School Science Lessons
2025-08-19
(UNBiol5C)
Sexually transmitted infections
Contents
Websites: 5.1.0 Sex safety, reproductive health, sexual health
5.2.0 Sexually transmitted infections, STIs
5.3.0 HIV/AIDS
5.4.0 WHO Guidelines on child birth
5.1.0 Sex safety, reproductive health, sexual health
5.1.01 Sexually transmitted infections.
5.1.1 Health-seeking behaviours to avoid unwanted outcomes
5.1.2 Infections, contact tracing recommended, STIs, HIV, TB
5.1.3 STIs and "venereal disease"
5.1.4 Treatment of STIs (STDs)
5.2.0 Sexually transmitted infections, STIs, genital diseases, contact tracing
5.2.1 Bacterial vaginosis, Gardnerella vaginalis
5.2.2 Candidiasis (Thrush)
5.2.3 Chancroid
5.2.4 Chlamydia
5.2,5 Cystitis
5.2.6 Donovanosis
5.2.7 Endometriosis
5.2.8 Epididymitis
5.2.9 Genital growths
5.2.10 Gonorrhoea
9.7 Hepatitis
5.3.0 HIV/AIDS
5.2.11 Lymphogranuloma venereum (LGV)
5.2.12 Mycoplasma genitalium
5.2.13 Non-specific urethritis (NSU)
5.2.14 Pediculosis
5.2.15 Pelvic inflammatory disease (PID)
5.2.16 Scabies
5.2.17 Syphilis
5.2.18 Trichomoniasis
5.2.19 Tuberculosis
9.9 Warts, genital warts
5.1.01 Sexually transmitted infections.
"Every day, there are more than 1 million new cases of curable sexually transmitted infections (STIs) among people aged 15-49 years, according to data released today by WHO.
This amounts to more than 376 million new cases annually of four infections - chlamydia, gonorrhoea, trichomoniasis, and syphilis.
On average, approximately 1 in 25 people globally have at least one of these STIs, according to the latest figures, with some experiencing multiple infections at the same time.
STIs are preventable through safe sexual practices, including correct and consistent condom use and sexual health education." World Health Organization
5.1.1 Health-seeking behaviours to avoid unwanted outcomes
1. Safer sexual intercourse means avoiding sexual contact where body fluids can pass into the body of another person.
Disease can be carried in all the body fluids, e.g. blood menstrual blood, semen, vaginal fluids, breast milk, amniotic fluid, pre-ejaculate.
The safest way to prevent body fluids passing between sexual partners is always to use a condom for all forms of sexual activity.
Condoms used with a water-based lubricant act as a barrier to prevent sexual fluids passing from one person to another.
However, anal sexual intercourse is always dangerous.
2. Never share injecting equipment, because needles, syringes, spoons, filters, water and glasses may have traces of blood in them that contain STIs.
Do not share personal toiletry items, e.g. toothbrushes, dental floss and razors, because they also may have traces of blood on them that contain STIs.
Always use disposable or properly sterilized needles for skin and body piercing or tattooing.
3. Avoid having many sexual partners.
Be true to one person.
The safest sexual choice is to have sexual intercourse with only one uninfected person, who has no other sexual partner and does not share injecting equipment.
4. Alcohol and other drugs impair judgment and can affect decisions about sexual behaviour, so avoid sexual intercourse while under the influence of alcohol or other drugs.
5. Both sexual partners should have healthy and clean bodies.
Many people use a shower with hot water and soap before sexual intercourse and wash thoroughly between the legs.
6. There are many alternatives to penetrative sex that allow partners to enjoy life together and not put the other partner at risk of STIs.
People can enjoy each other sexually by dancing, playing games, hugging, massage and other fun activities without passing body fluids between partners.
7. Prevent Infection and Spread of STDs
Use common sense and avoid sex with anyone who has genital sores, rashes, discharge, or other symptoms.
Get tested together with any new sexual partner.
All anyone has to do is enter their zip code and you can find somewhere near you to get tested.
Get tested for HIV and other commonly occurring, difficult to detect diseases.
HIV is a disease that is not commonly understood, as well as the process of getting tested for HIV.
Common conditions can be asymptomatic.
Although someone may have an STD they may show no symptoms of it.
So, getting tested regularly is important in making sure to get early treatment if one catches an STD.
If you think you have an STD:
Stop having sex.
Abstaining can be difficult if you are used to having sex on the regular, but if you think you have an STD this is the best way to prevent spreading it to others.
Seek medical treatment.
Do not try and play it off if you think you have an STD.
The best way to prevent getting an STD is to be safe and cautious.
Use condoms with partners.
Using condoms may seem like common sense prevention, but in the heat of the moment some people lose their head and forget to use common sense practice.
Make sure that your partners are aware and receiving treatment.
Do not let your emotions prevent you from being smart with your prevention practices.
Make sure that your partner is taking care of themselves so that you do not end up with an unwelcome surprise.
5.1.2 Infections, contact tracing recommended, STIs, HIV, TB
1. Contact Tracing in Context
Contact tracing is the process of identifying the relevant contacts of a person with an infectious disease (index patient) and ensuring that they are aware of their exposure.
For sexually transmissible infections (STIs), relevant contacts include those with whom the index patient has had sex during the infectious period as well as babies of infected mothers.
For blood-borne infections such as HIV, hepatitis B and C, needle-sharing contacts and transfusion recipients, as well as those who may have been accidentally exposed to blood by other means, also need to be traced.
For pulmonary tuberculosis (TB), contact tracing will involve domestic or other close social contacts.
The term partner notification is often used interchangeably with contact tracing. but by definition excludes needle-sharing contacts, transfusion recipients and children born to infected women.
Some understand contact tracing as being synonymous with provider referral (where a health professional carries out tracing of contacts), while equating patient referral (where the patient does the notifying themselves) with partner notification.
In this manual, the term contact tracing is used in its broadest sense, encompassing both patient and provider referral.
Aims: The general aims of contact tracing are:
1. To interrupt the ongoing transmission of infection.
2. To identify people with an infection who may benefit from treatment in order to minimize the likelihood of complications of infection.
3. To prevent reinfection from an untreated partner to help limit the prevalence of infection in the population.
Reinfection (also called superinfection) usually refers to an HIV-positiveperson acquiring a second strain of virus from someone else with HIV.
5.1.3 STIs and "venereal disease"
STIs and "venereal disease", Sexually transmitted diseases (STIs) are infectious diseases that spread from person to person during intimate sexual contact, direct body contact or contact with infected body fluids.
A person can become infected through having vaginal, oral or anal sexual intercourse with an infected sexual partner.
An individual can become infected with more than one STI at the same time.
It is unlikely that STIs can be transmitted from objects unless the object has fresh and wet infected body fluid on it.
Toilet seats are a very unlikely source of infection.
Formerly, STIs were called "venereal diseases (VD)".
STIs usually infect the genitals, rectum, throat, and conjunctiva of the eye.
Several STIs spread from an initial site and produce sores in many parts of the body.
People with one sexually transmitted infection are usually at high risk for other diseases common in the same environment.
Many clients attending a clinic solely "for an AIDS test" are usually found to have one or more STIs although their AIDS test is usually negative.
However, the statistics on sex differences may not reflect the actual situation because infected women often do not show any symptoms and are more difficult to diagnose than men.
The fact that many infected women show no symptoms of STIs is especially unfortunate since the complications can be quite serious in pregnant women.
They may pass infections to the foetus during pregnancy or to the baby during childbirth.
Females who have an infection, such as genital Chlamydia, gonorrhoea, (NSGI), are at risk of inflammation of the uterus and Fallopian tubes, if specific infections are not diagnosed or treated early.
Symptoms may be lower abdominal pain, a vaginal discharge, pain during sex, or abnormal vaginal bleeding or spotting.
Spotting plates (Modern Teaching Aids)
One or more attacks of PID may damage the Fallopian tubes.
This damage can prevent fertilization from occurring, or if fertilization does occur, the growing fertilized egg may be unable to pass along to the uterus causing the egg to implant in the Fallopian tube.
This is called an ectopic pregnancy that is very serious and requires emergency medical care.
5.1.4 Treatment of STIs (STDs)
Treatment of STIs, (STDs) involves medical treatment, counselling, and follow up.
The doctor or health worker should always explain the disease and its treatment to the patient.
A person may remain infected when symptoms disappear, or may become reinfected immediately after treatment, so a follow up visit is important.
The infected person should not have sexual intercourse until the follow up visit has confirmed the cure of the disease.
Sexual partners of people with STI infection should also seek medical examinationto avoid "ping-pong infection", i.e. passing disease back and forth between two sexual partners.
People who learn they are infected with STIs can fell guilty, depressed, anxious or angry, so they should discuss their feelings with a doctor, a counsellor or others who have the same problem.
The notifiable diseases (reportable diseases) that must be reported to governmental authorities by doctors may include Gonorrhoea, Syphilis, Hepatitis B, Hepatitis C and Chlamydia trachomatis.
5.2.15 Pelvic inflammatory disease (PID)
Pelvic inflammatory disease (PID)
See 5.2.15.1: Pelvic inflammatory disease (PID) contact tracing, (Chlamydia trachomatis), (Neisseria gonorrhoeae), (Mycoplasma genitalium)
In some countries, many people are infected with Chlamydia, but they are unaware of the infection.
They do not see or feel anything wrong so they can unknowingly pass on Chlamydia to their sexual partners if they are not using condoms.
Chlamydia can also be passed on by oral or anal sex.
Females may have symptoms of a burning sensation when passing urine, an unusual vaginal discharge, itch or irritation, lower abdominal pain, pain during sexual intercourse, abnormal bleeding or spotting between periods.
Males may have symptoms of a clear whitish or yellow discharge from the penis, burning or pain on passing urine, irritation or itching around the urethra, pain in the rectum or testicles, pain with ejaculation.
Chlamydia may cause pelvic inflammatory disease, PID, in women if left untreated.
A pregnant woman with a Chlamydia infection has an increased risk of having a stillborn or premature baby.
Chlamydia infection can make them infertile.
Laboratory tests can identify Chlamydia and the infection is easily treated with antibiotics.
The prescribed treatment must be completed.
Otherwise, the infection will not be cured.
The sexual partners should also get tested and treated.
Patients should not have sexual intercourse while they and the sexual partner are taking the treatment, as they could reinfect each other.
Chlamydia may cause infertility due to salpingitis, infection and inflammation in the Fallopian tubes.
Chlamydia infects the cervix in women, and the penile urethra in men.
According to a 2010 study by the CDC, Chlamydia is the most common STD among persons under the age of 25.
In Australia, the Queensland State Government reported in 2013 on the rapid and steady increase in annual notifications of Chlamydia rising 90 per cent between 2004 and 2009.
Symptoms: Pain during sex, and discharge from the penis or vagina.
Chlamydia is difficult to diagnose, because it can be carried for several months without symptoms.
That incubation period has helped lead to an increased rate of infection.
Treatment: The use of antibiotics Dexacycline and Tetracycline for seven days and persons with Chlamydia should abstain from having sex during the course of treatment.
5.2.10 Gonorrhoea
Gonorrhoea, urethral / vaginal discharge, "the clap"
See 5.1.5: Gonorrhoea contact tracing, Neisseria gonorrhoeae
Gonorrhoea is caused by the gonococcus bacterium (Neisseria gonorrhoeae).
People get infected by having sexual intercourse without a condom, oral sex, or touching infected genitals or anus.
After infection they may have no symptoms until 2-10 days after infection.
Symptoms include a cream yellow discharge from the penis or vagina, pain on intercourse, sore throat if infected in the throat, anus itch, if infected in the anus.
Even if the symptoms clear up, the infection may still be there and cause problems later.
Treat the disease with antibiotics.
Untreated gonorrhoea can cause the following:
1. Ulcers that increase the risk of infection by HIV, 2. Pelvic inflammatory disease (PID), 3. Infertility of women, 4. Infection in the eyes of the baby. 5. Infertility due to salpingitis, inflammation of the Fallopian tubes.
All the sexual partners of a person infected with gonorrhoea should be checked by a doctor.
Gonorrhoea, or "the Clap", is a bacterial STD that is very common among sexually active teens and young adults.
Gonorrhoea is often found with Chlamydia.
There are more than 700, 000 new cases a year in the US.
Condoms are a great preventive measure.
Be aware that, because this is a bacterial infections oral transmission is possible, often resulting in gonorrhoea of the throat.
Symptoms: "The Clap" is commonly recognizable by burning during urination.
For men, there is also a common penile discharge usually coloured white or yellow, but can sometimes come through green discharge.
Treatment: CDC recommends that uncomplicated gonorrhoea be treated only with the antibiotic ceftriaxone given as an injection and in combination with either azithromycin or doxycycline both of which are oral antibiotics.
5.2.13 Non-specific urethritis (NSU)
Non-specific urethritis (NSU), non-gonococcal urethritis (NGU), non-specific genital infection (NSGI)
Non-specific urethritis (NSU) is a common infection among young sexually active people who have sexual intercourse without using a condom.
Many people do not have any symptoms.
In males it is called non-gonococcal urethritis (NGU) or non-specific urethritis (NSU) or non-specific genital infection (NSGI).
Urethritis is an inflammation of the urethra.
The symptoms are a watery, white discharge from the urethra in the penis or pain on passing urine.
In females, NSGI is often cervicitis, inflammation of the cervix.
The symptoms are lower abdominal pain, vaginal discharge, pain on sexual intercourse or a burning sensation on passing urine.
People with these symptoms should be tested for STI infection.
The most common cause is Chlamydia trachomatis, although often the specific organism causing the symptoms cannot be identified.
Non-gonococcal urethritis is caused by a primitive bacterium, a mycoplasma.
Antibiotic treatment cures these infections.
Sexual partners of patients should be tested and treated whether or not they appear to have symptoms.
Sexual intercourse should be avoided until the treatment is complete.
If NSGI infections are not treated without delay, there is a danger in females of pelvic inflammatory disease (PID) damaged Fallopian tubes and infertility.
In males, there is danger of prostatitis (inflammation of the prostate gland), epididymitis (inflammation of the epididymis), and infertility.
5.2.14 Pediculosis
Head Lice, Healthe, NSW
Pediculosis, lice, louse, (Phthirus pubis)
Pediculosis or louse infestation is caused by the arthropod pubic louse, "crabs", crab louse, (Phthirus pubis).
The louse attaches to coarse body hair and causes irritation, redness and dermatitis.
Lice usually spread by close body contact, sharing combs and rarely by contact with unwashed bed linen or towels.
Treatment is by DDT powder or lotions or γ-benzene hexachloride to kill the lice and eggs.
Pubic lice move from person to person by close contact, often during sex.
They can be infected by pubic lice from sharing soiled clothes, bed sheets, or towels.
Other kinds of lice, the head louse, (Pediculus humanus capitus), and the body louse, (Pediculus humanus corporis), can be quite common in schools.
If infestation occurs, all the children in the school should be treated.
The eggs of lice, "nits", become attached to hairs. but may be removed with a special fine comb, "nit comb".
Trench fever, relapsing fever, that affects soldiers confined in warfare trenches, is transmitted by the faeces of lice.
Day 0 Egg laid on hair shaft, Day 6 -7 Louse hatches, Day 8-9 First moult, Day 11-12 Second moult, Day 17-18 Adult lice mate and female lays first eggs 1-2 days after mating
Day 19-32 Females lay 3-8 eggs each day for the next 16 days, Day 33-35 Louse dies.
"Crabs" was once the most common STD in existence, but have in recent years become one of the least seen infections.
This may be because those who are sexually active are choosing to shave off their pubic hair for an increase in pleasure during sex activity.
The crabs, which are a distant relative of head lice, need to be treated as soon as possible.
Safe sex with condoms can help prevent the spread, but will likely do very little since crabs is based in the sharing of the lice across pubic regions, and not external sexual genitalia.
Symptoms: Itching in the pubic area.
Small lice appear in the hair of the pubic region, with small eggs implanted just beneath the skin.
Treatment: A pharmacist can suggest a lice-killing lotion containing 1% permethrin or a mousse containing pyrethrins and piperonyl butoxide can be used to treat pubic (crab) lice.
Lindane shampoo is also effective for those with repeat outbreaks.
5.2.16 Scabies
Scabies is caused by the itch mite, (Sarcoptes scabiei), "crabs", or "sandy crabs".
It burrows into the skin often between the fingers and on the wrists and causes intense itching that is worse at night.
The entrances to the burrows have small scale-like swellings that become red and itchy.
Transmission is by close body contact during sexual intercourse and sharing clothes and bed linen with an infected person.
Treat it with a benzyl benzoate lotion applied externally to kill the mites and eggs.
Also, prescription strength | permethrin, C21H20Cl2O3, C21Cl2H20O3 | kills the scabies mite.
Wash all bedding and clothes used by the infected person.
Not always classified as an STD, the parasite Sarcoptes scabei, causes an extremely itchy rash that gets worse at night.
Scabies is most commonly found in folds of the skin, on the wrists and ankles, and in the genital area.
Symptoms: Scabies is incredibly contagious, and the mite can live for days off the human body.
It is not only spread by close personal contact, but by skin-to-skin contact in general, shared clothing, towels and bedding.
There is often plenty of scratching and red marks around the arms.
Treatment: Permethrin and Ivermectin the most effective treatment for scabies and the treatment of choice.
It is applied from the neck down usually before bedtime and left on for about eight to fourteen hours, then showered off in the morning.
5.2.17 Syphilis
11.1.11 Syphilis contact tracing, (Treponema pallidum)
Syphilis is caused by the bacterium, (Treponema pallidum).
The infection causes a painless sore on the mouth or genitals that disappears after two weeks.
The sore feels like a button under the skin.
Treat the infection with antibiotics, e.g. penicillin.
Months after infection symptoms include a skin rash, patchy loss of hair, moist lumps around the genitals or anus.
If not treated, these symptoms may disappear and then recur over the next two years.
An untreated person may infect sexual partners during sexual intercourse.
Without treatment, the disease may become latent with. but reappear years later with fatal consequences due to infection of the brain, heart, large blood vessels, the spinal cord, skin and bones.
People infected with syphilis are infectious and should avoid all sexual contact until advised by a doctor.
A pregnant woman who has syphilis can pass it on to her unborn baby that may be born dead or badly damaged as a consequence.
The bacteria that causes syphilis, (Treponema pallidum) can become a very serious battle for your body if left untreated.
Syphilis is transmitted by syphilis sores, which can appear on the external genitals mouth, the vagina and rectum.
Be sure to check your partner before going into direct physical contact.
Because the sores are not only on the genitalia, the condom use that prevents most STDs will only reduce your risk.
Symptoms: Lesions on the palms and the tops of the hands, and later several red bumps running along the back.
Treatment: For uncomplicated a single dose of intramuscular penicillin G or oral azithromycin does the task.
Those who are seeking later treatment will need ten days of heavy IV penicillin.
5.2.18 Trichomoniasis
See 5.1.12: Trichomonas vaginalis contact tracing
Trichomoniasis is caused by the flagellated protozoan (Trichomonas vaginalis).
It causes an unpleasant discharge and irritation of the vagina and painful urination.
Treat the infection with antibiotics.
It is mainly spread by sexual intercourse.
The infection poses no great threat to health. but it often occurs along with other STIs, e.g. gonorrhoea.
Women with trichomoniasis infection may become more easily infected with AIDS.
So an infected person should be checked for other STI infections.
5.2.1 Bacterial vaginosis, (Gardnerella vaginalis)
Bacterial vaginosis, (Gardnerella vaginalis) is probably NOT an STI, because women who are not sexually active, or have never been sexually active, can be infected.
Women develop bacterial vaginosis soon after intercourse with a new sexual partner.
Bacterial vaginosis is an overgrowth of various bacteria that are normally present in the vagina.
Gardnerella is one bacterium that may be involved so sometimes the condition is called "Gardnerella".
The reason this change in the vaginal bacteria occurs is not known.
It is not a serious disease and may require treatment only if symptoms cause distress or inconvenience.
Symptoms are irritation and vaginal discharge with an unpleasant odour.
To prevent Gardnerella, wipe from the front to the back, from vaginal area to the anus after going to the toilet, not from anus to vaginal area.
Keep wiping until the toilet paper is clean or wash the area.
The treatment is usually | metronidazole, C6H9N3O3 | tablets, "Flagyl".
5.2.2 Candidiasis (Thrush)
Candidiasis, thrush, is caused by the fungus, (Candida albicans), a yeast that normally occurs in the mouth, vagina and intestines without causing any symptoms.
It is not an STI, but sexual intercourse may irritate the vagina and allow Candida albicans to grow.
It causes itchy white vaginal discharge with a yeasty smell, swelling and redness of the vagina, discomfort during intercourse, and stinging when passing urine.
Repeated attacks may cause women to feel depressed and lose interest in sexual intercourse.
Thrush is more likely to occur during pregnancy, by taking the contraceptive pill after taking antibiotics that kill normal bacteria, during the week before and after the period of the menstrual cycle, and, because of diabetes when the immune system is suppressed.
When symptoms are noticed, the woman should see a doctor to have a swab taken for testing whether it is (Candida albicans) or another infection.
Doctors usually prescribe vaginal cream or pessaries.
It is important to complete the course of treatment.
The same cream should be applied to the penis under the foreskin.
Women patients should wear cotton underpants or loose flowing skirts.
They should not wear nylon pants, pantyhose or tight jeans.
Eating natural yoghurt with the course of antibiotics may help the bacteria in the intestines return to normal when possible.
To avoid infection, after toilet wipe from front to back with toilet paper to prevent risk of bowel bacteria contaminating the vaginal area.
After washing, women should gently wipe the vulva area dry.
Most soaps are alkaline and can neutralize the natural acidity of the body so it is better to wash with water only in that area.
Avoid using heavily perfumed soaps or sprays in the genital area, as they may cause irritation.
Thrush can be spread by sexual contact.
Men may also be affected, but usually less severely and do not necessarily require treatment.
The symptoms for men are red spots on the penis, scrotum or groin.
Occasionally, (Candida albicans) may live under the foreskin of an uncircumcised male, but he might be unaware of it if no discomfort occurs.
To avoid thrush, uncircumcised men should wash under the foreskin daily.
5.2.5 Cystitis
Cystitis, "honeymoon disease", (Escherichia coli) causes inflammation of the urethra (urethritis) and bladder (cystitis).
Cystitis is probably not an STI, because it is probably caused by poor toilet hygiene before sexual intercourse.
It formerly was called the "honeymooner's disease".
Cystitis is an inflammation of the bladder caused by an infection of the urinary tract by bacteria that normally live in the bowel.
Symptoms: scalding feeling when passing urine (dysuria) a desire to pass urine frequently, a persistent dull ache above the pelvic bone after passing urine.
Untreated cystitis can cause serious kidney infection.
Prevention includes better toilet hygiene as with Gardnerella, drinking large quantities of water, washing the vulva with soft soap, wearing cotton underpants and avoiding tight jeans.
If cystitis is suspected, see a doctor who will prescribe antibiotics and perhaps conduct a pelvic examination to ensure the vagina is healthy.
STIs also cause infection of the urethra.
People who learn they have cystitis can feel embarrassed, depressed and anxious.
Cranberry juice is said to help deal with this disease.
Untreated cystitis can result in inflammation in the kidneys, pyelitis, and pylonephritis leading to blood cells and pus in the urine.
5.2.9 Genital growths
Genital growths: Balanitis, Molluscum contagiosum
Balanitis is inflammation, redness and soreness, of the head of the penis.
It is not an STI. but sexual intercourse may irritate the head of the penis and lead to balanitis.
Men with foreskins are more likely to get this condition.
Treat the symptoms by keeping the head of the penis and the foreskin cleanand dry.
Sexual partners do not require treatment.
Molluscum contagiosum is a virus skin infection and appears on the genitals and adjacent areas as round, pearly lumps with a central white core.
It is a harmless condition and is treated by freezing with carbon dioxide.
It spreads by sexual and non-sexual contact.
5.2.7 Endometriosis
Endometriosis can lead to infertility, and occurs when cells lining the uterus begin to grow elsewhere, e.g. on the ovaries, fallopian tubes, bladder and bowel.
Research has identified two regions of DNA close to gene WNT4, strongly associated with this disorder and this may lead to a diagnostic test for this painful gynaecological condition.
Environment factors may also be important for the development of this disease.
At present, 2024, there is no known way to prevent endometriosis.
Currently there is no cure.
A range of medications can help manage endometriosis and its symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics (painkillers) like ibuprofen and naproxen are often used to treat pain.
5.3.0 HIV/AIDS
HIV/AIDS: Causative organism: Human immunodeficiency virus (HIV)
Incubation period: 16 weeks for primary HIV (many are asymptomatic); then up to 10 years to AIDS without treatment
How far to trace back: Start with recent sexual or needle-sharing partners; outer limit is onset of risk behaviour or last known negative HIV test result if known
Usual testing method: Serology for HIV.
Repeat test if recent infection possible after window period for test
Common symptoms: Usually asymptomatic unless immune-suppressed or AIDS
Likelihood of transmission per unprotected exposure:
Receptive anal sex: 0.83.2%
Receptive vaginal sex: 0.050.15%
Insertive vaginal or anal sex: 0.030.09%
Reused injecting equipment: 0.8%
Needlestick injury (freshly contaminated): 0.23%
Contaminated blood transfusion: 92.5%
Higher with elevated HIV viral load, for example, during primary infection and late infection, or if other STIs present or a man is uncircumcised.
Reduced by antiretroviral therapy
Likelihood of long-term sexual partner being infected: Increases with duration of relationship
Protective effect of condoms: High
Transmission by oral sex: Rare
Duration of potential infectivity: Lifelong
Important consequences: AIDS, Death, Mother-to-child transmission
Direct benefit of detection and treatment of contacts: Detection of HIV in contacts, potentially reducing further transmission
Usual management of contacts:
1. HIV-antibody testing and counselling For exposures to HIV within the last 72 hours, contacts may benefit from post-exposure
prophylaxis, 2. Referral to support agencies
Contact tracing priority: Very high given seriousness of infection.
(Note: If the index patient has donated or received blood products, contact the relevant blood bank as well.)
Notification: AIDS is notifiable by all doctors in all Australian states and territories and in New Zealand.
HIV notification is made by laboratories or doctors in most states and territories of Australia.
Public health legislation in some jurisdictions requires that people with HIV advise future sexual partners of their condition.
5.2.3 Chancroid
Chancroid: Causative organism: (Haemophilus ducreyi), Gram-negative coccobacillus, spherical to a rod-shaped bacterium, with fine pili appendages for attaching to cell surfaces, forms yellow-grey colonies.
Incubation period: 6 days to 2 weeks
How far to trace back: 2 weeks before ulcer appeared or since arrival in endemic area
Usual testing method: Nucleic acid amplification testing or culture
Common symptoms: Painful anogenital ulcers; enlarged tender inguinal nodes (buboes) which may break down and discharge
Likelihood of transmission per act of unprotected intercourse: High
Likelihood of long-term sexual partner being infected High; asymptomatic infection is thought to occur sometimes in women
Protective effect of condoms: Probably high
Transmission by oral sex: Rare
Duration of potential infectivity: Weeks
Important consequences: Local tissue destruction, inguinal abscesses and draining sinuses.
Enhanced HIV transmission
Direct benefit of detection and treatment of contacts: Cure
Usual management of contacts: Counselling, clinical examination and testing of lesions for chancroid
Treat partners with | azithromycin, C38H72N2O12 | or | ceftriaxone, C18H18N8O7S | by intramuscular injection
Contact tracing priority: High as not endemic in Australia or New Zealand.
Specialist support for contact tracing should be sought if local acquisition or transmission is possible
Notification: Notifiable by all doctors in all Australian states and territories, and in New Zealand, and by laboratory on positive isolation in Australian states and territories.
5.2.4 Chlamydia
Chlamydia: Causative organism: (Chlamydia trachomatis)
Incubation period: > 260 days for male urethral infection, though up to 90% are asymptomatic.
Most cervical infections in women and anal infections in men and women are also asymptomatic
How far to trace back: 6 months
Usual testing method: Nucleic acid amplification testing for example of vaginal, cervical or anal swab, or first void urine
Common symptoms: Usually asymptomatic in both men and women.
Urethral discharge and/or dysuria in men with urethral infection.
Vaginal discharge with cervical infection.
Pelvic pain, abnormal bleeding and dyspareunia, fever and malaise if PID present.
Scrotal pain, swelling, erythema if epididymitis present.
Likelihood of transmission per act of unprotected intercourse: 30-50%
Likelihood of long-term sexual partner being infected.
About two-thirds of male partners of infected women and female partners of infected men will be infected
Protective effect of condoms: High
Transmission by oral sex: Unknown
Duration of potential infectivity: Women can be infected for years.
Men can be infected for months.
Limited data on duration of infectiousness over time.
Important consequences: PID, Epididymo-orchitis, Infertility, Ectopic pregnancy, Neonatal pneumonitis and conjunctivitis, Preterm
labour and low birth weight, Enhanced HIV transmission
Direct benefit of detection and treatment of contacts: Cure
Usual management of contacts: Counselling, clinical examination and testing for Chlamydia.
Treat partners with | azithromycin, C38H72N2O12 | orally as a single dose (including pregnancy).
If partners have epididymo-orchitis or PID use other treatment
Contact tracing priority: High
Notification: Genital C. trachomatis infection is notifiable in all Australian states and territories by doctors or laboratories.
5.2.6 Donovanosis
Donovanosis: Causative organism: (Klebsiella granulomatis)
Incubation period: Weeks to months
How far to trace back: Weeks to months, according to sexual history
Usual testing method: Diagnosis is often made clinically after excluding syphilis; definitive diagnosis requires histology of punch biopsy specimen showing characteristic Donovan bodies or positive nucleic acid amplification testing.
Nucleic acid amplification testing may be performed on surface swab specimens and obviates need for biopsy
Common symptoms: Relatively painless granulomatous ano-genital lesions.
Perineum commonly involved with associated pseudo-buboes in inguinal region.
Lesions may ulcerate and bleed.
Secondary infection produces offensive odour.
May be mistaken for cancer of vulva or penis.
Likelihood of transmission per act of unprotected intercourse: Low
Likelihood of long-term sexual partner being infected: Low moderate
Protective effect of condoms: Probably low
Transmission by oral sex: Unknown
Duration of potential infectivity: Months to years if active lesions present
Important consequences: Local tissue destruction, scarring and secondary oedema.
Lesions may spread locally, intra-pelvically and to distant anatomic sites.
Enhanced HIV transmission.
Direct benefit of detection and treatment of contacts: Cure
Usual management of contacts: Counselling, clinical examination and appropriate investigation.
Medical treatment.
Contact tracing priority: High for regular partners.
Moderate for casual partners
Notification: Notifiable by doctors in all Australian states and territories, and in New Zealand Donovanosis is now rare in previously endemic areas in Central and Northern Australia, following intensive
case finding and treatment programs.
5.1.5 Gonorrhoea
Gonorrhoea Causative organism: (Neisseria gonorrhoeae)
Incubation period: 210 days for male urethral infection; occasionally weeks to months.
Most cervical, anal and throat infections are asymptomatic.
How far back to trace 2 months
Usual testing method: Culture or nucleic acid amplification testing
Common symptoms: Urethral discharge and dysuria with urethritis in men.
Purulent vaginal discharge with cervical infection.
Pelvic symptoms if PID.
Scrotal symptoms if epididymo-orchitis.
Likelihood of transmission per act of unprotected intercourse: 20% for insertive partner; 50% for receptive partner
Likelihood of long-term sexual partner being infected: > 50 %
Protective effect of condoms: High
Transmission by oral sex: Significant
Duration of potential infectivity: Up to 12 months
Important consequences: PID, Epididymo-orchitis, Disseminated gonococcal infection, Neonatal ophthalmia, Enhanced HIV
transmission.
Direct benefit of detection and treatment of contacts: Cure
Usual management of contacts: Counselling, clinical examination and testing of appropriate sites (urethra, cervix, pharynx, anus).
5.2.11 Lymphogranuloma venereum, (LGV)
Lymphogranuloma venereum, (LGV): Causative organism: (Chlamydia trachomatis serovars L1L3)
Incubation period: 1 week to 3 months
How far back to trace 1 month or since arrival in LGV endemic area if acquired overseas
Usual testing method: Nucleic acid amplification testing of swab from anus, genital ulcer or bubo aspirate, confirmed by genotyping at a reference laboratory.
Chlamydia serology may be helpful to confirm the diagnosis
Common symptoms: Genital ulceration, inguinal abscess (bubo), or proctitis
Likelihood of transmission per act of unprotected intercourse: Unknown
Likelihood of long-term sexual partner being infected: Unknown
Protective effect of condoms: Probably high
Transmission by oral sex: Probably rare
Duration of potential infectivity: Months
Important consequences: Inguinal and pelvic abscesses, anal stricture, likely enhanced transmission of HIV
Direct benefit of detection and treatment of contacts: Cure
Usual management of contacts: Counselling, clinical examination and urine or swab tests for Chlamydia (alert the laboratory to the possibility of an LGV strain so genotyping is performed).
Medical treatment.
Contact tracing priority: High as the number of LGV cases reported in Australasia has been limited
Notification: Notifiable by all doctors in all Australian states and territories.
Not notifiable in New Zealand.
5.2.12 Mycoplasma genitalium
Mycoplasma genitalium: Causative organism: (Mycoplasma genitalium) (Mg)
Incubation period: Unknown. but symptoms commonly develop within 13 weeks
How far back to trace: There is currently insufficient data to provide a definitive period for this, but partner notification is recommended
Usual testing method: Nucleic acid amplification testing on first pass urine in men (urethral swab less sensitive) and first pass urine, high vaginal or cervical swab in women
Common symptoms: Urethral discharge or dysuria in men.
May be asymptomatic.
Is a cause of cervicitis in women and likely cause of PID.
Symptoms of cervicitis/PID include dyspareunia, post-coital bleeding, vaginal discharge and abdominal pain.
Commonly asymptomatic in men and women
Likelihood of transmission per act of unprotected intercourse: Unknown
Likelihood of long-term sexual partner being infected: Unknown
Protective effect of condoms: Probably high
Transmission by oral sex: Unknown. but likely.
Duration of potential infectivity: Uncertain; however, persistent infection is common: 25% of infections persist > 12 months and infections up to 23 years have been reported
Important consequences: PID and infertility in women
Direct benefit of detection and treatment of contacts: Cure
Usual management of contacts: Counselling, Medical treatment.
Contact tracing priority: High
Notification: Not notifiable in Australia or New Zealand.
11.1.11 Syphilis
Syphilis: Causative organism: (Treponema pallidum)
Incubation period: 990 days (mean 30) to primary syphilis, 30150 days to secondary syphilis, 535 years to tertiary syphilis
How far back to trace: According to sexual history and clinical stage of infection:
1. Primary syphilis 3 months plus duration of symptoms, 2. Secondary syphilis 6 months plus duration of symptoms, 3. Early latent
syphilis 12 months
Usual testing method: Serology for syphilis.
Ulcer swab can be tested by nucleic acid amplification
Common symptoms: Anogenital or oral ulcers, Rash, Early infection commonly asymptomatic
Likelihood of transmission per act of unprotected intercourse: Early syphilis (primary, secondary, early latent): >20 %
Late latent and tertiary: usually not infectious
Likelihood of long-term sexual partner being infected: Up to 50% if early syphilis; <1% if no contact during infectious period
Protective effect of condoms: High if lesions covered by condoms
Transmission by oral sex: Probably common
Duration of potential infectivity: Up to 24 months (rare after 12 months)
Important consequences: Neurosyphilis, cardiovascular syphilis, and congenital infection.
Enhanced HIV transmission
Direct benefit of detection and treatment of contacts: Cure
Usual management of contacts: Consultation with sexual health physician in all cases is suggested.
Medical treatment.
Contact tracing priority: High
Notification: Notifiable by doctors in all Australian states and territories, and New Zealand.
5.1.12 Trichomoniasis
Trichomoniasis: Causative organism: (Trichomonas vaginalis)
Incubation period: 528 days
How far back to trace: There is currently insufficient data to provide a definitive period for this, but partner notification is recommended
Usual testing method: Wet preparation microscopy and culture are less sensitive than nucleic acid amplification testing
Common symptoms: 50% of women and most men are asymptomatic
Symptoms in women: vaginal itch, discharge
Symptoms in men: urethral discharge and dysuria
Likelihood of transmission per act of unprotected intercourse: Unknown but probably moderate to high
Peri natal transmission 5%
Likelihood of long-term sexual partner being infected: Up to 70% of male partners of infected women and 60-100% of female partners of infected men
Protective effect of condoms: Probably high
Transmission by oral sex: Unknown
Duration of potential infectivity: Women can be infected with Trichomonas vaginalis for up to 3-5 years, and men, probably up to 4 months
Important consequences: Preterm birth.
Enhanced HIV transmission
Direct benefit of detection and treatment of contacts: Cure
Usual management of contacts: Counselling, clinical examination and testing.
Medical treatment.
Contact tracing priority: High
Notification: Not notifiable in Australia or New Zealand.
5.2.19 Tuberculosis
Tuberculosis (TB) is a lower respiratory tract infection caused by (Mycobacterium tuberculosis), which infects the lungs.
It remains a major killer because of a rise in drug-resistant strains.
Tuberculosis (TB) is a communicable disease acquired when a person inhales the bacterium in droplets coughed out by someone with infectious pulmonary TB.
It is not transmitted sexually or via blood transmission.
Incubation period: Exposure to Mycobacterium tuberculosis may result in Latent TB Infection (LTBI), but not active TB disease.
TB disease may occur months to years after infection or may never appear.
People with extrapulmonary TB are rarely infectious.
People with LTBI infection are not infectious.
The Tuberculin Skin Test (TST) is the primary method for diagnosis of LTBI worldwide.
However, the specificity of the TST for the diagnosis of LTBI is adversely affected by BCG vaccination and cross- reaction with non-tuberculous mycobacteria.
Symptoms of pulmonary TB may include a cough that lasts for more than 3 weeks, pleuritic chest pain, haemoptysis, fever, night sweats and weight loss.
Ziehl-Neelsen stain (acid-fast stain) stains bright red mainly Mycobacteria, e.g. Mycobacterium tuberculosis that causes tuberculosis (TB). The vaccine against TB is one of the most widely used worldwide.
Pasteurization destroys all pathogenic organisms, e.g. tuberculosis and most other bacteria to reducing the risk of milk borne infection and delay milk becoming sour.
Rifampin, Rifampicin, C43H58N4O12, macrocyclic antibiotic, broad antibacterial activity against mycobacteria, prescription drug for treating tuberculosis
A person with not enough T-helper cells to respond to infection will become ill and develop AIDS. The infected person loses resistance to diseases and may die of opportunistic infections or AIDS-related illnesses, e.g. tuberculosis or bronchitis. Notification: TB is notifiable in all states and territories in Australia, and New Zealand.
Medical practitioners and public health laboratories are legally required to report cases of TB in Australia to the state and territory health authorities.
5.2.8 Epididymitis
Epididymitis: Causative organism: (Chlamydia trachomatis), (Neisseria gonorrhoeae)
Note: Sexually transmissible causes are more likely in younger men (<35 years), while urinary tract pathogens such as coliforms are more likely in older men (>35 years).
A pathogen is often not identifiable.
Incubation period: Poorly defined, probably days to weeks depending on the organism
How far to trace back: See 5.1.3 and 5.1.5 if Chlamydia or gonorrhoea are isolated
Usual testing method: Clinical diagnosis may be reinforced by detection of urethritis on gram stain.
Chlamydia and gonorrhoea nucleic acid amplification testing and urine microscopyand culture
Common symptoms: Scrotal pain, swelling and erythema may be associated with dysuria and urethral discharge
Likelihood of transmission per unprotected exposure: Depends on specific pathogen
Likelihood of long-term sexual partner being infected: Depends on specific pathogen
Protective effect of condoms: High for sexually transmitted pathogens
Transmission by oral sex: Relevant for N. gonorrhoea
Duration of potential infectivity: Depends on specific pathogen
Important consequences: If untreated, gonococcal, abscess formation
Some evidence for decreased fertility
Direct benefit of detection and treatment of contacts: Cure where a pathogen is found
Usual management of contacts: Counselling, clinical examination, test for C. trachpmatis and N. gonorrhoea
Contact tracing priority:
1. High, Where C. trachomatis or N. gonorrhoea isolated
2. Medium, Younger men and their current sexual partners where a sexually transmitted pathogen is not isolated
3. Low, Older men and their previous sexual partners, where a sexually transmitted pathogen is not isolated
None Where a urinary tract pathogen is isolated.
5.2.15.1 Pelvic inflammatory disease (PID)
Pelvic inflammatory disease: (PID) Causative organism: (Chlamydia trachomatis), (Neisseria gonorrhoea), (Mycoplasma genitalium)
Note: PID in women under the age of 35 years is often due to sexually transmissible pathogens, while PID in older women is less likely to be associated with a sexually transmitted pathogen.
In many cases of PID a specific pathogen is not found.
Incubation period: Poorly defined; depends on pathogen
How far to trace back: See 5.1.3, 5.1.5, 5.1.10 if Chlamydia, gonorrhoea or Mycoplasma genitalium are isolated
Usual testing method: Clinical diagnosis Test for Chlamydia, gonorrhoea and M. genitalium
Common symptoms: Commonly mild or subclinical
Pelvic pain, intermenstrual or post-coital bleeding, deep dyspareunia
Sometimes vaginal discharge
Likelihood of transmission per unprotected exposure: Depends on specific pathogen
Likelihood of long-term sexual partner being infected: Depends on specific pathogen
Protective effect of condoms: High for sexually transmitted pathogens
Transmission by oral sex: Unknown
Duration of potential infectivity: Depends on specific pathogen
Important consequences: Infertility, Chronic pelvic pain, Ectopic pregnancy, Fitz-Hugh Curtis Syndrome
Direct benefit of detection and treatment of contacts: Cure where a pathogen is isolated
Usual management of contacts: Counselling, clinical examination, test for C. trachpmatis, N. gonorrhoeae and M. genitalium.
Medical treatment.
Contact tracing priority:
1. High, Where C. trachomatis, N. gonorrhoea or M. genitalium are isolated
2. Medium, Younger women and current male sexual partners where a sexually transmitted pathogen is not isolated
3. Low, Older women and previous sexual partners where a sexually transmitted pathogen is not isolated.
Notification: Not notifiable.
5.3.1 Herpes
Herpes: Causative organism: (Herpes simplex viruses), (HSV) types 1 and 2
Incubation period: Usually 2 to 12 days, but may occur more than 12 months later.
Most remain either asymptomatic or have unrecognized symptoms (for example, mild non-specific rash, sore, spot, fissure or crack in the skin).
Many first episodes are not from recent infection.
Usual testing method: Nucleic acid amplification testing.
Common symptoms: Recurrent anogenital ulcers or blisters.
Can be severe with systemic symptoms with primary infection.
Likelihood of transmission per unprotected exposure:
Higher if lesions present,however, can occur in absence of lesions
Likelihood of long-term sexual partner being infected: Variable
Protective effect of condoms: Moderate and probably depends on site of lesions
Transmission by oral sex: Significant for HSV type 1
Duration of potential infectivity: Lifelong
Important consequences: Neonatal infection, Physical and psychosexual morbidity, Enhanced HIV transmission
Direct benefit of detection and treatment of contacts: Limited.
Frequent symptomatic recurrences can be suppressed with treatment
How far to trace back: Contact tracing not recommended
Usual management of contacts: Counselling
Contact tracing priority: Low and not recommended
Notification: Not notifiable.
5.4.0 WHO Guidelines on child birth
World Health Organization, New recommendations to establish global care standards for healthy pregnant women and reduce unnecessary medical interventions, 15 February 2018 (edited)
Worldwide, an estimated 140 million births take place every year and most of these occur without complications for women and their babies.
Yet, over the past 20 years, practitioners have increased the use of interventions that were previously only used to avoid risks or treat complications, such as oxytocin infusion to speed up labour, or caesarean sections.
"We want women to give birth in a safe environment with skilled birth attendants in well-equipped facilities.
However, the increasing medicalization of normal childbirth processes are undermining a woman's own capability to give birth and negatively impacting her birth experience," says WHO Assistant Director-General for Family, Women, Children and Adolescents.
If labour is progressing normally, and the woman and her baby are in good condition, they do not need to receive additional interventions to accelerate labour," she says.
Childbirth is a normal physiological process that can be accomplished without complications for the majority of women and babies.
However, studies show a substantial proportion of healthy pregnant women undergo at least one clinical intervention during labour and birth.
They are also often subjected to needless and potentially harmful routine interventions.
The new WHO guideline includes 56 evidence-based recommendations on what care is needed throughout labour and immediately after for the woman and her baby.
These include having a companion of choice during labour and childbirth; ensuring respectful care and good communication between women and health providers; maintaining privacy and confidentiality; and allowing women to make decisions about their pain management, labour and birth positions and natural urge to push.
Every labour is unique and progresses at different rates.
In a first labour, it usually does not extend beyond 12 hours, and in subsequent labours it usually does not extend beyond 10 hours.
The previous benchmark for cervical dilation rate at 1 cm/hr during the active first stage of labour may be unrealistic for some women and is inaccurate in identifying women at risk of adverse birth outcomes.
A slower cervical dilation rate alone should not be a routine indication for intervention to accelerate labour or expedite birth.
Health professionals should advise healthy pregnant women that the duration of labour varies greatly from one woman to another.
"Many women want a natural birth and prefer to rely on their bodies to give birth to their baby without the aid of medical intervention," says WHO Director, Department of Reproductive Health and Research.
Even when a medical intervention is wanted or needed, the inclusion of women in making decisions about the care they receive is important to ensure that they meet their goal of a positive childbirth experience.
Unnecessary labour interventions are widespread, often putting a strain on already scarce resources and further widening of the equity gap.
As more women give birth in health facilities with skilled health professionals and timely referrals, they deserve better quality of care.
About 830 women die from pregnancy-related or childbirth-related complications around the world every day, but the majority could be prevented Disrespectful and non-dignified care is prevalent in many
health facilities, violating human rights and preventing women from accessing care services during childbirth.
Often, the health provider controls the birthing process, which further exposes healthy pregnant women to unnecessary medical interventions that interfere with the natural childbirth process.
Achieving the best possible physical, emotional, and psychological outcomes for the woman and her baby requires a model of care in which health systems empower all women to access care that focuses on the mother and child.
While most women want a natural labour and birth, they also acknowledge that birth can be an unpredictable and risky event and that close monitoring and sometimes medical interventions may be necessary.
Even when interventions are needed or wanted, women usually wish to retain a sense of personal achievement and control by being involved in decision making, and by rooming in with their baby after childbirth.