Other sexually-transmitted infections (STIs)

Although safe sex may decrease the risk of transmission of some STIs [1][Sexually Transmissible (or Transmitted) Infection] Infections spread by the transfer of organisms from person to person during sexual contact. Also called venereal disease (VD) (an older public health term) or sexually transmitted diseases (STDs). , there are other significant ways in which STIs can be transmitted. Herpes and HPV (the virus associated with genital warts) can be transmitted even if condoms are used. Hepatitis A, gut and bowel infections, and the virus that is thought to be associated with Kaposi’s Sarcoma can be passed on through rimming.

There are vaccinations for some STIs (Hepatitis A and B for example) and vaccines are currently being trialled for Herpes. Vaccinations are recommended in most circumstances, so talk to your doctor about the pros and cons.

Most STIs can be treated but some can be more difficult to treat when you have HIV. Some of them (CMV and KS for example) can become serious opportunistic illnesses in people with advanced HIV disease.

While in some cases HIV treatments may minimise the impact of the STI, in others the treatments might cease to contain HIV from multiplying while the body fights this new infection.

In some cases, the presence of an STI can also make HIV easier to transmit. The discharges associated with gonorrhoea, for example, have been shown to contain high levels of HIV. This can result in the semen, pre-cum and rectal mucus of an HIV positive man with gonorrhoea containing more HIV, therefore creating a higher risk of HIV transmission. Also, bleeding from the genital sores associated with some STIs may make it easier for blood to be exchanged during sex.

Because we focus so much on HIV, many of us forget to ask our doctors to check for other STIs. In most cases the tests are simple and the treatments effective. It is particularly important for all of us who are sexually active to get regular STI check-ups. If we diagnose and treat STIs early we can avoid them becoming serious problems for ourselves and those we have sex with.

Checklist for the sexually active

• Consider getting vaccinated against hep A and hep B.
• Get screened for the most common STIs – gonorrhoea, chlamidia and NSU.

• The more casual sex you have, the more often you should get screened.

Chlamydia

Chlamydia is a bacterial infection that can affect the penis, anus or throat. Untreated it can cause inflammation of the testes, testicular discomfort and/or pain when urinating.

Gut & bowel infections

There are a range of gut and bowel infections which can cause symptoms like vomiting, diarrhoea and stomach cramps and can be especially bad for people with HIV. Shigella and Giardia are some of the more common of these infections. They are spread by tin y particles of contaminated shit entering the mouth, either by direct contact while rimming, or indirect contact when contaminated objects such as cocks or fingers are put in the mouth. Outbreaks of these infections occur regularly; watch gay newspapers for warnings about any current outbreaks in your city.

Washing your hands thoroughly with soap and warm water after sex, or between partners, and using dams when rimming helps to avoid exposure.

Genital herpes

Genital Herpes is characterised by blisters that can be painful and recur from time to time. Outbreaks can occur on the genitals, around the anal area and on other parts of the body.

Infection with genital herpes is common amongst gay men. Genital herpes outbreaks are more frequent and more severe in people with advanced HIV disease. Laboratory studies show an interaction between herpes and HIV with both viruses [2]A small infective organism which is incapable of reproducing outside a host cell. replicating faster. Aggressive treatment is recommended during outbreaks. Continuous treatment (prophylaxis) is usually recommended following an outbreak. Avoid contact with active herpes lesions.

Genital warts (HPV)

Genital warts are caused by a family of viruses called the human papillomaviruses or HPV. Anal warts are the most common type of genital warts among gay men. The viruses are spread by skin to skin contact and are very common among gay men. Warts can be harder to treat in people with HIV. Some of the wart viruses increase the risk of anal cancer. They can be removed, however this does not always prevent them from coming back. Avoid contact with warts. Condoms reduce the risk (but certainly do not eliminate any risk).

Gonorrhoea

A common bacterial STI that can occur in the throat, penis or anus and sometimes, but not always, causes pain or discharge. Because there are often no symptoms and it can be easily passed on (eg. through oral sex without ejaculation); outbreaks amongst gay men still occur regularly. Early detection and treatment is important as gonorrhoea has been linked to HIV progression. Regular screening is recommended for those sexually active. Testing requires a urethral swab and urine sample, throat swab, and anal swab. Treatment is usually by injected antibiotic in gay men.

Condoms reduce the risk of transmitting gonorrhoea during anal or oral sex.

Hepatitis A

A virus which causes short term liver [3]A large organ, located in the upper right abdomen, which assists in digestion by metabolising carbohydrates, fats and proteins, stores vitamins and minerals, produces amino acids, bile and cholesterol, and removes toxins from the blood. disease. Symptoms include jaundice (looking yellow), a lack of energy, a loss of appetite and changes in the composition and colour of urine and faeces. There have been regular outbreaks of Hepatitis A amongst gay men in Australia in the last ten years. Because Hepatitis A affects the liver it can make HIV treatments harder to tolerate.

Hepatitis A is transmitted through contact with shit. It is easily spread by any sexual contact that may result in the infected person’s shit entering the mouth or arse of another person. Rimming and any other oral-faecal contact, such as putting fingers into your mouth after they may have been up his arse, or after handling used condoms or sex-toys can easily spread Hepatitis A.

Hepatitis A can also be spread by contact with contaminated food, water, and utensils.

There is a vaccination available for Hepatitis A. Talk to your doctor about the arguments for and against getting vaccinated.

Hepatitis B

Hepatitis B causes liver disease and is a common infection amongst gay men. There is speculation about a possible impact on HIV but this is not demonstrated in laboratory studies. It can become a persistent and long-term infection making HIV harder to treat.

Hep B can be transmitted by unprotected anal sex and other activities where blood may be exchanged, eg. fisting multiple partners. Safe sex reduces the risk.

There is a vaccination available for Hepatitis B. Talk to your doctor about the arguments for and against getting vaccinated.

Hepatitis C

Hepatitis C causes liver disease and, like Hepatitis B, can result in long term liver disease making HIV disease harder to treat.

Hepatitis C is spread through blood-to-blood contact such as sharing injecting equipment and may also be transmitted through unprotected anal sex,where blood is often involved.

Don’t share any injecting equipment – needles (fits), syringes, spoons, waters or tourniquets . Condoms reduce the risk during anal sex. For more detailed information about Hepatitis C, please see page 23.

NSU

Non-specific urinary tract infection or non-specific urethritis is the most common STI amongst men in Australia. There may be no symptoms at all or they may range from pain while urinating, discharges from the penis or swelling in the testes.

NSU can be transmitted from the mouth to the penis. Treatment is usually by oral antibiotics.

Syphilis

An STI that has primary, secondary and tertiary stages. The primary stage is characterised by a chancre (sore). Although Syphilis is rare in Australia, it is becoming more common in some communities. Syphilis can be harder to diagnose and treat in people with HIV.

Safe sex protects you from Syphilis as it is usually spread by unprotected intercourse.

Tests for previous possible infections of syphilis are a standard part of STI check-ups.