Sexually Transmitted Infections (STIs) at Dolmen Family Medical Practice

Sexually Transmitted Infections (STIs)

When having sex, it is possible to pass an infection from one person to another. This is known as a sexually transmitted infection (STI). STIs can be spread by having vaginal, oral, or anal sex. The most common STIs in the Ireland are:

• Anogenital warts.
• Genital herpes.
• Human immunodeficiency virus (HIV).
• Hepatitis B.
• Hepatitis C.
• Pubic lice.

There are some other infections that may be mistaken for STIs because they affect the genitals and can be spread by close contact, including during sex. Examples include Scabies, Cystitis and Bacterial vaginosis. However, these are not STIs.

STI symptoms

The symptoms of each STI vary. Sometimes they may just affect the genitals area and other times symptoms affect various other parts of the body. Common symptoms for women include:

• Vaginal discharge.
• Abnormal bleeding from the vagina.
• A sore, ulcer, rash, or lump that appears around the vagina, vulva, or anus.
• Pain during sex.
• Pain when urinating (this can commonly be caused by a urine infection rather than an STI).
• Swelling of the glands in the groin.

Some people with STIs do not experience symptoms but can still pass on the infection to others. Therefore, if you think that you may have an STI, it is best to go to the GP to get tested or else you can access the HSE’s STI clinics https://www.sexualwellbeing.ie/sexual-health/hse-sti-services-in-ireland.html.

Diagnosing STI's

Your GP will examine you and order some tests in order to diagnose an STI. The type of test ordered will depend on your symptoms. Testing for trichomonas, chlamydia and gonorrhoea usually involves taking a swab which is then sent away for testing. Diagnosis of conditions such as syphilis, hepatitis B, hepatitis C and HIV are usually conducted by blood test. Some conditions such as anogenital warts and pubic lice are usually diagnosed by a physical examination and therefore may not need any laboratory tests to confirm the diagnosis.

Sometimes you may need to delay being tested. For example, following an initial infection of HIV it can take several weeks for a blood test to become positive so you may need to wait if the infection occurred within the previous few days.

In some cases, your doctor may also recommend a pregnancy test and, if required, can organise counselling if you find the testing process or the diagnosis distressing.

Until you receive any test results from your GP, and any treatment that is required, you should not have sex in order to prevent you passing on any infection.  If you are diagnosed with an STI then your doctor will encourage you to tell any current or recent sexual partners that you have an infection. You do not have to do this or to give any information about other people that may be infected. However, it is best to inform any recent sexual partners so that they can be offered testing and treatment if necessary. This will help to prevent any infection being spread.

As is the case in most countries, there is legislation in Ireland which requires that certain infectious diseases be notified to Public Health. Under our Infectious Disease Regulations, all medical practitioners are required to notify certian infectious diseases to the Director of Public Health. Further information is available at: http://www.hpsc.ie/notifiablediseases/. In line with these regulations, Public Health will undertake a process of contact tracing and partner notification in order to prevent the spread of sexually transmitted infections.

STI Treatments

Treatment depends on which STI is diagnosed. For example, antibiotics will usually be prescribed to treat chlamydia, gonorrhoea, syphilis and trichomonas. A cream or lotion is used to treat pubic lice and scabies. Topical treatments are used for most anogenital warts.

If you are prescribed antibiotics then it is important to finish the full course, otherwise the infection may not be fully cleared. For some STIs you will be asked to return after a course of treatment to check that the infection has gone.

Treatments for other STIs, including viral infections such as genital herpes, hepatitis B, hepatitis C and HIV are more complex:

• Genital Herpes. Treatment usually involves antiviral tablets, to help speed up the healing process. Any pain can usually be managed with over the counter painkillers or an anaesthetic cream. The antiviral medication is usually taken for 3 or 5 days. The virus remains dormant in the nerve cells in the affected area of your body and can reactivate and cause you to suffer more recurrences. Some people that experience many outbreaks may be put on antiviral medication for 6 months to a year, whereas other people who occasionally get recurrent episodes just take the antiviral medication when they get symptoms. Your GP will advise as to what option is best for you.
• Hepatitis B. There are different stages of hepatitis B infection, and some stages need treatment and some do not, but do need to be checked regularly. Over 90% of adults clear the hepatitis B virus within six months of infection. However, some people may need to be treated with medication and your GP will advise as to what treatment is best for you.
• Hepatitis C. Treatment with antiviral medication takes between 8 to 12 weeks. These tablets are highly effective at clearing the infection in more than 95% of people and usually have hardly any side effects.
• HIV. While there is no cure for HIV, there is treatment available which allows people with HIV to live a normal life. The treatment is called Highly Active Anti-Retroviral Therapy or HAART, which is a combination of medications that stop the virus replicating in the body and allow the immune system to recover. It is vitally important to adhere to the treatment schedule as HIV can become resistant to the medication if it is not taken properly. If taken properly, the HAART treatment will usually lead to undetectable viral load in the body and means that the infection is unlikely to be passed to sexual partners. If you are HIV positive, you may be required every 3 months to have a check-up and blood test to monitor your CD4 count (the number of CD4 cells in your blood) and your Viral Load, (the amount of HIV in your blood).

With any STI it is very important not have sex until the time advised by your doctor so that you do not pass on the infection to others. immunisation course consists of three doses of vaccine via an injection into the muscle at the top of the arm. A blood test will also be taken 2 months after the full course of immunisation to make certain that the immunisation has been effective.

Preventing STIs

The use of condoms reduces your risk of getting an STI. These are available freely from sexual health clinics or can be bought over the counter in many supermarkets, newsagents and pharmacies.

In addition, there are a number of vaccines available to prevent STIs, including for the Human Papillomavirus (HPV) and Hepatitis A and B.

·        HPV vaccine. The HPV vaccine protects against the HPV virus which can cause cancer in both men and women. You can get the free HPV vaccine if you are:

o   Female in second to sixth year of secondary school

o   Female aged under 25

o   Male in second to fourth year of secondary school

o   Male in fifth year and you skipped Transition Year

o   People under the age of 16 are offered a free vaccine at school as part of the school vaccination programme or in a HSE clinic in 2023.

If you were eligible for a free HPV vaccine but you did not get it, you can book a HPV vaccine catch-up appointment online. This applies if you are:

o   Female aged 16 to 25, or

o   Male aged 16 or older who started first year of secondary school, homeschool or a special school in September 2019

·        Hepatitis A. There is a safe and effective vaccine available for hepatitis A. It is available either as a vaccine on its own or combined with hepatitis B vaccine.

·        Hepatitis B. The vaccine has been part of the primary immunisation schedule for infants since 2008. However, adults can also be immunised, especially those at risk. The hepatitis B immunisation course consists of three doses of vaccine via an injection into the muscle at the top of the arm. A blood test will also be taken 2 months after the full course of immunisation to make certain that the immunisation has been effective.

Pre-Exposure Prophylaxis (PrEP) for HIV

PrEP is a medication taken by HIV-negative people to reduce the chance of getting HIV by stopping HIV from establishing itself in the body. It is a tablet that is taken orally. It has been shown in many studies to be safe and highly effective at preventing HIV. When taken correctly PrEP has been found to be about 99% effective.

In Ireland, PrEP is only available with a prescription. It is available free of charge from one of the approved public or private PrEP services in Ireland (https://www.sexualwellbeing.ie/sexual-health/prep/where-to-get-prep/) for those who meet the clinical eligibility criteria for PrEP, including those who test negative for HIV, are aged 17 years and older, are able to attend for a check-up at least once every 3 months, and meet other criteria, including being at higher risk of contracting HIV. If you do not meet the eligibility criteria, you may still be able to get PrEP on a private prescription.

Please remember, PrEP is only for HIV prevention and does not protect against other STIs.