# Friday, 06 April 2018
Posted: Friday, 06 April 2018 | Categories:

According to a 2017 report from Public Health England, HIV diagnoses are finally on the decline, 30 years after the original epidemic. In 2016, new HIV diagnoses in men who have sex with men decreased by 21% from the previous year (1). This decline has been attributed to falling rates of HIV transmission, which in turn may be associated with the availability of pre-exposure prophylaxis, a medication taken before sex to prevent infection.

Although this is encouraging news, HIV remains an issue – and particularly amongst those who practise chemsex.

Chemsex is a sexual practice whereby participants snort or swallow drugs to enhance pleasure and performance. Popular chemsex drugs include crystal methamphetamine, gamma hydroxybutyrate (GHB) and mephedrone (MCAT). An alternative form of chemsex is slamsex, which is where the drugs are injected for a more intense experience.

Chemsex is a cause for concern amongst medical professionals, as it is associated with risky sexual behaviours which can lead to the spread of sexually transmitted diseases such as HIV.

A recent article from Avert drew particular attention to this problem, noting that – while we have seen a decline in HIV diagnoses – we have also seen an increase in diagnoses of gonorrhoea and syphilis amongst men who have sex with men. The article also highlights a number of specific risk factors related to chemsex and HIV, quoting from a survey carried out by Public Health England, Imperial College London and University College London.

As noted in the article, "the survey revealed that 29.9% of gay men living with HIV reported having had chemsex in the last year, and 10.1% reported having had ‘slamsex’– where drugs are injected." The survey also revealed that men who practise chemsex are more likely to have a bacterial STIs and to practise unprotected anal sex.

This last factor is particularly concerning, as condomless anal sex is a high-risk behaviour when it comes to HIV transmission. The lining of the anus is very thin and easily broken, which means that receiving anal sex is the most risky sexual behaviour for HIV transmission; a person receiving anal sex is 13 times more likely to get infected than the person inserting their penis (2).

The popularity of slamsex is also concerning as it requires needle use, one of the riskiest behaviours for HIV transmission, along with anal and vaginal sex.

Now that the NHS has rolled out the PrEP Impact Trial across England, it’s fair to assume that certain men engaging in chemsex are also taking pre-exposure prophylaxis. However, the prevalence of STIs amongst men who practise chemsex may also suggest that certain people engaging in chemsex are not regularly visiting sexual health services for testing and treatment.

If you’re a gay or bisexual man concerned about HIV – whether or not you engage in chemsex – read on for a guide to staying safe.

Preventing HIV Transmission

As previously explained, the two most high-risk behaviours for HIV transmission are unprotected sex and sharing needles/injecting equipment.

When engaging in penetrative anal or vaginal sex with a man or woman whose HIV status is unclear, you should use condoms. Used correctly, male condoms are 98% effective and female condoms are 95% effective (4). HIV is not often transmitted through oral sex; however, it can happen. If in doubt, use condoms and dental dams for oral sex. To ensure that the condom doesn’t break, it’s a good idea to used water-based lubricants during sex; oil-based lubricants can cause latex condoms to tear.

If you inject drugs you should be incredibly careful not to share needles or other injecting equipment. If you do share equipment you may come into contact with infected blood. Talk to your GP or drug counsellor if you need information on where to get clean needles and equipment.

Depending upon your circumstances, you might also consider taking pre-exposure prophylaxis. PrEP is available on the NHS in Scotland, and is being trialled in Wales and England. PrEP comes in tablet form and is either taken every day, or on an on-demand basis. To find out more about PrEP, visit the PrEP Impact Trial site.

PrEP is available privately via various clinics. Some websites also facilitate the importation of PrEP for personal use (which is legal depending on the quantity being purchased). There is currently only one UK licensed online service allowing patients to have PrEP prescribed and that can be found here. This website can also do all of the essential monitoring required to ensure patient safety.

Lastly, if you are engaging in any behaviours that may expose you to HIV it’s a good idea to get regular tests. Early diagnosis will help you manage the infection effectively and, with the appropriate treatment, live a relatively normal life.

To order a home HIV test kit, visit our clinic.

Sources:

(1) https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/675809/Towards_elimination_of_HIV_transmission_AIDS_and_HIV_related_deaths_in_the_UK.pdf

(2) https://www.cdc.gov/hiv/risk/analsex.html

(3) https://www.nhs.uk/conditions/contraception/male-condoms/

(4) https://www.nhs.uk/conditions/contraception/female-condoms/

 
# Saturday, 06 January 2018
Posted: Saturday, 06 January 2018 | Categories: General Sexual Health

How Quickly do STIs Spread?

Once upon a time, sex was something that (in theory) happened only between marital partners. Times have changed, but despite the benefits of changing social mores, sexual freedom has its downsides, one of which is the prevalence of sexually transmitted infections. There are a number of myths surrounding sexually transmitted infections, which makes it all the more important that people are aware of the facts about them. This is especially true with regard to the symptoms that often manifest as a result of the exposure to these infections, and the speed with which they can appear after they have been contracted.

How soon after exposure do symptoms of infection begin?

The great majority of sexually transmitted infections do not even cause any symptoms, but if you are experiencing some then it is a good idea to be aware of how soon they are likely to develop after you engage in sexual activity. The time between the beginning of the infection and the moment when symptoms begin is referred to as the incubation period.

Symptoms

Chlamydia, gonorrhoea and genital herpes

A chlamydia infection does not usually result in short term symptoms, although one to three weeks after infection some people do get a discharge from the penis or vagina. However, symptoms can develop months or even years after the infection was originally contracted. Gonorrhoea likewise rarely results in short term symptoms, but still remains infectious. From several days after exposure to around a month later, penis or vaginal discharge can develop. Another infection with the ability to lie dormant without manifesting any symptoms is genital herpes. Symptoms that do occur can range from some mild soreness, to many painful ulcers developing around the penis or vulva a few weeks after infection. These symptoms can also recur.

HIV, AIDS, scabies and genital warts

HIV often results in no symptoms at all for many years, and sometimes symptoms never appear. Flu-like symptoms can materialise a few weeks following exposure, which most people will shrug off as a common virus. These symptoms can include swollen glands, a blotchy red rash and a sore throat. These symptoms may reappear years later, accompanied by loss of weight, diarrhoea, tiredness and sweating, and can ultimately lead to the development of AIDS. A number of different conditions are associated with AIDS, including brain disorders like dementia, skin cancer and various unusual infections. AIDS is now a very rare diagnosis in the UK because of the success of treatment interventions.

Scabies can appear within one or two months of infection and results in intense skin itching – although itching can begin within just a couple of days for those who have suffered the condition on a previous occasion. Genital warts do not always materialise on those who have contracted the virus, but if they do, it happens within three months of infection.

Hepatitis B and pubic lice

Hepatitis B results in symptoms between four to six weeks after infection, including sickness, fever, jaundice, loss of appetite and a general feeling of ill health. The immune system usually kills the virus eventually, though others may still have it for the rest of their life without symptoms. In rare instances however, it can cause symptoms of liver disease.

Pubic lice infection results in intense itching within the pubic region, usually followed by the materialisation of red spots. The itching takes at least five days to begin, but in some cases it can take several weeks after infection to develop.

Are you more at risk of STIs if you already have an infection?

Some sexually transmitted infections put you at a higher risk of contracting HIV if you come into sexual contact with an infected person who is not on treatment.

Risky sexual behaviour, including having unprotected sex and changing sexual partners on a frequent basis, can also cause people to be exposed to a greater number of sexually transmitted infections. People who need STI testing are usually tested for various different sexually transmitted infections in case they have contracted more than one.

Testing

If you feel there is a chance that you have acquired a sexually transmitted infection then you should not wait for symptoms to appear, but immediately ask to be tested.

 
# Thursday, 16 November 2017
Posted: Thursday, 16 November 2017 | Categories: General Sexual Health | Women's Sexual Health

Trichomonas and Prostate Cancer: Link Questioned by New Study

Trichomoniasis is a sexually transmitted infection caused by the parasite Trichomonas vaginalis. It affects both women and men and because it can be symptomless, or present with symptoms similar to other STIs, it can be difficult to diagnose.

The good news is that trichomonas is relatively rare in the UK; in a study from the end of last year it was found that only 6,000 cases are reported per annum. The bad news is that this fairly innocuous STI is a risk factor for other serious diseases – although not, as previously thought, prostate cancer.

Back in 2006, a study found that that men infected with the T. vaginalis parasite had a 40% greater chance of developing prostate cancer. In 2012, another researcher claimed to have discovered the "molecular mechanism" causing the association between the two conditions.

For men around the world this was concerning news, trichomonas being a common STI in many countries, and not always easily detected. However, doubt has been cast upon these findings by more recent research, which has challenged the idea that trichomonas could lead to prostate cancer.

A study from last year looked specifically at African American men, amongst whom the prevalence of trichomonas and the risk of developing prostate cancer is higher than average. Ultimately, researchers found no strong evidence to suggest a causal link between trichomonas and prostate cancer in these men.

It’s not clear yet what has caused these contradictory results, but one theory is that the T. vaginalis parasite increases inflammation, and encourages the growth of both benign and cancerous cells. Trichomonas, therefore, may not actively cause the development of prostate cancer, but may contribute to more aggressive forms of it.

In other words, men who are particularly at risk of prostate cancer (whether because of age, lifestyle or family history) may do well to stay cautious about STIs such as trichomonas; however, there’s no need to be overly concerned if you receive a diagnosis. Trichomonas is one of the easier STIs to treat. Typically you take an antibiotic called metronidazole for five to seven days.

What is more concerning is that trichomonas is known to increase the risk of HIV transmission and acquisition in women. The T. vaginalis parasite is thought to increase vaginal shedding in women with HIV, which makes them more infectious.

Going forward, the safest thing to do is to continue to practise safe sex, to familiarise yourself with the symptoms of STIs and to get tested if you think you might be at risk of infection.

Trichomonas, STIs & Safe Sex

The symptoms of trichomonas are similar to chlamydia and gonorrhoea. It is thought that about half of all people infected do not suffer any symptoms, but those who do might experience the following:

  • Abnormal discharge from the penis (thin, white) or vagina (thick, thin, or frothy, yellow or green, unpleasant smell)
  • Pain when urinating
  • Soreness and swelling around the vagina or the head of the penis
  • Men may need to urinate more frequently, and women may experience pain during sex

If you are with a partner who is showing any of these symptoms, you should refrain from sex until they have been tested. If you develop these symptoms you should get tested for trichomonas as soon as possible. Click here to visit our clinic and order a home test kit.

Other STI symptoms to watch out for include:

  • Blisters, bumps or sores around the genitals or anus
  • Itching, tingling or burning around the genitals or anus
  • In women, bleeding between periods or after sex
  • In women, pain in the abdomen

To avoid contracting these kinds of unpleasant symptoms, you should always use condoms for penetrative sex if you aren’t sure your partner is free from STIs. You should also be aware that oral sex can transmit STIs; to stay safe when you aren’t sure about your partner’s STI status, use condoms or dental dams during oral sex.

Avoid sharing sex toys that haven’t been washed between uses, and be aware that condoms can’t provide full protection against diseases like genital herpes or warts, as these are spread by skin-to-skin contact.

If you’ve had unprotected sex recently, or if you have sex with multiple or casual partners frequently, it is a good idea to get tested.

 
Posted: Thursday, 16 November 2017 | Categories: General Sexual Health

UK STI Rates: Some Positive News

In recent years, the UK headlines have been hit with news of gonorrhoea strains that cannot be treated with antibiotics, rising rates of STIs, and the return of sexually transmitted diseases we assumed were long dead. Confronted with this, it would be easy to feel like Britain’s sexual health is a lost cause. According to clinical pharmacist Laura Waters, however, it’s not all doom and gloom.

In a recent opinion piece, Waters put these alarming headlines into context, explaining that high STI rates and increasing diagnoses are not necessarily an indication that our sexual health practices are becoming worse. The first point made by Waters is that total STI cases in 2016 actually decreased by 4% from the previous year. Within specific groups, we also saw falling rates of first-episode genital warts (down 8%) and gonorrhoea (down 12%).

In perhaps the best news, diagnoses of HIV amongst men who have sex with men (MSM) fell by 23% between 2015 and 2016; this group also saw a significant decline in gonorrhoea diagnoses. The clinics which reported the sharpest decline in HIV diagnoses were also the ones in which testing for HIV had seen an increase. As Waters explains, HIV-negative MSM are likely to be driving this increase in testing, and increased screening seems to be having the doubly beneficial effect of catching gonorrhoea in its early stages and facilitating swift treatment.

While some STI rates have stayed relatively stable or even declined in recent years, it is true that we have seen a sudden increase in syphilis for MSM. Some have speculated that this is related to improved HIV treatment and campaigns such as "Can’t Pass It On" which publicise the fact that HIV-positive men receiving proper treatment have an undetectable viral load and cannot pass the virus on during sex. Though breaking down the stigma around HIV is crucial, it’s believed that these campaigns could have the effect of reducing condom use in MSM, thus making them vulnerable to other STIs such as syphilis.

Perhaps the most dispiriting revelation in Waters’ article is that there is a significant public funding gap when it comes to sexual health issues. In 2012, the Health and Social Care Act was introduced; this means that sexual health is now commissioned by local authorities and not the NHS. With huge reductions in public health spending, sexual health services have been seriously impacted.

And yet, there is still cause to stay hopeful. The roll-out of the HPV vaccination to schoolgirls has led to a significant drop in genital warts for this age group. Currently, the NHS and Public Health England are trialling HPV vaccinations for MSM under 45, which will hopefully lead to a decline in cases of genital warts for this category as well.

Moving forward, the best thing to do is push education around sexual health issues, for people of all ages. Second to that, regular testing should be encouraged amongst the most at-risk groups: MSM, the under-25s, and those of black African descent.

Safe Sex & STI Testing

One of the key STI facts that should be circulated is that sexually transmitted infections aren’t solely transmitted through penetrative sex. They can be passed on during oral sex, when sharing sex toys, and even simply by having skin-to-skin contact.

To stay safe, you should always use condoms and dental dams for oral sex with someone whose STI status is unclear. You should always wash sex toys between uses or cover them with a fresh condom. You should also refrain from sexual contact if you spot any STI symptoms.

STI symptoms can include:

  • pain when urinating
  • unusual discharge from the penis or vagina
  • in men, pain in the testicles
  • in women, pain in the pelvis or abdomen
  • in women, irregular bleeding (e.g. after sex or between periods)
  • fleshy growths around the genitals or anus
  • painful blisters around the genitals or anus
  • a painless blister on the genitals or mouth

To get tested for STIs, visit an NHS centre such as a sexual health clinic, or order home test kits from The STI Clinic. Click here to learn about our Quad Blood Test, which screens for HIV, syphilis, hepatitis B and hepatitis C.

 
# 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.

 

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