Texts for Translation 2006:
  Sexual Health

GENITAL HERPES

What is it?
Genital Herpes is caused by infection with Herpes Simplex virus (HSV). There are two trains of the virus, HSV-1 and HSV-2, both of which can cause genital herpes. Genital infection with the virus does not always result it symptoms, but if it does, these usually consist of blisters and sore areas on the skin surface.

HOW CAN I TELL IF I HAVE GENITAL HERPES
In most people, symptoms are mild or nonexistent. If symptoms do occur, they typically include itching/burning/tingling of the skin, followed by redness and small blisters which break open to form little sores. The first outbreak can last two or three weeks and often feels like “flu” with muscle aches, headaches, swollen glands and burring on passing urine.
Sometimes, there are no further outbreaks. Generally, HSV-1 is less likely to cause recurrences that HSV-2. Recurrences result in fewer blisters/sores, they are much less painful and healing takes on ly a few days. For very many people, the frequency of recurrences declines with time.

HOW IS IT TRANSMITTED?
Herpes is transmitted by direct contact, including genital to genital, mouth to mouth, mouth to genital and genital to mouth contact. Herpes is most infectious during outbreaks, from the first signs of burning/itching/tingling until the skin has completely returned to normal. Sometimes, the virus can be active, but not cause visible sores or other signs of infection. This is called “asymptomatic shedding”. On average, research has shown that this happens about 4-15 days in a year. Although there is much less virus on the surface of the skin than when visible sores occur, it is still possible to transmit herpes to a partner if direct contact occurs at this time.
Regular use of condoms may help to reduce transmission of the virus in between recurrences; however, even condoms don’t guarantee complete protection, as occasionally, the virus is shed from an area not covered by the condom. Contraception foams containing nanoxynol-9 may offer some additional protection because this substance kills the herpes virus.

HOW CAN I PREVENT OUTBREAKS
Keep a record of when you have herpes outbreaks, as you may begin to see a pattern of tripper factors. Many people find that recurrences occur when they’re run down, under stress, around menstruation or when the skin gets irritated due to friction or tight clothing. Sunlight (or sunbeds) may also induce an outbreak. If you do see a patter of trigger factors, try to adjust your lifestyle to avoid them.

WHAT SHOULD I TELL MY PARTNER?
If you choose to tell your partner, make sure that you yourself are clear about the facts and feel confident. Put genital herpes into perspective, it is identical to cold sores on the mouth area, basically a nuisance skin condition caused by a virus which is carried by a high proportion of the population. You may wish to talk the facts over with a sexual health advisor first.

WHAT ABOUT BEING PREGNANT?
Genital herpes does not affect the baby in the womb. However, if you have a recurrence of herpes during labour, there is a small chance (research suggest that this is less than 5%) of passing the virus to the baby during delivery. As this can be prevented by Caesarean section, it is sensible to tell you mid-wife or obstetrician if you have had genital herpes in the past.

GONORRHOEA

WHAT IS GONORRHOEA?
Gonorrhoea is an infection caused by a germ spread by unprotected sexual intercourse. If one partner is infected the germ can be passed from one partner to the other. Both men and women can pass the infection to and from their sexual partner(s). the infection is becoming very common in the community, mainly because the infection can be carried without people knowing they have it, as they have no symptoms or signs.

HOW IS GONORRHOEA TRANSMITTED?
Gonorrhoea likes to live in the genital area in men, the urethra (water passage) and rectum (back passage). In women, it likes to live in the urethra, cervix (neck of the womb) and the rectum. Because of this, gonorrhoea is usually passed on during sex. It can also be found in the throat from unprotected oral sex. But gonorrhoea is NOT caught by kissing or from towels, toilet seats or any other non-sexual contact.

WHAT ARE THE SYMPTOMS?
Most men with gonorrhoea in the urethra experience pain on passing urine and have a green or yellow discharge from the tip of the penis. These signs usually appear 4 – 6 days after sex, but they can take up to two weeks to show and in a few people thre may be no noticeable symptoms. Most women with gonorrhoea of the cervix or urethra have no signs of their infection. A few may complain of increased vaginal discharge or a burning sensation on passing urine. In both women and men, gonorrhoea in the rectum can cause constipation, pain around the anus, bleeding when the person opens their bowels or streaking of the stools with a green or white discharge. In most cases however, there are no signs of infection. When the infection is in the throat there are usually no noticeable complaints. If untreated in men, gonorrhoea can cause abscesses to form in and around the water passage or epididymitis (inflammation of tubes round around the testicle). In woman, untreated gonorrhoea can cause PID (Inflammation of the fallopian tubes). Untreated gonorrhoea of the rectum can result in formation of an abscess in the anal region.

HOW IS IT TREATED?

This requires a course of antibiotics. A few important points about this
Take the complete course. Any symptoms may take a few days to disappear, it is very important to continue to take treatment even if symptoms disappear.
You partner may be asked to attend for a check-up and also may require treatment.
Do not have sex until treatment is complete. It is important to come back to the clinic for a check up

GENITAL WART VIRUS INFECTION (HUMAN PAPILLOMA VIRUS OR HPV)

WHAT IS IT?
The genital wart virus (also known as human papilloma virus, HPV) commonly infects the genital skin. In most people it never causes any symptoms. In a very small number of people (about 20%) it may cause the appearance of visible warts which look exactly the same as warts which may occur in any other part of the body. In women, wart virus infection can show up in the cervical smear test, even if they do not have any visible warts on the surface of the skin.

HOW IS THE GENITAL WART VIRUS TRANSMITTED?
There are at least 70 different types of HPV. However, only about five strains commonly cause infection in the genital area. The virus is passed on from one person to another by direct skin to skin contact, so the most common way for the virus to occur in the genital area is during sexual activity. However, as most people who carry the wart virus have no symptoms, this means that it can be easily transmitted without either partner realising it. It is not possible to catch the wart virus infection from toilet seats swimming pools. In exceptional cases “non-genital” strains of wart virus can pass from other parts of the body to the genital area (for example, the finger) but this is thought to be unusual.

HOW COMMON IS GENITAL WART VIRUS INFECTION?
Using research techniques, HPV has been detected in 30-80% of young, health, sexually active people, most showing no visible warts.

WHICH PARTS OF THE BODY ARE AFFECTED?
The wart virus infects the surfaces of the entire genital and anal areas., including the cervix (neck of the womb), vagina, water passage and rectal areas. The virus remains on the surface and does not get into the deeper tissues or the blood stream. If warts appear they generally do so in warm, moist areas or where the body’s skin surfaces are rubbing together. In men, warts are most commonly found on the penis beneath the foreskin, in women, they tend to appear around the entrance of the front passage. In both men and women, warts can be commonly be found around the anal area.

HOW CAN I TELL IF I HAVE GENITAL WART VIRUS INFECTION?
Most people are completely unaware of the fact that they are carrying this very common surface skin infection, because they have no visible warts. In women, HPV sometimes shows up in a smear test. At the moment, there is no easy routine way to detect the virus, although a number of specialised methods are sometimes used in medical research. If warts do appear, they are usually easy to feel and appear as small soft fleshy lumps which often appear in groups. The diagnosis can easily be confirmed by a doctor or nurse.

WHAT TREATMET IS AVAILABLE?
See your doctor or nurse.

SMOKING AND WART VIRUS INFECTION?
Recent research shows that smoking has a very powerful effect on the immune system’s response to dealing with wart virus infection. This means that visible warts are much more likely to appear in people who smoke and also may take longer to disappear in smokers. It therefore appears likely that reducing or stopping smoking may help your body to deal with the effects or wart virus infection.

WILL MY PARTNER(S) BE AFFECTED?
Judging by the fact that almost half of young sexually active people may be carrying genital HPV, this virus seems to be extremely easily passed on. It is reassuring for partners to attend the GUM clinic for a careful check up and to make sure that they understand how easily the virus is passed on between partners. This gives an opportunity to answer the many questions which a couple may have about wart virus infection. The average length of time between acquiring HPV and developing visible warts is 3 months but can take many years.

WHAT ARE THE LONG TERM EFFECTS OF THE GENITAL WART VIRUS INFECTION?
With time, your body’s immune system will suppress the virus, but probably never get rid of it completely. The vast majority of people ewith ordinary visibly warts never have any problems at all. A tiny proportion of women carrying certain HPV strains may develop precancerous changes. This type of HPV infection does not usually cause visible warts. In women who are smokers or are HIV positive, this link may be stronger. Minor smear test changes are very common, occurring in 30% of women with genital warts. This will usually result in recommendation that you have more frequent smears for a while.
Sometimes, women may be offered a further test called a “colposcopy” which is simply a way of looking at the cervix more closely through a magnifying instrument. This test gives additional information to the smear test and takes about 10-15 minutes and is quite painless. There is no need for women with genital warts to have a smear test any more often that at the usual three yearly intervals, provided that their smears are always normal

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