Sexually Transmitted Infections
Chances are you have heard the phrase ‘safe sex’, but what exactly does this mean?
Pregnancy isn’t the only unanticipated outcome that might occur from sexual intercourse: sexually transmitted diseases can have devastating outcomes on your health, wellbeing and fertility – the longer they go untreated, the higher your chance of not being able to have children.
The more sexual partners and/or sex without condoms you have, the higher the risk. Injecting drugs using shared equipment can also cause some infections (like hepatitis B or HIV).
Safe sex refers to reducing your risk of acquiring an infection that is known to be transmitted through intimate contact.
Any barrier method, like condoms or dams help to prevent spread of bacteria and viruses that would otherwise move between skin, mucous membranes or bodily fluids.
See [https://www.qld.gov.au/health/staying-healthy/sexual-health/safe-sex#help] for more information.
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There are lots of different types of sexually transmitted infections (STIs). Some of the most common for young women at or just after their sexual debut, include chlamydia, HPV and gonorrhoea. These are discussed below.
Take home message:
It’s worth having commitment to safe sex practices and regular annual screening for STIs as soon as you start having sex. Testing can be done any time you are concerned, even if you don’t have symptoms.
Blood tests can be taken for hepatitis B, HIV and syphilis, with a urine test for chlamydia.
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Consider it part of looking after yourself, your body and your health.
What is a cervical screening test?
At age 25, sexually active women will be recommended to have their first cervical screening test.
This is done with a speculum (looks a bit like a duck's bill), inserted into the vagina and held open so the cervix can come into view. We test for DNA associated with cancer-causing HPV types, by inserting disposable instruments that collect cells from the cervix, and sending those off to the laboratory for analysis.
At the same time, we can also collect swabs from high and low in the vagina to detect bugs like chlamydia and gonorrhoea, and other nasties that can cause problems like thrush, thick or smelly vaginal discharge, or pelvic inflammatory disease.
Chlamydia is caused by a little bug that doesn’t necessarily cause symptoms, but if it does, can cause problems with painful weeing or pooing, pelvic pain, an abnormal vaginal discharge, bleeding between periods or after sex. It can also cause little ulcers on the vulva or about the anus.
It’s worthwhile getting tested annually if you are sexually active, particularly if you don’t use condoms (like if you are on the pill, or use other contraception). You can do this through your doctor or accessing the test kit through 13 HEALTH [https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/sex-health/13health-webtest].
Testing involves catching the first part of the first wee of the morning, so if there are any bugs there, they’ll be peed into the collection jar and be seen under the microscope. It can also be collected with a vaginal swab if you’re having a vaginal examination (see further information, above).
Treatment is easy with a single dose or 7-day course of antibiotics. If you or your partner test positive for Chlamydia, you should both be treated, and your doctor can help with notifying any other sexual partners you may have had in the prior six months (see also [https://letthemknow.org.au]).
Longer term, untreated chlamydia infection can cause inflammation in the pelvis which can lead to problems with fertility, including pregnancies that occur outside the uterus. These “ectopic” pregnancies are life-threatening.
Human Papilloma virus (HPV) is transmitted by skin-to-skin contact or direct mucous membrane contacts.
You don’t need to have sex to transmit the virus, as it can travel up through the vagina to the cervix. So, any genital contact, with skin, vagina, mouth and anus can cause viral transmission, and in fact, the most common people to be infected are young men and women after their first sexual encounter(s).
You won’t necessarily know about these infections, as your immune system can clear them as a matter of course (taking up to two years). However, if this doesn’t happen (only 10% of the time), persistent infection can slowly develop into invasive tumours of the cervix, vagina, vulva and/or anus.
In fact, to HAVE cancer of the cervix, you must have untreated infection with HPV; the longer you have it, the greater the chance of developing cancer.
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That’s the reason the Gardasil vaccine was developed and put on the immunisation schedule here in Australia for girls aged 11-13.
If you haven’t already, it’s wise to consider vaccination against HPV before you start having sex, as that’s the best timing to prevent persistent HPV infection and progression to pre-cancerous cells. The vaccine is generally safe and well tolerated, and has essentially halved the numbers of Australian women with cervical cancer.
If you smoke, your chances of transforming any HPV infection into a particular type of cervical cancer (squamous cell) increase. Using the Pill also increases your chances, presumably because if using that for contraception, you’re not using a barrier between the penis and vagina when you have sex.
Did you know?
Over 100 different types of human papilloma virus (HPV) are known, of which 40 infect the anogenital region, and 15 of those 40 are considered high risk for causing cancer.
HPV can cause lesions that are benign (not cancerous), including warts on the skin or inside the vagina, anus, mouth and throat. These are often caused by low-risk types 11 and 16. Lesions like this can be biopsied to examine under a special microscope for diagnosis, which then guides treatment.
Although you might think gonorrhoea is a disease that happened only in the middle ages (along with syphilis), it’s on the rise in Australia, particularly amongst young women, our Aboriginal and Torres Strait Islander population, as well as those in regional and remote areas.
Risk is increased the more sexual partners you have and if you don’t consistently use condoms.
Caused by a bacterium called Neisseria gonorrhoeae, up to 80% of cases can be asymptomatic.
When symptoms do occur, they include vaginal or anal discharge, painful sex, painful pooping, and other complications, like conjunctivitis, arthritis or meningitis. Infection can lead to pelvic inflammatory disease, which causes abnormal vaginal bleeding, and problems with fertility.
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A swab inserted into the vagina (by your healthcare worker or yourself, under their guidance) can diagnose the infection if bacteria are seen under the microscope, and treatment is simple with a one-off injection of antibiotics and tablet(s). You are best to avoid sex for 7 days after treatment and don’t have sex with your partner(s) until they have also been treated.
Your doctor can help with tracing any sexual contacts you have had in the previous two months.
See also [https://letthemknow.org.au/ltk.html].
Syphilis in Australia is also on the rise. It’s caused by a bug with a cool name: Treponema palladium.
Like gonorrhoea, syphilis is a heavily stigmatized condition, and it has huge consequences for your personal health.
If you are pregnant or ever plan to be, syphilis can be passed on to your children, with devastating consequences.
Like many STIs, you won’t necessarily know you have syphilis, but keep a look out for any unusual lumps or sores, anywhere that is in sexual contact with penises or vaginas.
If untreated, syphilis infections go through different stages, all with their own symptoms, including rash, runny nose, sore throat, swollen glands, fever, and feeling unwell, which may be transient, and later can cause meningitis, seizures, sudden visual loss/blindness, dementia, or coronary artery disease.
Testing is via blood tests, and treatment is with antibiotics depending on stage of infection. Partners need to be alerted, and you may need follow up treatment.
Check out this fantastic Lady Peeps video!
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See also recent news article (17 May 2021) “Melbourne grappling with 220 per cent rise in syphilis cases among women” with video (commences at 2:13).
There are other sexually transmitted infections you’ve probably heard about, and they differ in how frequently they affect certain other populations, like same-sex relationships, Indigenous Australians, immigrants, people who inject drugs, and sex workers.
Although anyone can get any STI, I’ve used http://www.sti.guidelines.org.au to inform what goes on for young people. They’ve got information for specific populations, though it’s targeted for clinicians and could be a bit boring. Still, check it out if you want to read about those particular groups, because there’s inconsistency in available resources for those listed (some are technical or research papers, for example).
The Drama Downunder, has further information for men who have sex with men (MSM).
Queensland Health do have some animations about different STIs that you may like to check out (though all of them are discussed on this current page).
The herpes simplex virus (HSV), the same sort of virus that causes cold sores, can cause similar painful lesions on your vulva. These are called genital herpes.
Herpes lesions can be extensive and painful, causing ulcers on the outside, your vulva, all the way through the vagina, to the cervix (neck of the womb). Ulceration can even occur in your bum. These ulcers might give you an itching or tingling sensation and stinging or burning when you wee.
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If you have lesions or can feel that tingling, it can be accompanied by cold- or 'flu-like symptoms, and at that time, you’ll be infectious.
Antiviral treatment is available for both initial outbreaks and recurrences. After infection first takes place, the problem never quite goes away: although episodes may resolve, they are recurrent.
Along with the stress and stigma this condition can cause, genital herpes can affect your bladder's ability to urinate longer term, as well as increasing your risk for getting infected with HIV.
Herpes simplex virus types 1 and 2 can also be transmitted during childbirth, causing serious neonatal infections.
You don’t need to do formalised contact tracing if you have herpes, but it’s best not to sleep with anyone if you have lesions – or to sleep with anyone who might have an ulcer on their genitals. Even oral sex and kissing can transmit the virus, so be careful if you or your partner have cold sores!
Each blister contains a high volume of the virus (HSV1 or HSV2), making active lesions highly contagious. This means that if you have sex with someone while they have an active infection, you are very likely to get infected, yourself. Unfortunately, even if you don't have active lesions, if you've had HSV infection, virus can still be transmitted. Even condoms aren’t 100% here, but they can work well in combination with spermicidal foam. If you can, speak with your partner about sexually transmitted infections before you get into bed!
Hepatitis B is caused by a virus that can be acquired through blood or bodily fluids via sex, sharing injecting needles, and even living in the same household as another person who is infected. Infection can take up to 6 months to establish after exposure and can be asymptomatic thereafter.
Because the virus likes to hang around the liver, symptomatic infection can cause you to feel washed out, nauseous and off your food, have dark urine, pale poo, and even for your skin or the whites of your eyes to turn yellow.
If these symptoms occur, go to hospital to have testing and treatment.
Infections lasting more than six months increase your risk of other complications, including liver scarring and cancer.
Blood tests can see if you have been exposed to the infection, if you have had the Hep B vaccine, and whether your immune response has been adequate to protect you.
Many people may already have immune protection against Hepatitis B, because it’s included in the Australian vaccination schedule.
Treatment is usually done under specialist medical care with antiretroviral medication.
Even if you are sexually active, and have no symptoms, it’s part of routine screening to test for hepatitis B.
Human Immunodeficiency Virus (HIV) attacks particular cells in the human immune system, hijacking their cellular machinery to create more virus. Once many more virus copies have been made, they bud out into the bloodstream from infected cells (T helper aka CD4+ cells).
HIV used to be restricted to particular populations (MSM and injecting drug users) but has become a global problem for everyone to be aware of, get tested for, and get treatment if needed.
It’s transmitted through sharing bodily fluids with someone who is infected, including during sex, breast-feeding, or through injections (drugs, tattoos, piercings) using shared equipment.
Did you know?
You can’t get infected by HIV through kissing!
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Saliva contains substances that ruptures HIV affected cells.
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So even if you are kissing someone living with HIV, no transmission can occur.
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(Same goes for sweat, tears, urine and poo).
After a flu-like illness, HIV infection is asymptomatic until such time, years later, that HIV has weakened the immune system, making a person more susceptible to oral thrush, weight loss, and the runs (diarrhoea), as well as the herpes zoster virus, which causes chicken pox and shingles. Acquired Immunodeficiency Syndrome (AIDS) can result.
See science alert – it’s actually pretty interesting.
Blood or saliva tests can detect if you been infected with HIV, and if positive, you’re going to be supported through a whole heap of other tests to check your health.
Antiretroviral treatment is available in Australia for everyone with HIV.
The best way to prevent HIV infection is to use condoms, get regular sexual health tests, every three months, ensuring your partner gets them too.
If you can’t use a condom (or if it broke, or you’ve been sexually assaulted, or had accidental injury with a needle), post-exposure prophylaxis (known as PEP) taken within 72 hours, daily for 28 days can prevent HIV.
See PEP info from NSW Health, and for USA based info from the Centre for Disease Control.
Pre-exposure prophylaxis is also available. For more info, see also https://www.pan.org.au.
Science alert!
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CD4+ cells can sense they are infected with HIV, and literally blow themselves up (pyroptosis and apoptosis) or get marked by antibodies for death by other immune cells. But the vast majority of CD4+ cells (90%), don’t get infected, but start to travel to lymph nodes to learn about how to deal with this HIV infection. After viral particles try to invade them in the lymph node, the CD4+ cells also blow up, setting up a series of explosions of neighbouring cells. That’s why your lymph nodes in the neck and groin can get swollen with acute infections. Along with fever, rash and flu-like symptoms, these mark the initial symptoms, which occurs two weeks after viral infection.
The whole process sets up a cascade of inflammation throughout the body, which puts yet more immune cells into hyperactivation, so they burn out too. This causes a weakened immune system, which means a blunted response to other infections, because there are less essential immune cells ready to respond. Eventually this leads to AIDS: Acquired Immunodeficiency Syndrome. It’s also why HIV infections can co-infect with other diseases, like hepatitis C (or hep B), tuberculosis, and malaria. One infection can also lead to another other, like HPV or HSV.
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Thanks to Khan Academy Medicine (2015) for the info in this top section. The remainder of info was sourced from references listed below (see reference list at the end of the page).
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A brief history:
In the 1980s (the decade I was born), HIV caused many millions of deaths across the world: to be infected was virtually a death sentence.
HIV infections developed into Acquired Immunodeficiency Syndrome (AIDS).
The virus had jumped species from infecting monkeys and apes to actively infecting humans, and came to attention because of a sharp rise of HIV infections and premature death from AIDS in distinct populations, namely men who have sex with men.
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There was lots of stigma, judgement, discrimination, turning of blind eyes and hard-heartedness from the general community, with some people believing people with AIDS deserved it (see compilation of ads, below, at 2:24).
In Australia, the infamous Australian 1987 Grim Reaper advert was pulled off air because it was considered too confronting (see video above).
For more history, see this paper.
People didn’t want that epidemic to touch them – if they could compartmentalise and distance themselves from it, it wasn’t significant.
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Beyond that, with the development of many different types of anti-retroviral therapies, it is possible for people living with HIV to lead full and reasonably healthy lives.
HIV is no longer a death sentence, but stigma is still a problem.
From the archives:
(0:26)
Graphic warning, but that’s the point – like the photos of health complications from smoking on boxes of cigarettes, this 1997 ad features a man with Stage 9 AIDS.
(0:58)
Australian ad campaign from 1987 featuring a young Russell Crowe! (Drug themes).
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1986 Australian AIDS campaign promoting a range of brochures.
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Trailer for Philadelphia (1993) movie.
This movie made a huge image on me at the time, particularly the scene where Tom Hank’s character, who has AIDS, meets the lawyer, played by Denzel Washington. When Denzel's character learns Tom Hank's character has AIDS, he treats him like a 1980s leper. Tom Hank's character seeks legal representation in an unfair dismissal case against his previous employing law firm because he has AIDS.
(11:00)
This is a compilation of the world’s "Top 10 scariest AIDS awareness Public Service Announcements". Some of them are already shown in the links above. I’ve included this particularly for the following:
(from 2:24) Public opinion about people with AIDS for a charity's advertising campaign,
(from 5:02) A French ad (nudity alert) quotes a shocking 2007 statistic -
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Around the world, 1 person dies from AIDS every 10 seconds
(23:57)
Rich in 1980s culture, this educational video about HIV/AIDS was made especially for young people.
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Who are your programs and workshops for?Any young woman who is interested in these programs may feel free to be in touch. Likewise teachers, community group leaders and service providers for young women may be interested in discussing a customised presentation and workshop for your students, group and/or clients. Originally intended for high school girls, aged 11-17, Dr Stephanie also has experience with younger girls aged 5-10 while an Assistant Leader for Girl Guides Australia. Through her work, she now provides medical care to kids, through adolescence, and into adulthood. Dr Stephanie is passionate about young people holding themselves precious and not falling into the all-too-common traps of self-loathing, disregard, self-bashing and abuse. Reach out if you are interested.
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What do your programs cover?Quite simply, whatever you want! My expertise is in medicine and women's health, but I also have a passion for supporting mental health and counselling, which form a natural part of my job (I have a PhD in life!). From puberty to periods, sex to sexually transmitted infections, contraception to conception, I can offer a range of content that empowers young women by education about their bodies. With understanding about how the body works, one can begin to feel renewed awe - inspiring you to take deeper care and have greater respect not just for your body, but the being that lives inside it. And that's really important, because if you feel honoured and cared for, you are more likely to contribute more of the same to society, whereas if you are disgruntled and disenfranchished, then we have more of THAT in the world. You get to have choice and governance in what this world we live in looks like, all by taking deep and precious care of YOU.
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Are your programs part of the Queensland school curriculum?At this stage, no. My background is not in education, but in medicine. However, the Department of Education (Education Queensland) is aware of this initiative and supports schools working independently with external experts to provide services that support their students. If in doubt, ask!
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How long are your workshops?I aim to customise programs and workshops around your needs and interest. Initial program discussion groups last 60 minutes and are loosely based on topics as outline on this website. You and the group decide what we are going to talk about. I can take groups during elective periods through the school day to suit, or we can discuss after school presentations.Weekends are out at this stage, although I can do school holiday workshops.
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How much do your programs and workshops cost?$10 per participant. $5 per participant is matched by $5 from the school. Community groups may elect to pass costs onto the girls and their families themselves. This is a nominal fee: all costs associated with this program are otherwise solely funded and supported by Dr Stephanie Pommerel.
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When is the next program available?Contact Dr Stephanie (yo@honouryoself.com.au) to express your interest and she will return your email as soon as possible. Programs are offered around part-time work as a medical practitioner and part-time studies in health promotion.
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Is there any more content or materials available online?Whilst rich in content and detail, this website is intended as an introduction only, such that you can get a feel for what is offered and from that, choose what you'd like to include in discussion groups. Programs are customisable based on what YOU want covered. Further materials may be provided to participants but these are not yet freely accessible online. All content on this website is copyright to the author.