# Saturday, 08 July 2017
Posted: Saturday, 08 July 2017 | Categories: Women's Sexual Health

If you’re a woman, you may be familiar with Gardnerella vaginalis, a type of bacteria that can invade the vaginal tract, altering the pH balance and causing unpleasant odours and discharge. Usually this condition is known as bacterial vaginosis, but it’s also sometimes referred to as gardnerella (after the bacteria that is commonly responsible).

Typically, bacterial vaginosis is associated with foul, fishy smelling vaginal discharge – but it’s not a serious condition in any sense, and is not usually accompanied by any other symptoms. What is known, however, is that conditions that change the vaginal microflora can have implications for the transmission of sexually transmitted infections. Recently, we reported that, because gardnerella can disrupt the "good" bacteria in the vagina, this can lead to inflammation, which can in turn make HIV transmission easier. In the same article, we also noted that women with bacterial vaginosis may also be harder to treat with the anti-HIV pre-exposure treatment tenofovir. Now, further studies have come to light seeming to confirm this worrying research.

The Research

As reported here, Dr Sharon Hillier from the University of Pittsburgh School of Medicine has been looking into the HIV/gardnerella question for some time. In a recent study she looked at 41 HIV-negative women who were administered tenofovir vaginal gel or film for six days. Before the trial, vaginal swabs were collected to ascertain levels of bacterial vaginosis, and at the end, further tests were carried out to measure levels of tenofovir in the women’s systems.

Hillier and her team found that, overall, concentrations of tenofovir were lower in women with high levels of gardnerella bacteria. In simple terms, that means that gardnerella reduces the amount of tenofovir that can enter the genital tissues and blood.

This is significant because it could change the way that doctors administer pre-exposure prophylaxis, such as tenofovir, to HIV-negative women. Before PrEP of this kind can be administered, it may be that women will have to undergo a gardnerella test and, if their levels of these bacteria are too high, take a course of antibiotics.

Until more is known about the efficacy of PrEP treatments, people at risk of HIV transmission are advised to take certain precautions, which can be found below.

Preventing HIV Transmission

The best way to avoid contracting HIV is to practise safe sex. That means that you should always use condoms when you aren’t certain that your sexual partner is free from infection. You should never share needles or other injecting equipment, as HIV is carried in blood as well as seminal, anal and vaginal fluids.

During sex, using lubricants can help prevent condoms from breaking, and dental dams can be used for oral stimulation (HIV can be passed on through oral sex, although the risk is far greater with penetrative vaginal or anal sex).

If you already know that your sexual partner has HIV, there are some other things to be aware of; if your partner is being treated for their HIV and they have what is known as an undetectable viral load, for instance, it is extremely unlikely that they can pass on the infection during sex.

However, if you have had unprotected sex with an HIV-positive partner and you think you may have been exposed, you should seek out post-exposure prophylaxis. This is an emergency anti-HIV treatment that must be commenced within 72 hours of unprotected sex. It lasts for a month and is often accompanied with serious side effects; however, it’s the best option for people who have been exposed.

Unfortunately, pre-exposure prophylaxis such as tenofovir vaginal gel is not currently available on the NHS. However, it is going to be trialled in the UK over the next three years.

The last thing to bear in mind is that HIV is best managed when it is diagnosed early. If you think you might be at risk of HIV you should get regular tests.

Gardnerella Tests

Until pre-exposure prophylaxis such as tenofovir becomes available on the NHS, concerns over gardnerella and bacterial vaginosis needn’t be a priority. However, if you would like to get tested for gardnerella, you can do so easily at your local NHS centre or through The STI Clinic. We can safely supply a simple home test kit and a course of prescription antibiotics.

 
# Thursday, 06 July 2017
Posted: Thursday, 06 July 2017 | Categories: Gonorrhoea

In April 2016, gonorrhoea hit the headlines after Public Health England revealed that antibiotic-resistant strains (known as "super-gonorrhoea") had been found in the Midlands and the southeast of the country, after originally being identified in the north. This information was alarming because it suggested the spread of a disease that is becoming harder to treat day by day.

Currently, super-gonorrhoea strains are resistant to the antibiotic azithromycin. A secondary antibiotic, ceftriaxone, is being used in place of azithromycin, but it’s feared that gonorrhoea strains could develop resistance to that as well, leaving doctors unable to treat the infection at all.

With this issue becoming one of the big health scares of the moment, it’s unsurprising that scientists are dedicating more time to looking into the precise mechanisms of the infection. Most recently, researchers at the University of Maryland carried out a study investigating how gonorrhoea bacteria – "Neisseria gonorrhoeae" – are able to penetrate the cells of the cervix in women.

This study was undertaken because the cervix is usually able to shed and dispose of infected cells without compromising the integrity of the cervix lining. It was found that the N. gonorrhoeae bacteria disrupt this normal function, by breaking the tight connections between the cells of the cervix lining and inducing cell shedding; this in turn enables the bacteria to infect the cervix cells. The study indicated that gonorrhoea has this effect upon the cervix lining by provoking the activation of a certain protein.

It isn’t yet known how this study could affect the current medical approach to gonorrhoea, but it’s hoped that this kind of research will, in the future, suggest alternative, safe treatments for antibiotic-resistant strains. Until this kind of treatment has been developed, it’s advised that people take more caution than usual when engaging in sexual activity.

Staying Safe in the Bedroom

The main rules for engaging in safe sex are:

  • Always use condoms for penetrative sex when you aren’t sure your partner is free from STIs
  • Never share sex toys without washing them or applying a new condom
  • Use dental dams for oral sex if you aren’t sure your partner is free from STIs
  • Don’t engage in sexual contact if you or your partner has any noticeable symptoms (see below)
  • Get tested if for STIs if you have unprotected sex (e.g. if the condom splits) with someone who may have an infection
  • Get tested if you develop any symptoms
  • Get tested regularly if you are having regular sex with new or multiple partners, particularly if you are in the high risk group of men who have sex with men

The above can all be applied to the risks associated with contracting gonorrhoea. This is because gonorrhoea is carried in semen and vaginal fluid, and can be passed on through vaginal, anal and oral sex. It can also be transmitted via unwashed sex toys. Less commonly, gonorrhoea infects the eyes and throat, which is why it can be a good idea to use condoms for oral sex.

The classic symptoms of gonorrhoea can be confused with other STIs such as chlamydia; however, whatever the cause, it’s important to get them checked out. It’s also worth noting that gonorrhoea doesn’t always cause symptoms in its early stages – for that reason, you should get tested if you think you may have been exposed, even if you feel completely healthy.

Gonorrhoea symptoms in women include:

  • Unusual vaginal discharge that is thin, watery or green or yellow in colour
  • Pain or a burning sensation when urinating
  • Pain in the abdomen
  • Irregular bleeding e.g. after sex, between periods
  • Heavier periods

Gonorrhoea symptoms in men include:

  • Unusual white, yellow or green discharge from the penis
  • Pain or a burning sensation when urinating
  • Swelling in the foreskin
  • Pain in the testicles

If you have had unprotected sex with someone displaying the symptoms listed above, or if you are experiencing them yourself, you should get tested for gonorrhoea. You can do this for free at NHS centres; alternatively you can order a home test kit through an online service like The STI Clinic. Click here to learn more.

 
# Saturday, 25 February 2017
Posted: Saturday, 25 February 2017 | Categories: HIV

For many years after the AIDS crisis of the 80s and 90s, being HIV-positive was considered a death sentence. Many of those who discovered they had the virus – which slowly attacks the immune system – were shunned, unfairly associated with immoral behaviour, and considered too "contagious" to be around.

Today, attitudes towards those who are HIV-positive have changed for the better, in no small part due to the incredible medical advances that have been made.

Currently, an HIV-positive person can expect to live a long and healthy life, provided they are diagnosed early enough, follow a healthy lifestyle and take the recommended antiretroviral medicines. For this reason, it’s now relatively uncommon for an HIV-positive person to develop AIDS, the final stage of infection where the immune system becomes totally compromised.

Of course, while many advances have been made with HIV treatment, a full cure still eludes scientists. However, recent research could play a hugely important role in the development of a working vaccine.

New Antibody Research

According to two new studies published in Science Translational Medicine, antibodies could be the key to the HIV vaccine. Antibodies are proteins created by the immune system and sent out whenever antigens (harmful bacteria or viruses) enter the body. Antibodies identify and bind to a specific type of antigen; this allows the immune system to identify the "intruder" and destroy it. Researchers have long stressed the importance of antibodies in the fight against HIV; these new studies have revealed that antibodies could be even more important than first thought.

One of the studies saw scientists create a special type of antibody that seeks out hidden HIV cells. When cultured together with an "HIV-killer" cell, these antibodies proved effective in destroying previously hidden cells of the virus.

The second study discovered three different antibodies that have a "neutralising" effect on HIV. It's hoped that this means that they can be administered to HIV-positive patients to prevent the virus from progressing.

With studies like this going on all the time, it is possible that we will see an HIV vaccine within the next decade. Currently, however, there are many treatments available to keep HIV infection properly managed and under control. To find out more, read on.

Diagnosing, Treating & Preventing HIV 

The first thing to know about HIV is that it is spread through bodily fluids (semen, vaginal and anal fluid, blood and breast milk). The most common mode of transmission is unprotected vaginal or anal sex.

HIV can also be spread in the following ways:

  • sharing drug needles or other injecting equipment
  • from mother to baby before or during birth
  • from mother to baby when breastfeeding

The instance involving mother and baby can be controlled so the risk is higher where the mother is infected and it is not known.

If you think you might have been exposed to the virus, or if you fall into an at-risk group (men who have sex with men, black African men and women), you should get tested for HIV.

There are different types of HIV test available – normally you will have your blood taken at a clinic and sent away for testing. Order a home test kit through The STI Clinic and you can take a blood sample at home and return it to our lab for testing; our test can detect HIV as early as 10 days after exposure but a negative result is not considered conclusive until 6 weeks after the point of potential infection.

If you think you have been infected in the past 72 hours, you should talk to a doctor about getting post-exposure prophylaxis (PEP); an emergency treatment that can prevent infection from setting in.

For people who are diagnosed with HIV, the treatment programme will involve regular blood tests to monitor the amount of virus in your system, and how healthy your immune system is. At a certain point, you will start treatment with antiretroviral medicines, which work by preventing the virus from multiplying. 

If you’re concerned about contracting HIV, make sure you always use condoms when having sex with someone who may be infected, and never share needles. If your partner is HIV-positive, it is possible to have safe sex – consult the resources available at Terence Higgins Trust to learn more.

 
# Thursday, 26 January 2017
Posted: Thursday, 26 January 2017 | Categories: General Sexual Health

STI Rates Up in Older People

In the UK, most people tend to associate sexually transmitted infections with irresponsible teenagers and drunken students. But while the statistics certainly support this stereotype to some degree (in this 2016 Public Health England report, 16 to 24-year-olds were found to be most at risk for chlamydia, genital herpes and genital warts), it’s worth bearing in mind that STIs affect every age category. In fact, when it comes to gonorrhoea and syphilis, men over the age of 25 seem to be most at risk.

In perhaps the most surprising news of all, sexually transmitted infections are actually on the rise amongst the oldest age categories. In the last decade, STI diagnoses in people aged between 50 and 70 have risen by a third. To get more specific with the numbers, 2010 saw sexual health clinics recording 11,366 new infections in this age group; by 2014 that number had risen to 15,726.

It’s hard to pin down exactly why we’re currently seeing this trend, but there are a few factors to consider.

Safe Sex Campaigns

The first thing to think about is the fact that safe sex campaigns tend to be targeted towards young people. As a result, the average 18-year-old may well know more about the STI symptoms and where to get tested than the average 62-year-old. In fact, in a study by the Office for National Statistics carried out between 2008 and 2009, it was found that only 19% of men aged 50-69 could correctly answer a series of questions about chlamydia symptoms (as opposed to 37% of men aged 30-34).

Consider too that a lot of sexual education material can be found online, and the fact that youngsters tend to be more proficient with computers and the internet than their parents and grandparents.

Divorce rates

Another factor in rising STI rates amongst older people is divorce. As shown by another Office for National Statistics study, the average age at which people are getting divorced has risen in the UK in recent years – in 2013, the average age for a man to get divorced was 45. But how does that relate to STI rates?

Well, following a divorce, it’s common for newly single people to begin dating and enjoying casual sex. But after many years of marriage, divorced men and women who may be used to having unprotected sex may find it difficult to readjust and start taking precautions again.

Women in the 50 - 70 age bracket may also be more careless when it comes to sex if they have been through the menopause. When the risk of pregnancy is taken out of the equation, it can be tempting to forgo condoms – despite the threat of STIs.

Overcoming the Stigma

When it comes to sex, older people may also feel more reluctance in talking to their doctor, or getting advice about doing things safely. They may even feel embarrassed walking into a pharmacy to buy condoms, particularly if they have not done so in a long while.

The important thing to remember is that the consequences of unprotected sex can be far worse than the slight embarrassment of getting advice from your GP or pharmacist. This is also the case when it comes to getting tested and treated properly.

If you have engaged in unprotected sex and you aren’t sure that your sexual partner or partners were STI-free, you should get tested. You can do this for free by visiting an NHS clinic, or by ordering a home test kit through a private service like The STI Clinic (click here to learn more about our Full STI Screen).

It’s also important to get an STI test if you are experiencing any of the following symptoms:

  • pain or a burning sensation when urinating
  • unusual discharge from the penis or vagina
  • fleshy growths around the genitals or anus
  • sore red blisters around the genitals or anus
  • in women, irregular bleeding, heavy periods, pain in the abdomen or pain during sex
  • in men, pain or tenderness in the testicles

Be aware that this is not an exhaustive list of STI symptoms, and that many infections are initially symptomless, so if you think you may have been exposed to something, you should get tested regardless.

 
# Saturday, 07 January 2017
Posted: Saturday, 07 January 2017 | Categories: Women's Sexual Health

Can Gardnerella bacteria increase HIV risk?

The vagina is not a body part that many people feel comfortable talking about. But, as with many medical issues, the more we educate ourselves, the better equipped we are to stay healthy.

In the case of bacterial vaginosis, for instance, it’s important to understand that there’s a link between this common, but not life-altering, condition and the transmission of more serious infections – most critically HIV.

New studies have found that the microflora of a woman’s vagina has a direct effect upon how susceptible she is to the human immunodeficiency virus. To understand this connection, it’s important to elaborate a little on what we mean by vaginal microflora.

The first thing to know is that a healthy vagina is slightly acidic, as this keeps unwanted bacteria from multiplying. The second thing to know is that this acidity level is, strangely enough, maintained by a type of (good) bacteria called Lactobacillus.

In women who have lower levels of Lactobacillus, the acidity of the vagina can become compromised, and unwanted bacteria can begin to develop. One common type of bacteria that develops under these circumstances is Gardnerella vaginalis. Its presence can lead to bacterial vaginosis, which causes unusual, unpleasant-smelling vaginal discharge.

The question is: what does this all have to do with HIV?

Well, as described here, HIV transmission is more likely when there is inflammation in the vagina. In turn, vaginal inflammation is closely associated with low levels of Lactobacillus. When researchers examined which types of bacteria were linked to decreasing levels of Lactobacillus and inflammation, one in particular was singled out: Prevotella bivia. Shockingly, women whose vaginal microflora contained more than 1% P. bivia showed the highest levels of inflammation; these women were 13 times more likely to contract HIV.

Gardnerella was also found to play a role in HIV transmission when it comes to pre-exposure prophylaxis (where medication is taken to prevent infection). In one study looking at tenofovir, an anti-HIV drug applied to the vagina in the form of a gel, it was found that the efficacy of the medication dropped by half when Gardnerella was introduced to the vagina.

This research could lead to much progress being made in the HIV/AIDS crisis, particularly in African countries. If bacterial infections in the vagina can be effectively treated with antibiotics, and if greater awareness can be spread about the importance of vaginal health, then we could start to see a decrease in HIV diagnoses.

Maintaining a Healthy Vagina

The first thing to know about vaginal health is that vaginal discharge is a completely natural feature of a healthy vagina. It is produced by the cervix to keep the vagina moist and free from infection. Normal vaginal discharge is clear or white, and thick and sticky for the majority of your menstrual cycle (it may become wetter around ovulation). Normal vaginal discharge should not smell strong or unpleasant.

Unusual vaginal discharge is characterised by any significant change in colour, consistency or smell. If it smells fishy, becomes lumpy, or turns green, yellow, or grey and watery, this is typically a sign of a sexually transmitted infection or a condition such as bacterial vaginosis.

Bearing this information in mind, it’s advised that you follow these guidelines to keep your vagina healthy:

  • Keep the vagina, anus and perineum clean, particularly during your period
  • Wash your hands before and after changing your sanitary towel, tampon or menstrual cup
  • Avoid using vaginal douches, as these can disrupt your vaginal microflora
  • Avoid using perfumed or antiseptic products on your vagina as these can also disrupt the microflora
  • Use condoms and dental dams during sex when you aren’t sure that your partner is free from STIs
  • Get tested for STIs if you might be at risk, even if you are not experiencing symptoms
  • Get checked out if you experience any significant change in your discharge, or experience irregular bleeding or pelvic pain
  • Attend a cervical screening every three years

The STI Clinic can supply safe home sampling kits for all kinds of STIs, including HIV and chlamydia. We can also supply a test for bacterial vaginosis. Click here to visit our clinic and find out more.

 

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