The last thing you want to think about when you're getting up close and personal with a new love is a sexually transmitted infection, but the truth is STIs are a reality for many Australians.
Research by the Kirby Institute shows the rates of gonorrhoea and infectious syphilis are on the rise, highlighting the need to be aware of the diseases you might be at risk of contracting or passing on, and knowing how to prevent, diagnose and treat infections.
Seeking advice if you think you might be at risk is important, even if it makes you feel nervous or squeamish, says Associate Professor Martin Holt, who co-authored the UNSW's Annual Report of Trends in Behaviour.
"The massive problem with all of this stuff is that people can feel embarrassed or ashamed about talking about sexual health or admitting that they've been having casual sex, and that can delay them going forward for screenings," he said.
"In the majority of cases everything is fine, and even if there is something, it can usually be easily treated.
"If you're worried about going to your GP, then go to a sexual health clinic. They'll make you feel at ease and guide you through the process."
Which STIs should you worry about?
- Chlamydia: One of the most common STIs in Australia, and one of the sneakiest, as it often has no symptoms. However, it can cause genital pain in men and women, and lead to infertility in women. It's treated with antibiotics.
- Gonorrhoea: Previously rare in young, urban heterosexuals, this disease is up 63 per cent in this group over the past five years. It can cause genital and anal pain and discharge in both men and women, as well as a sore, dry throat. Untreated, it can lead to fertility problems for women. It's treated with antibiotics.
- Syphilis: This bacterial infection causes various symptoms including sores, rashes and fever. Left untreated, it can eventually lead to serious damage to organs including the brain and heart. Syphilis is seeing a resurgence, especially among young Indigenous Australians. It's treated with penicillin, with repeat blood tests to make sure the treatment has worked.
- HIV: Once considered a death sentence, this virus is stable in Australia, with gay and bisexual men (a high-risk group) increasingly using HIV medications to prevent its spread. HIV can't be cured, but it can be managed with antiretroviral treatment.
- Herpes: This is a common skin infection that has mild symptoms for most people, including blisters and stinging or tingling in the affected area. You can't cure herpes, but most people will find the recurrences become milder and less frequent, and many eventually have no symptoms at all. Severe outbreaks can be treated with antivirals.
- Hepatitis B: This inflammation of the liver can lead to fever, fatigue, jaundice and nausea — but half of people with the infection don't have symptoms, which is why it's important to get checked. There is no cure for Hepatitis B, although most infected people make a full recovery. It can turn into a serious health problem for a small percentage of people, and can also be passed from a mother to her unborn baby. The best protection against Hepatitis B is to get immunised.
- Trichomonas: This infection is caused by a parasite and can lead to vaginal itching, burning and smelly discharge. It's common in remote Indigenous communities but rare elsewhere in Australia. It's treated with antimicrobial tablets.
The most effective way of avoiding these infections if you're having penetrative sex is to use a condom.
But Dr Holt warned that even consistently using condoms isn't a get-out-of-jail free card for avoiding STIs — you should still get checked regularly.
"STIs are clever little buggers and they can be passed on in other ways," he said.
How often should you get checked?
Well, it depends who you are.
In general, the more partners that you have the greater the risk of contracting an STI, particularly if those sexual encounters are unprotected. But some groups are at higher risk of infection.
- Young people: Get checked for chlamydia annually if you're aged between 15 and 29. Consider a HPV vaccine if you haven't already been vaccinated at school.
- People at the beginning or end of a relationship: When you change your partner, it's a good time to talk to your doctor about a check, particularly if you're considering dating for a while.
- Women: Have a pap smear every two years to check for warning signs of cervical cancer.
- Men who have sex with men (MSM): If you're in a relationship, get tested annually for chlamydia, gonorrhoea, syphilis, HIV, hepatitis A and B if not immunised, and hepatitis C if HIV positive or using intravenous drugs. If you're having casual sex, unprotected anal sex, participate in group sex or use recreational drugs during sex, get tested twice a year or more often.
- Aboriginal and Torres Strait Islander people: Get tested regularly for chlamydia, gonorrhoea, hepatitis B, and possibly syphilis and trichomonas. People in remote communities are at higher risk than those near urban or regional hubs.
- Travellers and migrant or fly-in, fly-out (FIFO) workers: Get an STI check-up regularly if you're away a lot for work, and when you come home from overseas travel. Being away from home can see people take greater risks, such as engaging in unprotected sex or visiting sex workers.
- People who inject drugs: Get checked regularly for blood-borne viral infections, such as HIV and hepatitis B and C, which can be transmitted from person to person via shared needles. You're also at increased risk of STIs including chlamydia, gonorrhoea and syphilis.
What happens during an STI check-up?
Just as the risk of contracting an STI varies from person to person, a sexual health check-up will also vary from one person to the next.
If you request an STI check-up, either because you have had unprotected sex or you want to get a clean bill of health before commencing a new sexual relationship, your doctor may request a more thorough STI screen.
Under these circumstances your doctor may also request more information on your sexual history than if they were simply offering a routine test.
Each STI requires a specific sample to be taken for laboratory analysis. In many cases, a single sample will be tested for multiple infections at once. These are some of the samples your doctor might require:
- Urine: To identify chlamydia and gonorrhoea.
- Vaginal or cervical swab (women): Can be used to grow (or "culture") infectious organisms such as gonorrhoea and trichomonas in the laboratory. A pap smear is often performed at the same time.
- Anal, urethral or throat swab (men): Swabs from specific sites help to ensure that chlamydia and gonorrhoea infections do not go undetected. MSM will commonly be tested at all sites, whereas heterosexual men are usually only required to provide a urine sample.
- Blood: Is used to detect the presence of antibodies, proteins made by the body in response to a specific infection. Antibody tests are used to diagnose HIV, hepatitis A, B and C, and syphilis.
Most infections have a window period between when exposure to the infection occurs and when it can first be detected through laboratory tests.
This window period can last up to 12 weeks for HIV and syphilis, and retesting once this window period has elapsed is the only way to ensure that a new infection is detected.
Test results are usually available a few days after samples are collected, and rapid HIV tests that can provide on-the-spot results are being adopted by some services as a preliminary screening tool for people at high risk of infection.
What if you have symptoms?
Having an STI check-up when you don't have symptoms is a responsible way of stopping the spread of STIs and protecting yourself against complications from undetected infections.
But definitely get your sexual health checked if you do have any of the following symptoms:
- Lumps and bumps: These can be due to normal anatomical variations, but if new lumps and bumps arise on or near the genitals, they could be genital warts (caused by a wart-causing HPV type) or a viral infection called Molluscum contagiosum.
- Ulcers: Blisters, sores and split skin are usually due to genital herpes, which can be diagnosed by taking a swab of the lesion. Syphilis causes distinctive lesions that will be confirmed by blood test.
- Discharge in men: Infection of the urethra — the tube that enables men to urinate and ejaculate — can result in inflammation and discharge. Discharge can indicate someone has chlamydia or gonorrhoea, but many infections don't show any symptoms.
- Discharge in women: Vaginal discharge can indicate infection with chlamydia, gonorrhoea or trichomonas. But other conditions, such as bacterial vaginosis and vaginal thrush (which is not an STI), can also cause vaginal discharge.
- Pelvic pain: Some STIs can pass through a woman's cervix to infect her uterus and fallopian tubes — the upper genital tract. These infections, known collectively as pelvic inflammatory disease (PID), can be severe, causing acute pain, fever and scarring that can result in infertility.