STD Screening

A sexually transmitted infection (STI) is an infection that can be passed from person to person when having sex. You can get an STI by having vaginal sex, anal sex, or oral sex. There are several different types of STI.

The ten most common STIs in the Ireland are: anogenital warts, chlamydia, genital herpes, gonorrhoea, HIV, hepatitis B, hepatitis C, pubic lice, syphilis, and trichomonas. These are briefly described below.
Anogenital warts are small lumps that develop on the genitals and/or around the anus (back passage). They are sometimes just called genital warts. They are caused by a virus called the human papillomavirus (HPV). However, most people infected with HPV do not develop visible warts. You can be a ‘carrier’ of the virus without realising it, and you may pass on the virus to others who then develop warts. Treatment options include applying chemicals to the warts or freezing the warts to destroy them.

Chlamydia is caused by a bacterium (germ) called Chlamydia trachomatis. It is the most common STI in the Ireland. Symptoms include a vaginal discharge in women, and a discharge from the penis in men. You can be infected with chlamydia for months, even years, without realising it as it often causes no symptoms. However, even if you have no symptoms, you can still pass on the infection and complications may develop if it is left untreated (such as pelvic infection and infertility in women). A short course of an antibiotic clears chlamydia in most cases.

Genital herpes is caused by the herpes simplex virus. Once you catch this virus it stays with you for life but lies dormant without causing symptoms for most of the time. In fact, many people who are infected with this virus never have symptoms. If symptoms occur, they can range from a mild soreness to many painful blisters on the vulva or penis and surrounding area. A first episode of symptoms can last 2-3 weeks, but may be shorter. Recurrent episodes of symptoms then develop in some cases from time to time, but are usually less severe than the first episode. (It is similar to having ‘cold sores’ on the genitals from time to time.) Antiviral medication can ease symptoms when they develop.

Gonorrhoea is caused by a bacterium called Neisseria gonorrhoeae. Symptoms include a vaginal discharge in women, and a discharge from the penis in men. Again, some people infected with gonorrhoea do not develop symptoms. However, even if you have no symptoms, you can still pass on the infection and complications may develop if it is left untreated (such as pelvic infection and infertility in women). A short course of an antibiotic clears gonorrhoea in most cases.

HIV (human immunodeficiency virus) is most commonly passed on by sexual contact. HIV attacks cells of the immune system. Over time (usually several years) the immune system ‘weakens’ so that you cannot defend your body against various bacteria, viruses and other germs. This is when AIDS develops (acquired immunodeficiency syndrome). Many infections and conditions can develop if you have AIDS. Treatment with antiretroviral drugs can reduce the ‘viral load’ of HIV and allow your immune system to work effectively. However, treatment does not clear the virus from the body. Therefore, if you are infected with HIV you will need monitoring for the rest of your life, and treatment is long-term.

Hepatitis B is a virus that primarily attacks the liver. The virus is mainly passed on by sexual contact, sharing contaminated needles to inject ‘street drugs’, or from an infected mother to her baby. The hepatitis B virus can cause a short term (acute) infection, which may or may not cause symptoms. Following an acute infection, some people develop a persistent infection called chronic hepatitis B. Many people with chronic hepatitis B remain well, but can still pass on the virus to others (as they are ‘carriers’). Some develop serious liver problems. If needed, antiviral medication may prevent or reduce the severity of liver inflammation and liver damage.

Hepatitis C is is a virus that primarily attacks the liver. Most cases occur in people who share needles to inject ‘street drugs’ that are contaminated with traces of infected blood. There is a small risk that an infected person can pass on the virus whilst having sex. Some people clear the infection naturally. Some people with persistent infection remain free of symptoms, but some have symptoms. After many years of infection some people develop cirrhosis (a severe scarring of the liver), and some develop liver cancer. Treatment is difficult but it can clear the infection in up to half of cases.

Pubic lice (often called ‘crabs’) are tiny insects about 1-2 mm long (smaller than a match-head). They lay eggs which hatch into lice after seven days. Pubic lice attach strongly to hairs, and do not wash or brush off with normal cleaning. Pubic lice are passed on by close bodily contact, especially when having sex. The main symptom is itch, usually in the pubic hair area. However, you may not have any symptoms, but may still pass on the lice to others. Treatment with a lotion or cream usually clears the lice.

Syphilis is caused by a bacterium called Treponema pallidum. If it is not treated, it can spread in the bloodstream from the genital region to cause various symptoms and problems in different parts of the body over many years. A short course of antibiotics usually clears syphilis infection.

Trichomonas is a protozoan, which is a tiny germ similar to bacteria. It can cause an infection that is not normally serious but symptoms can be unpleasant. Symptoms include a vaginal discharge in women, and a discharge from the penis in men. Some people infected with trichomonas do not have symptoms but can still pass on the infection. A course of antibiotics usually clears trichomonas infection.

There are some other STIs that are uncommon in Ireland. For example, donovanosis and chancroid.

Scabies

Scabies is a common skin rash that is caused by a mite (a tiny insect). It is usually very itchy. You need close skin-to-skin contact with an infected person to catch scabies. Most cases are probably caught from holding hands with an infected person. The hand is the most common site to be first affected. However, sleeping in the same bed, and sexual contact are other common ways of passing on the mite which is why some people regard scabies as an STI.

Molluscum contagiosum

This is a common skin rash that is caused by a virus. It is passed on by skin-to-skin contact. The rash consists of small lumps which are pearly-white or slightly pink. Each lump (‘molluscum’) looks like a small wart and is round, firm, and about 1-5 mm across. Sometimes the virus is passed on during the close contact of having sex. So, some people regard molluscum contagiosum as an STI. If it is passed on whilst having sex then the first mollusca to appear tend to be on the skin around the penis or vagina.

However, many cases of molluscum contagiosum are not caused by a sexual contact but by simply touching other affected people. It is a common condition that is seen both in adults and children.

These terms describe the site of a problem rather than a particular cause of the problem.

Urethritis

Urethritis means inflammation of the urethra. The urethra is the tube that passes out urine from the bladder. If you have urethritis you may develop a burning sensation when you pass urine, and men may have a discharge from the end of the penis. Urethritis is usually caused by a sexually transmitted infection, but not always. For example, it can be caused by chlamydia or gonorrhea.

Balanitis

Balanitis means inflammation of the tip of the penis. Balanitis is sometimes caused by an STI. However, it is most commonly caused by non-sexually transmitted infections, and skin conditions. Balanitis is common in young children due to non-sexually transmitted infections.

Pelvic inflammatory disease (PID)

PID is an infection of the uterus (womb). Bacteria that cause the infection usually travel into the uterus from the vagina or cervix (neck of the uterus). An STI is a common cause of PID. Most cases are caused by chlamydia or gonorrhoea. However, some cases are not due to an STI.

Symptoms of PID include pain in the lower abdomen, fever, abnormal vaginal bleeding and a vaginal discharge. Possible complications include: infertility, persistent pain, and an increased risk of an ectopic pregnancy if you become pregnant.

Vulvitis

This means inflammation of the vulva. (The vulva is the ‘lips’ and skin just outside the vagina.) There are various causes of vulvitis including some STIs.

The genitals (vagina and vulva in women, penis in men) can be affected by various other conditions. Some people are confused as to what is and what is not caused by a sexually transmitted infection. For example, the following are not usually due to a sexually transmitted infection:

Thrush. This is an infection caused by a yeast called Candida. Small numbers of Candida commonly live on the skin and around the vaginal area. These are usually harmless. However, when conditions are good for Candida, it multiplies and may invade the vagina and cause symptoms such as a vaginal discharge.
Cystitis (bladder infection).
Bacterial vaginosis. This is a common condition of the vagina. It is caused by an overgrowth of various bacteria that are normally found in the vagina. It is the most common cause of a vaginal discharge.

Symptoms of each STI can vary from local symptoms affecting the genitals, to symptoms that affect various other parts of the body. The following is not a full list of all possible symptoms. However, these are the common symptoms to look out for:

A vaginal discharge.
Abnormal vaginal bleeding.
A discharge from the penis.
A sore, ulcer, rash, or lump that appears on the penis or around the vagina, vulva or anus.
Pain when you have sex.
Pain when you pass urine (although the common reason for this is a urine infection and not an STI).
Swelling of the glands in your groin.
But remember, in many cases of STI, no symptoms may develop. However, you can still pass on the infection to others even if you have no symptoms. Therefore, if you think that you may have an STI, it is best to get it checked out

Contact the D2 Medical Centre Ph 6314500

Initial assessment

You will be seen initially by a doctor. They will ask you some questions to try to assess the situation and to determine what tests (if any) you may need. Examples of questions that you may be asked include:

What symptoms and/or concerns do you have?
How many people have you had sex with in the last few weeks and were they male or female?
What type of sex have you had – vaginal, oral, anal sex?
Have you previously had an STI?
What is the state of your general health?
Do you take any regular medication?
Do you have any allergies?
If you are a woman you may be asked about the date of your last period and whether there is a chance that you may be pregnant as this might affect treatment options.

Examination

A doctor will usually examine you. You can ask for a male or female doctor, but you may have to return at a different time (or even to a different clinic) if a doctor of a particular sex is not currently available. The examination includes looking carefully at your genitals for signs of discharge, redness, lumps or ulcers. The doctor may also feel your groins (the top of your legs) to check for enlarged or tender lymph nodes (glands). If necessary, the doctor may also do a general examination to check on your general health.

Tests

Depending on the initial assessment and examination, the doctor may advise on some tests and ask for your consent to do the tests. Tests may include:

A urine test. This can detect some infections of the urethra such as chlamydia. For this test you will be asked to pass some urine into a sterile pot. (It is best not to go to the toilet just before attending a clinic in case you are asked for a urine sample.)

Swabs. A swab is a small ball of cotton wool on the end of a thin stick. It can be gently rubbed in various places to obtain a sample of mucus, discharge, or some cells. The sample can be looked at under a microscope and sent away to the lab for testing.

Depending on what is suspected, a swab can take a sample from: just inside the urethra, inside the vagina, the cervix (neck of womb), throat, and rectum (back passage). For women, to see the cervix and to make sure the swab sample is taken from the correct place an instrument called a speculum is used. This is a small plastic or metal device that is gently pushed into the vagina to hold open the vagina whilst the swab sample is taken from the cervix. Swabs are used to detect chlamydia, gonorrhoea, trichomonas and genital herpes. A swab sample can also detect thrush, bacterial vaginosis and various other bacteria which may not be sexually transmitted infections.

Blood tests. A sample of blood from a vein may be taken. This is mainly used to test for syphilis, hepatitis B, hepatitis C and HIV. Note: sometimes you may be advised to delay having a blood test. For example, following an initial infection of HIV it can take several weeks for a blood test to become positive. So, for example, if you had sex with someone who is HIV positive within the last few days, you may be advised to wait several weeks to have a blood test to see if you have become infected.

Diagnosis

Sometimes a doctor will be able to diagnose an STI from the examination. Sometimes you will need to wait for the results of some tests. Some test results can be available quickly – during your time in the clinic. For other tests it takes a few days for the results to come back from the lab. You may be given an appointment to come back for the results of tests, or in some situations you may be able to phone for the results.

Advice about sexual partners

If you are diagnosed with an STI then the clinic will encourage you to tell any current or recent sexual partners that you have an infection. You are not obliged to do this or to give out any information about other people. However, it is best that any recent sexual partners should know that they might also be infected. They should be offered testing, and treatment if necessary, to prevent the infection being spread any further. This telling of sexual partners is sometimes called ‘contact tracing’. If you prefer, clinics can contact people anonymously if you do not wish to tell them yourself.

Treatment

The treatment that you will be offered depends on what STI is found. For example, a short course of antibiotics can usually clear away chlamydia, gonorrhoea, syphilis, and trichomonas. A cream or lotion can clear pubic lice and scabies. Topical treatments can usually clear most anogenital warts. Treatments for genital herpes, hepatitis B, hepatitis C, and HIV are more involved and complex. You will be given advice about what treatment options you have and given time to ask questions.

If you are prescribed antibiotics then it is important to finish the full course of tablets, or else the infection may not be fully cleared.

Do not have sex again until the time advised by the clinic. Depending on the infection, this may be for a certain length of time after treatment is finished or it may be until you are given the ‘all clear’ from a repeat test. The aim is to prevent you from passing on the infection to other.

Other services

In addition to diagnosing and treating STIs, if needed, the D2 medical centre can also usually:

Do a pregnancy test.
Arrange counselling if you are pregnant and are not sure what to do.
Arrange counselling about the decision to have an HIV test.
Provide advice about contraception.
Provide emergency contraception.
Do a cervical smear test on women if one is due.
Diagnose and treat some other conditions of the genitals that are not sexually transmitted. For example, a urine infection, thrush, and some skin conditions affecting the genital area.
Sexually Transmitted Infection Screening
Sexually transmitted infections are common. Remember any sexually active person may be exposed to a sexually transmitted infection. If you suspect you have an infection get it checked out as soon as possible. Most treatments are simple and painless and you do not have to be admitted to hospital. Treatment is confidential, non judgmental. The staff in the clinic are trained to treat sexually transmitted infections in an understanding and helpful way so there is no need for you to feel embarrassed. If you are pregnant and think you may have picked up a sexually transmitted infection it is particularly important to get it checked out and treated as soon as possible. The D2 medical centre in Dublin 2 provides a private, comprehensive Sexually Transmitted Infection service which includes full STI testing, advice and necessary referrals or prescriptions. The experts in full std screening Dublin 2.