Gonorrhoea (and Super-Gonorrhoea) Explained

Last month, a UK man hit the headlines for contracting the first recorded case of "super-strength" gonorrhoea. As reported by The Guardian, the man contracted the infection in South East Asia and visited a UK clinic at the beginning of the year for treatment. Unfortunately, the two antibiotics which were administered – azithromycin and ceftriaxone – failed to cure the infection. This is the first time that a strain of gonorrhoea has proved resistant to both antibiotics.

In recent years, we’ve heard many accounts of super-gonorrhoea – a name for strains of the infection that have developed resistance to first line antibiotics. Today, the treatment for gonorrhoea involves an injection in the buttocks or thigh, and one oral antibiotic (1); as explained here, the recommended antibiotics are usually ceftriaxone (in injection form) and azithromycin or doxycycline (in tablet form). This combination is usually sufficient, even for super-gonorrhoea – but as we have seen, it was not effective in the case of the man discussed above.

News of super-strength gonorrhoea strains is worrying because gonorrhoea is a fairly common STI. There are an estimated 78 million new cases each year (2); in 2016 there were 36,000 diagnoses in England alone (3). It’s also worrying because, when left untreated, gonorrhoea can cause serious complications such as pelvic inflammatory disease and pregnancy complications – in rare cases it can even cause septicaemia.

If you’re concerned about contracting gonorrhoea, read on for a guide to staying safe.

How is gonorrhoea spread?

Gonorrhoea is a bacterial infection that is spread during unprotected sex. The bacteria responsible, Neisseria gonorrhoeae, are found in semen and vaginal fluid.

Sexual acts that can lead to the spread of gonorrhoea include:

• Vaginal sex
• Anal sex
• Oral sex
• Sharing sex toys

Penetrative sex is not required for gonorrhoea to be passed on; if semen or vaginal fluid from an infected person gets inside the penis, vagina, rectum, throat or eyes it can cause an infection.

Gonorrhoea cannot be caught by kissing, hugging, sharing towels, toilet seats or crockery, or by using public swimming pools.

How can I avoid gonorrhoea?

The best way to avoid catching gonorrhoea is to always practise safe sex. If you aren’t sure of your partner’s STI status, or if you haven’t recently been tested yourself, it’s always a good idea to use condoms and dental dams during sex.

Condoms should be used for penetrative vaginal and anal sex. They can also be used for oral sex, and to cover sex toys. Dental dams should be used for oral sex.

Remember that gonorrhoea doesn’t always cause symptoms in its early stages. This means that you or your sexual partner may have it and not know that you are infected. It’s estimated that 1 in 10 men, and half of all women don’t experience any obvious symptoms in the early stages of infection (4).

What are the symptoms of gonorrhoea?

Though gonorrhoea doesn’t always cause obvious symptoms, it’s worth familiarising yourself with the symptoms that can occur. If you’re aware of the symptoms you can get tested promptly if you notice them in yourself; you will also be better prepared to notice them in potential sexual partners.

Symptoms of gonorrhoea in men can include:

• Unusual discharge from the penis that is often white, green or yellow
• Pain when urinating
• Inflamed foreskin
• Painful, tender testicles

Symptoms of gonorrhoea in women can include:

• Unusual vaginal discharge that may be thin or watery and yellow or green
• Pain when urinating
• Pain in the abdomen
• Irregular bleeding e.g. between periods, after sex
• Heavy periods

In both men and women, gonorrhoea can cause an infection of the rectum, throat or eyes. Symptoms of these infections can include irritation, pain and discharge.

How do you get tested for gonorrhoea?

If you develop any of the symptoms above it’s a good idea to get tested for gonorrhoea; your doctor may also want to test you for other STIs such as chlamydia. It’s also a good idea to get tested if you’ve had unprotected sex with someone whose STI status isn’t known, or if you regularly engage in casual sex with new partners.

If you would prefer not to visit a clinic in person, you can order a home test kit through The STI Clinic. Click here to find out more.

Sources:

(1)  https://www.nhs.uk/conditions/gonorrhoea/treatment/

(2)  https://www.medicalnewstoday.com/articles/155653.php

(3)  https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/617025/Health_Protection_Report_STIs_NCSP_2017.pdf

(4)  https://www.nhs.uk/conditions/gonorrhoea/symptoms/

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/

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.

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.

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.

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.

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.

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.

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.