the most common STI and it’s spread through vaginal, oral and anal sex. There are a number of different kinds of HPV and some types can cause issues like genital warts and cancer.

One of the main reasons for the spread of HPV is that it often doesn’t come with any signs or symptoms, and an infected person can pass it on even if they are asymptomatic. There is also no approved check to find out your HPV status, so this is not done during a sexual health check.

Even though the infection is extremely common, it usually goes away on its own without causing any symptoms of health problems. Depending on the kind of HPV that you have though, it can cause health problems like genital warts and cancer.

Any health problems caused by HPV don’t necessarily appear straight away, and it can be months or even years before signs show so you may never know when exactly you contracted the infection.

Genital warts are normally diagnosed by a healthcare professional just by looking at the genital area, as these often look similar and are normally raised fleshy lumps or bumps that can appear cauliflower-like.

HPV can cause cervical cancer, as well as cancers of the vulva, vagina, penis, or anus. It can also lead to cancer in the tonsils, tongue and back of the throat.

Having HPV doesn’t automatically mean that you are going to develop cancer. Cancer often takes years, even decades, to develop after a person gets HPV, and not all HPV causes cervical cancer. The types of HPV that can cause cancers are also not the same as the ones that can cause genital warts, so you shouldn’t be disproportionately worried if you have genital warts.

How can I prevent HPV?

HPV is passed on through vaginal, oral and anal sex, but not necessarily only unprotected sex. This is because HPV can infect areas not covered by a condom, so it can still be passed on. However, using condoms when you have sex can lower your chances of contracting HPV, as well as other STI’s like Chlamydia, Gonorrhoea and HIV.

You should also get the HPV vaccine in order to reduce your risk. It’s safe, effective and can protect against disease and cancers. This is rolled out to women around the age of menstruation, but you can get this at a later age if you missed out when you were younger. For more advice, speak to your GP if you’re unsure whether or not you’ve had this.

It’s also important to attend your smear test when contacted. These begin as a routine from the age of 25 and they can help to detect abnormal cells at an early stage, including those caused by HPV. If you do contract a cancer-causing strain of HPV then catching it early is key to treating it.

Can you get an STI without having sex?

Everyone has heard the notion that abstinence is the best form of contraception, but does abstaining from sex protect you fully? Can you still get an STI without having sex?

This depends on how you’re classifying sex. If you’re wondering whether or not you can get an STI without having penetrative vaginal sex then the answer is yes. Sexually transmitted infections can be passed in a number of ways, including during anal or oral sex. People often don’t protect themselves properly during oral sex due to the belief that it’s safer.

In actual fact, a wide range of STI’s can be passed during oral sex, including Chlamydia and Gonorrhoea, while anal sex is a high-risk activity for passing HIV.

You can also pass on sexually transmitted infections through sharing sex toys, without having any actual sexual contact with another person at all. That’s why you should always use condoms if you’re sharing sex toys and be sure to clean them properly after use.

Can you get an STI during protected sex?

Plenty of women go on contraception to protect themselves against pregnancy (means such as the pill, the coil or the implant). So while any sex while on these forms of contraception is technically protected, you are only protected against pregnancy – not STI’s.

The only effective contraceptive method for protecting against STI’s is condoms (male or female). Condoms are 99% effective (when used properly) and prevent pregnancy as well as reduce your risk of contracting a sexually transmitted infection.

It’s important to bear in mind though that no method is 100% effective and condoms may not protect against infections such as genital herpes or genital warts, as these can infect areas of the skin that condoms don’t cover.

To reduce your risk of contracting and passing on STI’s, ensure you’re using the proper protection and get yourself tested regularly. Either every 6 months or after each new partner is sufficient.

Can you catch any STI’s from kissing?

There are only a couple of STI’s that you actually can get through kissing. Herpes simplex virus (HSV) is the virus that causes cold sores and genital herpes, and this can be spread easily through kissing, especially when sores are open and visible.

It’s easier to catch HSV-1 (the virus that causes cold sores) through kissing than it is to catch HSV-2 (the virus that causes genital herpes). However, mouth-to-mouth transmission is still possible, and if you do contract the virus then you will live with it forever, as the body cannot expel the virus completely.

Even though herpes can’t be cured, there are antiviral medications available to treat symptoms and minimise the number of flare-ups and outbreaks you experience.

Syphilis is another sexually transmitted infection that can rarely be passed on through kissing. The infection is more commonly transmitted through vaginal, anal or oral sex, but one of the symptoms of syphilis is sores in the mouth, and these can allow the bacteria to pass on to someone else through kissing (especially deep, open-mouthed kissing with tongue).

Syphilis is a bacterial infection, so it is curable with a short course of antibiotics. It’s important to catch (and treat) syphilis as early as possible to avoid any long-term complications and to prevent the spread of the disease.

Myths about Chlamydia

So you now know the score when it comes to Chlamydia (and other STI’s) and kissing. But what about some other things you may have heard? Let’s separate the myth from the fact…

You’ll know if you have chlamydia because you’ll have symptoms

Myth. Chlamydia is asymptomatic around 50% of the time in men and around 75% in women, so there’s a fairly good chance that you could have Chlamydia without even realising it.

The fact that Chlamydia can go by undetected so easily is why it’s so important to get checked for STI’s regularly and to always practise safe sex by using condoms.

If you do get symptoms for Chlamydia then these will usually include genital discharge, pain when urinating, pain during sex or lower abdominal pain. However, these can also be the symptoms of other infections (sexually transmitted and otherwise) so you should always get checked.

You can’t get Chlamydia the first time you have sex

Myth. Any unprotected sex that you have puts you at risk of sexually transmitted infections including chlamydia, gonorrhoea and HIV. It doesn’t matter if it’s the first time or the hundreth time; unprotected sex puts you at risk of infection.

You can only have one STI at a time

Myth. Sexually transmitted infections do not work mutually exclusively from each other, and having one does not stop you from getting another. In fact, it often works in the opposite way; being infected with one STI can increase your risk of catching another.

You can get Chlamydia through oral or anal sex

Fact. People often seem to worry less about protecting themselves during oral or anal sex, possibly due to the lack of risk regarding pregnancy. However, you leave yourself just as open to sexually transmitted infections like Chlamydia if you don’t use proper contraception during all kinds of sex.

You can only get Chlamydia once

Myth. Some people mistakenly believe that after a Chlamydia infection, the body builds up an immunity to the disease and you can’t get it again. This is entirely false and there is no limit to the amount of times you can catch Chlamydia if you don’t follow safe sex practises.

Treating Chlamydia with antibiotics like Azithromycin or Doxycycline is simple and clears the infection quickly. However, if your partner isn’t treated too, or if you have unprotected sex with a new partner straight after, you could easily become reinfected.

You’ll definitely get Chlamydia if you have sex with an infected person

Myth. If you have sex once with one partner who has Chlamydia then there’s around a 30% chance that you’ll become infected too. Which may not sound as alarmingly high as you expected. But of course, the more times you have sex or the more people you have sex with, the higher the risk gets.

The risk of transmission is impacted by a number of factors, including the severity of the infection, the gender of the infected/uninfected partner, your overall health, whether or not you already have any other STI’s, how long you have sex for, the type of sex you’re having, whether or not you use any lubricants and the type of lubricants used.

It’s not an exact science though and you should view all unprotected sex as a risk of catching Chlamydia and other STI’s. To ensure you properly look after your sexual health, you should always use condoms and get yourself checked every 12 months or with every new partner.

STI differences for men and women – Women are more at risk!

Women are less likely to have symptoms of an STI

Bacterial infections, like Chlamydia and Gonorrhoea, can often be asymptomatic. This means that for around 70% of cases, the infected person will have no symptoms at all and therefore not know they have anything unless they’ve been tested.

This is how these bacterial infections continue to be so common, because people can pass them on and spread them without knowing anything is wrong.

While both men and women can be asymptomatic, this is far more common for women. And even if symptoms do occur, they can pass quickly even though the infection hasn’t cleared. In order to clear a bacterial infection, antibiotics are needed.

Women symptoms are easy to confuse with something else

If women with STIs do have symptoms, then these can be very similar to things that women experience for a number of other reasons. Discharge is a common symptom of sexually transmitted infections, but a lot of women normally have discharge anyway due to the vagina being self-cleaning.

If this discharge seems unusual (like a change in smell, colour or consistency) then this could be confused with thrush or bacterial vaginosis. Meanwhile, men don’t tend to get discharge from the penis for any other reason, and will be more likely to think it strange and get it checked out.

Women are more at risk of STIs based on anatomy

The direction of transmission of sexually transmitted infections is far more common from a man to a woman than from a woman to a man. This is because a woman’s anatomy makes her more susceptible to infection.

The vaginal lining is thinner and more delicate than the skin on the penis, making it easier for bacteria and viruses to penetrate. The vagina is also warm and moist, making it the perfect breeding ground for bacteria.