11. Watch What You Catch! Close the Door on Sexually Transmitted Infections

Sexually transmitted infections (STIs) are on the rise in Irish men. In the last few years, Ireland has fallen victim to a silent epidemic of sexually transmitted infections. One of the consequences of the Celtic Tiger has been the explosion in relatively cheap foreign travel opportunities. However, in some cases, men are bringing back much more than their suntan and duty-free. Despite all the information available about the importance of safe sex, more men than ever are becoming infected with STIs. Risk-taking behaviour is described as being a naturally male thing, particularly for young men. Many men continue to play Russian roulette with their sexual health.

Sexually transmitted infections (STIs) are diseases or infections that are transmitted by oral, anal or vaginal sexual intercourse. They are caused by bacteria, viruses and other organisms that can be present in blood, semen, bodily fluids or the pubic area of an infected person.

Sexually transmitted infections are one of the ways in which we pay for being irresponsible when we are sexually active. This price, for many men, can be a heavy one.

HIV infection is undoubtedly the most serious of all STIs, as it remains incurable. HIV can be fatal or at best lead to chronic lifelong illness requiring daily medication. Hepatitis B and C infections can cause chronic liver disease or liver cancer. Syphilis can actually lead to insanity if left untreated. Herpes, once caught, is a friend for life. Other infections like chlamydia can damage the reproductive organs in women, leading to long-term infertility, which can have devastating consequences for couples trying to conceive a baby. Other STIs may not pose the same degree of threat to personal health, but that does not mean that they cannot cause both pain and embarrassment, not to mention long-term health problems.

Unprotected sex with a variety of partners will inevitably lead to a sexually transmitted infection at some stage. These encounters often occur within the context of too much alcohol or other drugs, when one’s guard is down. Alcohol or illicit drugs will lower inhibitions and cloud one’s ability to judge safe sexual activity from irresponsible sex.

STIs tend to hunt in packs, so if you get one STI then you are more likely to have another. The fact that STI rates continue to rocket in Ireland amongst Irish men indicates either a lack of knowledge about the risks or a ‘could not happen to me’ attitude of denial. The more irresponsibly one behaves sexually, the greater the chance of becoming infected. Remember, sleeping with a new partner is like sleeping with everyone they have ever slept with.

It is not possible to judge whether a person is infected with an STI by sight – it requires medical testing, which is why it is safest to take precautions when having sex. Your lover may not even know themselves if they have an infection. Sometimes it can be difficult to detect an STI infection. Whenever an obvious symptom does develop you should visit your GP or local STI clinic.

If you are sexually active and notice any of the following symptoms, you should make an appointment to see your doctor as soon as possible:

Remember, not all STIs have symptoms. Men often have no symptoms. Because of this fewer men seek treatment, and many are carriers without even knowing it. People who have no symptoms can still have an STI and can spread it to others.

If you have symptoms that suggest an STI or if you have had unprotected sex, do not delay to get yourself checked out. This can be done confidentially by your own family doctor, or alternatively you can go to an STI clinic.

The sooner an STI is diagnosed and treated, the greater the chance of it being properly treated without complications. It is also important to alert your partner, as they need to be examined and treated if necessary. Diagnosis usually involves analysis of swabs taken from any unusual sores or discharge. In some cases a urine or blood test is also required. Do not be embarrassed; it is worse to live in ignorance than to put your own long-term health and that of your partner at risk.

This is the most common STI in Ireland. Genital warts are caused by the human papillomavirus (HPV), which is a cousin of the virus that causes hand warts. Genital warts are highly contagious and can have a very long incubation period, meaning they may not appear for up to a year after exposure. Genital warts in themselves are not a serious infection in men but they may indicate the presence of other STIs, which must be screened for and appropriately treated.

Infection with the human papillomavirus is the leading cause of cervical cancer in women. Therefore wearing a condom can not only protect you against acquiring sexually transmitted infections but can also potentially protect your partner against cervical cancer.

Genital warts are small cauliflower-shaped growths usually seen on the penis. Warts can also appear on the scrotum or around the anus and may spread around the anus without you having had anal sex. Sometimes the warts can be seen around and in the mouth and throat of those who have had oral sex with an infected person.

Genital warts are treated with lotions or creams prescribed by your doctor. Sometimes the warts can be frozen off with liquid nitrogen in a process known as cryotherapy. It is probable that you may require more than one type of treatment before the warts go. Unfortunately, like most viruses, there is no treatment that will get rid of the virus itself. The genital warts can be treated; however, they may reappear at a later stage.

Pubic lice or ‘crabs’ are crab-shaped insects that can take up residence in the pubic hair. Crabs like the warm moist areas of our bodies so can also be found in the armpits, in facial hair and sometimes even in eyelashes. The adult lice feed on human blood and lay their eggs, or nits, on the hair shafts close to the skin.

You get crabs by direct close physical contact with someone who already has them. They can occasionally be caught from the towels, bed sheets or clothes of an infested person. The lice can only survive for between 24 and 48 hours away from the human body.

Pubic lice can cause severe itch in the genital area. The lice may be seen crawling around on the pubic area. The eggs of the lice may be seen as black specks on pubic hair. After the eggs hatch a baby louse, called a nymph, emerges. They are smaller versions of the adults they become after seven days. Adult crabs are visible to the naked eye but because of their gray, white or brown colour are difficult to see as they can easily blend in with their surroundings. You may see faint blue spots where they have bitten you.

There are a number of topical treatments available either from your pharmacy or on prescription from your doctor. It is important to follow the instructions carefully. This includes all appropriate measures to prevent re-infection such as:

Chlamydia (pronounced klam-id-e-a) is a sexually transmitted infection that is easy to pass on during unprotected sexual contact through vaginal, anal or oral sex. Chlamydia infection is common among sexually active men. It often has no symptoms and is therefore known as a silent infection.

Men with chlamydia can have a penile discharge. Chlamydia can cause pain and discomfort while urinating. It can also cause you to urinate more often and you can have a burning and itching sensation around the opening of the penis. Sometimes it can cause swelling of the lining of the testicles, which is known as epididymitis. It can also lead to inflammation of the prostate gland, known as prostatitis. Untreated chlamydia can lead to eye problems and a form of arthritis known as Reiter’s syndrome.

Unfortunately chlamydia can be an even more serious infection for women, causing pelvic inflammatory disease, ectopic pregnancy and sometimes infertility.

Chlamydia is diagnosed in men by either a urine test or by taking a swab from the penis. It is easily treated with antibiotics. It is important if you have chlamydia that you abstain from sexual intercourse until you and your sexual partner have completed treatment. If you don’t, you will simply get re-infected. A test to ensure you are cured can be carried out several weeks after treatment but is generally not necessary. Unfortunately, there are many men out there who don’t know they have chlamydia, with the result that they are infecting and sometimes re-infecting their female partners.

Gonorrhoea is a bacterial infection commonly known as ‘the clap’. Gonorrhoea is caused by bacteria called Neisseria gonorrhoeae , which love the warm, moist linings of the mouth, rectum, vagina and urethra. Gonorrhoea can be successfully treated with antibiotics. There are about 200 million cases of gonorrhoea worldwide.

Symptoms can develop up to a month after exposure and include discomfort in the penis, a discharge from the tip of the penis, and pain or a burning sensation when urinating. This discharge is often greenish or yellow in colour. Other symptoms may include painful testicular swelling or inflammation of the prostate gland. About one in ten infected men will not have any symptoms of gonorrhoea.

Gonorrhoea infection following anal sex can result in soreness and itching with a possible anal discharge. Sometimes this is accompanied by severe pain, especially when defaecating. On the other hand, there may be no symptoms except a moist feeling in the rectum. The infection is passed on during subsequent anal intercourse.

In order to test for gonorrhoea, swabs are taken from the urethra and throat, and a rectal swab is also taken if applicable, and these are examined under the microscope.

Treatment for gonorrhoea with antibiotics is usually successful. A new drug-resistant strain of gonorrhoea, now found in many countries, can make treatment more difficult. A second test is needed following treatment to confirm that the infection has gone. Untreated gonorrhoea can lead to a form of arthritis. It is also important that your partner is tested and appropriately treated because, in women, untreated gonorrhoea can lead to infertility.

Syphilis is a sexually transmitted disease that has been around since at least the sixteenth century. It is caused by bacteria called Treponema pallidum, which like the warm moist linings of the genital passages, rectum and mouth, but die quickly outside the body. Syphilis is commonly known as ‘the pox’ and it has been called ‘the great mimic’ because it can produce so many different symptoms in the body.

Syphilis often begins with a crusty sore on the penis. Swelling of the glands in the groin may occur. The sore heals after a few weeks without treatment. However the syphilis bug has not gone away and it continues to spread throughout the body. After several weeks you may start to feel unwell, with flu-like symptoms, swollen glands and a rash. These symptoms can last for several months.

The main treatment for syphilis is antibiotics, usually penicillin, which can completely cure it. Without treatment, syphilis can hide in the body for many years before reappearing to potentially cause blindness, dementia, insanity or death from a ruptured aneurysm.

Genital herpes is caused by the herpes simplex virus type 2 (HSV-2). This is related to the herpes simplex virus type 1, which causes cold sores on the mouth or lips. Symptoms are tiny blisters on the penis, sometimes with a temperature, tiredness and swollen glands in the groin region. This tends to occur within about a week of exposure to the herpes virus. Without treatment, genital herpes tends to settle down after a week or so. However the infection can reoccur at any time, even without further sexual exposure. Antiviral medication can speed recovery from outbreaks of herpes, but it is not curable.

The hepatitis A virus is not an STI. However the hepatitis B and C viruses can be spread through sexual contact or by the exchange of bodily fluids, such as blood, saliva or urine, with an infected person. Symptoms include tiredness, jaundice and flu-like aches and pains.

These viruses can cause serious liver inflammation, which may lead to liver damage, liver failure and liver cancer. Infection is confirmed by means of a blood test. There is an excellent vaccine to protect against hepatitis B, which can be given to people at risk of infection. Hepatitis C can be treated with certain antiviral agents. Unfortunately there is no vaccine available to protect against hepatitis C.

Since it was first identified about twenty-seven years ago, HIV has become a global catastrophe, infecting millions of people annually. HIV is an extremely deadly virus because it affects our natural immune system. It destroys the white blood cells that are needed to fight infection. By destroying the body’s own immune system the floodgates to infection are opened. Therefore the system becomes overrun with bacterial, fungal and viral infections. Fortunately, medical breakthroughs in recent years have led to the development of new antiviral medicine: anti-HIV drug ‘cocktails’. These allow many people to survive HIV/AIDS and live active lives. To benefit most from these antiviral drugs, HIV/AIDS must be diagnosed early.

If you have had unprotected exposure to the HIV virus, make sure to get yourself tested. Blood tests can accurately diagnose HIV. However, there is a recognised window period, meaning that it may take some time – at least three months and sometimes longer – after unprotected exposure to HIV before the test may show up positive in your blood.

Early signs of HIV/AIDS infection can include flu-like symptoms, unexplained rashes, fungal infections in the throat, swollen glands and unusual tiredness. These symptoms and signs are similar to many different flu-like or viral infections and diseases. The person appears to recover, usually between a week and a month later. Often, however, early infection with HIV/AIDS has no symptoms.

Later signs and symptoms of HIV/AIDS can include rapid weight loss, dry cough, fevers or night sweats, fatigue, swollen lymph glands in the armpits, groin or neck, recurrent infections such as chest infections, pneumonia or candida infections (thrush) in the mouth, memory loss and depression. At this stage the person is said to have progressed from having a HIV infection to having full-blown AIDS. As the disease progresses and the immune system is weakened further, cancers and other life-threatening infections can occur.

Many people who carry the HIV virus don’t know they are infected; that’s why being tested is so important. If you are sexually active with more than one partner – or have any reason to think you might have been exposed to HIV in the past – go to your doctor and discuss whether you should be screened or not.

Yes, in fact STIs are easily prevented. The only foolproof way is to avoid sex. The next best way to prevent an STI is simply to have sex with an uninfected partner in the context of a monogamous, faithful relationship. The third way is to always practise safe sex. Using condoms that prevent the sharing of body fluids cuts down on the likelihood of cross-infection, but occasionally they do fail during use. However, they are still highly effective at preventing the spread of STIs.

There is no doubt that there is a big knowledge deficit among men when it comes to men’s sexual health issues, as with other health-related areas. The challenge is to provide information and education about sexually transmitted infections so that men can make informed choices. It is also important that equal emphasis is put on alcohol and drug awareness as unplanned sexual encounters often occur in the context of alcohol and/or drug use.

Because the pill is taken by many women to prevent pregnancy, men may feel they are off the hook when it comes to taking responsibility for sexual health issues. If avoiding pregnancy is your aim then the birth control pill can be quite effective, though not 100 per cent so. However, the pill is of no use whatsoever in blocking the transmission of an STI. Only condoms have been demonstrated to prevent the spread of STIs during sexual contact. However, it seems that even the fear of catching AIDS has not stopped people from having unsafe sex. Like most things in life, using a condom is simple once you know how. Condoms help prevent the spread of sexually transmitted infections and can also be an effective form of family planning.

Some men are allergic to latex products, including condoms. Most condoms are made of latex so men with a latex allergy should consider using a natural membrane, but these are less effective in terms of preventing pregnancy, so additional precautions should be taken.

Some of the Reasons for Condom Failure

Condoms breaking during sex – condoms can sometimes break, especially with vigorous sexual activity.
Defective condoms – the kitemark standard shows that the manufacturer tests their products to a high standard. Tests on condoms include water volume and air burst tests, but not a friction test.
Not using appropriate lubricant – if you are using a lubricant make sure it is water- or silicone-based, such as glycerin or lubricating jellies (which can be purchased at any pharmacy). NEVER use oil-based lubricants such as petroleum jelly, cold cream, hand lotion or baby oil with a condom as they will weaken the condom and can cause it to disintegrate.
Using an expired condom – take the expiry date seriously, because condoms can lose their elasticity and become defective. After that date, the condom may not provide the protection you need to avoid pregnancy or infection.
Re-using condoms – remember always use a new condom each time you have sex. Never re-use a condom and always dispose of it after use.

If you do not protect yourself each time you have sex then you risk getting and passing on a sexually transmitted infection.

Sexually transmitted infections are on the increase.
These infections may have no symptoms.
There can be serious long-term effects.
Be responsible and practise safe sex.
Wear a condom.
Remember ABC – Abstinence; Be faithful; use a Condom.