Sexually Transmitted Infections

• Around half of people with bacterial vaginosis won’t have any signs and symptoms at all, or may not be aware of them.
• You might notice a change in your usual vaginal secretions (discharge). This may increase, become thin and watery, change to a white/grey colour and develop a strong, unpleasant, fishy smell, especially after sex.
• Bacterial vaginosis isn’t usually associated with soreness, itching or irritation.

You may notice these symptoms yourself, or they may be identified by a clinician during a vaginal examination. If you think you might have bacterial vaginosis you can book an appointment at one of our clinics.

Bacterial vaginosis isn’t a sexually transmitted infection, but it’s important you don’t delay in getting advice if you may have been at risk of an STI.

A clinician may examine inside your vagina to look at any vaginal discharge and collect a sample from the vaginal walls using a swab. A swab looks like a cotton bud, but is smaller and rounded. It sometimes has a small plastic loop on the end rather than a cotton tip. It only takes a few seconds to wipe over the area and isn’t usually painful, though it may be uncomfortable for a moment.

The pH (alkaline/acid balance) of the vagina may be measured by wiping a sample of vaginal discharge over a piece of specially treated paper.

Sometimes your test result will be available straight away, but other times it can take up to two weeks.

Sometimes bacterial vaginosis is noticed during a cervical screening test (smear test), but you’ll only need treatment if you have problems with discharge. Routine blood tests don’t detect infections such as bacterial vaginosis.

It’s also possible to buy a bacterial vaginosis test to do at home. If you buy a testing kit, get advice from a pharmacist, Sexual Health Adviser or a clinician.

It’s not always necessary to have a test for bacterial vaginosis.

The accuracy of a bacterial vaginosis test depends on the test used and the type of sample that’s collected. Microscopy tests (where a sample is looked at with a microscope) for bacterial vaginosis are usually accurate.

• Treatment for bacterial vaginosis is simple and involves taking antibiotic tablets. There are several different antibiotics that can be used. These are taken either as a single dose or a longer course (up to one week).
• You may be given a cream or gel instead. You’ll need to use this in the vagina for 5–7 days.
• The Sexual Health Adviser or clinician will advise you how to use the treatment. If you’re given the antibiotic metronidazole, either in tablet form or as a vaginal gel, you’ll be advised not to drink alcohol during the treatment and for 48 hours afterwards. This is because it reacts with alcohol and can make you feel very unwell.
• Some creams can weaken latex condoms, diaphragms and caps. Polyurethane (soft plastic) types can be safely used. Ask the Sexual Health Adviser or a clinician for advice.
• Tell the Sexual Health Adviser, clinician or pharmacist if you’re pregnant, think you might be, or you’re breastfeeding. This can affect the type of treatment you’re given.

Treatment is effective if used correctly. It’s quite common for bacterial vaginosis to return, and some people get it multiple times.

You only need another test if:

• signs and symptoms don’t go away
• signs and symptoms come back

For many people, bacterial vaginosis goes away by itself.

Chlamydia is usually passed from one person to another through sexual contact. You can get the infection if you come into contact with the semen (cum or pre-cum) or vaginal fluids of someone who has chlamydia.

Chlamydia is most commonly spread through:

• vaginal or anal sex without a condom
• sharing sex toys that aren’t washed or covered with a new condom each time they’re used

It can be spread by giving or receiving oral sex (going down, giving head) with someone who has chlamydia. The risk can be lowered by using a condom or a dam (a latex or soft plastic square) to cover the genitals.

If infected semen or vaginal fluid comes into contact with the eye (for example, if it’s transferred from the genitals to the eye by the fingers) it can cause conjunctivitis (infection or irritation of the eye).

If you’re pregnant it’s possible to pass chlamydia to the baby (see ‘What happens if I get chlamydia when I’m pregnant?’ in the ‘Other things to know’ section).

It’s not clear if chlamydia can be spread by transferring infected semen or vaginal fluid to another person’s genitals on the fingers or through rubbing vulvas (female genitals) together.

You can’t get chlamydia from kissing, hugging, sharing baths or towels, swimming pools, toilet seats or from sharing cups, plates or cutlery.

Most people with chlamydia won’t have any obvious signs or symptoms, or will have symptoms so mild they go unnoticed.

Signs and symptoms can show 1-3 weeks after coming into contact with chlamydia, many months later, or not until the infection spreads to other parts of the body.

You might notice:

If you have a vulva

• bleeding between periods and/or heavier periods (including women using hormonal contraception)
• bleeding after sex
• pain and/or bleeding during sex  
• lower abdominal pain (pelvic pain) 
• an unusual vaginal discharge  
• pain when passing urine

If you have a penis

• a white/cloudy or watery discharge from the tip of the penis
• pain when passing urine
• pain in the testicles

Other parts of the body

There are rarely any symptoms if the infection is in the rectum (back passage) but it may cause discomfort and discharge.

Infection in the throat is less common than genital infection and usually has no symptoms.

Infection in the eyes can cause pain, swelling, irritation and/or discharge

It’s important not to delay going for a test if you think you might have chlamydia. A test can be carried out straight away, but you may be advised to have another test two weeks after having sex. You can have a test for chlamydia even if you don’t have any symptoms.

What does a chlamydia test involve?

• If you have a vulva, you may be asked to take a swab around the inside of your vagina yourself
• A clinician may take a swab during an internal examination of your vagina and cervix (entrance to the womb)
• You may be asked to provide a urine sample. Before having this test, you’re advised not to pass urine (pee) for 1-2 hours
• A clinician may take a swab from the entrance of the urethra (tube where urine comes out)
• If you’ve had anal or oral sex, a clinician may swab your rectum (back passage) or throat (you may be given the option to do your own tests). These swabs aren’t done routinely on everyone
• If you have persistent conjunctivitis (an eye infection), and have had a sexual risk, the doctor or nurse may also consider taking a swab of discharge from your eye(s).

A swab looks a bit like a cotton bud but is smaller and rounded. It sometimes has a small plastic loop on the end rather than a cotton tip. It’s wiped over the parts of the body that could be infected. This only takes a few seconds and isn’t painful, though it may be uncomfortable for a moment.

Cervical screening (smear tests) and routine blood tests don’t detect chlamydia.

If you’re not sure whether you’ve been tested for chlamydia, just ask.

How accurate are the tests?

The accuracy of a chlamydia test depends on the kind of test used and the type of sample that’s collected. The recommended tests are over 95% accurate in picking up chlamydia. As no test is 100% accurate, there’s a small chance that the test will give a negative result when you do have chlamydia. This is known as a false negative result. This can sometimes explain why you might get a different result from another test, or why you and a partner might get a different test result.

Chlamydia is treated with antibiotics. If you take the treatment according to instructions, it’s over 95% effective at treating chlamydia.

• You’ll be given a course of antibiotics for 3 or 7 days, or sometimes up to two weeks
• If there’s a high chance you have chlamydia, treatment may be started before the results of the test are back. You’ll always be given treatment if a sexual partner is found to have chlamydia.
• You may also need other treatment if complications have occurred
• Tell the Sexual Health Adviseror clinician if you’re pregnant, or think you might be, or you’re breastfeeding. This may affect the type of antibiotic you’re given.
• Complementary therapies (treatments outside of mainstream healthcare) can’t cure chlamydia.

When will the signs and symptoms go away?

You should notice an improvement quite quickly after having treatment.

• Discharge or pain when you urinate should improve within a week, but may take up to two weeks to go away.
• Bleeding between periods or heavier periods should improve by your next period
• Pelvic pain and pain in the testicles should start to improve quickly, but may take up to two weeks to go away.

If you have pelvic pain or painful sex that doesn’t improve, see your Sexual Health Adviser or a clinician, as it may be necessary to have some further treatment or investigate other possible causes of the pain.

Do I need to have a test to check that the chlamydia has gone?

A Test of Cure (a test to ensure that your infection has been treated successfully) is not usually needed if you have completed your treatment as prescribed, and not had any sexual contact as advised by the Doctor or Nurse in clinic.  If you are pregnant or have been advised by the Doctor or Nurse in clinic to have a Test of Cure this needs to be completed 6 weeks after your treatment; if you test within this 6 week period it is likely that your test is still positive (not because you are truly positive but because the test that the laboratory is so sensitive)

You may need a repeat test or more treatment if:

• you think you’ve come into contact with chlamydia again
• you had sex without a condom with a partner before the treatment for both of you was finished (see ‘How soon can I have sex again?’ in the ‘Other things to know’ section)
• you didn’t complete the treatment, or didn’t take it according to the instructions
• the signs and symptoms don’t go away (see above, ‘When will the signs and symptoms go away?’)
• your test was negative but you develop signs or symptoms of chlamydia (see ‘Signs and symptoms’)
• you’re pregnant.

If the chlamydia was in your rectum (back passage), you may need another test around 3 weeks after finishing the treatment. A Sexual Health Adviser or clinician will let you know if you need another test.

You can go back to the clinic if you have any questions or need advice on how to protect yourself from infection in the future.

What happens if chlamydia isn’t treated?

Only some people who have chlamydia will have complications. If chlamydia is treated early, it’s unlikely to cause any long-term problems. But, without proper treatment, the infection can spread to other parts of the body. The more times you have chlamydia the more likely you are to get complications.

• If you have a vulva, chlamydia can spread to other reproductive organs, causing pelvic inflammatory disease (PID). This can lead to long-term pelvic pain, blocked fallopian tubes, infertility and ectopic pregnancy (when the pregnancy develops outside the uterus, usually in a fallopian tube).
• In people with a vulva, chlamydia can also cause pain and inflammation around the liver, though this is rare. This usually gets better with the correct antibiotic treatment.
• If you have a penis, chlamydia can lead to infection in the testicles. If this isn’t treated, there’s a possibility it could affect your fertility, but more research is needed to understand how likely this is.
• Rarely, chlamydia can lead to inflammation of the joints. This is known as Sexually Acquired Reactive Arthritis (SARA) and is sometimes accompanied by inflammation (pain, redness or swelling) of the urethra (tube where urine comes out) and the eye. This is more likely to occur in people with a penis than people with a vulva.

Can chlamydia go away without treatment?

It can, but it can take a long time. If you delay seeking treatment you risk the infection causing long-term damage, and you may still be able to pass the infection on to someone else.

Telling your partner

If the test shows that you have chlamydia then it’s very important that your current sexual partner(s) and any other recent partners are also tested and treated, as they may have the infection without knowing it. This will help to stop them re-infecting you, or passing chlamydia on to anyone else.

You may be given a contact slip to send or give to your partner(s) or, with your permission, the clinic can do this for you. This is called partner notification. It can sometimes be done by text message. The message or contact slip will say that they may have been exposed to a sexually transmitted infection and suggest they go for a check-up. It may or may not say what the infection is. It won’t have your name on it, so your confidentiality is protected.

You’re strongly advised to tell your partner(s), but it isn’t compulsory. The staff at the clinic or general practice can discuss with you which of your sexual partners may need to be tested.

Don’t have oral, vaginal or anal sex, or use sex toys, until you and your partner(s) have both finished the treatment and any symptoms have gone. This is to help prevent you being re-infected or passing the infection on to someone else.

If you’re given antibiotic treatment called azithromycin, you’ll still need to avoid sex for seven days after starting the treatment, as that’s how long it takes to work.

How will I know if the chlamydia has affected my fertility?

Chlamydia is just one of many factors that can affect your fertility. Most people who’ve had chlamydia won’t become infertile or have an ectopic pregnancy (see ‘What happens if chlamydia isn’t treated?’ in the ‘Treatment’ section). If you’ve had chlamydia you won’t normally be offered any routine tests to see if you’re fertile unless you or a partner are having difficulty getting pregnant. If you’re concerned, talk to a Sexual Health Adviser or clinician.

What happens if I get chlamydia when I’m pregnant?

• Chlamydia during pregnancy has been associated in very rare cases with problems such as premature (early) birth, and infection of the uterus (womb) lining after the birth.
• It can be passed to the baby during the birth and (less commonly) before the baby is born. This can cause inflammation and discharge in the baby’s eye(s) (conjunctivitis) and/or pneumonia.
• You may be offered a chlamydia test as part of your antenatal care.
• Chlamydia can be treated with antibiotics when you’re pregnant and when you’re breastfeeding. The antibiotics won’t harm the baby, but do tell the Sexual Health Adviser clinician that you’re pregnant or breastfeeding.
• You’ll be advised to have another test after you complete your treatment.

Does chlamydia cause cervical cancer?

No, chlamydia doesn’t cause cervical cancer

Epididymitis and epididymo-orchitis are usually caused by a bacterial infection. Infection can result from surgery, the insertion of a catheter into the bladder, or the spread of infections from elsewhere in the urinary tract. Sometimes, the cause is a sexually transmitted disease. Rare causes include infection by certain viruses or fungi.

Sometimes there is no infection of any kind. In such cases, doctors believe the epididymis becomes inflamed by reverse flow of urine into the epididymis, perhaps because of straining (as when men lift something very heavy).

Symptoms may include:

• sudden or gradual pain in one or both of your testicles (balls)
• the bag of skin containing your testicles (scrotum) feeling tender, warm and swollen
• a build-up of fluid around your testicle (a hydrocele) that feels like a lump or swelling.

You may have other symptoms depending on the cause, such as difficulty peeing, or a white, yellow or green discharge from the tip of the penis.

Epididymitis is usually caused by a sexually transmitted infection (STI) such as chlamydia or gonorrhoea. This is more likely in younger men under 35 years old. It can also be caused by a urinary tract infection (UTI), but UTIs are less common in men than women.

Sometimes a cause cannot be found.

Epididymitis and epididymo-orchitis are diagnosed by physical examination and urinalysis (a test of your urine).

Epididymitis and epididymo-orchitis are usually treated with antibiotics taken by mouth, bed rest, pain relievers, and ice packs applied to the scrotum. Immobilising the scrotum with a jockstrap decreases pain from repetitive, minor bumps.

Abscesses usually require surgical drainage.

Can I pass the infection to my sex partner?

• Yes, if the infection is from an STD. (This is most often the cause in men under 40 who have sex.) In this case, the infection can be passed back and forth through sex. Your sex partner needs to be treated as well.
• No, if the infection is from bacteria in the urinary tract. There is no risk of infecting your partner in this case.

Do epididymis or testicular infections lead to cancer?

These infections are not linked to cancer. However, in cases that are not getting better, a physical examination by a urologist and/or an ultrasound may identify something else as the cause of the pain. Most cancer of the testes are painless, but a small percentage will start with pain in this area of the body.

Genital herpes is passed from one person to another during sexual contact. Anyone who’s sexually active can get the virus and pass it on.

Herpes simplex is most likely to be passed on just before, during or straight after an outbreak.

Genital herpes can be passed on:

• from one person to another during vaginal or anal sex, or by sharing sex toys
• by direct genital contact – you don’t need to have penetrative sex (vaginal or anal)
• by skin to skin contact with the affected area during sex, if the virus is active on the skin outside of the area protected by a condom or dam (a latex or plastic square)
• if you receive oral sex from someone who has a cold sore or is just about to get one
• if a person with an active herpes sore on the hand or finger touches a partner’s vagina, genitals or anal area.

If you’re pregnant it’s possible to pass the virus to the baby if you’re having your first outbreak at the time of giving birth (see ‘Other things to know’).

If you already have one type of herpes simplex virus it’s still possible for you to get the other type, although you may not notice symptoms.

You can’t get genital herpes from hugging, sharing baths or towels, from clothing, from swimming pools, toilet seats or from sharing cups, plates or cutlery.

Can I pass the virus to a partner when I have no signs or symptoms?

In some people, the body can shed the virus from the affected skin or mucous membranes without there being any signs or symptoms of genital herpes. This is called asymptomatic shedding.

It’s possible to pass the virus on during periods of asymptomatic shedding, but for most people the risk is low. Shedding is higher in the first year after infection and in people with frequent outbreaks. When there’s a long gap between outbreaks, asymptomatic shedding is less likely to take place.

Many people won’t have any visible signs or symptoms at all, or won’t be aware of them.

Some people will get symptoms within 2-14 days of coming into contact with the virus. In others, the virus may be in the body for several weeks, months or years before any signs or symptoms appear. So if you do get symptoms it doesn’t necessarily mean you’ve only just become infected.

If you do get signs or symptoms, they usually follow a pattern. You may feel generally unwell with flu-like symptoms, which might include fever, tiredness, headache, swollen glands, aches and pains in the lower back and down the legs or in the groin. This may be followed by:

• stinging, tingling or itching in the genital or anal area
• discharge from the vagina
• discharge from the urethra (tube where urine comes out)
• small, fluid-filled blisters which could be in the genital or anal area, on the buttocks, or at the top of your thighs; these burst within a day or two, leaving small, red sores which can be very painful
• pain when passing urine (peeing) caused by urine flowing over the sores.

What are the signs and symptoms of recurrent genital herpes?

Signs and symptoms of recurrent outbreaks are usually milder than with the first outbreak and clear up more quickly (in about a week).

There’s often an early-warning tingling sensation before an outbreak.

The blisters and sores are usually fewer, smaller, less painful and heal more quickly. They normally appear in the same part of the body as in previous outbreaks, but in some people they may appear nearby.

How will I know if I have genital herpes?

You can only be certain you have genital herpes if you have a check-up when you’ve got signs or symptoms. You could have genital herpes even if a partner has never had an outbreak.

It’s possible to have more than one sexually transmitted infection at the same time. A check-up for infection is recommended if:

• you or a partner have a new diagnosis of herpes
• you or a partner have, or think you might have, symptoms
• you’ve recently had unprotected sex with a new partner
• you or a partner have had unprotected sex with other partners
• a sexual partner tells you they have a sexually transmitted infection
• you have another sexually transmitted infection
• you’re pregnant or planning a pregnancy.

Having genital herpes may mean you’re more at risk of getting HIV from a sexual partner who’s living with HIV. If you’re living with HIV and have genital herpes, you may be more likely to pass HIV on to a partner. Effective treatment can suppress HIV in the body. This is known as having an undetectable viral load and means that HIV can’t be passed on, even if you or a partner have genital herpes.

When will the signs and symptoms go away?

Outbreaks of genital herpes last a different length of time in each person and will depend on their general state of health, and whether this is the first or a recurrent outbreak. The first outbreak may last from 2–4 weeks in total.

• Flu-like symptoms usually last for about a week
• Individual sores take around 5–10 days to heal. Once the sores start healing they’re less painful.
• Pain and irritation can last up two weeks, or sometimes longer

The signs and symptoms of a recurrent outbreak of genital herpes usually last for a shorter time than the first outbreak.

You can have a check-up as soon as you have signs or symptoms. There’s no routine test for genital herpes if you don’t have signs or symptoms.

In many cases, a clinician may diagnose genital herpes by looking at the affected skin. They’ll want to confirm this by taking a swab of fluid from the infected area, if they can. The swab will be sent to a laboratory. The result will usually be known within 1–3 weeks. Some clinics may be able to give you the result earlier, within 1–2 days.

A swab looks a bit like a cotton bud but is smaller and rounded. It’s wiped over the parts of the body that could be infected and easily picks up samples of fluid. This only takes a few seconds and may sting for a moment if the blisters and sores are tender.

There’s a specific blood test that can be done to look for antibodies to the virus. This isn’t used as a routine test for genital herpes and may not be reliable.

Cervical screening tests (smear tests) and routine blood tests don’t detect the herpes simplex virus.

No tests are 100% accurate. It’s easier to diagnose genital herpes at the beginning of an outbreak when it’s possible to take a sample of fluid from a blister or sore before it starts to heal.

An accurate diagnosis will depend on the amount of virus present on the skin at the time, the stage of the blisters or sores and the type of test used on the swab specimen. The Sexual Health Adviser or clinician will talk to you about how accurate your test result might be.

Testing can only be done when you have symptoms on the skin surface, as a swab has to be taken from the affected area.

The aim of the treatment is to relieve the pain, and to prevent the virus from multiplying.

• Treatment is recommended when you have the first outbreak, as this may provide some relief.
• Treatment is usually started within five days of the start of the first outbreak and while new blisters or sores are still forming. You take antiviral tablets daily (usually two or three times a day) for five days. There are several different antiviral tablets that can be used.
• Some people find it helpful to take antiviral treatment when they get another outbreak of genital herpes. You may be given some tablets to take at home. These need to be started as soon as the outbreak begins and are usually taken for 1–3 days.
• People who have repeated outbreaks (usually more than five in a year) may be given a long course of the tablets to reduce the number of outbreaks. This is known as suppressive therapy. It also reduces asymptomatic shedding (see the ‘Signs and symptoms’ section) and, for most people, it stops outbreaks completely, while you’re taking the tablets.
• If you’re pregnant or trying to get pregnant, tell the Sexual Health Adviser or clinician, so they can talk to you about pregnancy and herpes simplex. If you have an outbreak of herpes in pregnancy it can be safely treated (see ‘Other things to know’).
• As genital herpes is caused by a virus and not bacteria, antibiotics won’t help.
• The treatment you can buy for facial cold sores isn’t suitable for genital herpes.

Will I have to pay for tests and treatment?

All tests are free through NHS services. Treatment is also free unless you go to your general practice, when you may have to pay a prescription charge for the treatment.

Do I need a follow-up appointment?

Not necessarily. If the Sexual Health Adviser or clinician would like to test for other sexually transmitted infections, you may be asked to go back when the outbreak is over. This is a good time to ask any other questions you may have.

Contact the clinic if you have other questions or are troubled by recurrent outbreaks in the future.

Is there anything I can do to ease the discomfort?

There are several things you can do to ease the discomfort and speed up the healing process:

• Apply a local anaesthetic ointment such as lidocaine. This will help relieve the pain. You can buy it from the pharmacy.
• Apply petroleum jelly. Be aware that oil-based products can damage latex condoms, diaphragms or caps, making them less effective.
• Gently bathe the area using cotton wool and a warm salt water solution (1 teaspoon of salt to half a litre of water).
• Apply an ice pack. Put ice cubes in a plastic bag, wrap them in a clean towel or flannel, and hold on the sores for up to an hour or so. Don’t put ice directly onto the skin.
• Take a cool shower to soothe the sores.
• Avoid washing too often, and dab the affected area gently to dry it.
• If urinating (peeing) is painful, urinate in a warm bath or shower.
• Wash your hands before touching the blisters or sores. This helps to avoid introducing bacteria which may cause an infection and delay the healing process.
• Drink extra fluids, such as water.
• Wear loose clothing.
• Use a mild pain-relieving drug, if you need to.

How can I prevent further outbreaks?

Outbreaks can be triggered by different things in different people. If you notice a pattern, you might be able to make changes that will help prevent further outbreaks.

Some people find that these are triggers:

• being ill, run down, tired or stressed
• different times in the menstrual cycle
• friction from sex or masturbation; using a lubricant can help
• ultraviolet light on the affected skin area (such as from sunbathing or using sunbeds)
• tight clothing and nylon or Lycra underwear
• drinking alcohol or smoking.

Outbreaks can eventually stop altogether. This can be within 18–24 months for many people, although it may take much longer for others. Suppressive therapy can prevent further outbreaks (see above, ‘What’s the treatment for genital herpes?’)

What happens if genital herpes isn’t treated?

It’s not essential to have treatment as genital herpes will clear up by itself. However, prompt treatment at the start of an outbreak can reduce the time the outbreak lasts, help the healing process and reduce the risk of you passing the virus on to someone else.

Should I tell my partner?

If the test shows you have genital herpes, it isn’t usually recommended that a partner has a check-up unless they have signs or symptoms.

You’ll be advised to tell your sexual partner(s) but it’s not compulsory. The staff at Hope House Sexual Health Service can discuss with you how to do this.

The Herpes Viruses Association has advice on talking to a sexual partner about herpes.

If a partner is pregnant, you should use condoms or dams (latex or polyurethane squares) during sex and avoid sex for the last six weeks of the pregnancy. This is to reduce the risk of passing on the virus to your partner and the baby (see ‘Other things to know’).

How soon can I have sex again?

It’s strongly advised that you don’t have any sexual intercourse (including vaginal, anal or oral sex) if you know an outbreak is coming, while you have signs and symptoms, and for a week after the symptoms have gone.

This is to help prevent you passing the virus on to someone else. Having sex while you have blisters or sores can also delay the healing process.

Will I know how long I’ve had the virus?

The genital herpes test can’t tell you how long the virus has been there. If you feel upset or angry about having genital herpes and find it difficult to talk to your partner(s) or friends, don’t be afraid to discuss how you feel with the staff at the clinic, or with a support group.

Does genital herpes affect my fertility?

No. Genital herpes doesn’t affect fertility.

What happens if I have genital herpes when I’m pregnant?

Genital herpes can be safely treated during pregnancy. It’s possible for the virus to be passed to the baby during the birth or, extremely rarely, before the baby is born.

If you get genital herpes before you get pregnant, or during the first six months of your pregnancy, the risk of passing it on to your baby during the birth is very low. You’ll usually be able to have a vaginal delivery. However, it’s important to tell your midwife or obstetrician that you have genital herpes so they can talk to you about your options and help you to plan the birth. You should also be seen by a Sexual Health Adviser or a clinician.

If you get genital herpes for the first time during the last three months of your pregnancy, especially within six weeks of your due date, you won’t have time to pass on immunity to your baby. This can mean the virus may be passed to the baby during vaginal delivery; you’ll be recommended a caesarean birth.

With repeat outbreaks of genital herpes during pregnancy, the risk of passing the virus to the baby during the birth is very low. You’ll usually be able to have a vaginal delivery. Treatment with antiviral tablets three times daily should be considered from 36 weeks of pregnancy onwards. This can reduce the possibility of an outbreak occurring when you’re due to give birth.

You can get more information on genital herpes in pregnancy from www.rcog.org.uk.

Does genital herpes cause cervical cancer?

No. There’s no evidence that genital herpes causes cervical cancer.

How can I protect myself from genital herpes and other STIs?

Herpes blisters and sores are highly infectious. If you or a partner have cold sores or genital herpes avoid:

• kissing when you or a partner have cold sores around the mouth
• oral sex when you or a partner have mouth or genital sores
• any genital or anal contact when you or a partner have genital sores or blisters, or if you feel an outbreak starting

It’s possible to get a sexually transmitted infection (STI) by having sex with someone who has an STI, even if they have no symptoms.

The following measures will help protect you from most STIs including chlamydia, gonorrhoea and HIV.

If you have a sexually transmitted infection they’ll also help prevent you from passing it on to someone else.

• Use condoms (external/maleor internal/female) every time you have vaginal or anal sex.
• If you have oral sex, use a condom to cover the penis, or a latex or polyurethane (soft plastic) square to cover the anus or female genitals.
• Avoid sharing sex toys. If you do share them, wash them or cover them with a new condom before anyone else uses them.
• How to use condoms.

Genital warts are easily passed on through sexual contact. Anyone who’s sexually active can get the HPV virus and pass it on.

• Genital warts can be passed on during vaginal or anal sex.
• They can also be spread by skin to skin contact, so it can be passed on by any close genital contact, even if you don’t have vaginal or anal sex.
• Genital warts can’t pass through a condom, but as condoms don’t cover the whole genital area, it’s possible to infect genital skin that’s not covered by the condom.
• It’s possible, but very rare, to develop warts in the mouth or throat, or on the lips, from oral sex.
• Warts can be easily spread from the genital area to the area around the anus without having anal sex.
• If you’re pregnant and have genital warts at the time, it’s possible to pass HPV to the baby at birth, but this is rare. See ‘What if I get genital warts when I’m pregnant?’ in the ‘Other things to know’ section.
• You can’t get genital warts from kissing, hugging, sharing baths or towels, from swimming pools, toilet seats or sharing cups, plates or cutlery.

Most people with HPV infection won’t develop visible warts. This means you may not know whether you or a partner have HPV.

If warts do appear, this can happen from 3 weeks to many months, or even years, after coming into contact with HPV. You might notice small, fleshy growths, bumps or skin changes. These may appear anywhere in or on the genital or anal area, on their own or in groups.

• If you have a vagina, warts are most likely to appear on the vulva (the external part of the genitals), and may sometimes be found on the cervix (entrance to the uterus/womb) or in the vagina.
• If you have a penis, warts are most likely to appear on the penis or scrotum and may sometimes be found on the urethra, the tube where urine (pee) comes out.
• Genital warts may also be found on the upper thighs, and around or inside the anus.
• You might see or feel warts, or a partner might notice them. Often, they’re so tiny, or so difficult to see, that you don’t know you have them.
• They can be flat or smooth small bumps or quite large, cauliflower-like lumps.
• Genital warts are usually painless but may occasionally itch and cause some inflammation (pain, redness or soreness).
• They may cause bleeding from the anus or from the urethra.
• If your flow of urine (pee) is distorted this may be a sign of warts in the urethra.

A Sexual Health Adviser or clinician can usually confirm whether you have warts by looking at the affected area.

Even if you or a partner feel sure you have genital warts, it’s still advisable to have a check-up to confirm this.

It’s possible to have more than one sexually transmitted infection (STI) at the same time. A check-up for other STIs is recommended if:

• you or a partner have a new diagnosis of genital warts
• you or a partner have, or think you might have, any other symptoms
• you’ve recently had sex without a condom with a new partner
• you or a partner have had sex without a condom with other partners
• a sexual partner tells you they have an STI
• you have another STI
• you’re pregnant or planning a pregnancy.

There are a variety of ways to treat genital warts. The treatment will depend on what the warts look like, how many you have and where they are. The options include:

• putting cream or a liquid on to the warts. You can usually do this yourself at home, a few times a week for a number of weeks. Some people ask a partner to apply the cream or liquid for them. Ask the Sexual Health Adviser or clinician if the treatment will affect condoms, diaphragms or caps.
• freezing (cryotherapy)
• heat (electrocautery), using local anaesthetic
• surgery, using local anaesthetic
• laser treatment, using local anaesthetic

Some wart treatments may be uncomfortable but they’re not usually painful. Treatments can cause irritation and soreness for a couple of days, so the Sexual Health Adviser or clinician may recommend you use some pain-relieving drugs.

• Avoid perfumed soap, bath oils, bubble baths, creams and lotions until treatment is completed, as these may irritate the skin.
• Tell the Sexual Health Adviser or clinician if you’re pregnant or think you might be. This may affect the treatment you’re given, and some treatments shouldn’t be used when you’re pregnant.
• As genital warts are caused by a virus and not bacteria, antibiotics won’t get rid of warts.
• Wart treatments sold at the pharmacy aren’t suitable for genital warts.
• Complementary therapies (treatments outside of mainstream healthcare) can’t cure genital warts.

How soon after sex can I be checked for genital warts?

You can get a check-up for genital warts as soon as you notice any signs or symptoms. There’s no routine test for the types of HPV that cause genital warts.

What does the check-up involve?

• The main check for genital warts is for a clinician to look at the warts. They may do this using a magnifying lens.
• You may also need an internal examination of the vagina or anus to see if there are any warts inside.
• Very rarely, it may be necessary to take a biopsy (small sample) of the wart for closer examination. Depending on the area being examined, a local anaesthetic may be used.
• There’s no routine blood test for HPV.

How accurate is the check-up?

Most warts are easily diagnosed by looking at them.

Will I have to pay for the check-up and treatment?

All check-ups, tests and treatment are free through NHS services.

Do I need to have a check-up to see if the warts have gone?

If you’re having treatment for the warts it’s important to return regularly for treatment. This is so the Sexual Health Adviser or clinician can check that the treatment is working, or advise whether a change of treatment is needed.

Many clinics don’t ask you to return if you think the warts have cleared up. They’ll always be happy to see you if you want advice or to be checked.

What happens if genital warts aren’t treated?

If left untreated, genital warts may disappear, stay the same, or grow larger in size or number. Over time, most warts will eventually go away without treatment. For some people this may take a long time, particularly if they have an illness that affects the way their immune system works, making it difficult to fight off infection.

It’s not usually harmful to your health if the warts aren’t treated, but you may find them uncomfortable and may not like the way they look. Treating the warts may reduce the risk of you passing them on to someone else.

How quickly will the warts go away?

How effective the treatment is depends on the size and type of warts, the treatment used and how good your immune system is at fighting the virus.

For most people, warts go away within a few weeks or months of starting treatment. Sometimes the warts can be stubborn, and treatment may have to be repeated a number of times. It can also take a while for the treatment to start working.

If you feel your warts aren’t responding to treatment, speak to your Sexual Health Adviser or a clinician about this. They may recommend a change in treatment.

Evidence suggests that smokers respond less well to treatment than non-smokers. If the first treatment doesn’t work, another treatment may be tried. Sometimes the warts come back (see below).

Will the warts come back?

Some people only ever get one episode of genital warts. For many others, the warts can come back. If you do get new genital warts, it’s not possible to say if these are due to the original infection or a new infection.

Should I tell my partner?

If you’re told you have genital warts it’s a good idea for your current or most recent sexual partner(s) to have a check-up for sexually transmitted infections, and to see if they have any warts that they haven’t noticed.

Will I know how long I’ve had genital warts?

It’s not possible to tell how long you’ve had HPV.

If you feel upset or angry about having genital warts and find it difficult to talk to a partner or friends, don’t be afraid to discuss how you feel with the staff at the clinic.

How soon can I have sex again?

You may be advised to avoid sex until the warts have cleared up to help protect the affected area.

Sex without a condom when you have warts can increase the risk of passing on HPV to a partner. Avoiding sex or using condoms while the warts are present, and for the first 3 months after they’ve gone, may help to reduce the risk of passing on HPV. The condom needs to cover the affected area of skin.

If you’re using a cream or liquid to treat the warts, don’t have sex straight after applying the treatment, and ask your Sexual Health Adviser or clinician if the treatment will affect condoms.

Will genital warts affect my fertility?

No. Your fertility won’t be affected by having genital warts or the HPV that causes them.

What happens if I get genital warts when I’m pregnant?

Tell the Sexual Health Adviser or clinician that you’re pregnant, as this may affect the treatment they can offer you.

• During pregnancy, warts often grow in size and number. They may appear for the first time or they can appear again after a long time of having no warts.
• They can be treated safely during pregnancy, though treatment may be delayed until after you’ve given birth.
• If the warts get very big, they may be removed to avoid problems during birth. If this isn’t possible, you may be advised to have a caesarean delivery, but this is very rare.
• HPV can be passed to the baby during a vaginal delivery but this is rare.
• Warts may clear by themselves during the first few months after giving birth.

Do genital warts cause cancer?

It’s extremely rare for genital warts to cause cancer. The types of HPV (types 6 and 11) that cause most visible genital warts are only very rarely associated with cancer.

Some other types of HPV can cause cell changes that may lead to cancer. For more information about HPV and cervical cancer see the Jo’s Trust website.

Is there a vaccine against genital warts?

Yes. The HPV vaccine protects against HPV 6 and 11 (which cause genital warts) and HPV 16 and 18 (types of HPV that can cause cell changes that lead to cancer).

In England, all 12 to 13-year-olds are routinely offered the HPV vaccine at school.

Young people who were eligible to be vaccinated at school but missed the vaccine can be vaccinated for free up to the age of 25.

Men who have sex with men and are aged up to 45 can be vaccinated for free at sexual health and HIV clinics. Some other people, including some trans people, sex workers, and people living with HIV, may be able to have the vaccine for free – ask your Sexual Health Adviser or clinician.

How do I protect myself from genital warts and other STIs?

It’s possible to get a sexually transmitted infection (STI) by having sex with someone who has an STI, even if they have no symptoms.

The following measures will help protect you from getting and passing on genital warts and most other STIs such as chlamydia, gonorrhoea and HIV.

If you have a sexually transmitted infection they’ll also help prevent you from passing it on to someone else.

• Use condoms or internal condoms every time you have vaginal or anal sex. They help protect you from other STIs and may give some protection from getting, or passing on, genital warts, particularly if they’re used while warts are present and for the first 3 months after they’ve gone.
• If you have oral sex (going down, giving head), use a condom to cover the penis, or a dam (latex or plastic square) to cover the vulva (external female genitals) or anus.
• How to use condoms.
• Avoid sharing sex toys. If you do share them, wash them or cover them with a new condom before anyone else uses them.

Around half of people with a vulva and 1 in 10 people with a penis with genital gonorrhoea won’t have any obvious signs or symptoms.

Signs and symptoms can show up 2–14 days after coming into contact with gonorrhoea, many months later, or not until the infection spreads to other parts of your body.

You might notice the following:

If you have a vulva

• An unusual vaginal discharge which may be thin or watery, yellow or green
• Pain when passing urine
• Lower abdominal pain or tenderness
• Rarely, bleeding between periods or heavier periods (including women who are using hormonal contraception)

If you have a penis

• An unusual discharge from the tip of the penis – the discharge may be white, yellow or green
• Pain when passing urine
• Rarely, pain or tenderness in the testicles

Other parts of the body

• Infection in the rectum (back passage) doesn’t usually have any signs and symptoms but may cause anal pain, discomfort or discharge
• Infection in the throat – usually has no symptoms
• Infection in the eyes (conjunctivitis) – can cause pain, swelling, irritation and discharge

You can only be certain you have gonorrhoea if you have a test. It’s important not to delay getting a test so that you can start treatment and don’t pass the infection on to anyone else. A test can be done straight away, but you may be advised to have another test two weeks after having sex. You can have a test for gonorrhoea even if you haven’t got signs or symptoms.

You should have a test if:

• you or a sexual partner have, or think you might have, symptoms
• you’ve recently had unprotected sex with a new partner
• you or a partner have had unprotected sex with other partners
• during a vaginal examination your clinician says that the cervix is inflamed and/or there’s an unusual discharge
• a sexual partner tells you they have a sexually transmitted infection (STI)
• you have another STI

You could have gonorrhoea even if a partner has tested negative. The only way to make sure you don’t have gonorrhoea is to get tested yourself.

If you’ve had gonorrhoea and it’s been treated, you won’t be immune to the infection – you can get it again.

If you have gonorrhoea, you’ll be encouraged to be tested for other STIs, as you can have more than one STI at the same time.

What does the test involve?

• If you have a vulva, you may be asked to use a swab yourself around the inside of your vagina.
• A clinician may take a swab during an internal examination of your vagina and cervix (entrance to the womb).
• If you have a penis, you may be asked to provide a urine sample. Before having this test you’re advised not to pass urine (pee) for 1-2 hours.
• A clinician may use a swab around the entrance of the urethra (tube where urine comes out). This test is usually for people with a penis, but may sometimes be offered to people with a vulva.
• If you’ve had anal or oral sex, the clinician may swab your rectum (back passage) or throat (you may be given the option to do your own tests).These swabs aren’t done routinely on everyone.
• If you have symptoms of conjunctivitis (an eye infection), swabs will be used to collect a sample of discharge from your eye(s).

A swab looks a bit like a cotton bud, but is smaller and rounded. It sometimes has a small plastic loop on the end rather than a cotton tip. It’s wiped over the parts of the body that could be infected. This only takes a few seconds and isn’t painful, though it may be uncomfortable for a moment.

It may be possible to look at your swab sample under a microscope straight away and give you the result before you leave the clinic or surgery. Otherwise you’ll have to wait up to two weeks to get your result.

Cervical smear tests and routine blood tests don’t detect gonorrhoea. If you’re not sure whether you’ve been tested for gonorrhoea, just ask.

Home tests

In many areas, free home self-sampling tests for gonorrhoea and chlamydia are available to order online. This is where you take your own sample and send it to be tested.

It’s also possible to buy a gonorrhoea test from a private online provider to do at home. The accuracy of these tests varies, so it’s recommended that you go to a sexual health service to have a test. You can also choose to pay for a gonorrhoea test at a private clinic.

If a self-sampling test or home test shows that you have gonorrhoea, it’s important to seek treatment straight away. The test should have instructions explaining what to do.

If you have symptoms you should always get tested at a sexual health service.

Gonorrhoea is treated with antibiotics.

Increasingly, antibiotics don’t always work when treating gonorrhoea. A clinician should always take a swab to check which antibiotics might work best at treating the type of gonorrhoea you have. If they don’t know which antibiotics will work best, the antibiotics will usually be given as an injection.

If there’s a high chance you have gonorrhoea, treatment may be started before the test results are back. You’ll also be given treatment if a partner was diagnosed with gonorrhoea in the previous two weeks.

You may also need other treatment if complications have occurred.
Complementary therapies don’t cure gonorrhoea.

Do I need to have a test to check the gonorrhoea has gone?

Yes. This is very important, as gonorrhoea can be resistant to antibiotics. You’ll need a follow-up test 1-2 weeks after finishing the treatment to check it’s worked. Your Sexual Health Adviser or clinician may also advise other tests. This is particularly important if:

• you think you may have come into contact with gonorrhoea again
• you had unprotected sex with a partner before the treatment for both of you was finished (see ‘How soon can I have sex again?’ in the ‘Other things to know’ section)
• the signs and symptoms don’t go away (see ‘When will the signs and symptoms go away?’ in the ‘Treatment’ section)
• you had gonorrhoea of the throat
• your test was negative but you develop signs or symptoms of gonorrhoea (see ‘Signs and symptoms’).

How quickly the test can be repeated will depend on which test is being used. The clinic or general practice will advise you.

If you were treated for gonorrhoea in early pregnancy, you may be advised to have another test later in the pregnancy.

You can always go back to the Sexual Health Adviser or clinician if you have any questions, or need any advice on how to protect yourself from infection in the future.

How accurate are the tests?

The accuracy of a gonorrhoea test depends on the kind of test used, the type of sample that’s collected and which part of your body the sample is collected from.

As no test is 100% accurate there’s a small chance that the test will give a negative result when you do have gonorrhoea. This is known as a false negative result. This can sometimes explain why you might get a different result when you go to a different clinic to have another test, or why you and a partner might get a different test result.

It’s possible for the test to be positive if you haven’t got gonorrhoea, but this is uncommon.

If there are doubts about the result you may be offered a second test.

When will the signs and symptoms go away?

Most people notice an improvement quite quickly after having treatment.

• Discharge or pain when you urinate (pee) should improve within 2–3 days.
• Discharge and discomfort in the rectum (back passage) should improve within 2–3 days.
• Bleeding between periods or heavier periods that have been caused by gonorrhoea should improve by your next period.
• Pelvic pain and pain in the testicles should start to improve quickly, but may take up to two weeks to go away.

If you have pelvic pain or painful sex that doesn’t improve, see your Sexual Health Adviser or a clinician. It may be necessary to have further treatment or to investigate other possible causes of the pain.

What happens if gonorrhoea isn’t treated?

Only some people who have gonorrhoea will have complications.

If gonorrhoea is treated early it’s unlikely to cause any long-term problems. However, without effective treatment, the infection can spread to other parts of the body.

The more times you have gonorrhoea, the more likely you are to get complications.

• If you have a vulva, gonorrhoea can spread to other reproductive organs causing pelvic inflammatory disease (PID).This can lead to long-term pelvic pain, blocked fallopian tubes, infertility and ectopic pregnancy (when the pregnancy develops outside the uterus).
• If you have a penis, gonorrhoea can lead to a painful infection in the testicles and possibly reduce fertility.
• Less commonly, gonorrhoea can cause pain and inflammation of the joints and tendons, known as sexually acquired reactive arthritis (SARA); this can sometimes also cause inflammation of the eyes, and skin lesions.

Can gonorrhoea go away without treatment?

It can, but it can take a long time. If you delay seeking treatment you risk the infection causing long-term damage and you may pass the infection on to someone else.

Should I tell my partner?

If the test shows that you have gonorrhoea, it’s very important that your current sexual partner(s) and any other recent partners are tested and treated.

You may be given a contact slip to send or give to your partner(s) or, with your permission, the clinic can do this for you. This is called partner notification. It can sometimes be done by text message. The message or contact slip will say that they may have been exposed to a sexually transmitted infection and suggest they go for a check-up. It may or may not say what the infection is. It won’t have your name on it, so your confidentiality is protected.

You are strongly advised to tell your partner(s), but it isn’t compulsory. The staff at the clinic or general practice can discuss with you which of your sexual partners may need to be tested.

How soon can I have sex again?

It’s strongly advised you don’t have any sexual intercourse, including vaginal, anal or oral sex, or use sex toys, until seven days after you and your partner(s) have both finished the treatment. This is to help prevent you being re-infected or passing an infection on to someone else.

Will I know how long I’ve had gonorrhoea?

The gonorrhoea test can’t tell you how long the infection has been there. If you feel upset or angry about having gonorrhoea and find it difficult to talk to a partner or friends, don’t be afraid to discuss how you feel with the staff at the clinic or general practice.

How will I know if the gonorrhoea has affected my fertility?

Gonorrhoea is just one of many factors that can affect your fertility. Most people who’ve had gonorrhoea won’t become infertile or have an ectopic pregnancy (see ‘What happens if gonorrhoea isn’t treated?’ in the ‘Treatment’ section). You won’t normally be offered any routine tests to see if you’re fertile unless you or a partner are having difficulty getting pregnant. If you’re concerned, talk to your Sexual Health Adviser or a clinician.

What happens if I get gonorrhoea when I’m pregnant?

Gonorrhoea can be passed to the baby during the birth. This can cause inflammation and discharge in the baby’s eyes (conjunctivitis). Gonorrhoea can be treated with antibiotics when you’re pregnant or breastfeeding. The antibiotics won’t harm the baby, but do tell the Sexual Health Adviser or clinician if you’re pregnant or breastfeeding.

Will I have to pay for tests?

All tests are free through NHS services. Treatment is also free.

Does gonorrhoea cause cervical cancer?

No, gonorrhoea doesn’t cause cervical cancer.

Hepatitis A is most widespread in parts of the world where standards of sanitation and food hygiene are generally poor, such as parts of Africa, the Indian subcontinent, the Far East, the Middle East, and Central and South America.

You can get the infection from:

• eating food prepared by someone with the infection who has not washed their hands properly or washed them in water contaminated with sewage
• drinking contaminated water, including ice cubes
• eating raw or undercooked shellfish from contaminated water
• close contact with someone who has hepatitis A
• less commonly, having sex with someone with hepatitis A (this is particularly a risk for men who have sex with men) or injecting drugs using contaminated equipment

Someone with hepatitis A is most infectious from around 2 weeks before symptoms appear until about a week after symptoms first develop.

At-risk destinations

Hepatitis A is found worldwide, but areas where it’s most widespread include:

• sub-Saharan and northern Africa
• the Indian subcontinent (particularly India, Bangladesh, Pakistan and Nepal)
• some parts of the Far East (excluding Japan)
• the Middle East
• South and Central America

To find out about the potential health risks in a specific country, see country information on the Travel Health Pro website.

People at risk of hepatitis A in the UK

Although the chances of getting hepatitis A in the UK are much smaller than in other parts of the world, certain groups have an increased risk. These include:

• close contacts of someone with hepatitis A
• men who have sex with other men
• people who inject illegal drugs
• people who may be exposed to hepatitis A through their job – this includes sewage workers, people who work for organisations where levels of personal hygiene may be poor, such as a homeless shelter, and people working with monkeys, apes and gorillas (these animals may be infected with hepatitis A)

People in these groups are usually advised to have the hepatitis A vaccine to minimise their risk of infection.

The symptoms of hepatitis A develop, on average, around 4 weeks after becoming infected. But not everyone with the infection has symptoms. See your GP if you think you could have been infected with the virus.

A blood test will be needed to rule out more serious conditions that have similar symptoms.

Initial symptoms

The initial symptoms of hepatitis A can include:

• feeling tired and generally unwell
• joint and muscle pain
• a raised temperature
• loss of appetite
• feeling or being sick
• pain in the upper right part of your tummy
• a headache, sore throat and cough
• constipation or diarrhoea
• a raised, itchy rash (hives)

These symptoms usually last from a few days up to a couple of weeks.

Later symptoms

After the initial symptoms, the following symptoms may develop:

• yellowing of the skin and eyes (jaundice)
• dark pee
• pale poo
• itchy skin
• the upper right part of your tummy becoming swollen and tender

Most people make a full recovery within a couple of months, although the symptoms can come and go for up to 6 months.

Signs of a serious problem

Hepatitis A is not usually serious, but in rare cases it can cause the liver to stop working properly (liver failure).

As well as the symptoms mentioned, signs of liver failure can include:

• sudden, severe vomiting
• a tendency to bruise and bleed easily (for example, frequent nosebleeds or bleeding gums)
• irritability
• problems with memory and concentration
• drowsiness and confusion

Get medical advice as soon as possible if you have these symptoms. Liver failure can be life threatening if not treated quickly.

The hepatitis A virus test is a blood test that shows if you have a hepatitis A infection now or had it in the past. The test looks for antibodies made by the body to fight the virus. They will be in your blood if you have a hepatitis A infection now or have had one in the past.

There’s currently no cure for hepatitis A, but it normally gets better on its own within a couple of months. You can usually look after yourself at home. But it’s still a good idea to see your GP for a blood test if you think you could have hepatitis A, as more serious conditions can have similar symptoms.

Your GP can also advise you about treatments. They may carry out regular blood tests to check how well your liver is working.

Go back to your GP if your symptoms get worse or have not started to improve within a couple of months.

Relieving your symptoms

The following advice may help:

• get plenty of rest – especially during the initial stages of the infection, as you’ll probably feel very tired
• take painkillers, such as paracetamol or ibuprofen, if you have any aches and pains – how much you can take depends on how well your liver is working (ask your GP for advice)
• reduce itching by maintaining a cool, well-ventilated environment, wearing loose clothing and avoiding hot baths or showers – your GP may recommend using an antihistamine in severe cases
• eat small, light meals to help reduce nausea and vomiting – your GP can prescribe a medication called an antiemetic if the problem persists
• avoid alcohol – drinking alcohol can put additional strain on your liver, so avoid it until your GP says it’s safe

Preventing the spread of infection

While you’re ill, it’s also important to try to reduce the risk of spreading the infection to others.

You should:

• stay off work or school until at least a week after your jaundice or other symptoms started
• avoid preparing food for others if possible
• wash your hands with soap and water regularly, particularly after going to the toilet and before preparing food
• avoid sharing towels
• wash soiled laundry separately on a hot cycle
• clean the toilet, flush handles and taps more frequently than usual
• avoid having sex while you’re infectious – hepatitis A is most infectious from around 2 weeks before the symptoms start until about a week after they first develop (ask your GP for advice about this)

Any close contacts, such as people who live in the same house as you, may be advised to have the hepatitis A vaccine to reduce their risk of becoming infected.

The hepatitis B virus is found in the blood and bodily fluids, such as semen and vaginal fluids, of an infected person.

It can be spread:

• from a mother to her new-born baby, particularly in countries where the infection is common (read more about hepatitis B in pregnancy)
• within families (child to child) in countries where the infection is common
• by injecting drugs and sharing needles and other drug equipment, such as spoons and filters
• by having sex with an infected person without using a condom
• by having a tattoo, body piercing, or medical or dental treatment in an unhygienic environment with unsterilised equipment
• by sharing toothbrushes or razors contaminated with infected blood

Hepatitis B is not spread by kissing, holding hands, hugging, coughing, sneezing or sharing crockery and utensils.

Many people with hepatitis B will not experience any symptoms and may fight off the virus without realising they had it.

If symptoms do develop, they tend to happen 2 or 3 months after exposure to the hepatitis B virus.

Symptoms of hepatitis B include:

• flu-like symptoms, including tiredness, a fever, and general aches and pains
• loss of appetite
• feeling and being sick
• diarrhoea
• tummy pain
• yellowing of the skin and eyes (jaundice)

These symptoms will usually pass within 1 to 3 months (acute hepatitis B), although occasionally the infection can last for 6 months or more (chronic hepatitis B).

A blood test can be carried out to check if you have hepatitis B or have had it in the past.

The hepatitis B vaccine may also be recommended to reduce your risk of infection.

Treatment for hepatitis B depends on how long you have been infected for.

If you have been exposed to the virus in the past few days, emergency treatment can help stop you becoming infected.

If you have only had the infection for a few weeks or months (acute hepatitis B), you may only need treatment to relieve your symptoms while your body fights off the infection.

If you have had the infection for more than 6 months (chronic hepatitis B), you may be offered treatment with medicines that can keep the virus under control and reduce the risk of liver damage.

Chronic hepatitis B often requires long-term or lifelong treatment and regular monitoring to check for any further liver problems.

Hepatitis B can be serious, so you should get medical advice if:

• you think you may have been exposed to the hepatitis B virus – emergency treatment can help prevent infection if given within a few days of exposure
• you have symptoms associated with hepatitis B
• you’re at a high risk of hepatitis B – high-risk groups include people born in a country where the infection is common, babies born to mothers infected with hepatitis B, and people who have ever injected drugs
• You can go to your local GP surgery, drug service, genitourinary medicine (GUM) clinic or sexual health clinic for help and advice.

The hepatitis C virus is usually spread through blood-to-blood contact.

Some ways the infection can be spread include:

• sharing unsterilised needles – particularly needles used to inject recreational drugs
• sharing razors or toothbrushes
• from a pregnant woman to her unborn baby
• through unprotected sex – although this is very rare

In the UK, most hepatitis C infections happen in people who inject drugs or have injected them in the past.

It’s estimated around half of those who inject drugs have the infection.

Hepatitis C often does not have any noticeable symptoms until the liver has been significantly damaged. This means many people have the infection without realising it.

When symptoms do occur, they can be mistaken for another condition.

Symptoms can include:

• flu-like symptoms, such as muscle aches and a high temperature (fever)
• feeling tired all the time
• loss of appetite
• tummy (abdominal) pain
• feeling and being sick

The only way to know for certain if these symptoms are caused by hepatitis C is to get tested.

Seek medical advice if you have persistent symptoms of hepatitis C or there’s a risk you’re infected, even if you do not have any symptoms.

A blood test can be carried out to see if you have the infection.

GPs, sexual health clinics, genitourinary medicine (GUM) clinics or drug treatment services all offer testing for hepatitis C.

Early diagnosis and treatment can help prevent or limit any damage to your liver, as well as help ensure the infection is not passed on to other people.

Find out more about testing for hepatitis C.

Hepatitis C can be treated with medicines that stop the virus multiplying inside the body. These usually need to be taken for several weeks.

New tablet-only treatments are now available which have been found to make treatment more effective, are easier to tolerate, and have shorter treatment courses. They include simeprevir, sofosbuvir and daclatasvir.

Using the latest medications, more than 90% of people with hepatitis C may be cured.

But it’s important to be aware that you will not be immune to the infection and should take steps to reduce your risk of becoming infected again.

If the infection is left untreated for many years, some people with hepatitis C will develop scarring of the liver (cirrhosis). Over time, this can cause the liver to stop working properly.

In severe cases, life-threatening problems, such as liver failure, where the liver loses most or all of its functions, or liver cancer, can eventually develop.

Treating hepatitis C as early as possible can help reduce the risk of these problems happening.

Find out more about the complications of hepatitis C. 

Preventing hepatitis C

There’s no vaccine for hepatitis C, but there are ways to reduce your risk of becoming infected.

These include:

• not sharing any drug-injecting equipment with other people – including needles and other equipment, such as syringes, spoons and filters
• not sharing razors or toothbrushes that might be contaminated with blood

The risk of getting hepatitis C through sex is very low. But it may be higher if blood is present, such as menstrual blood or from minor bleeding during anal sex.

Condoms are not usually necessary to prevent hepatitis C for long-term heterosexual couples, but it’s a good idea to use them when having anal sex or sex with a new partner.

Anyone who has sex without a condom or shares needles is at risk of HIV infection.

There are many effective ways to prevent or reduce the risk of HIV infection, including:

• using a condom for sex
• post-exposure prophylaxis (PEP)
• pre-exposure prophylaxis (PrEP)
• treatment for HIV to reduce the viral load to undetectable
• if you use drugs, never sharing needles or other injecting equipment, including syringes, spoons and swabs

Speak to your local sexual health clinic or a GP for further advice about the best way to reduce your risk.

For people with HIV, if you have been taking effective HIV treatment and your viral load has been undetectable for 6 months or more, it means you cannot pass the virus on through sex. This is called undetectable=untransmittable (U=U).

Further information:

NAM aidsmap: undetectable equals untransmittable (U=U) consensus statement

Most people experience a short flu-like illness 2 to 6 weeks after HIV infection, which lasts for a week or two.

After these symptoms disappear, HIV may not cause any symptoms for many years, although the virus continues to damage your immune system. This means many people with HIV do not know they’re infected.

Anyone who thinks they could have HIV should get tested.

Some people are advised to have regular tests as they’re at particularly high risk.

Read more about who’s most at risk of HIV.

Seek medical advice as soon as possible if you think you might have been exposed to HIV.

You can get tested in a number of places, including at a GP surgery, sexual health clinic and clinics run by charities.

The only way to find out if you have HIV is to have an HIV test. This involves testing a sample of your blood or saliva for signs of the infection.

It’s important to be aware that:

• emergency anti-HIV medicine called post-exposure prophylaxis (PEP) may stop you becoming infected if started within 72 hours of possible exposure to the virus – it’s recommended that you start it as soon as possible, ideally within 24 hours
• an early diagnosis means you can start treatment sooner, which can improve your chances of controlling the virus, reduce the risk of becoming more unwell and reduce the chance of passing the virus on to others

Both positive and negative HIV tests may need to be repeated 1 to 3 months after potential exposure to HIV infection (this is known as the window period), but you should not wait this long to seek help:

• clinics may offer a finger prick blood test, which can give you a result in minutes, but it may take up to a few days to get the results of a more detailed HIV test
• home testing or home sampling kits are available to buy online or from pharmacies – depending on the type of test you use, your result will be available in a few minutes or a few days

If your first test suggests you have HIV, a further blood test will need to be carried out to confirm the result.

If this is positive, you’ll be referred to a specialist HIV clinic for some more tests and a discussion about your treatment options.

Antiretroviral medicines are used to treat HIV. They work by stopping the virus replicating in the body, allowing the immune system to repair itself and preventing further damage.

These come in the form of tablets, which need to be taken every day.

HIV is able to develop resistance to a single HIV medicine very easily, but taking a combination of different medicines makes this much less likely.

Most people with HIV take a combination of medicines. It’s vital these are taken every day as recommended by your clinician.

The goal of HIV treatment is to have an undetectable viral load. This means the level of HIV virus in your body is low enough to not be detected by a test.

If you’re living with HIV, taking effective HIV treatment and being undetectable significantly reduces your risk of passing HIV on to others.

You’ll also be encouraged to:

• take regular exercise
• eat a healthy diet
• stop smoking
• have yearly flu jabs to minimise the risk of getting serious illnesses

Without treatment, the immune system will become severely damaged, and life-threatening illnesses such as cancer and severe infections can occur.

If you’re planning on getting pregnant, it’s important to talk to a GP. Although rare, it’s possible to transmit HIV to your baby.

Many types of HPV affect the mouth, throat or genital area. They’re easy to catch. You do not need to have penetrative sex.

You can get HPV from:

• any skin-to-skin contact of the genital area
• vaginal, anal or oral sex
• sharing sex toys

HPV has no symptoms, so you may not know if you have it.

HPV testing is part of cervical screening. There’s no blood test for HPV.

During cervical screening, a small sample of cells is taken from the cervix and tested for HPV.

Screening is offered to all women and people with a cervix aged 25 to 64. It helps protect them against cervical cancer.

Some sexual health clinics may offer anal screening to men with a higher risk of developing anal cancer, such as men who have sex with men.

Find out more about cervical screening and how it helps protect against cervical cancer here.

There’s no treatment for HPV. Most HPV infections do not cause any problems and are cleared by your body within 2 years.

Treatment is needed if HPV causes problems like genital warts or changes to cells in the cervix.

Read more about treating genital warts and treating abnormal cell changes in the cervix.

You cannot fully protect yourself against HPV, but there are things that can help.

Condoms can help protect you against HPV, but they do not cover all the skin around your genitals, so you’re not fully protected.

The HPV vaccine protects against the types of HPV that cause most cases of genital warts and cervical cancer, as well as some other cancers. It does not protect against all types of HPV.

Find out more about the HPV vaccine and who can have it here.

Some people with LGV may have no symptoms but can still pass on the infection to their partner(s).

Symptoms can include swollen lymph glands in the groin on one or both sides, or an ulcer or sore on the penis, vagina or around the anus.

You may notice some anal symptoms such as:

• blood or pus from the anus on underwear, or after using toilet paper
• pain in the anal area when pooing or having receptive anal sex
• constipation, painful straining or loose poos when trying to open the bowels
• a feeling of incomplete emptying after opening the bowels

If you think you may have LGV you should make an appointment with your GP or local sexual health services.

When testing for LGV, a swab is taken from the back passage (rectum), vagina, throat or an ulcer (if you have one). A pee sample can also be used.

If this sample tests positive for chlamydia and your Sexual Health Adviser or clinician thinks you might have LGV infection, the sample undergoes further testing for LGV. This can take up to three weeks.

LGV is usually treated with an antibiotic called doxycycline, which is taken twice a day for three weeks. Sometimes different antibiotics are used.

As the result of the LGV test can take three weeks to come back, your Sexual Health Adviser or clinician may advise you to start treatment before the final result is available.

If left untreated, LGV can cause scarring and swelling of the skin. It can also cause permanent swelling of the genitals. Rectal infection can also cause swelling and scarring resulting in risk of long-term bowel complications. Rarely the infection may spread via the bloodstream causing inflammation of the joints or liver.

If your infection is untreated you may pass it onto other sexual partners.

To avoid passing LGV on to your partner you should avoid having sex (this includes oral sex, and sex with condoms) until both you and your partner have finished all your antibiotic treatment.

As LGV is sexually transmitted it’s important that all the sexual partners you’ve had in the last three months are tested for LGV and other STIs too.

The main symptom of molluscum contagiosum (MC) is a number of small spots on the skin. The spots are usually firm and dome-shaped, with a small dimple in the middle. They’re usually less than 5mm (0.5cm) across, but can sometimes be bigger.

They’re typically pink or red on white skin or a beige colour on darker skin, although they may have a tiny white or yellow head in the centre. If this head splits (ruptures), a thick yellowy-white substance will be released, which is highly infectious.

It’s important not to squeeze the spots, as this will increase the risk of the infection spreading to other parts of the body.

The spots associated with MC are usually painless, although they can sometimes be itchy and some people develop areas of red, dry and cracked skin around them.

Most people have between 20 and 30 spots, although people with a weakened immune system often have more. The spots may develop in small clusters and can be spread across different parts of the body.

They’re most often found in the armpit, behind the knees or on the groin.

In a few cases, particularly when it’s spread during sexual contact, spots can develop on the genitals and nearby skin.

Visit the sexual health clinic if you notice the spots associated with MC. They’re usually easy to recognise, so they should be able to diagnose the condition without the need for further tests.

If the Sexual Health Adviser or clinician thinks the infection may be caused by something other than MC, they may want to:

• take a skin sample (biopsy) from one of the spots to test it for the molluscum contagiosum virus (MCV)
• refer you to a genitourinary medicine (GUM) clinic to be tested for sexually transmitted infections (STIs) – if you prefer, you can go to an STI clinic directly

They may refer you to a specialist in hospital if you have:

• spots on your eyelids, near your eye, or your eye is red or painful
• HIV and your symptoms are severe
• a weakened immune system for another reason – such as receiving chemotherapy

Treatment for molluscum contagiosum (MC) is not routinely recommended because most cases clear up on their own in around 6 to 18 months.

If left alone, MC does not tend to result in scarring or cause any symptoms other than spots. Squeezing or scratching the spots can cause pain and bleeding and may increase the chances of scarring. It also increases the risk of spreading the infection.

Many of the treatments available for MC can be painful or upsetting for young children and some may increase the chances of permanent scarring.

Treatment is usually only recommended for adults and older children who have spots that are particularly unsightly and are affecting their quality of life.

Treatment can also be recommended for people with weakened immune systems, as the condition can take several years to clear in these cases.

Topical treatments

There are a number of topical treatments (creams, lotions and ointments) that can be used to treat MC, although there’s not enough evidence to know if any particular treatment is more effective than the others.

• Potassium hydroxide is a medicine available in liquid form that can improve MC by breaking down the skin cells infected by the virus, allowing the immune system to tackle it. The liquid is applied twice a day on each spot. The spots should eventually become inflamed, before healing and disappearing within the next few weeks.

You should stop using the medicine once the spots have started to become inflamed, or after 14 days if the medicine does not seem to be working.

Side effects of potassium hydroxide can include redness and a slight burning or itching sensation, which usually only lasts for a few minutes after the medicine is applied.

• Podophyllotoxin comes in liquid form and poisons the cells of the spots. A special application stick is used to draw up the correct dosage of liquid, which is then dripped onto each spot. You may experience some mild irritation. The treatment needs to be applied for a few days, followed by a few days without treatment. This is referred to as a treatment cycle.

• Imiquimod is a cream that can be used to treat larger spots or large clusters of spots. Some studies have found that imiquimod is usually only effective when it is used by people with a weakened immune system. It works by stimulating your immune system into attacking the spots.

  You apply the cream to the spots, then wash it off after 6-10 hours. This should be done 3 times a week. It may take several weeks of treatment before you notice an improvement. Common side effects of imiquimod include:

• hard and flaky skin
• redness and swelling of the skin
• a burning or itching sensation after applying the cream
• headache

These side effects are usually mild and should pass within 2 weeks of stopping treatment.

• Benzoyl peroxide is usually available in cream or gel form. It’s applied to the spots once or twice a day, after washing and drying the affected area. Use benzoyl peroxide sparingly, because too much can harm your skin.

Benzoyl peroxide makes your skin more sensitive to sunlight, so either avoid excessive exposure to sunlight and sources of ultraviolet (UV) light such as sunbeds or sun lamps, or wear sun cream.

Avoid getting the medicine on hair and clothes, as it can bleach them. Wash your hands thoroughly after you finish applying the medicine.

Common side effects of benzoyl peroxide include:

• dry and red skin
• a burning, itching or stinging sensation
• some peeling of the skin

These side effects are usually mild and should resolve after the treatment has finished.

• Tretinoin is available as a liquid that’s applied once or twice a day to individual spots. As with benzoyl peroxide, tretinoin can make your skin sensitive to sunlight and UV light.

Tretinoin is not suitable for use during pregnancy because it can cause birth defects. It’s important to use a reliable method of contraception while taking tretinoin if you’re a sexually active woman.

The most common side effects of tretinoin are mild irritation and stinging of the skin. It may take several months before you notice an improvement in your symptoms.

Other treatments

There are a number of minor procedures that can help remove or destroy MC spots. They can be painful, so are not generally suitable for children. They must always be carried out by a suitably qualified healthcare professional.

• Cryotherapy involves freezing the spots with liquid nitrogen to remove them. Each spot is frozen for 5-10 seconds, so that a layer of ice forms over the spot and surrounding skin. You may need several sessions of cryotherapy before each spot clears completely. You’ll need to wait 2 to 3 weeks between each treatment session.

• Diathermy uses heat to remove the spots. The area being treated is numbed with a local anaesthetic and a heated electrical device is used to burn off the spots.
• Curettage removes spots by scraping them off with a thin, metal, spoon-like instrument called a curette. As with diathermy, you may have a local anaesthetic before having this type of treatment.
• Pulsed-dye laser treatment is a relatively new type of treatment for MC. It uses a powerful beam of light to destroy the cells that make up each spot. You may experience some skin discolouration and discomfort in the treated areas, but this should improve within a few weeks. The procedure may need to be repeated several times to clear all of your spots.

Pulsed-dye laser treatment uses expensive equipment and its availability on the NHS is limited. You’ll probably have to pay privately for the treatment, which can be expensive.

In many cases, the individual spots will start to crust over and heal within 2 months. Some people may experience mild swelling and redness around each spot as it begins to heal.

The spots do not usually leave scars, but they may leave a small area of lighter skin or a tiny pitted mark, particularly if treatment was needed.

As the virus that causes MC can spread to other parts of the body, new spots may develop as the old ones are disappearing. This can result in an episode of MC lasting for quite a long time.

Most cases clear up within around 6-18 months, but the condition can, occasionally, persist for several years.

Almost all MG infections are symptom free, lasting for months to years, and cause no harm to the human body. Very occasionally MG will infect someone who gets symptoms from it. These symptoms are different in men and women:

MG symptoms in men can include:

• pain when peeing
• white discharge from the tip of the penis
• burning or itching in the urethra (the tube that carries urine out of the body)
• discomfort or discharge from your bum – if you have had anal sex
• pain in the testicles

MG symptoms in women can include:

• pain when peeing
• unusual vaginal discharge
• pain in the tummy or pelvis
• pain during sex
• bleeding after sex
• painful bleeding between periods
• discomfort or discharge from your bum – if you have had anal sex

MG is also thought to be a potential cause of early labour and miscarriage in pregnant women. However this link is not yet well understood.

If you have any of the symptoms linked to MG we would recommend you book an appointment at one of our sexual health clinics. We will need to assess you to decide if testing or treatment for MG is recommended and we can talk you through the options.

You may have heard of MG if you have had unprotected sex with someone who has the infection. Unless you have symptoms, or are the current partner of the person who has MG, we do not recommend testing specifically for MG. However, other sexually transmitted infections such as chlamydia often don’t have any symptoms and are much more common, so we would recommend that you book an appointment and come and have a chat and a check-up.

MG is tested for by taking a swab from the vagina or bum (rectum), as well as a urine sample for men. The results will usually be available in one to two weeks.

MG is treated with antibiotics over a course of 10 days. The right choice of antibiotics is changing all the time as MG can become resistant to some treatments. We can talk you through the latest information about this. Treatment choice is also different if you have allergies or are breastfeeding or pregnant. You shouldn’t have any kind of sex, even with a condom, during your treatment.

You can avoid getting MG by using a condom whenever you have any type of sex with a partner. Wash sex toys or cover them with a condom and replace them between partners. Also, talk to your partner about their sexual history. When did they last have unprotected sex? When did they last have a test for STIs?

Non-gonococcal urethritis (NGU) can cause different symptoms in men and women. In some cases, NGU does not cause any symptoms at all.

Symptoms of NGU in men

The symptoms of NGU in men can include:

• a white or cloudy discharge from the tip of your penis
• a burning or painful sensation when you pee
• the tip of your penis feeling irritated and sore

Depending on the cause of NGU, symptoms may begin a few weeks or several months after an infection.

If NGU has a non-infectious cause, such as irritation or damage to the urethra, symptoms may begin after a couple of days.

Symptoms that start a day or 2 after sex are not usually caused by a sexually transmitted infection (STI), but testing for STIs is still recommended.

Symptoms of NGU in women

NGU usually causes no noticeable symptoms in women.

However, the infections that cause NGU in men can spread to other parts of the female reproductive system – for example, the womb or fallopian tubes, which connect the ovaries to the womb.

If the infection does spread, a woman may develop pelvic inflammatory disease (PID).

PID is a serious health condition that can cause persistent pain. Repeated episodes of PID are associated with an increased risk of infertility.

Some women with PID do not have symptoms. If there are symptoms, they include:

• pain around the pelvis or lower part of your stomach (abdomen)
• discomfort or pain during sexual intercourse that is felt deep inside the pelvis
• bleeding between periods and after sex
• pain when you urinate
• heavy or painful periods
• unusual vaginal discharge – especially if it is yellow or green

A few women with PID become very ill with:

• severe lower abdominal pain
• high temperature
• feeling and being sick

Visit your GP or sexual health clinic if you think you may have PID.

Two tests can be used to diagnose NGU, and both may be carried out to make sure the diagnosis is correct.

The tests are:

• a swab test – a sample of fluid is taken from your urethra using a swab, which is like a small cotton bud. The swab may have a small plastic loop or cotton tip at the end; it’s not painful, but can feel a little uncomfortable for a few seconds.
• a urine test – you’ll be asked not to pee for at least 2 hours before providing a urine sample as this can help make the test results more reliable

You may also be offered tests for other STIs. It’s up to you whether to have these or not, but a test for all infections is recommended. You can discuss this with healthcare professionals at the clinic if you wish.

Healthcare professionals at the clinic will tell you when you’ll get your test results, and they’ll also arrange your treatment.

Non-gonococcal urethritis (NGU) is usually treated with a short course of antibiotics to kill the bacteria that caused the infection.

The healthcare professionals at the sexual health clinic will arrange your treatment.

If your urethritis is caused by gonorrhoea, this may be treated differently.

Antibiotics

Treatment with antibiotics may be started before you receive your test results. Most people with NGU are prescribed antibiotic tablets or capsules.

This may be:

• azithromycin – a three-day course
• doxycycline – taken twice a day for 7 days

NGU is usually caused by an STI, so practising safer sex is the best way to reduce the chances of contracting it.

Safer sex involves using barrier contraception, such as condoms, and having regular checks at sexual health clinics.

Read a guide to contraception.

Complications of non-gonococcal urethritis

NGU can have some complications – for example, the condition can keep coming back.

Return to the sexual health clinic if you still have symptoms after finishing your course of antibiotics.

Serious complications are rare, but may include:

• reactive arthritis – when the immune system starts attacking healthy tissue, which can lead to joint pain and conjunctivitis
• epididymo-orchitis – inflammation inside the testicles

Women often have no symptoms of NGU. However, it can lead to pelvic inflammatory disease (PID) if it’s caused by chlamydia and left untreated.

Repeated episodes of PID are associated with an increased risk of infertility.

Sometimes normally harmless bacteria found in the vagina can get past the cervix and into the reproductive organs. Although harmless in the vagina, these types of bacteria can cause infection in other parts of the body.

This is most likely to happen if:

• you have had PID before
• there’s been damage to the cervix following childbirth or a miscarriage
• you have a procedure that involves opening the cervix (such as an abortion, inspection of the womb, or insertion of an intrauterine contraceptive device)

If an infection spreads upwards from the vagina and cervix, it can cause inflammation of the:

• womb lining (endometrium)
• fallopian tubes
• tissue around the womb
• ovaries
• lining of the inside of the abdomen (peritoneum)

Pockets of infected fluid called abscesses can also develop in the ovaries and fallopian tubes.

Sexually transmitted infections

In about 1 in 4 cases, PID is caused by a sexually transmitted infection (STI) such as chlamydia, gonorrhoea or mycoplasma genitalium.

These bacteria usually only infect the cervix, where they can be easily treated with a single dose of an antibiotic.

But if they’re not treated there’s a risk the bacteria could travel into the upper genital tract.

It’s estimated 1 in 10 women with untreated chlamydia may develop PID within a year.

If it’s diagnosed at an early stage, pelvic inflammatory disease (PID) can be treated easily and effectively with antibiotics. These can be prescribed by your GP or a clinician at our sexual health clinic.

But left untreated, it can lead to more serious long-term complications.

Find out more about the complications of PID

Antibiotics

Treatment with antibiotics needs to be started quickly, before the results of the swabs are available.

PID is usually caused by a variety of different bacteria, even in cases where chlamydia, gonorrhoea or mycoplasma genitalium is identified. This means you’ll be given a mixture of antibiotics to cover the most likely infections.

Tell your Sexual Health Adviser or clinician if you think you may be pregnant before starting antibiotic treatment, as some antibiotics should be avoided during pregnancy.

You’ll usually have to take the antibiotic tablets for 14 days, sometimes beginning with a single antibiotic injection.

It’s very important to complete the entire course of antibiotics, even if you’re feeling better, to help ensure the infection is properly cleared.

In particularly severe cases of PID, you may have to be admitted to hospital to receive antibiotics through a drip in your arm (intravenously).

If you have pain around your pelvis or tummy, you can take painkillers such as paracetamol or ibuprofen while you’re being treated with antibiotics.

Follow-up

In some cases, you may be advised to have a follow-up appointment 3 days after starting treatment so your Sexual Health Adviser or clinician can check if the antibiotics are working.

If the antibiotics seem to be working, you may have another follow-up appointment at the end of the course to check if treatment has been successful.

If your symptoms haven’t started to improve within 3 days, you may be advised to attend hospital for further tests and treatment.

If you have an intrauterine device (IUD) fitted, you may be advised to have it removed if your symptoms haven’t improved within a few days, as it may be the cause of the infection.

Treating sexual partners

Any sexual partners you have been with in the 6 months before your symptoms started should be tested and treated to stop the infection recurring or being spread to others, even if no specific cause is identified.

PID can occur in long-term relationships where neither partner has had sex with anyone else.

It’s more likely to return if both partners aren’t treated at the same time.

You should avoid having sex until both you and your partner have completed the course of treatment.

If you haven’t had a sexual partner in the previous 6 months, your most recent partner should be tested and treated.

Your Sexual Health Adviser can help you contact your previous partners. This can usually be done anonymously if you prefer.

Most women with PID who complete their course of antibiotics have no long-term problems. However, PID can sometimes lead to serious and long-term conditions – particularly if it isn’t treated with antibiotics quickly. These include:

• Repeated episodes of PID

Some women experience repeated episodes of PID. This is known as recurrent pelvic inflammatory disease. The condition can return if the initial infection isn’t entirely cleared. This is often because the course of antibiotics wasn’t completed, or because a sexual partner wasn’t tested and treated.

If an episode of PID damages the womb or fallopian tubes, it can become easier for bacteria to infect these areas in the future, making it more likely that you’ll develop the condition again.

Repeated episodes of PID are associated with an increased risk of infertility.

• Abscesses
  PID can sometimes cause collections of infected fluid called abscesses to develop, most commonly in the fallopian tubes and ovaries. Abscesses may be treated with antibiotics, but sometimes laparoscopic surgery (keyhole surgery) may be needed to drain the fluid away.

The fluid can also sometimes be drained using a needle that’s guided into place using an ultrasound scan.

• Long-term pelvic pain

Some women with PID develop long-term (chronic) pain around their pelvis and lower abdomen, which can be difficult to live with and lead to further problems, such as depression and difficulty sleeping (insomnia).

If you develop chronic pelvic pain, you may be given painkillers to help control your symptoms.

Tests to determine the cause may be carried out.

If painkillers don’t control your pain, you may be referred to a pain management team or a specialist pelvic pain clinic.

• Ectopic pregnancy
  An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes.

If PID infects the fallopian tubes, it can scar the lining of the tubes, making it more difficult for eggs to pass through.

If a fertilised egg gets stuck and begins to grow inside the tube, it can cause the tube to burst, which can sometimes lead to severe and life-threatening internal bleeding.

If you’re diagnosed with an ectopic pregnancy, you may be given medication to stop the egg growing or have surgery to remove it.

• Infertility
  As well as increasing your risk of having an ectopic pregnancy, scarring or abscesses in the fallopian tubes can make it difficult for you to get pregnant if eggs can’t pass easily into the womb.

It’s estimated about 1 in 10 women with PID become infertile as a result of the condition, with the highest risk for women who delayed treatment or had repeated episodes of PID.

But a long-term study in the US showed that women who’d been successfully treated for PID had the same pregnancy rates as the rest of the population.

Blocked or damaged fallopian tubes can sometimes be treated with surgery. If this isn’t possible and you want to have children, you may want to consider an assisted conception technique, such as IVF.

IVF involves surgically removing eggs from a woman’s ovaries and fertilising them with sperm in a laboratory, before planting the fertilised eggs into the woman’s womb.

This technique can help you get pregnant if you can’t have children naturally. But the success rate is often low, depending on your age and other factors.

Pubic lice aren’t related to poor personal hygiene. They’re usually spread through close bodily contact with an infected person.

The lice crawl from hair to hair, but can’t fly or jump. They need human blood to survive, so will only leave the body to move from one person to another.

The most common way pubic lice are spread is through sexual contact, including vaginal, anal and oral sex.

Using condoms and other methods of barrier contraception doesn’t protect you against pubic lice.

Other types of close bodily contact, such as hugging and kissing, can also spread the lice.

It’s also possible – though much rarer – for pubic lice to be spread through sharing clothes, towels and bedding.

After getting pubic lice, it can take several weeks before any symptoms appear.

Symptoms are the same for men and women, and include:

• itching in the affected areas, especially at night
• inflammation and irritation caused by scratching
• black powder in your underwear
• blue spots or small spots of blood on your skin, such as on your thighs or lower abdomen (caused by lice bites)

Itching is the most common symptom of pubic lice and is an allergic reaction to their saliva.

The itching is usually worse at night because that’s when the lice are most active.

Pubic lice are usually easy to diagnose by examining the affected area.

The clinician may use a magnifying glass to look for signs of the lice, such as pale-coloured eggs or the lice themselves.

You should be tested for other sexually transmitted infections (STIs) if you have pubic lice through sexual contact.

The lice don’t transmit HIV or other STIs, but a check-up is usually recommended as a precaution.

Any sexual partners you have had over the last 3 months will also need to be seen and treated.

If you prefer, staff at the clinic can contact a person on your behalf without releasing your details.

Pubic lice can be treated at home with insecticide cream, lotion or shampoo.

Some treatments only need to be applied to the affected area, but sometimes the whole body must be treated, taking care to avoid the eyes.

The treatment usually needs to be repeated 7 days later to get rid of any lice that have hatched during that time.

If the treatment doesn’t work, you may need to use another type. This is because pubic lice can develop resistance to some treatments. Your pharmacist or healthcare professional at our sexual health clinic will be able to advise of alternative treatments.

To prevent reinfestation, anyone you have had close bodily contact with, including any sexual partners you have had in the past 3 months, should also be treated, even if they don’t have symptoms.

Certain groups, such as young people under 18 years of age and pregnant or breastfeeding women, may require a specific type of treatment. Your pharmacist or healthcare professional at our sexual health clinic will be able to advise of alternative treatments.

Applying a lotion, cream or shampoo

In most cases the instructions for using a lotion, cream or shampoo will be as follows:

• apply the product to the affected area, such as your eyebrows, beard or moustache – depending on the product, you might need to apply it to your whole body, including the scalp, neck, ears and face
• be careful not to get the product in your eyes – if you do, rinse your eyes thoroughly with water
• reapply the treatment if you wash any part of your body during the treatment time
• after the treatment time (stated on the packet) has passed, wash the lotion or cream off
• repeat the treatment as instructed, usually after 7 days

Don’t use the medication more than twice. If you think it hasn’t worked, contact our sexual health service.

Side effects

Insecticides used to treat pubic lice may cause skin irritation, such as itchiness, redness, stinging or burning. If you have skin irritation, wash the insecticide off the affected area.

Some aqueous and alcohol-based medications may discolour permed, coloured or bleached hair. Check the patient information leaflet.

Follow-up treatment

The first treatment application will probably kill the lice, but the eggs may not have been destroyed. This means more lice could hatch and the cycle will start again.

Reapplying the treatment after 7 days will ensure that any lice are killed before they’re old enough to lay more eggs.

Check for lice 1 week after your second treatment, or return to our sexual health clinic so we can check for you. Finding empty eggshells (dead nits) doesn’t necessarily mean you’re still infested as they can remain stuck to the hairs even after treatment.

Treating an eyelash infestation

Eyelash infestations are rare. If your eyelashes are infested, seek advice from our sexual health service – we will be able to recommend the correct treatment for you.

You can’t use the same insecticide lotion or cream that’s used on your body as it will irritate your eyes. Make sure you follow the treatment instructions carefully.

Washing clothing, towels and bedding

Wash clothing, towels and bedding in a washing machine. This should be on a hot cycle (50C or higher) to ensure the lice are killed and to prevent reinfection.

Sometimes a pubic lice infestation can lead to minor complications, such as skin or eye problems. Scratching can irritate your skin, or it could lead to an infection such as impetigo (a bacterial skin infection) or furunculosis (boils on the skin).

Eye infections, such as conjunctivitis, and eye inflammation, such as blepharitis, can sometimes develop if your eyelashes have been infested with pubic lice.

You may also have a mild fever or feel tired and run down.

Seek medical advice if you have severe skin irritation or sore eyes.

Symptoms can take up to 6 weeks to start to appear. You may notice:

• intense itching in the affected area which may become worse in bed at night or after a hot bath or shower
• an itchy red rash or tiny spots
• inflammation or raw, broken skin in the affected areas – usually caused by scratching
• fine silvery lines are sometimes visible in the skin where mites have burrowed

Scabies mites are too tiny to see with the naked eye, but sometimes signs of scabies will be noticed during a routine genital or medical examination.

The mites which cause scabies can be found in the genital area, on the hands, between the fingers, on the wrists and elbows, underneath the arms, on the abdomen, on the breasts, around the nipples in women, on the feet and ankles, and around the buttocks.

You can only be certain you have scabies if you have a check-up.

You can book an appointment at one of our clinics and have a check-up as soon as you have signs or symptoms, or if you think you may have been in contact with scabies.

A clinician can often tell if you have scabies just by looking at the affected areas. In some cases, treatment will be suggested if scabies is suspected, even if it can’t be confirmed.

Your GP or pharmacy can also help, although you may have to pay for treatment.

Scabies is not usually a serious condition, but it does need to be treated. One of our healthcare professionals will recommend a cream or lotion that you apply over your entire body, from the neck downwards and rinse off after 12 hours. This is best done overnight.

You will need to repeat the treatment 1 week later.

If you use the treatment according to the instructions, it’s rare for it not to work. Even after successful treatment, the itching or rash may continue for a few weeks. Special tablets or creams (antihistamines), or anti-irritant lotions such as calamine, can ease the itching.

If your skin is still itching 4 weeks after treatment has finished, seek advice from your pharmacist or sexual health clinic.

Things you can do during treatment to stop scabies spreading

Do

• wash all bedding and clothing in the house at 50C or higher on the first day of treatment
• put clothing that cannot be washed in a sealed bag for 3 days until the mites die
• stop babies and children sucking treatment from their hands by putting socks or mittens on them

Don’t

• have sex or close physical contact until you have completed the full course of treatment
• share bedding, clothing or towels with someone with scabies

How long does it take to get rid of scabies?

You or your child can go back to work or school 24 hours after the first treatment.

Although the treatment kills the scabies mites quickly, the itching can carry on for a few weeks.

Some people get no symptoms at all. Others have very mild symptoms which will seem to clear up on their own – they will remain infected though unless it is treated. Noticeable symptoms of syphilis can include:

• small, painless sores or ulcers that appear on the penis, vagina, or around the anus, but can occur in other places such as the mouth. These can also occur inside the anus, and because they aren’t sore, you may not realise you have them. These can take 2 – 6 weeks to disappear and are highly infectious!
• a blotchy red rash that often affects the palms of the hands or soles of the feet – this isn’t always itchy
• small skin growths that look like genital warts, that may develop on the vulva in women or around the anus in both men and women
• white patches in the mouth
• flu-like symptoms, including tiredness, headaches, joint pain, high temperature and swollen glands in your neck, groin or armpits.

If syphilis is left untreated it can spread to the brain or other parts of the body and cause serious, long-term health problems. Early diagnosis is key.

You’ll be asked about your sexual history, and whether you’re experiencing any symptoms.

To diagnose syphilis, you’ll usually have a:

• physical examination – a clinician will ask to examine your genitals (and inside the vagina for women) or other parts of your body to look for growths or rashes that may be caused by syphilis
• blood test – this can show whether you have syphilis or have had it in the past; repeating the test a few weeks later may be recommended if it’s negative, in case it was too early to give an accurate result
• swab test – a swab (similar to a cotton bud) is used to take a small sample of fluid from any sores, so it can be checked for syphilis

You should also be tested for other STIs, such as chlamydia and gonorrhoea, as it’s possible to have more than one STI at a time. Some results may be available the same day, while others may take a week or two to come back.

You should avoid having sex or close sexual contact with anyone else until you get your test results.

A short course of antibiotics can usually cure syphilis. These are only available on prescription, so you’ll need to be tested for syphilis to get them.

The type of treatment you need depends on how long you’ve had syphilis.

Syphilis that has lasted less than 2 years is usually treated with an injection of penicillin into your buttocks, or a 10-14 day course of antibiotic tablets if you can’t have penicillin.

Syphilis that has lasted more than 2 years is usually treated with 3 penicillin injections into your buttocks given at weekly intervals, or a 28-day course of antibiotic tablets if you can’t have penicillin.

More serious cases that affect the brain are usually treated with daily penicillin injections given into your buttocks or a vein for 2 weeks, or a 28-day course of antibiotic tablets if you can’t have penicillin.

Follow-up blood tests will be recommended once treatment finishes to check that it has worked.

You should avoid any kind of sexual activity or close sexual contact with another person until at least two weeks after your treatment finishes. Unfortunately, you can catch syphilis more than once, even if you have been treated.

Side effects of treatment

You may experience some side effects shortly after treatment. Around 2 in every 5 people experience short-lived flu-like symptoms, such as:

• a high temperature (fever)
• headaches
• muscle and joint pain

These symptoms usually only last 24 hours and can often be treated with paracetamol. Seek medical advice if they’re severe or don’t settle down.

There’s also a risk of having an allergic reaction shortly after a penicillin injection. You’ll be monitored after treatment to check for this and will be treated if it occurs.

When should I get tested for syphilis?

You should get tested for syphilis if:

• you’re worried you might have it
• a sexual partner has been diagnosed with syphilis
• you have symptoms of syphilis

It’s particularly important to get tested in these cases if you’ve had sex without a condom (unprotected sex), you have multiple sexual partners, you’re a man who has sex with men, or you’ve had sexually transmitted infections (STIs) in the past.

The best place to get tested for syphilis is a sexual health clinic. These clinics are staffed by healthcare professionals with special expertise in STIs. They tend to have easier access to the tests and treatments for syphilis than your local GP surgery.

You also don’t have to pay for treatment if you go to a sexual health clinic. If you go to your GP surgery for treatment, you may have to pay a prescription charge.

Can I have sex during treatment?

Avoid any kind of sexual activity or close sexual contact with another person until at least 2 weeks after your treatment finishes. This includes vaginal, anal and oral sex, as well as close skin contact.

If you have sex during treatment, you could become infected again, or pass the infection on to someone else.

Should I tell my partner?

Your current and previous sexual partners should be tested and treated for syphilis as well, as leaving the infection untreated can lead to serious problems.

How far back you need to go depends on how long you had syphilis before it was diagnosed and treated.

You can choose to either notify your previous sexual partners yourself, with support from clinic staff, or the clinic can contact them by letter or phone and advise them to go for a check-up.

If the clinic contacts your previous sexual partners for you, your details will remain totally confidential and no information about you will be given out without your consent.

How can I avoid getting syphilis?

Wear a condom during any sexual activity, including vaginal, anal or oral sex. This isn’t 100% effective, but it’s the best way of avoiding an infection. Use a condom or dam (a latex or soft plastic square) to cover the genitals during oral sex. Wash sex toys or cover them with a condom and replace it between partners.

Also, talk to your partner about their sexual history. When did they last have unprotected sex? When did they last have a test for STIs?

I’m pregnant – should I be worried?

All pregnant women are offered a blood test to check for syphilis, usually at around 8-12 weeks of pregnancy. A syphilis infection during pregnancy can be very dangerous for the baby, but the screening test can help ensure it’s detected and treated as soon as possible.

The test can be repeated if there’s a risk you may have been exposed to syphilis later in your pregnancy.

Pregnant women with syphilis can be safely treated with antibiotics. The treatment you need depends on how long you’ve had syphilis and how far along in your pregnancy you are.

Pregnant women who’ve had syphilis for less than 2 years are usually treated with an injection of penicillin into the buttocks (if treated during the first or second trimester) or 2 injections given a week apart (if treated during the third trimester).

Pregnant women who’ve had syphilis for more than 2 years are usually treated with 3 penicillin injections into the buttocks given at weekly intervals.

A short course of antibiotic tablets may be needed if you can’t have penicillin.

Thrush is not classed as a sexually transmitted infection (STI), although the irritation it causes can also affect your partner when you have sex. Some of the symptoms (signs) of thrush can be similar to those of other STIs.

Common symptoms of thrush are redness, itching and discomfort in the genital area, as well as pain or discomfort when having sex or peeing (urinating). Additional symptoms include;

Women

• Itching and irritation of the vulva (lips) or vagina
• Thick white discharge – sometimes described as like ‘cottage cheese’ – which does not usually smell
• Soreness and stinging during sex, or when you pee

Men

• Irritation, burning and redness around the head of the penis and under the foreskin
• Difficulty in rolling the foreskin back
• White, creamy substance under the foreskin (like cottage cheese)
• An unpleasant smell

Thrush has very similar symptoms to a lot of sexually transmitted infections, so if you have had unprotected sex, or if this is your first time having thrush, then we would recommend that you make an appointment with us.

Thrush in other areas

Thrush can affect other areas of skin, such as the armpits, groin and between the fingers. This usually causes a red, itchy or painful rash that scales over with white or yellow discharge. The rash may not be so obvious on darker skin.

Sometimes thrush causes no symptoms at all.

When you visit our sexual health clinic we will want to confirm it’s thrush and rule out other infections.

You’ll be asked about your symptoms. If it’s not clear it’s thrush:

• a clinician may look at your vagina, penis or skin
• a cotton bud may be wiped over the discharge to test for other infections

You’ll usually need antifungal medicine to get rid of thrush. This can be a tablet you take, a tablet you insert into your vagina (pessary) or a cream to relieve the irritation.

Thrush should clear up within 7 to 14 days of starting treatment.

You do not need to treat partners unless they have symptoms.

Recurring thrush

You might need to take treatment for longer (for up to 6 months) if you keep getting thrush (you get it more than 4 times in 12 months).

A GP or sexual health clinic can help identify if something is causing your thrush, such as your period or sex.

They’ll recommend how often you should use treatment.

A pharmacist can help with thrush

If you have had thrush before and are certain that it is the cause of your discomfort, then you can get medication over the counter at a pharmacy. A pharmacist can recommend the best treatment for you. Ask if they have a private area to talk if you’re embarrassed.

You should not use antifungal medicine more than twice in 6 months without speaking to a pharmacist, consulting the sexual health service, or talking to your GP.

Things you can do yourself to ease discomfort and prevent thrush returning

Do

• use water and emollient (like E45 cream) instead of soap to wash the affected area
• dry properly after washing
• wear cotton underwear
• avoid sex until thrush has cleared up if sex is uncomfortable

Don’t

• use soaps or shower gels
• use douches or deodorants on your vagina or penis
• wear tight underwear or tights

Important

If you have sex during treatment, be aware that antifungal creams can damage condoms and diaphragms. This means your contraception might not work.

Over half of women with TV won’t know they have the infection, and it is unusual for men to develop any symptoms at all – although they can still pass the infection on to others.

If a person does have symptoms they usually show within about a month of contact with the infection.

The symptoms of TV are similar to those of many other sexually transmitted infections (STIs), so it can sometimes be difficult to diagnose.

Symptoms in women

TV in women can cause:

• abnormal vaginal discharge that may be thick, thin or frothy and yellow-green in colour
• producing more discharge than normal, which may also have an unpleasant fishy smell
• soreness, swelling and itching around the vagina – sometimes the inner thighs also become itchy
• pain or discomfort when passing urine or having sex

Symptoms in men

TV in men can cause:

• pain when peeing or during ejaculation
• needing to pee more frequently than usual
• thin, white discharge from the penis
• soreness, swelling and redness around the head of the penis or foreskin

All of the above symptoms can also be the sign of other common infections, so if you are sexually active and notice anything different from normal, it’s important to contact us for advice.

TV is tested for by taking a sample from the vagina in women and performing a laboratory test. If the test shows TV is present, the infection is treated with a course of antibiotics. It is not normally possible to test men for TV; they usually get treated when a female partner is diagnosed with the infection.

If the test shows you have TV, it’s important that your current sexual partner and any other recent partners are also tested and treated.

TV is unlikely to get better on its own and is easily treated with an antibiotic tablet called metronidazole. Sometimes this is taken as a large single dose, but more commonly you take the tablets twice a day for 5-7 days.

When you take metronidazole you will be advised to avoid alcohol for the days you are taking the medication, plus 48 hours after the last tablet is taken. This is because alcohol interacts with this antibiotic and will make you feel very unwell.

Most people notice an improvement in their symptoms within a few days of starting the medication, but it is important to take all of the medication you are given to ensure it is properly treated.

Your current sexual partner and any other recent partners should also be treated.

How can I avoid getting trichomonas vaginalis (TV)?

Use a condom when having sex with new or unknown partners. Talk to partners about their sexual health and ask if they have been tested for STIs since their last sexual partner. If they haven’t been tested before, encourage them to attend a sexual health clinic or use condoms until they have had tests to show they have no STIs.

Limiting the number of people you have sex with also reduces the chance that you will come into contact with TV, and all other STIs.

Carefully disinfect and clean any sex toys between uses.

Can TV make me infertile?

Serious complications with TV are rare. It does not usually cause infertility. Other more common STIs can cause problems with fertility, so if you have had unprotected sex (sex without a condom) with a new partner it is important to attend a sexual health clinic for STI testing, even if you feel normal and don’t have any symptoms.

How soon after treatment can I start having sex again?

It is important to avoid sex completely (even with a condom) until 7 days after you and your partner have completed treatment. Sometimes a follow-up test is done to check the infection has cleared – this is especially important if you are pregnant. If you continue to have symptoms after treatment, you should avoid sex until all test results are known, in case there is another infection present which may need additional treatment.