School Science Lessons
2024-10-27
(UNBiol5C)
Sexually transmitted infections
Please send comments to: j.elfick@uq.edu.au
Contents
Websites:
5.1.0 Sex safety, reproductive health, sexual health
5.2.0 Sexually transmitted infections, STIs
5.3.0 HIV/AIDS
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 also 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 many kinds of 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
this 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-positive
person acquiring a second strain of virus from someone else with HIV.
5.1.3 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.
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)
The management of STIs involves 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 examination
to 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), Chlamydia, Neisseria, Mycoplasma
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""the clap", Neisseria gonorrhoeae
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
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 were once the most common STD in existence, but have in recent years become one of the least seen infections, possibly, because those who are sexually active are choosing to shave off their pubic hair for an increase in pleasure during sex.
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: 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, Sarcoptes scabiei
Scabies is caused by the itch mite, Sarcoptes scabiei, "crabs", "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 5% ("Elimite", Lyclear") 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.
Treponema pallidum, the bacteria that causes syphilis 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
Trichomoniasis, Trichomonas vaginalis
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
This 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 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 an 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.
The symptoms are a scalding feeling when passing urine (dysuria) a desire
to pass urine frequently, and 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
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 clean
and 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
This condition that can lead to infertility, 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.
5.3.0 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
Causative organism: Haemophilus ducreyi
Haemophilus ducreyi, Gram-negative coccobacillus, spherical to a rod-shaped bacterium, with fine pili appendages for attaching to cell surfaces.
It 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 1g as a single dose or ceftriaxone 500 mg as a single dose 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
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 1g 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
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
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)
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
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
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
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.
Causative organism: Mycobacterium tuberculosis
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
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 microscopy
and 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)
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
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.