tag:theconversation.com,2011:/us/topics/gonorrhoea-12387/articlesGonorrhoea – The Conversation2023-06-09T10:42:20Ztag:theconversation.com,2011:article/2073442023-06-09T10:42:20Z2023-06-09T10:42:20ZGonorrhoea and syphilis diagnoses are at their highest in decades – here’s what you need to know about these STIs<figure><img src="https://images.theconversation.com/files/531101/original/file-20230609-5823-jorbr6.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C3500%2C2488&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gonorrhoea is now the second most commonly diagnosed STI in the UK.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendering-neisseria-gonorrhoeae-bacteria-640972273">Peddalanka Ramesh Babu/ Shutterstock</a></span></figcaption></figure><p>The <a href="https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2022-report#:%7E:text=The%20most%20commonly%20diagnosed%20STIs,herpes%20(24%2C910%2C%206.4%25).">latest data</a> from the UK Health Security Agency shows that diagnoses of gonorrhoea and syphilis have surged in the last year. Shockingly, gonorrhoea rates are the highest they have been since records began in 1918.</p>
<p>Gonorrhoea has increased from 71,133 diagnoses per year before the pandemic to 82,592 in 2022. It’s now the second most commonly diagnosed STI behind chlamydia. In people aged 15-24, rates of gonorrhoea almost doubled in 2021 compared to the year before. Syphilis, which in the early 2000s was almost non-existent in the UK, has increased to 8,692 diagnoses in 2022.</p>
<p>Both these sexually transmitted infections were known by Victorian society. Syphilis was especially feared because of the visible and debilitating symptoms it causes. But the advent of testing and antibiotic treatment has meant most people have forgotten about them – and the risks they can pose. </p>
<h2>What symptoms do they cause?</h2>
<p><em><strong>Gonorrhoea</strong></em></p>
<p><a href="https://www.nhs.uk/conditions/gonorrhoea/">Gonorrhoea</a> is caused by a small round bacteria called gonococcus which infects the urethra, testes, prostate and anus in men, and the vagina, cervix, womb and anus in women. It’s passed from one person to another during unprotected sex. </p>
<p>Untreated, it causes a pus-filled discharge or “drip” from the penis and severe pain while urinating. In women symptoms can be less obvious, but include a watery, green, yellow or sometimes bloodstained vaginal discharge, and pain when urinating.</p>
<p>If the infection spreads to the womb and ovaries this causes <a href="https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/">pelvic inflammatory disease</a>. Symptoms include fever and abdominal pain. Pelvic inflammatory disease is treatable but can lead to long-term complications even after the infection has subsided – including fertility problems and greater chance of ectopic pregnancies.</p>
<p>Gonorrhoea used to be easily treated by antibiotics. But in the last ten years, several <a href="https://www.cdc.gov/std/gonorrhea/drug-resistant/default.htm">extremely drug resistant strains</a> have been detected worldwide (including in the UK), making some infections difficult to treat. Drug resistant strains can happen when an infection is partially treated with the wrong antibiotic, or if a person stops treatment before the infection is completely gone. There’s a real and frightening risk that <a href="https://www.who.int/en/news-room/detail/07-07-2017-antibiotic-resistant-gonorrhoea-on-the-rise-new-drugs-needed">gonorrhoea could become untreatable</a> once again, as it was in the 19th century. </p>
<p>For this reason, it’s essential to get diagnosed and treated if you’re experiencing any symptoms. Current treatment involves an <a href="https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/gonorrhoea#:%7E:text=Gonorrhoea%20is%20treated%20with%20antibiotics,it%20more%20difficult%20to%20treat">injection of a single antibiotic</a> alongside close follow-up to ensure the infection is eliminated.</p>
<p><em><strong>Syphilis</strong></em></p>
<p>Syphilis is much less common than gonorrhoea, but it can cause much more harm. </p>
<p>The infection is caused by a small spiral bacterium called <em><a href="https://youtu.be/qL1T4_Dj6n8">Treponema pallidum</a></em>. Without treatment, this bacterium stays in the body and can cause complications that can happen 20 years or more after the infection.</p>
<p>It can also be passed from mother to baby in the womb, and can cause stillbirth or congenital syphilis. This means the child is born infected with syphilis and may develop the <a href="https://rarediseases.org/rare-diseases/congenital-syphilis/#symptoms">unpleasant complications</a> of the infection in childhood. Every pregnant woman in the UK is <a href="https://www.nhs.uk/pregnancy/your-pregnancy-care/screening-for-hepatitis-b-hiv-and-syphilis/#:%7E:text=During%20your%20pregnancy%2C%20you'll,booking%20appointment%20with%20a%20midwife.">screened for syphilis</a>. If detected, the mother will be treated – which also protects the baby from harm.</p>
<p>Syphilis causes <a href="https://www.nhs.uk/conditions/syphilis">three stages of disease</a>. The first stage is a painless lump or ulcer on the genitals or infected area. This usually goes away in a matter of weeks. The second stage is a full-body rash, sometimes with a sore throat and swollen lymph glands. These symptoms can also settle without treatment, though the person remains infected and infectious. The disease now enters a latent phase where it stays in the body while showing no symptoms. It can also still be passed to sexual partners or from pregnant women to their babies. </p>
<figure class="align-center ">
<img alt="A digital drawing of the bacterium Treponema pallidum" src="https://images.theconversation.com/files/531100/original/file-20230609-15-xewjit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531100/original/file-20230609-15-xewjit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531100/original/file-20230609-15-xewjit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531100/original/file-20230609-15-xewjit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531100/original/file-20230609-15-xewjit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531100/original/file-20230609-15-xewjit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531100/original/file-20230609-15-xewjit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Syphilis is caused by the bacterium <em>Treponema pallidum</em>.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/treponema-pallidum-syphilis-bacterium-responsible-dangerous-299898134">Peddalanka Ramesh Babu/ Shutterstock</a></span>
</figcaption>
</figure>
<p>In about <a href="https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/syphilis#:%7E:text=The%20third%20stage%20(tertiary%20syphilis)&text=Up%20to%201%20in%203,body%20the%20infection%20spreads%20to.">a third of infected people</a> who are untreated, the disease can return after a number of years as the third stage of <a href="https://www.osmosis.org/answers/tertiary-syphilis">tertiary syphilis</a>. This causes a range of symptoms which were dreaded in the years before effective treatment – including skin and bone disfigurations, nerve pain, heart problems, deafness, blindness, dementia and other neurological symptoms such as difficulty walking and incontinence.</p>
<p>Fortunately syphilis is still <a href="https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/syphilis/treatment-follow-up.html#a2">very treatable using penicillin</a> or similar antibiotics. As you might expect, once a case is diagnosed, great efforts are made not only to cure the affected person, but to <a href="https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/canadian-guidelines/syphilis/treatment-follow-up.html#a4">trace and screen sexual partners</a> – going back many years if necessary.</p>
<h2>Why have rates increased?</h2>
<p>It’s not entirely clear why rates of syphilis and gonorrhoea have increased so rapidly in the UK. In part it may be due to a “bounce back” from the restrictions of the pandemic years, and the fact that people were <a href="https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2022-report#overall-trends">not able to access diagnosis and treatment</a> as readily during that time.</p>
<p>Young people may also have <a href="https://mashable.com/article/online-sex-education-covid-pandemic">missed out on sex education</a> during the pandemic and may not know how to properly protect themselves from STIs. </p>
<p>Sexual health services in England have also experienced <a href="https://www.kingsfund.org.uk/blog/2018/12/sexual-health-services-and-importance-prevention">funding cuts</a> – making it more difficult for some people to access sexual health advice, diagnosis and treatment. Data shows that rates of gonorrhoea in particular are <a href="https://www.futuremedicine.com/doi/10.2217/fmb.14.110">sensitive to social and political change</a>, including changes to funding for sexual health services.</p>
<h2>What can I do to protect myself?</h2>
<p>The best way to protect yourself and your partners against gonorrhoea or syphilis is to get tested before starting a new relationship, and to use condoms with new or casual sexual partners.</p>
<p>If you have a symptom you’re worried about, get it checked. Self-test kits for gonorrhoea and syphilis are <a href="https://sh24.org.uk/stis/gonorrhoea">available online in some areas</a> or you can go to a sexual health clinic if you prefer.</p>
<p>If you’re notified by a partner or clinic that you’ve been in contact with someone who’s been diagnosed with one of these infections, attend a clinic to get screened and treated if necessary.</p>
<p>We’re fortunate that both syphilis and gonorrhoea are still treatable once diagnosed. But it’s important to know about them and to get tested and treated promptly.</p><img src="https://counter.theconversation.com/content/207344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walker has previously received funding from Bayer PLC, and has been a consultant to NaturalCycles.</span></em></p>Two Victorian STIs are back – here’s how you can protect yourself.Susan Walker, Reader in Contraception, Reproductive and Sexual Health, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1879092022-10-05T12:20:12Z2022-10-05T12:20:12ZGonorrhea became more drug resistant while attention was on COVID-19 – a molecular biologist explains the sexually transmitted superbug<figure><img src="https://images.theconversation.com/files/484662/original/file-20220914-18-3dakt1.jpg?ixlib=rb-1.1.0&rect=21%2C32%2C7156%2C3977&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The _Neisseria gonorrhoeae_ bacterium causes gonorrhea by infecting mucous membranes.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/bacterium-neisseria-gonorrhoeae-gonorrhea-royalty-free-image/1128533488?adppopup=true">Design Cells/iStock Getty Images Plus via Getty Images</a></span></figcaption></figure><p>COVID-19 has rightfully dominated infectious disease news since 2020. However, that doesn’t mean other infectious diseases took a break. In fact, U.S. rates of <a href="https://www.cdc.gov/std/statistics/2020/tables/1.htm">infection by gonorrhea have risen</a> during the pandemic.</p>
<p>Unlike COVID-19, which is a new virus, gonorrhea is an ancient disease. The first known reports of gonorrhea date from <a href="https://doi.org/10.1001/archdermatol.2011.2716">China in 2600 BC</a>, and the disease has plagued humans ever since. Gonorrhea has long been one of the most commonly reported <a href="https://www.cdc.gov/std/statistics/2020/tables/1.htm">bacterial infections in the U.S.</a>. It is caused by the bacterium <em>Neisseria gonorrhoeae</em>, which can infect mucous membranes in the genitals, rectum, throat and eyes. </p>
<p>Gonorrhea is typically transmitted by sexual contact. It is sometimes <a href="https://www.emedicinehealth.com/why_is_gonorrhea_called_the_clap/article_em.htm">referred to as “the clap</a>.” </p>
<p>Prior to the pandemic, there were around <a href="https://www.cdc.gov/std/gonorrhea/arg/public-health-threat/public-health-threat-text-only.htm">1.6 million new gonorrhea infections</a> each year. Over 50% of those cases involved strains of gonorrhea that had <a href="https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf">become unresponsive to treatment</a> with at least one antibiotic. </p>
<p>In 2020, gonorrhea infections initially <a href="https://www.cdc.gov/std/statistics/2020/impact.htm">went down 30%</a>, most likely due to pandemic lockdowns and social distancing. However, by the end of 2020 – the last year for which data from the Centers for Disease Control and Prevention is available – <a href="https://www.cdc.gov/std/gonorrhea/stats.htm">reported infections were up 10% from 2019</a>. </p>
<p>It is unclear why infections went up even though some social distancing measures were still in place. But the CDC notes that reduced access to health care may have led to longer infections and more opportunity to spread the disease, and sexual activity may have increased when <a href="https://www.cdc.gov/std/statistics/2020/impact.htm">initial shelter-in-place orders were lifted</a>.</p>
<p>As <a href="https://science.psu.edu/bmb/people/kck11">a molecular biologist</a>, I have been <a href="https://scholar.google.com/citations?user=rkmd4gQAAAAJ&hl=en">studying bacteria</a> and working to develop new antibiotics to treat drug-resistant infections for 20 years. Over that time, I’ve seen the problem of antibiotic resistance take on new urgency. </p>
<p>Gonorrhea, in particular, is a major public health concern, but there are concrete steps that people can take to prevent it from getting worse, and new antibiotics and vaccines may improve care in the future. </p>
<h2>How to recognize gonorrhea</h2>
<p>Around <a href="https://doi.org/10.1016/S0091-7435(02)00058-0">half of gonorrhea infections are asymptomatic</a> and can only be detected through screening. Infected people without symptoms can unknowingly spread gonorrhea to others.</p>
<p>Typical early <a href="https://www.mayoclinic.org/diseases-conditions/gonorrhea/symptoms-causes/syc-20351774">signs of symptomatic gonorrhea</a> include a painful or burning sensation when peeing, vaginal or penal discharge, or anal itching, bleeding or discharge. Left untreated, gonorrhea can cause <a href="https://www.cdc.gov/std/gonorrhea/stdfact-gonorrhea.htm">blindness and infertility</a>. Antibiotic treatment can cure most cases of gonorrhea as long as the infection is susceptible to <a href="https://www.cdc.gov/std/gonorrhea/treatment.htm">at least one antibiotic</a>.</p>
<p>There is currently only one recommended treatment for gonorrhea in the U.S. – an antibiotic called ceftriaxone – because the bacteria have become resistant to other antibiotics that were <a href="https://www.cdc.gov/std/gonorrhea/treatment.htm">formerly effective against it</a>. Seven different families of antibiotics have been used to treat gonorrhea in the past, but many strains are now resistant to <a href="https://www.who.int/news-room/fact-sheets/detail/multi-drug-resistant-gonorrhoea">one or more of these drugs</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/iFwlnljV2Go?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The CDC tracks the emergence and spread of drug-resistant gonorrhea strains.</span></figcaption>
</figure>
<h2>Why gonorrhea is on the rise</h2>
<p>A few factors have contributed to the increase in infections during the COVID-19 pandemic.</p>
<p>Early in the pandemic, most U.S. labs capable of testing for gonorrhea switched to testing for COVID-19. These labs have also been contending with the same <a href="https://www.usnews.com/news/health-news/articles/2022-07-28/staff-shortages-choking-u-s-health-care-system">shortages of staff</a> and <a href="https://www.aamc.org/news-insights/shortages-syringes-dye-diagnostic-exams-how-world-events-are-straining-everyday-health-care-supply">supplies that affect</a> <a href="https://www.cdc.gov/std/statistics/2020/impact.htm">medical facilities across the country</a>.</p>
<p>Many people have <a href="https://doi.org/10.1371/journal.pone.0272609">avoided clinics and hospitals</a> during the pandemic, which has decreased opportunities to identify and treat gonorrhea infections before they spread. In fact, because of decreased screening over the past two and a half years, health care experts don’t know exactly how much antibiotic-resistant gonorrhea has spread.</p>
<p>Also, early in the pandemic, many doctors <a href="https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf">prescribed antibiotics to COVID-19 patients</a> even though antibiotics do not work on viruses like SARS-CoV-2, the virus that causes COVID-19. Improper <a href="https://www.cdc.gov/antibiotic-use/index.html">use of antibiotics</a> can contribute to greater drug resistance, so it is reasonable to suspect that this has happened with gonorrhea.</p>
<h2>Overuse of antibiotics</h2>
<p>Even prior to the pandemic, resistance to antibiotic treatment for bacterial infections was a growing problem. In the U.S., antibiotic-resistant gonorrhea infections <a href="https://www.cdc.gov/drugresistance/pdf/covid19-impact-report-508.pdf">increased by over 70%</a> from 2017-2019.</p>
<p><em>Neisseria gonorrhoeae</em> is a specialist at picking up new genes from other pathogens and from <a href="https://doi.org/10.1038/nrmicro.2017.169">“commensal,” or helpful, bacteria</a>. These helpful bacteria can also become antibiotic-resistant, providing more opportunities for the gonorrhea bacterium to acquire resistant genes.</p>
<p>Strains resistant to ceftriaxone have been observed in other countries, including <a href="https://doi.org/10.1128/AAC.00325-11">Japan</a>, <a href="https://doi.org/10.1038/s41598-021-00675-y">Thailand,</a> <a href="https://doi.org/10.1016/S1473-3099(20)30055-4">Australia and the U.K.</a>, raising the possibility that some gonorrhea infections may soon be completely untreatable. </p>
<h2>Steps toward prevention</h2>
<p>Currently, changes in behavior are among the best ways to limit overall gonorrhea infections – particularly <a href="https://www.who.int/news/item/07-07-2017-antibiotic-resistant-gonorrhoea-on-the-rise-new-drugs-needed">safer sexual behavior and condom use.</a></p>
<p>However, additional efforts are needed to delay or prevent an era of untreatable gonorrhea. </p>
<p>Scientists can create new antibiotics that are effective against resistant strains; however, decreased investment in this research and development over the past 30 years <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358500/">has slowed the introduction</a> of <a href="https://www.idsociety.org/globalassets/idsa/policy--advocacy/current_topics_and_issues/antimicrobial_resistance/10x20/statements/070104-as-antibiotic-discovery-stagnates-a-public-health-crisis-brews.pdf">new antibiotics to a trickle</a>. No new drugs to treat gonorrhea have been introduced since 2019, although <a href="https://doi.org/10.1128/aac.01991-21">two are in the final stage</a> of clinical trials.</p>
<p>Vaccination against gonorrhea isn’t possible presently, but it could be in the future. Vaccines effective against the meningitis bacterium, a close relative of gonorrhea, can sometimes also provide <a href="https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/strategies/global-health-sector-strategies">protection against gonorrhea</a>. This suggests that a gonorrhea vaccine should be achievable. </p>
<p>The World Health Organization has begun an initiative to <a href="https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/strategies/global-health-sector-strategies">reduce gonorrhea worldwide by 90%</a> before 2030. This initiative aims to promote safe sexual practices, increase access to high-quality health care for sexually transmitted diseases and expand testing so that asymptomatic infections can be treated before they spread. The initiative is also advocating for increased research into vaccines and new antibiotics to treat gonorrhea.</p>
<p>Setbacks in fighting drug-resistant gonorrhea during the COVID-19 pandemic make these actions even more urgent.</p><img src="https://counter.theconversation.com/content/187909/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kenneth Keiler receives funding from NIH.</span></em></p>The US currently has only one antibiotic available to treat gonorrhea – and it’s becoming less effective.Kenneth Keiler, Professor of Biochemistry and Molecular Biology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1480122020-10-27T14:23:13Z2020-10-27T14:23:13ZDrug-resistant gonorrhoea is a growing threat: a South African case study<figure><img src="https://images.theconversation.com/files/364530/original/file-20201020-15-gyni1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Illustration of Neisseria gonorrhoeae bacteria.</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>Gonorrhoea is a sexually transmitted infection caused by a bacterium called <em>Neisseria gonorrhoeae</em>. This infection affects <a href="https://apps.who.int/iris/bitstream/handle/10665/277258/9789241565691-eng.pdf?ua=1">87 million </a> people every year across the world. It can lead to genital discharge, pregnancy complications and infertility. Gonorrhoea can be treated successfully with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6452490/">antibiotics</a>. </p>
<p>Current first-line treatment is a ceftriaxone injection combined with azithromycin given as oral tablet. But in recent years, alarming reports emerged of these drugs failing to treat gonorrhoea patients. Drug-resistance has been reported in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3204624/pdf/10-0397_finalL.pdf">Asia</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446956/pdf/eurosurv-24-8-2.pdf">Europe</a> and <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30340-2/fulltext">Australia</a>. </p>
<p>Most of these infections were in populations at high risk for sexually transmitted infections. They include commercial sex workers and men who have sex with men. </p>
<p>Continued increase in resistance and the limited pipeline of new antibiotics have raised global concerns about the development of untreatable gonorrhoea. It prompted the World Health Organisation to <a href="https://www.who.int/medicines/publications/global-priority-list-antibiotic-resistant-bacteria/en/">classify</a> <em>Neisseria gonorrhoeae</em> as a high-priority pathogen for the development of new antibiotics.</p>
<p>The African region has the <a href="https://www.who.int/bulletin/volumes/97/8/18-228486.pdf?ua=1">highest burden</a> of gonorrhoea worldwide. In South Africa alone, it is estimated that more than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188893/pdf/pone.0205863.pdf">2 million</a> new cases occur annually. Yet there isn’t much information about antibiotic resistance.</p>
<p>The lack of data poses a serious public health challenge. Drug-resistant <em>Neisseria gonorrhoeae</em> infection, when introduced, could spread widely before being detected. It would most likely emerge in high-risk populations. In a <a href="https://aac.asm.org/content/early/2020/08/26/AAC.00906-20.long">recent study</a> we found a high prevalence of antimicrobial resistance in <em>Neisseria gonorrhoeae</em> strains obtained from high-risk men in South Africa. </p>
<p>South Africa manages sexually transmitted infections by giving patients a combination of antibiotics that covers the most likely cause of their symptoms. There is no laboratory confirmation of the cause. In suspected cases of gonorrhoea, patients would get medication without diagnostic testing. This approach is used in other resource-constrained countries too. It is relatively cheap and easy. But it also leads to unnecessary use of antibiotics. This, in turn, contributes to resistance development. </p>
<p>To prevent an outbreak of infections that resist multiple drugs, the country should introduce diagnostics and scale up surveillance for gonorrhoea. </p>
<h2>Antibiotic resistance</h2>
<p>We <a href="https://aac.asm.org/content/early/2020/08/26/AAC.00906-20.long">recently</a> analysed <em>Neisseria gonorrhoeae</em> strains obtained from 42 high-risk men presenting with gonorrhoea symptoms at public healthcare facilities in Johannesburg, South Africa. Each bacterial strain was grown on a culture plate from urine samples. In the laboratory we tested how well individual drugs worked on each of these bacterial strains.</p>
<p>Drug resistance rates were alarming. Almost 30% of strains were classified as multidrug-resistant (resistant to more than three drugs). Almost 80% were resistant to ciprofloxacin. This drug was used to treat gonorrhoea in South Africa until 2008. Fifteen percent of the strains were resistant to azithromycin. Fortunately no resistance to cefixime and ceftriaxone was present. Most of the bacterial strains were unique to South Africa and genetically different from those reported elsewhere in the world. </p>
<p>Despite the relatively small sample size, this study highlights important gaps in the response to the global threat of drug-resistant gonorrhoea.</p>
<p>First, it shows the importance of investing in drug resistance surveillance at a large scale across the country. The current surveillance performed in South Africa can only accommodate a limited number of facilities. High-risk populations are also not included. </p>
<p>Levels of ciprofloxacin resistance are consistently high across the country (more than 65%) but prevalence of azithromycin resistance is variable. A recent <a href="https://journals.lww.com/stdjournal/Fulltext/2019/04000/Resistance_Profile_of_Neisseria_gonorrhoeae_in.10.aspx">study</a> from KwaZulu-Natal province found azithromycin resistance in 68% of <em>Neisseria gonorrhoeae</em> bacteria; 71% were multidrug-resistant. In contrast, surveillance sites reported azithromycin resistance in less than <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6188893/pdf/pone.0205863.pdf">5%</a> of samples. </p>
<p>These differences warrant an intensive effort to determine the level of azithromycin resistance across the country. Depending on the outcome, it might be necessary to reconsider using this drug. Fortunately, ceftriaxone resistance was not detected in any of these studies. It remains the drug of choice to treat gonorrhoea.</p>
<p>Second, the high-risk populations, especially men who have sex with men, must be included in gonorrhoea surveillance programmes. Historically, drug-resistant gonorrhoea emerged first in these populations. For example, the first two cases of cefixime-resistant gonorrhoea in South Africa occurred in <a href="https://academic.oup.com/jac/article/68/6/1267/764499">2012 in men who have sex with men</a>. Since then, several more cases have been identified. Similarly, azithromycin resistance was detected in 15% of the high-risk men with gonorrhoea in Johannesburg. National <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165174/pdf/antibiotics-07-00058.pdf">surveillance</a> of the general population detected it in less than 2% of <em>Neisseria gonorrhoeae</em> strains in that city.</p>
<p>Further, there’s a need for more specific care. Point-of-care tests would enable targeted antibiotic treatment of infections. Additional diagnostic tests are needed to manage individuals with treatment failure. </p>
<p>This requires further investment in laboratory resources, logistics and infrastructure so that specimens can be stored and transported between the healthcare facility and laboratory. The biological nature of <em>Neisseria gonorrhoeae</em> makes these requirements even more complicated. </p>
<p>Finally, development of new drugs is essential. Good news is the recent start of a multicountry trial of zoliflodacin as a potential <a href="https://gardp.org/news-resources/world-sexual-health-day-south-africa-gonorrhea-treatment/">treatment for gonorrhoea </a>.</p>
<h2>Way forward</h2>
<p>The global threat of drug-resistant gonorrhoea is real. Ceftriaxone-resistant strains have not yet been identified in South Africa. But the presence of cefixime resistance and the potential emergence of azithromycin resistance are a clear warning. </p>
<p>Investment in better drug prescription practices, diagnostic testing and drug resistance surveillance is crucial to prevent a future epidemic of drug-resistant gonorrhoea.</p><img src="https://counter.theconversation.com/content/148012/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Remco Peters is affiliated with the Research Unit of the Foundation for Professional Development in East London, South Africa.</span></em></p><p class="fine-print"><em><span>Liteboho Daniel Maduna does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The African continent has the highest burden of gonorrhoea worldwide. In South Africa alone, it’s estimated that more than 2 million new cases occur annually.Remco Peters, Extraordinary Professor in the Department of Medical Microbiology, University of PretoriaLiteboho Daniel Maduna, Post doctoral researcher, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/842102017-09-21T03:00:01Z2017-09-21T03:00:01ZPunishing one person for STI transmission weakens public health efforts<figure><img src="https://images.theconversation.com/files/186712/original/file-20170920-895-18as0ho.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In most Australian states, if you have certain STIs, you have a legal responsibility to notify your potential sexual partners.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Is one person to blame if another gets a sexually transmissible infection (STI)? In most Australian states, if you have certain STIs, you have a legal responsibility to notify your potential sexual partners. </p>
<p>The NSW government <a href="http://www.news.com.au/national/nsw-act/con-or-condom-uproar-over-changes-to-hiv-and-sti-disclosure-law/news-story/7e07c4f76526d4073f5f423e3303da07">last week</a> passed an amendment to the state’s <a href="https://www.parliament.nsw.gov.au/bills/Pages/bill-details.aspx?pk=3426">Public Health Act</a> that increased the associated penalties by doubling the maximum fines and adding potential jail time. </p>
<p>Section 79 (1) of the Act <a href="https://www.parliament.nsw.gov.au/bills/DBAssets/bills/BillText/3426/b2016-144-d26_House.pdf">now reads</a>:</p>
<blockquote>
<p>A person who knows that he or she has a notifiable disease, or a scheduled
medical condition, that is sexually transmissible is required to take reasonable
precautions against spreading the disease or condition.</p>
<p>Maximum penalty: 100 penalty units or imprisonment for 6 months, or both.</p>
</blockquote>
<p>In addition to increasing potential penalties, the amendment removed an earlier provision mandating disclosure of STI status, replacing it instead with the need for “reasonable precautions”. </p>
<p>This is a positive change for the law that reflects the best available research on STIs and transmission. Yet its coupling with increased penalties has sent a mixed message about sexual health in the state. </p>
<p>Further, the idea that punishing STI exposure or transmission will decrease rates of infection is <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2128015">not supported by global research</a> on HIV, and there is no reason to believe this would be any different for other STIs. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/moral-responsibilities-to-disclose-your-hiv-status-to-partners-arent-so-clear-cut-51383">Moral responsibilities to disclose your HIV status to partners aren't so clear-cut</a>
</strong>
</em>
</p>
<hr>
<h2>Laws across Australia</h2>
<p>Health law is pretty complex and mainly left up to each state and territory. Generally speaking, across Australia you risk some kind of punishment for knowingly infecting another person with what are often referred to as “<a href="http://www.health.gov.au/internet/main/publishing.nsf/content/cda-pubs-cdi-2000-cdi2408-cdi2408g.htm">notifiable diseases</a>”. This list covers a range of infections but STIs include chlamydia, gonorrhoea, syphilis, HIV, shigella, donovanosis, and hepatitis a, b and c. </p>
<p>In some states, notably <a href="https://www.legislation.nsw.gov.au/#/view/act/2010/127">New South Wales</a>, <a href="https://www.legislation.tas.gov.au/view/whole/html/inforce/current/act-1997-086">Tasmania</a> and <a href="https://www.health.qld.gov.au/publichealthact">Queensland</a>, it’s an offence just to knowingly expose someone to an infection, even if they don’t actually become infected. While in other states, like <a href="https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiou86chLPWAhXDTbwKHbZXAYUQFggoMAA&url=http%3A%2F%2Fwww.legislation.vic.gov.au%2FDomino%2FWeb_Notes%2FLDMS%2FPubStatbook.nsf%2Ff932b66241ecf1b7ca256e92000e23be%2F8B1B293B576FE6B1CA2574B8001FDEB7%2F%24FILE%2F08-46a.pdf&usg=AFQjCNHWftaXq4M2CKSHQw-mCoyIC_27lw">Victoria</a> and <a href="https://www.legislation.sa.gov.au/LZ/C/A/SOUTH%20AUSTRALIAN%20PUBLIC%20HEALTH%20ACT%202011.aspx">South Australia</a>, health acts do not specify penalties for exposure or transmission, referring instead to the respective crime acts. For the most part, curable STIs do not rank as serious enough for criminal prosecution.</p>
<p>What is unique about NSW is that it uses the Public Health Act to single out STIs and describe specific punishments above and beyond other infections. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186724/original/file-20170920-927-cnybuc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Moving away from mandating disclosure of a person’s STI status to their partner is actually positive.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/photos/partners?photo=p3UCTiZIU6M">Photo by Gerrit Vermeulen on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Although laws in NSW seem unusually fixated on STIs, the move away from mandated disclosure in favour of “reasonable precautions” is a positive step. While disclosure may seem sensible on the surface, it’s not the most effective at preventing transmission. This is because disclosure requires that someone be aware of an infection and many people with an STI don’t realise they are infected. For example, <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">it’s estimated</a> nearly three quarters of chlamydia infections in young people in Australia go undiagnosed every year. Relying on disclosure can, therefore, give people a false sense of security. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sexually-transmissible-infections-on-the-rise-in-australia-a-snapshot-68681">Sexually transmissible infections on the rise in Australia: a snapshot</a>
</strong>
</em>
</p>
<hr>
<p>There are other more effective strategies than disclosure for protecting someone from infection. With HIV, for example, <a href="https://hptn.org/research/studies/hptn052">successful treatment</a> means the risks of transmitting the virus to another person are virtually nonexistent. Under the amended NSW law, treatment could quite rightly be considered a reasonable precaution to avoid transmitting HIV.</p>
<p>But the state’s Public Health Act is relevant to all STIs, not just HIV. For other infections, it’s less clear what precautions might be seen as reasonable. Condoms can offer protection from some infections, but not all, and they are <a href="http://onlinelibrary.wiley.com/doi/10.1363/3800606/full">rarely used</a> for oral sex. Given more and more chlamydia and gonorrhoea cases are <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">identified in the throat</a>, this is potentially problematic.</p>
<h2>Punishment doesn’t help</h2>
<p>Every year, there are over 100,000 STI <a href="https://kirby.unsw.edu.au/report/annual-surveillance-report-hiv-viral-hepatitis-stis-2016">diagnoses across Australia</a>, the vast majority of which can be cured using antibiotics. Ultimately, public health initiatives aim to reduce new cases and lower the overall amount of infection.</p>
<p>It’s been suggested by public health experts that criminalising transmission can <a href="http://www.tandfonline.com/doi/full/10.1080/09581596.2015.1052731">undermine public health efforts</a> by reinforcing stigma and causing people to delay accessing testing, treatment and care. </p>
<p>And in <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2128015">a review</a> of legal conditions around the world, researchers found that there was no link between laws criminalising HIV transmission and lower infection rates. The review also found such laws disproportionately impacted those who may experience marginalisation, such as young people and women. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/stigma-and-lack-of-awareness-stop-young-people-testing-for-sexually-transmitted-infections-80265">Stigma and lack of awareness stop young people testing for sexually transmitted infections</a>
</strong>
</em>
</p>
<hr>
<p>In reality, situations where an individual recklessly or wilfully places another at risk of an STI are <a href="http://www.hivmediaguide.org.au/media-tool-kit/hiv-in-the-news/criminal-cases-involving-hiv-transmission-or-exposure/">incredibly rare</a> and health officials have many options besides punishment. </p>
<p>As part of their core work, doctors and clinics counsel on and work with people to prevent onward transmission, and in some cases public health orders can be used to compel people to, among other actions, attend counselling and refrain from activities that might spread an infection. In the most extreme situations, criminal charges can be brought on the basis of grievous bodily harm.</p>
<p>Overall, a special and punitive focus to STIs risks further entrenching stigma and undermining the Act’s intent, which is to manage and reduce infection. If there is any hope of reducing STIs in Australia, laws must aim to foster an environment where people feel comfortable, able and willing to get tested and engaged with their sexual health. </p>
<p>While it seems unlikely a rush to prosecute those who expose others to STIs will spring up from this amendment, the law as it is currently written leaves open that rather serious possibility. In NSW and across Australia, health law consistently places the burden of prevention on one partner. In an ideal world, all parties to a sexual encounter take “reasonable precautions” to protect themselves and each other from infection.</p><img src="https://counter.theconversation.com/content/84210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Denton Callander receives funding from the Australian Department of Health, the Australian Research Council, the National Health and Medical Research Council, and the New South Wales Ministry of Health. </span></em></p>NSW has changed its laws imposing criminal penalties on someone with an STI who doesn’t take “reasonable precautions” to not infect their sexual partner.Denton Callander, Research fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/810202017-08-04T00:35:05Z2017-08-04T00:35:05ZFun sex is healthy sex: Why isn’t that on the curriculum?<figure><img src="https://images.theconversation.com/files/180963/original/file-20170804-10723-1x3m6ao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Damn — we forgot to teach our kids how to have fun sex. </p>
<p>Most news covers the sex lives of young people in terms of hookups, raunch culture, booty calls and friends with benefits. You might think that young people have it all figured out, equating sex with full-on, self-indulgent party time. </p>
<p>Despite my decades as a researcher studying their intimate lives, I too assumed that the first years of consensual partnered sex were pleasurable for most, but got progressively worse over time. How else to explain the high rates of sexual dysfunctions reported by adults? I was wrong.</p>
<p>Our research at the University of New Brunswick shows that young people (16 to 21 years) have <a href="http://dx.doi.org/10.1111/jsm.12419">rates of sexual problems</a> comparable to those of adults. This is <a href="http://dx.doi.org/10.1016/j.jadohealth.2016.05.001">not just a matter of learning to control ejaculation</a> timing or how best to have an orgasm. Their sex lives often <a href="http://www.cdc.gov/healthyyouth/data/yrbs/pdf/2015/ss6506_updated.pdf">start out poorly and show no improvement over time</a>. Practice, experience and experimentation only help so much. </p>
<p>This project came to be after a former colleague at my university’s health centre told me that many young women complained of pain from vulvar fissures (essentially tearing) from intercourse. The standard of care is to offer lubricant, but she began to ask: Were you aroused? Was this sex you wanted? They would look at her blankly. They had been having sex without interest, arousal or desire. This type of tearing increases a young woman’s risk of STIs, but also alerted my colleague to a more deep-seated issue: Was sex wanted, fun and pleasurable?</p>
<p>What emerged from our first study was verified in our larger study: Low desire and satisfaction were the most common problems among young men followed by erectile problems. Trouble reaching orgasm, low satisfaction and pain were most common among young women. </p>
<p>Was this a select group? No. Overall, 79 per cent of young men and 84 per cent of young women (16-21 years old) reported one or more persistent and distressing problems in sexual functioning over a two-year period.</p>
<h2>Parents focus on disaster</h2>
<p>Despite what you might think from their over-exposed social media bodies, today’s youth start sex later and have fewer partners than their parents’ (and often their grandparents’) generation did. A recent U.S. national survey found that young people <a href="http://www.cdc.gov/healthyyouth/data/yrbs/pdf/2015/ss6506_updated.pdf">have sex less often</a> than previous generations. </p>
<p>Did years of calamity programming in the form of “good touch/bad touch,” “no means no,” and “your condom or mine” take a toll? Perhaps that was intended as so much of our programming is designed to convince young people of the blame, pain and shame that awaits them in their sexual lives. If we really believe that young people are not supposed to be having sex (that it should just be reserved for adults in their reproductive years and no others, thank you), it might as well be unpleasant, dissatisfying or painful when young people have sex, right?</p>
<p>Young people are over-stressed, over-pampered and over-diagnosed. They are also under-resourced for dealing with challenges in their sexual lives. This is how a bad sex life evolves. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179537/original/file-20170724-7881-1g5q5rq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179537/original/file-20170724-7881-1g5q5rq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179537/original/file-20170724-7881-1g5q5rq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179537/original/file-20170724-7881-1g5q5rq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179537/original/file-20170724-7881-1g5q5rq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179537/original/file-20170724-7881-1g5q5rq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179537/original/file-20170724-7881-1g5q5rq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Progressive countries such as The Netherlands and Switzerland reinforce positive messages about sexual intimacy.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Parents make efforts to talk to their children about sex and believe they get their messages across. Yet, their children typically report that parents fail to communicate about topics important to them, such as jealousy, heartbreak, horniness and lack of horniness. Parents’ messages are usually unidirectional lectures that emphasize avoiding, delaying and preventing. Young people dismiss these talks, especially in light of media portrayals of sex as transformative and rapturous. </p>
<h2>Sex in Canada’s schools</h2>
<p>Canada’s schools deliver <a href="http://globalnews.ca/news/1847912/sexual-education-compared-across-canada/">fairly progressive sex education</a> across the provinces. But they do not resemble the comprehensive approaches offered in countries such as The Netherlands and Switzerland. Those countries have <a href="https://unstats.un.org/unsd/demographic/products/dyb/dyb2.htm">teen pregnancy rates</a> as low as 0.29 per cent of girls aged 15 to 19. Canada’s rate is 1.41 per cent, far higher than many European countries (such as Italy, Greece, France and Germany) but consistently lower than the United States. Thankfully. </p>
<p>These rates are a general metric of youth sexual health and key differences in the socialization and education of young people. They reflect the extent to which we are willing to provide a range of sexual information and skills to young people. More progressive countries reinforce messages that sex can be a positive part of our intimate lives, our sense of self, our adventures and connection. Young people in those countries have healthier and happier sexual lives. They know how to enjoy sex while preventing infections and unwanted pregnancy.</p>
<p>Many countries, including Canada, are swayed by a vocal minority who strongly believe that teaching young people about the positive components of sexuality will prompt unhealthy outcomes, despite all evidence to the contrary. When parents and educators fail you, and peers lack credibility, where else are you to turn? </p>
<h2>Porn - lessons in freak</h2>
<p>Enter porn. Young people turn to porn to find out how things work, but what they learn is not especially helpful. Porn provides lessons in exaggerated performance, dominance and self-indulgence. The relationships are superficial and detached. Producers rely heavily on shock value and “freak” to maximize viewer arousal, distorting our understanding of what is typical or common among our peers.</p>
<p>Of course young people turn to porn to find out how sex happens. It’s free, easily accessible and, for the most part, private. One young man in our interviews said, “I learned a lot about what goes where, all the varieties from porn, but it’s pretty intimidating. And, I mean, they don’t look like they’re loving it, really loving it.”</p>
<p>Our research makes painfully clear how few messages young people have learned about how to have fun, pleasurable, satisfying sex. They may seem self-indulgent to you, but then nobody took on the task of saying, “Sex should be fun, enjoyable and a way to connect. Let’s talk about how it all works.” </p>
<h2>Fun sex as safe sex</h2>
<p>Did anyone teach you these lessons? A friend and esteemed fellow researcher told me that he learned how sex worked by viewing his dad’s porn magazines. The only problem was that in his first sexual encounter he did not realize that there was movement involved.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/179258/original/file-20170721-28519-q2xcsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/179258/original/file-20170721-28519-q2xcsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/179258/original/file-20170721-28519-q2xcsw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/179258/original/file-20170721-28519-q2xcsw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/179258/original/file-20170721-28519-q2xcsw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/179258/original/file-20170721-28519-q2xcsw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/179258/original/file-20170721-28519-q2xcsw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teaching kids about sexual intimacy and joy can prevent sexual dysfunctions and lead to healthier adult lives.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Without a platform of positive communication with our youth about sexuality, and specifically about how sex unfolds and can brighten life and improve health and well-being, there is no room for them to address new challenges in the sexual realm. The World Health Organization’s alarming report of the <a href="http://www.who.int/reproductivehealth/publications/rtis/who_rhr_11_14/en/">rise of antibiotic resistant gonorrhea</a>, for instance, will sound like another dire warning from an endless stream. Nobody is consistently motivated by threats. </p>
<p>We must talk to young people about how to have fun sex. This will help to offset the chances that young people struggling with problems in their sexual lives now will develop <a href="https://doi.org/10.1016/S0140-6736(13)62366-1">sexual dysfunctions and relationship strain</a> that distress so many adults. These lessons will arm them with the information and skills required to keep them safe and to seek effective solutions when problems emerge. Best of all, they will be healthier and happier now and as adults as a result.</p><img src="https://counter.theconversation.com/content/81020/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lucia O'Sullivan received funding from The Canadian Institutes for Health Research that funded a project that she described in this article. She is an Associate Editor of The Journal of Sex Research.</span></em></p>Sex education in progressive countries like The Netherlands and Switzerland emphasizes intimacy, adventure and connection. Lower rates of teen pregnancy and sexual dysfunction ensue.Lucia O'Sullivan, Professor of Psychology, University of New BrunswickLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/808642017-07-18T23:09:15Z2017-07-18T23:09:15ZCanada could lead the fight for life in a post-antibiotic world<figure><img src="https://images.theconversation.com/files/178530/original/file-20170717-6084-14ldnjt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drug-resistant strains of gonorrhoea, once easily dispatched with penicillin, are spreading across the globe resulting in chronic pain and sterility</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Infectious diseases that once were tamed are roaring back, past the last line of our antibiotic defences. They threaten the lives of millions, but where is the public outcry? </p>
<p>Drug-resistant strains of gonorrhoea, once easily dispatched with penicillin, are spreading across the globe. The result: chronic pain, sterility and a <a href="http://www.who.int/mediacentre/news/releases/2017/Antibiotic-resistant-gonorrhoea/en/">call for new drugs by the World Health Organization</a>. In North America, <a href="https://www.cdc.gov/mmwr/volumes/66/wr/mm6601a7.htm?s_cid=mm6601a7_w&utm_source=Global+Health+NOW+Main+List&utm_campaign=813e656ea4-EMAIL_CAMPAIGN_2017_01_12&utm_medium=email&utm_term=0_8d0d062dbd-813e656ea4-890763">people are dying</a> from infections caused by bacteria that are resistant to all available drugs. And sepsis, a deadly syndrome triggered by untreatable bacterial infections, is causing <a href="http://www.contagionlive.com/news/sepsis-remains-significant-challenge-for-hospitals-public-health-watch-weekly-report">millions of deaths</a> and <a href="https://www.bloomberg.com/news/articles/2017-07-14/america-has-a-27-billion-sepsis-crisis">massive health-care costs</a> among the elderly and very young.</p>
<p>Where is the Canadian co-ordination, leadership and resolve to develop new antimicrobial substances? To move innovations into the marketplace?</p>
<p>This spring, we represented Canada at the Drug-Resistant Infections Conference in Brisbane, Australia — an event that featured academic, public health and pharmaceutical industry researchers from around the world. The goal of the conference was to showcase the best research and development available to battle the antibiotics crisis. We are proud to report that Canadian research is among the most innovative in the world. </p>
<p>The time is right to launch a Canadian Anti-Infectives Innovation Network. It is time to coalesce and co-ordinate Canadian academic, private sector, not-for-profit and government research to solve the antibiotics crisis. Such a network would galvanize Canadian antibiotic research and development. It could ensure that we play a role on the international stage commensurate with our ability and promise.</p>
<h2>The microbes are winning</h2>
<p>The incredible scientific advances of the last century have allowed us to live longer and better lives by preventing or treating many diseases that were once fatal. Pneumonia, blood infections and tuberculosis were once common killers. Now they are generally cured with antibiotics. Cheap and abundant antibiotics have allowed us to <a href="http://dx.doi.org/10.1016/S1473-3099(13)70318-9">cure illnesses, keep fragile pre-term babies alive, carry out safe surgeries and treat cancer</a>.</p>
<p>Those very benefits have lulled us into ignoring a frightening problem that has been looming for decades, undermining that progress and threatening to undo those advances. </p>
<p>While we were enjoying the benefits of antibiotics, the microbes were fighting back. They were finding ways around the obstacles science and medicine had placed in their way. Now the microbes are starting to <a href="http://www.who.int/mediacentre/news/releases/2017/bacteria-antibiotics-needed/en/">win</a>. And although we have good reason to believe <a href="http://www.pewtrusts.org/en/research-and-analysis/analysis/2017/01/18/why-the-antibiotic-pipeline-is-broken-and-how-to-fix-it">new weapons</a> could beat them back again, for some reason the world is not making enough effort to preserve our fragile safety.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/178534/original/file-20170717-6075-x8zy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/178534/original/file-20170717-6075-x8zy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/178534/original/file-20170717-6075-x8zy1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/178534/original/file-20170717-6075-x8zy1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/178534/original/file-20170717-6075-x8zy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/178534/original/file-20170717-6075-x8zy1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/178534/original/file-20170717-6075-x8zy1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sepsis dates back to ancient Greece and is now a global public health challenge, resulting in millions of death every year.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>We are in this situation because of the ever-increasing number of <a href="https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf">bacteria</a> that are no longer sensitive to the antibiotics we discovered decades ago. And because most pharmaceutical companies no longer see profitability in new antibiotic drugs. The <a href="http://petrieflom.law.harvard.edu/assets/publications/Outterson_Health_Law_Workshop_paper.pdf">business case </a>is not strong for inventing drugs that patients will only need for a short time, compared to lifelong prescriptions to treat heart and blood-pressure conditions, for example. </p>
<p>But this is not a business case. This is a public health crisis.</p>
<h2>Ordinary illnesses could kill millions</h2>
<p>We are perilously close to plunging back into a time when illnesses we consider ordinary could kill tens of millions. For some deadly strains of bacteria, we are already in a post-antibiotic world. Clinicians are out of options. Once curable diseases are incurable. <a href="http://www.contagionlive.com/news/sepsis-remains-significant-challenge-for-hospitals-public-health-watch-weekly-report">Six million people already die of sepsis</a> every year for want of effective antibiotics, and the cost to the U.S. alone is <a href="https://www.bloomberg.com/news/articles/2017-07-14/america-has-a-27-billion-sepsis-crisis">$27 billion annually</a>. Highly resistant <a href="http://www.cbsnews.com/news/superbug-gene-spotted-on-us-pig-farm/">superbugs are being found on our farms</a>.</p>
<p>In September 2016, 193 members of the United Nations came together to announce that <a href="http://www.un.org/pga/71/2016/09/21/press-release-hl-meeting-on-antimicrobial-resistance/">anti-microbial resistance (AMR) is the largest threat to medicine</a>. This was reaffirmed this month in the final statement from the <a href="https://www.g20.org/gipfeldokumente/G20-leaders-declaration.pdf">G20 meeting in Hamburg</a>. Without urgent action to overcome AMR, the <a href="https://amr-review.org/">UK’s Review On Antimicrobial Resistance</a> estimates the world could witness 10 million extra deaths every year by 2050. That is an increase of total deaths by one sixth.</p>
<p>Even those who survive drug-resistant infections will need twice as much time in hospital. And that is just one expense flowing from a problem that is expected to cost the global economy <a href="https://amr-review.org/">$100 trillion by 2050</a>.</p>
<h2>Canada could lead</h2>
<p>In a context of neglect and inaction, and the misconception that antibiotic discovery is the job of the private sector, no country is ideally positioned to solve this problem alone. Canada, however, is in a position to lead if it wants to.</p>
<p>Canadian researchers have pioneered creative solutions: alternatives to antibiotics that block and inhibit resistance, innovative drug combinations that boost antibiotic activity and enhance host immunity to prevent infection.</p>
<p>Canada’s natural resources, including the Arctic and three oceans, have the potential to deliver new antimicrobial and anti-infective substances. Vaccine development for animals and humans can reduce our need for new drugs. Our innovative thinking can deliver alternatives to reduce dependency on antibiotics. </p>
<h2>Canadian Anti-Infectives Innovation Network</h2>
<p>Innovations alone won’t help. We must do more to get Canadian know-how into action immediately. Canada is a global leader in many areas of basic and applied research that can contribute to solving the problem. But we lack co-ordination, common objectives and resolve.</p>
<p>We need to develop our innovations so we can lead the world in alternatives and adjuncts to antibiotics. We need to become an essential partner in international initiatives such as CARB-X, a public-private accelerator funded by the U.K. and U.S., to move creative antibiotic discoveries into the marketplace. Ironically, two discoveries made at McMaster University are being considered by CARB-X for funding, following licensing to U.S.-based companies. Two others developed at the University of British Columbia, and originally the basis of Canadian spinoffs, are in advanced clinical trials with U.S. companies.</p>
<p>The opportunity to grow these discoveries here in Canada has been lost. So has the associated commercial, employment and skills benefits.</p>
<p>Canada is competing and leading in anti-infective innovation, but we are rapidly falling behind in our ability to capitalize on these discoveries, foster and support new research and commercialization in Canada. </p>
<p>We must act now to ensure that we not only do our share on the international stage to solve the antibiotic crisis, but also provide a made-in-Canada innovative approach. We can do so, with support and leadership, in the form of a Canadian Anti-Infectives Innovation Network that assembles leading researchers in universities, hospitals, government and the private sector.</p><img src="https://counter.theconversation.com/content/80864/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gerry Wright is a Professor and Director of the Michael G. DeGroote Institute for Infectious Disease Research at McMaster University. He is a co-founder and owns shares in the company Symbal Therapeutics that seeks to identify new anti-infective agents and strategies to address the antibiotic crisis. He consults widely for private sector and not-for profit agencies in the antibiotics field. His laboratory receives funding from federal and provincial funding agencies and not-for-profit groups such as the Bill and Melinda Gates Foundation. His lab has received funding over the years from both large and small pharmaceutical companies working in the area of antibiotic research and discovery.</span></em></p><p class="fine-print"><em><span>Bob Hancock has been awarded 56 patents for his UBC discoveries, largely in the area of alternatives to antibiotics, and these have been assigned to his university and licensed to several companies. If these products are successful in the long run there is the possibility that he and his co-inventors could receive milestone payments or royalties.
His laboratory has been highly funded in the past by Canadian funding agencies, and his current research is funded by CIHR, NSERC, CFI, Cystic Fibrosis Canada, and Genome Canada, as well as funding from NIH and the Australian granting agency NHMRC. He believes that he has a responsibility to ensure that his inventions are developed for the good of the Canadian public, and as such he recently founded, and is a majority shareholder in, two virtual companies - ABT Innovations and Sepset Inc - that are developing new anti-infective therapeutics and sepsis diagnostics, respectively. He consults extensively with both large Pharma and small to medium-sized biotech companies.</span></em></p>Without leading edge innovations and coordination, Canadians will die from the epidemic of antibiotic resistant infections.Gerry Wright, Professor of Biochemistry and Biomedical Sciences, McMaster UniversityBob Hancock, Professor of Microbiology and Immunology, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/807392017-07-10T22:45:50Z2017-07-10T22:45:50ZMore reason to use Meningococcal B vaccine – it could also cut the Clap<figure><img src="https://images.theconversation.com/files/177676/original/file-20170711-29267-1gupfbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An epidemic of Group B meningococcal disease in New Zealand prompted the development of a vaccine, which also provides moderate protection against gonorrhoea.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?src=kUXovT9Lc_9UMtkSKVBVeA-1-50">from www.shutterstock.com</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Gonorrhoea, a sexually transmitted infection also known as the Clap, has become a superbug. </p>
<p>Some strains of the bacterium that cause gonorrhoea are now resistant to all available antibiotics. With no new drugs on the near horizon, the disease is in desperate need of a vaccine.</p>
<p>Our <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31449-6/fulltext?elsca1=tlpr">research</a>, published in the Lancet medical journal today, shows that protection against gonorrhoea could come from an unexpected source - a vaccine against meningococcal group B disease.</p>
<h2>WHO issues urgent call for global policy</h2>
<p>Last week, the World Health Organisation (WHO) called for <a href="https://www.scimex.org/newsfeed/who-warns-gonorrhoea-is-getting-impossible-to-treat-as-rates-soar">urgency in the development of global policy</a> to address multi-drug-resistant gonorrhoea, which has now adapted to every class of antibiotics used to treat it since the mid-1930s. </p>
<p>If left untreated, gonorrhoea can lead to complications such as pelvic inflammatory disease, ectopic pregnancy and infertility. It can also <a href="https://www.ncbi.nlm.nih.gov/pubmed/7848598">facilitate the transmission</a> of the human immunodeficiency virus (HIV). </p>
<p>There are about 78 million new cases of gonorrhoea worldwide each year, and the <a href="https://theconversation.com/stigma-and-lack-of-awareness-stop-young-people-testing-for-sexually-transmitted-infections-80265">rates of infection are increasing</a> in New Zealand and elsewhere. </p>
<p>While efforts to develop a vaccine began over a century ago, the candidates that made it to clinical trials all failed. Unfortunately, there has been little to guide the development of an effective vaccine. </p>
<p>People who get gonorrhoea are not protected from further infections. Infamously, 18-century philanderer <a href="https://www.theguardian.com/commentisfree/2012/jun/13/james-boswell-history-gonorrhoea">James Boswell</a>, best known as the biographer of Samuel Johnson, reportedly had gonorrhoea at least 19 times. </p>
<p>In addition to no observable immunity, there are no useful animal models in which to study the disease. It really does prefer humans. </p>
<h2>Meningococcal vaccine offers cross protection</h2>
<p>Due to a devastating epidemic of Group B meningococcal disease in New Zealand, a tailormade vaccine (MeNZB™) was developed and given to over a million New Zealanders under the age of 20 between 2004 and 2008. </p>
<p>The vaccine was reasonably effective against meningococcal disease, although it was administered late, when the epidemic had already begun to wane after raging for about 15 years. </p>
<p>We thought that was the end of it. However, it was noted that the MeNZB vaccine was more broadly effective than expected. One of the observations was that gonorrhoea rates appeared to decline immediately following the use of both the MeNZB vaccine and similar vaccines in Cuba, and to a lesser extent in Norway. </p>
<p>This raised the question whether these vaccines could be cross protective. Given that the bacteria that cause the two diseases, <em>Neisseria gonorrhoeae</em> and <em>Neisseria meningitides</em>, share 80 to 90% of their primary gene sequences, it seemed at least biologically plausible. But we needed proof. </p>
<p>Neither Cuba nor Norway could test this hypothesis as they did not have the means to determine the vaccination status of gonorrhoea cases. Enter New Zealand.</p>
<h2>Vaccine cuts the Clap</h2>
<p>In a case control study involving more than 14,000 people we were able to determine that exposure to the MeNZB™ vaccine during the New Zealand mass vaccination campaign reduced the likelihood of contracting gonorrhoea. Vaccinated individuals were significantly less likely to have gonorrhoea than controls. The estimated vaccine effectiveness was 31%.</p>
<p>In an environment of rising gonorrhoea rates and antibiotic resistance this is very good news. Not only is this the first time that a vaccine has shown any protection against gonorrhoea, and in real people - it will likely provide a new direction for gonorrhoea vaccine development. </p>
<h2>How it works</h2>
<p>The meningococcal group B vaccines include little “blebs” of bacterial membrane from the outside of the bacterial cell wall. These structures, known as Outer Membrane Vesicles (OMV), are purified from the bacteria and used as vaccine antigens. </p>
<p>OMVs include a range of immunogenic proteins. Some are well characterised, others less so, which means there are many angles to explore. The focus to date has been on those most pertinent for protection against meningococcal disease, but those that may be of interest to gonorrhoea have yet to be more comprehensively considered. </p>
<p>MeNZB was developed to control a meningococcal disease epidemic and is no longer available, but the OMV antigens in that vaccine have been included in the more recently developed 4CMenB vaccine (Bexsero), which is available in many countries, including Australia. In addition, the Cuban vaccine, which was associated with a drop in gonorrhoea in that country, has been used widely and is still available.</p>
<p>At the moment, the specific mechanism behind this immune response is unknown, but our findings provide experimental evidence and proof of principle that an OMV meningococcal group B vaccine could offer moderate cross protection against gonorrhoea. This approach could also inform future vaccine development for both meningococcal and gonorrhoea vaccines.</p>
<h2>Public health benefits</h2>
<p>Although 31% does not sound like a very effective vaccine, models suggest it is enough to decrease the prevalence of gonorrhoea significantly within 15 years, if immunity is maintained.</p>
<p>It’s worth noting our study likely underestimated the vaccine’s effectiveness, and also while they need to be tested, the other aforementioned vaccines may be more effective than MeNZB. Even moderate protection against gonorrhoea would have substantial public health benefits, especially if it’s no longer possible to treat the disease with antibiotics.</p>
<p>While many countries, including the US, Canada, UK and Australia, use meningococcal vaccines, no country is currently using an OMV vaccine routinely in an adolescent program. The UK has recently introduced the 4CMenB vaccine for infants and it has been used in the USA, Canada and Australia. While it must be stressed that further evidence is yet to be published (we have more to come), it’s possible we have at least a partial solution to the escalating gonorrhoea problem in the form of group B meningococcal vaccines administered to adolescents.</p><img src="https://counter.theconversation.com/content/80739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen has served on Advisory Boards for GSK, Merck, and Pfizer but does not receive honoraria. This work was conducted with a grant from Novartis, later acquired by GSK. Helen does not personally receive funds from industry. </span></em></p>As the WHO calls for urgency to address antibiotic resistance in gonorrhoea, new research shows that a vaccine developed against an unrelated disease offers protection.Helen Petousis-Harris, Senior Lecturer, Vaccinology, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/695392016-11-30T08:27:43Z2016-11-30T08:27:43ZWhy over 45s are at risk of sexually transmitted infections – new findings<figure><img src="https://images.theconversation.com/files/147944/original/image-20161129-10973-1jq9c0v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's not all ha ha hee hee hee. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-498122908/stock-photo-olderly-couple-happiness-romantic-holding-hand-concept.html?src=KkrtiFyAdjdk-6Imgqmt9Q-1-76">Rawpixel.com</a></span></figcaption></figure><p>One consequence of our <a href="http://www.bbc.co.uk/news/uk-34666382">ageing population</a> is that people are now sexually active <a href="https://www.ncbi.nlm.nih.gov/pubmed/20215365">later</a> in life. Combined with a <a href="http://www.telegraph.co.uk/news/uknews/12011714/Divorce-rate-at-lowest-level-in-40-years-after-cohabitation-revolution.html">high rate</a> of older adults divorcing and changing partners, this has created a conducive environment for sexually transmitted infections (STIs) among those in middle age and beyond. </p>
<p>While the under 25s and gay men remain most at risk from STIs, heterosexual adults over 45 have recently seen <a href="https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables">increases</a> in <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/401662/2014_PHE_HIV_annual_report_draft_Final_07-01-2015.pdf">HIV</a>, gonorrhoea, herpes, syphilis, chlamydia and genital warts. In England, <a href="https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables">rates for chlamydia</a>, the commonest STI, rose 63% among 45-64s between 2011 and 2015 while falling for 15-24s. Yet this is an area of public health that has so far been ignored. </p>
<p>Knowledge about STIs plays a contributing role in reducing the spread of infection. Recent evidence about older adults’ knowledge has largely been confined to HIV, so our understanding of this age group’s knowledge of STIs in general is limited. </p>
<p>In <a href="http://www.rhm-elsevier.com/article/S0968-8080(16)30035-0/abstract">research</a> that I have just co-published, we sought to address this deficiency. By carrying out in-depth interviews with 31 heterosexual men and women in Glasgow aged between 45 and 65, we explored not only what middle-aged adults know about HIV and other STIs but also the social circumstances surrounding that knowledge. </p>
<p>Most of the study participants lived in the most deprived areas in Scotland and had been through divorce, separation or the death of their partner. The interviews led us to four main observations. </p>
<h2>1. STI knowledge is limited</h2>
<p>Most participants had heard about gonorrhoea, syphilis, chlamydia, herpes, general warts and HIV, but beyond recognising the names they were often unsure about any further detailed information. They tended to know more about HIV, often remembering the <a href="http://news.bbc.co.uk/1/hi/programmes/panorama/4348096.stm">national HIV/AIDS campaign</a> in the 1980s and the <a href="http://www.nydailynews.com/entertainment/gossip/celebrities-hiv-positive-aids-article-1.2436964">celebrity deaths</a> in the years before treatment improved. </p>
<p>In keeping with the association of early HIV epidemic with specific risk groups such as gay men and intravenous drug users, the participants often viewed STIs as riskier for other people than for themselves. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147945/original/image-20161129-10949-15sf73k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Is ignorance bliss?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-1216477/stock-photo-older-couple-in-love-kisses.html?src=xXtNcIpATQgFNHt5v1eCAQ-1-4">Cate Frost</a></span>
</figcaption>
</figure>
<h2>2. Old stigmas have endured</h2>
<p>The participants had first learned about STIs as teenagers and young adults between the 1960s and 1980s. Most said their sex education at home had been very limited and unclear, with overtones of moral disapproval, and that school sex education was extremely basic and did not cover STIs. As one put it:</p>
<blockquote>
<p>And it was always make sure you don’t get into trouble and I didn’t know what the hell getting into trouble was so that was that.</p>
</blockquote>
<p>The little they had learned about STIs was usually in the context of promiscuous sexual behaviour being condemned and disease being seen as a consequence – with worse stigma where women were concerned. As a result, many participants had gone through life regarding STIs as something to be ashamed of. </p>
<p>During the years when they were in long-term relationships, several participants also did not see it as relevant to improve their knowledge about STIs. And now in middle age, several continued to prefer not to engage with the subject. In the words of one person: </p>
<blockquote>
<p>None of them are anything that I’d want to trawl the internet to find out more about you know; don’t know anybody that’s ever had them or even if they’d admit to it.</p>
</blockquote>
<h2>3. Parents learn about STIs from their children</h2>
<p>We found that parenting had the capacity to influence how much participants knew about STIs. Women in particular had sometimes learned about STIs either to find out about the risks to their children or because their children had been diagnosed with one. </p>
<p>Studies have <a href="http://bmjopen.bmj.com/content/5/3/e007834">previously shown</a> that it is women who mostly provide sex education to their children. Our study is the first to indicate that parenting can also be a source of sex education for the parents themselves. </p>
<h2>4. Knowledge is not the only problem</h2>
<p>Participants who were well informed about STIs did not necessarily practice safer sexual behaviour. Despite the lack of discernible symptoms with many STIs, several participants said they had not sought a test after having unprotected sex with a new partner. Instead they had waited to see if symptoms would appear:</p>
<blockquote>
<p>She’s been sleeping with other people and I let her sleep with me and never used a condom and … then you worry that something happens, that something’s going to come out of it, or are you lucky and I was just praying that something didnae happen.</p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147946/original/image-20161129-10957-1qiigxs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Here’s Johnny!</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/pic-58634179/stock-photo-man-hand-holding-a-condom.html?src=K0L1ZLFWx3G-jHbaMq8omA-2-11">focal point</a></span>
</figcaption>
</figure>
<h2>Next steps</h2>
<p>These findings should be useful for developing interventions for middle-aged adults that help them to learn more about STIs and to make wiser decisions in relation to their sexual health. Public <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/142592/9287-2900714-TSO-SexualHealthPolicyNW_ACCESSIBLE.pdf">health policy</a> in the UK makes <a href="http://www.gov.scot/Resource/0048/00484414.pdf">reference</a> to the life-long nature of sexual health, but few health promotion programmes <a href="https://www.ncbi.nlm.nih.gov/pubmed/25921479">directly address</a> older adults taking risks with STIs.</p>
<p>Public health officials need to be aware that people emerging from lengthy relationships often know little about STIs and are poorly equipped to make good decisions about their sexual health. The sense of stigma around STIs with this age group is a barrier that needs to be addressed. Policymakers need to fully engage with gendered attitudes to older women’s sexuality, as well as the full range of lengths and varieties of relationships that people get involved in regardless of their stage in life.</p><img src="https://counter.theconversation.com/content/69539/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Dalrymple is a part-time sexual health nurse for NHS Greater Glasgow and Clyde.</span></em></p>When it comes to sexual health, public information has tended to focus on the young. Time for a change.Jenny Dalrymple, Clinical Academic Research Fellow, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/458222016-02-09T19:06:23Z2016-02-09T19:06:23ZChronic pain and infertility: the trauma of untreated pelvic inflammatory disease<figure><img src="https://images.theconversation.com/files/110093/original/image-20160203-28554-uvg76l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some women have experienced relationship conflict or breakdown over how the STI that led to their PID was acquired.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our series examining hidden women’s conditions. You can read about bacterial vaginosis, chronic thrush and other pieces in the series <a href="https://theconversation.com/au/topics/womens-health-series">here</a>.</em></p>
<hr>
<p>Pelvic inflammatory disease (PID) is an infection of a woman’s reproductive organs, which include the uterus, fallopian tubes and ovaries. </p>
<p>The condition’s often distressing consequences are unmatched by the low level of awareness about it. Left untreated, <a href="http://www.racgp.org.au/afpbackissues/2006/200611/20061103dayan.pdf">PID can cause infertility</a>, chronic pelvic pain and ectopic pregnancy (where the fetus develops outside the womb, usually in the fallopian tube). The psychological impact of these experiences can be severe.</p>
<p>PID is <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pelvic_inflammatory_disease">referred to</a> as the “silent epidemic” because it can have mild or no symptoms and often goes unrecognised by women and their doctors. But <a href="http://www.cdc.gov/std/tg2015/pid.htm">delays in diagnosis</a> put women at greater risk of long-term complications.</p>
<h2>Physical impacts</h2>
<p><a href="http://www.cdc.gov/std/pid/stdfact-pid-detailed.htm">Pelvic inflammatory disease</a> comes from an infection that travels up the cervix or vagina to infect the uterus, fallopian tubes and other reproductive organs. </p>
<p>A number of harmful organisms can cause the disease, but sexually transmitted infections (STIs) – <a href="http://www.ncbi.nlm.nih.gov/pubmed/16597205">specifically chlamydia and gonorrhoea</a> – are responsible <a href="http://kirby.unsw.edu.au/publications/genital-chlamydia-review-evidence">for about one-third</a> to half of known cases. </p>
<p>PID <a href="http://www.fpnsw.org.au/PID.pdf">can also be caused</a> by other infections, including overgrowth of normal vaginal bacteria. It can follow procedures such as having an abortion and/or having an intrauterine device (IUD) inserted.</p>
<p>While PID can be treated with antibiotic therapies, this can’t reverse the scarring of the reproductive organs that the infection may have already caused.</p>
<p>Sometimes there are no symptoms. When they are present they <a href="http://www.cdc.gov/std/pid/stdfact-pid-detailed.htm">may include</a>: </p>
<ul>
<li>lower abdominal or pelvic pain</li>
<li>abnormal vaginal discharge </li>
<li>irregular menstrual bleeding </li>
<li>fever </li>
<li>pain during sexual intercourse </li>
<li>painful or increased urination.</li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110099/original/image-20160203-5830-14qjrz8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">PID comes from an infection that travels up the cervix or vagina.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>The risk of <a href="http://www.cdc.gov/std/pid/stdfact-pid-detailed.htm">long-term complications</a> from PID depends on its severity and number of repeat occurrences.</p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/1411832">Research</a> shows tubal scarring caused by PID can lead to tubal factor infertility (a condition in which the fallopian tubes are blocked or damaged) in between 8% (after one PID occurrence) and 40% of women (after three or more occurrences). </p>
<p>Ectopic pregnancy occurs in around 9% of women with PID and about 18% experience chronic pelvic pain.</p>
<h2>Psychological impacts</h2>
<p>We <a href="http://hpq.sagepub.com/content/19/5/618.abstract">explored</a> the psychological and social impacts of PID on women’s sense of self and their relationships. We also questioned women about their health care experiences in relation to their diagnosis.</p>
<p>We found being diagnosed with PID was a distressing experience for most women, with fears focused mostly on future fertility. </p>
<p>Infertility worries influenced the way women viewed themselves. Many thought they might be abnormal, inadequate, or damaged. Some believed they would be incapable of fulfilling traditional female roles of “normal” wife and mother. </p>
<p>The disease negatively impacted the level of intimacy and emotional closeness many women shared with their partner. Some experienced relationship conflict or breakdown over how the STI that led to their PID was acquired. </p>
<p>Almost all women felt their diagnosis had negatively affected sexual aspects of their relationships. Many had pain or discomfort during intercourse, which caused general anxiety about sex and made them engage in it less.</p>
<h2>Under-diagnosed</h2>
<p>Partly because PID is difficult to diagnose definitively, and due to a lack of routine data collection, it’s difficult to accurately estimate its prevalence. </p>
<p>It’s <a href="http://www.sexualhealthaustralia.com.au/page/pelvic_inflammatory_disease.html">estimated around 10,000</a> are treated for pelvic inflammatory disease in hospitals each year. Ten to 30 times that number are treated as outpatients.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1129&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1129&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110094/original/image-20160203-28538-qbsdxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1129&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Infertility worries influenced the way women viewed themselves.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>As women with pelvic inflammatory disease often show either mild or no symptoms, it isn’t surprising the condition often goes unrecognised. </p>
<p>Prompt treatment of chlamydia and gonorrhoea infections is essential for the prevention of potential PID.</p>
<p>In Australia, <a href="http://www.sti.guidelines.org.au/">rates of chlamydia and gonorrhoea diagnoses</a> are highest among 15- to 24-year-olds. The Royal Australian College of General Practitioners recommends annual <a href="http://www.racgp.org.au/your-practice/guidelines/redbook/">chlamydia testing</a> for all sexually active people between 15 and 29 and for any person at high risk. </p>
<p>High-risk <a href="http://www.sti.guidelines.org.au/">groups include</a> men who have sex with men and young heterosexual Aboriginal and Torres Strait Islanders.</p>
<p>Laparoscopic surgery, which uses a camera to examine inside the pelvis, is the best way to <a href="http://www.cdc.gov/std/tg2015/pid.htm">diagnose</a> PID. But its cost and limited availability means it’s not easily justifiable for women with mild or vague symptoms.</p>
<p>Both <a href="http://www.cdc.gov/std/tg2015/default.htm">international</a> and <a href="http://www.sti.guidelines.org.au/syndromes/pid-pelvic-inflammatory-disease">national</a> guidelines encourage doctors to treat for PID when a woman presents with lower abdominal pain and all other causes have been excluded. </p>
<p>But research shows large numbers of Australian women have a diagnosis <a href="http://www.ncbi.nlm.nih.gov/pubmed/18723585">missed</a> or <a href="https://www.mja.com.au/journal/2012/197/11/frequent-occurrence-undiagnosed-pelvic-inflammatory-disease-remote-communities">inadequately treated</a>. </p>
<p>In our research, <a href="https://www.mja.com.au/journal/2012/197/11/frequent-occurrence-undiagnosed-pelvic-inflammatory-disease-remote-communities">women with PID often described</a> experiences of incorrect diagnoses, incorrect prescriptions and inadequate medical care. Some women also reported receiving inadequate information from their health care provider about the diagnosis and management of their condition. </p>
<p>Women may also delay seeking treatment. We found the majority of women had symptoms for longer than four weeks before they sought medical care. Several reported having symptoms for more than six months before they saw a medical professional. </p>
<p>A major contributor to this delay was a lack of awareness. Many women had never heard of PID prior to their diagnosis.</p>
<p>Community education emphasising the importance of safe sex and STI screening must include information about PID and its symptoms. And early presentation for the diagnosis and treatment of pelvic pain should be a key message of all sexual health promotion programs.</p><img src="https://counter.theconversation.com/content/45822/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Danielle Newton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pelvic inflammatory disease’s traumatic consequences are unmatched by the low level of awareness around it. Left untreated, it can cause chronic pelvic pain, ectopic pregnancy and infertility.Danielle Newton, Research Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/474072015-09-13T20:17:30Z2015-09-13T20:17:30ZGood news and bad in latest annual report on HIV, hepatitis and STI rates<figure><img src="https://images.theconversation.com/files/94473/original/image-20150911-1551-tm9k8p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The biggest growth in sexually transmitted infections is for chlamydia and gonorrhoea.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/lazyartist/15141070532/">J. Michel (aka: Mitch) Carriere/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p>The latest instalment of Australia’s annual report card on HIV, hepatitis and sexually transmissible infections has been released this morning. Here’s what experts who work in these areas make of the results.</p>
<hr>
<h2>HIV</h2>
<p>The number of newly diagnosed HIV infections in Australia has been stable over the past three years, with 1,081 HIV infections newly diagnosed in 2014. This represents an important deflection from previous trends showing year-on-year increases in new HIV diagnoses since 1999, when 714 HIV infections were newly diagnosed (the lowest annual number to date). In Australia, gay men and other men who have sex with men remain most affected by HIV; in 2014, 70% of HIV diagnoses were in men who had sex with men.</p>
<p>Condomless anal intercourse is a main risk factor for HIV infection among men who have sex with men. Previously, increases in such sex coincided with an increasing number of HIV cases being reported to the authorities. But HIV notifications are now stable, despite continuing increases in condomless anal intercourse. </p>
<iframe width="100%" height="650" scrolling="no" frameborder="no" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" src="https://cdn.theconversation.com/infographics/163/cecdd1ee8f5d4ab009583e1afe6038160d9fcf60/site/index.html"></iframe>
<p>In 2014, <a href="http://kirby.unsw.edu.au/projects/gay-community-periodic-surveys">Gay Community Periodic Surveys</a> in the main urban areas across Australia found 39% of participants had condomless anal intercourse with casual partners. The stable number of new HIV cases notified to health authorities despite decreasing condom use reflects that HIV risk is being offset by other prevention strategies, such as the well-established “serosorting”, whereby men have condomless sex only with a partner of the same HIV-status. Other new HIV-prevention strategies may also be having effect.</p>
<p>These’s strong evidence that combination antiretroviral therapy (cART) reduces HIV transmission to an uninfected partner by as much as 96%. Early initiation of cART is now recommended as it also benefits the health outcomes of people with HIV. </p>
<p>In Australia, uptake of cART has increased substantially. In 2014, 84% of HIV-positive Gay Community Periodic Survey participants were taking ART, up from 60% in 2005. This increased treatment uptake has resulted in a decrease in the HIV viral load at the individual and community level, and reduced the likelihood of HIV transmission. It may have also offset the risks of increased rates of condomless anal intercourse. </p>
<p>The current stable number of newly diagnosed HIV infections in Australia is encouraging and highlights the success of a continued HIV response that remains one of the best in the world. Evidence is emerging that the increase in treatment uptake may also benefit prevention of HIV infections in Australia. </p>
<p>There’s now a real possibility of reducing new HIV infections through a combination of established and new HIV prevention tools. </p>
<h2>Chlamydia and gonorrhoea</h2>
<p>Chlamydia remains the most frequently reported notifiable sexually transmissible infection in Australia with 86,136 diagnoses in 2014. The majority (78%) of cases occurred among 15- to 29-year-olds. </p>
<iframe src="https://datawrapper.dwcdn.net/V5eRg/4/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="600"></iframe>
<p>Increases in testing – 91% in the past seven years – likely account for the steady increases in chlamydia diagnoses. But the vast majority of infections (76%) remain undiagnosed and hence untreated. This emphasises the need for testing to be routinely offered to sexually active adolescents, young adults and other at-risk populations. </p>
<p>New gonorrhoea infections have been detected more frequently in the past five years, with 15,786 cases notified in 2014. Gonorrhoea in Australia continues to be an infection primarily of men who have sex with men, and of young Aboriginal people living in remote areas of Australia. The rate of diagnosis of gonorrhoea in the Aboriginal population was 18 times that in the non‑Indigenous population. </p>
<iframe src="https://datawrapper.dwcdn.net/sP9Rt/4/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="500"></iframe>
<p>Increased testing for this infection may explain much of this increase in gonorrhoea diagnoses, but whether transmission itself has increased remains unclear. Over the past five years, most pathology laboratories in Australia have adopted dual testing, whereby if a clinician orders a test for either chlamydia or gonorrhoea, both tests are automatically performed. </p>
<p>The emphasis on testing for chlamydia in young people has therefore led to a substantial rise in the number of tests conducted for gonorrhoea. That may explain the increase in diagnoses.</p>
<h2>Hepatitis C</h2>
<p>The hepatitis C epidemic in Australia has reached a crucial crossroads. The age of people with chronic hepatitis C means that thousands of Australians each year are now progressing to advanced liver disease, with a risk of liver failure, primary liver cancer and liver-related death. </p>
<p>Current interferon-containing hepatitis C treatments have had minimal impact on the rising burden of hepatitis C-related liver disease. This is due to low uptake rates and sub-optimal response rates. The advent of interferon-free hepatitis C treatments, with simple delivery (some are one pill per day for 12 weeks), minimal side effects and high cure rates (above 90%), provides one of the greatest advances in clinical medicine in recent decades.</p>
<iframe src="https://datawrapper.dwcdn.net/FpTMo/2/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="400"></iframe>
<p>The Pharmaceutical Benefits Advisory Committee has <a href="http://www.pbs.gov.au/industry/listing/elements/pbac-meetings/pbac-outcomes/2015-07/web-outcomes-july-2015-positive-recommendations.pdf">recommended that these new hepatitis C treatments be listed</a> on the Pharmaceutical Benefits Scheme, which means they will be subsidised by the government. But price negotiations have not been completed and federal cabinet approval will be required before the medicines are subsidised. </p>
<p>The listing of these drugs would increase treatment rates several-fold and turn around the enormous and rising burden of hepatitis C liver disease in Australia. Australia has the potential to be an international leader in its response to hepatitis C, if these treatments are made broadly available. </p>
<h2>Syphilis</h2>
<p>Syphilis is a less common sexually transmissible infection compared with chlamydia and gonorrhoea. It continues to be an infection primarily of men who have sex with men and of young Aboriginal people. At 1,999 cases in 2014, the number of syphilis notifications has reached its highest level since recording began in 2004. The vast majority (92%) of cases are among men. </p>
<iframe src="https://datawrapper.dwcdn.net/fd3dz/2/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="500"></iframe>
<p>There were 235 infectious syphilis diagnoses in Aboriginal and Torres Strait Islander people in 2014. A roughly equal number of diagnoses among males and females indicates predominantly heterosexual transmission. About half (46%) resided in remote or very remote areas and 38% in outer regional areas. Notifications of congenital syphilis declined from 16 in 2005 to three in 2009, then increased to five in 2014. </p>
<iframe src="https://datawrapper.dwcdn.net/lutnY/3/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="400"></iframe>
<p>Efforts to increase syphilis testing and treatment in men who have sex with men need to be strengthened. The resurgence of infection in young Aboriginal people in remote communities after years of declining rates, bringing with it cases of congenital syphilis, emphasises the need for testing and treatment in this population, particularly in antenatal settings so we can prevent more cases of congenital syphilis.</p><img src="https://counter.theconversation.com/content/47407/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John de Wit is one of the authors of the Annual Report of Trends in Behaviour (ARTB) 2015.</span></em></p><p class="fine-print"><em><span>Gregory Dore is an advisory board member and receives honorarium from Gilead, Merck, Abbvie, Bristol-Myers Squibb, Janssen. He has received research grant funding from Gilead, Merck, Abbvie, Bristol-Myers Squibb, Janssen, and travel sponsorship from Gilead, Merck, Abbvie, and Bristol-Myers Squibb. Gilead, Bristol-Myers Squibbe, and Abbvie manufacture hepatitis drugs currently in price negotiations for being listed on the PBS.</span></em></p><p class="fine-print"><em><span>Rebecca Guy receives funding from the NHMRC.</span></em></p><p class="fine-print"><em><span>Skye McGregor receives funding from the Department of Health.</span></em></p>The latest instalment of Australia’s annual report card on HIV, hepatitis and sexually transmissible infections has been released this morning. Here’s what experts make of the results.John de Wit, Professor and Director of the Centre for Social Research in Health, UNSW SydneyGregory Dore, Professor of Medicine, Clinical Researcher and Epidemiologist, UNSW SydneyRebecca Guy, Associate Professor of Epidemiology & Program Head of Surveillance Evaluation and Research, UNSW SydneySkye McGregor, Epidemiologist, The Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/449862015-07-28T20:06:52Z2015-07-28T20:06:52ZLet’s talk about sex over 60: condoms, casual partners and the ageing body<figure><img src="https://images.theconversation.com/files/89885/original/image-20150728-7665-1crqcmz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-19730155/stock-photo-happy-senior-adult-couple-kissing.html?src=iuJk2rIBZnXwZ3yXytVmZg-3-123">Andy Dean Photography/Shutterstock</a></span></figcaption></figure><p>Over the past few years we’ve seen a dramatic rise in the rates of sexually transmitted infections (STIs) among Australians aged 60 years and older. Rates of gonorrhoea <a href="http://kirby.unsw.edu.au/surveillance/2012-annual-surveillance-report-hiv-viral-hepatitis-stis">more than doubled</a> in this age group between 2007 and 2011. Rates of chlamydia also rose significantly during this time, mirroring similar <a href="http://sti.bmj.com/content/early/2008/06/27/sti.2007.027847.full.pdf">trends internationally</a>.</p>
<p>STIs can be accompanied by some <a href="http://www.sciencedirect.com/science/article/pii/S0378512210002100">unpleasant symptoms</a> and health complications, or lead to major chronic conditions, in the case of HIV. It’s therefore important STIs are diagnosed and treated, regardless of age. </p>
<p>To understand why STIs are on the rise, we need to know more about older people’s sexual and romantic relationships, their knowledge of STIs and safe sex, and the safe sex practices that they use. However, older people are routinely <a href="https://theconversation.com/invisible-sexuality-older-adults-missing-in-sexual-health-research-34078">excluded</a>
from research on sex and relationships. Here’s what we know so far. </p>
<h2>Changing sexual and relationship patterns</h2>
<p>The Baby Boomer generation is renowned for challenging norms around <a href="https://theconversation.com/sex-desire-and-pleasure-in-later-life-australian-womens-experiences-35725">sex and age</a> and this has continued in recent decades.</p>
<p>Improvements to life expectancy and overall health in later life mean that older people may be more willing and able to engage in varying kinds of sexual activity. In fact, there is some evidence to suggest that remaining sexually active is associated with <a href="http://link.springer.com/article/10.1007/s12126-011-9110-7">better health in older age</a>.</p>
<p>Changes in the social acceptability of divorce and dating in later life have also opened up the possibility of entering in to a new sexual relationship. With new sexual partners comes an <a href="http://www.maturitas.org/article/S0378-5122(12)00405-7/abstract?rss=yes">increased possibility</a> of contracting an STI. </p>
<p>Alongside this, internet dating has increased the opportunities to meet <a href="http://apo.org.au/research/love-actually-older-adults-and-their-romantic-internet-relationships-0">new sexual or romantic partners</a>. And medical advances such as Viagra have made (penetrative) sex in later life more of a possibility for older men than was previously the case.</p>
<p>However, this does not mean that all older people are sexually active, or that they are sexually active in the same ways as younger people. Instead, <a href="http://www.tandfonline.com/doi/full/10.1080/14681994.2014.936722#abstract">research suggests</a> that older people engage in a diverse range of sexual practices, and may have to adjust to ageing bodies. </p>
<h2>Let’s (not) talk about sex</h2>
<p>Despite these changes, and increasing <a href="https://theconversation.com/britons-have-sex-sooner-older-but-less-often-20735">evidence</a> that older people continue to be sexually active, there’s a reluctance to acknowledge this shift. Many in the community continue to cling to outdated and ageist assumptions that older people are asexual.</p>
<p>As a result, medical professionals can be reluctant to talk to their older patients about sex. <a href="http://www.sciencedirect.com/science/article/pii/S0277953603004490">Research in the United Kingdom</a>
shows GPs assume the topic of sexual health is not relevant to older people, and fail to proactively raise this issue with their older patients. This is often based on an <a href="https://theconversation.com/a-ripe-old-age-the-joy-of-sex-later-in-life-just-dont-forget-the-condoms-1969">incorrect assumption</a> that older people are no longer sexual.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=298&fit=crop&dpr=1 600w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=298&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=298&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=375&fit=crop&dpr=1 754w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=375&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/89888/original/image-20150728-7668-191s5jk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=375&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">How do you negotiate condom use and an ageing body?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-298213292/stock-photo-two-open-condoms-and-sealed-condoms.html?src=otN1pL8KgmCMUv71EspmGg-2-20">Studio KIWI/Shutterstock</a></span>
</figcaption>
</figure>
<p>This reluctance can have direct and negative implications for the sexual health of older people. It becomes less likely that older patients will be offered <a href="https://theconversation.com/health-check-the-sti-check-up-warts-and-all-32160">routine sexual health screenings</a>
, or have the opportunity to ask their GP questions about sexual health.</p>
<h2>Learning about safe sex is a life-long endeavour</h2>
<p>When we talk about safe sex and STIs, our focus tends to be on <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1741-6612.2008.00336.x/full">younger people</a>. In some ways this makes sense: many younger people are entering their first sexual relationships and need to learn how to have sex safely. </p>
<p>There is also an assumption that older people already know about safe sex. Yet, many older people grew up in a time when comprehensive sex education wasn’t provided in school. For those who have been in long-term, monogamous relationships, using condoms may have seemed irrelevant.</p>
<p>Older Australians need different types of information at different stages in the life course. Those reentering the dating or casual sex scenes, for instance, might benefit from a refresher on safe sex. </p>
<p>Older people might also have unique or different safe sex needs to their younger counterparts. For example, how does one negotiate condom use and an ageing body? How can issues around increased friction and pain that can be associated with condom use (particularly for postmenopausal women) be managed? </p>
<p>We need age-specific education and resources.</p>
<h2>Don’t delay treatment</h2>
<p>STIs can be costly to treat, and the economic burden of STIs increases with delayed diagnosis and treatment. Delayed treatment can result in more <a href="http://link.springer.com/article/10.1007/s11908-006-0010-z">severe symptoms</a> and <a href="http://www.sciencedirect.com/science/article/pii/S0197457211003363">complications</a>. Ignoring older people as sexual beings may contribute towards poorer overall health and deny their sexual agency.</p>
<p>We need to be more proactive in engaging older Australians around their sexual health. This could start with providing education, access to testing, and opportunities for discussions about sex, relationships, and sexual health. </p>
<p>We also need to know more about sex and relationships among older Australians and what they already know or don’t know about STIs and safe sex. This week we launched <a href="http://sexagemesurvey.org.au">SexAge&Me</a>, the first national study of older Australians’ sexual and romantic relationships, to help answer these questions and inform future approaches to sexual health policy and health care responses. </p>
<p><em>If you’re an Australian resident aged over 60 and want to take part in the survey, <a href="http://www.demographix.com/surveys/N5FZ-LWS6/8XQ4JKG3/">click here</a>.</em></p><img src="https://counter.theconversation.com/content/44986/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bianca Fileborn receives funding from the Australian Research Council to undertake research on STIs and ageing.</span></em></p><p class="fine-print"><em><span>Anthony Lyons receives funding from the Australian Research Council to undertake research on the sexual health of older Australians. </span></em></p>Over the past few years we’ve seen a dramatic rise in the rates of sexually transmitted infections (STIs) among Australians aged 60 years and older.Bianca Fileborn, Research Officer at the Australian Research Centre for Sex, Health & Society, La Trobe UniversityAnthony Lyons, Senior Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/321602014-10-27T03:31:36Z2014-10-27T03:31:36ZHealth Check: the STI check-up – warts and all<figure><img src="https://images.theconversation.com/files/62613/original/99xp9hch-1414044091.jpg?ixlib=rb-1.1.0&rect=0%2C267%2C5760%2C3095&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Technology has done away with the need to insert swabs into the male urethra and speculums into the vagina. Instead, blood and urine are tested.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-216141157/stock-photo-medical-urine-test-close-up.html?src=pp-same_artist-216145360-_cx5M619eKLmHluUfhtomw-3">In Tune/Shutterstock</a></span></figcaption></figure><p>Sexuality is a means of pleasure, fulfilment and intimate connection with other humans. But it can also be a source of anguish. So it’s perhaps no surprise that of all the areas in health care, the “STI check” is one of the most fraught. </p>
<p>An STI check is one or more tests performed on a person who has no symptoms but is potentially at risk of having one or more sexually transmitted infections. </p>
<p>If you have symptoms – such as vaginal or urethral discharge; lower abdominal, pelvic, testicular or genital pain or itch; lumps, warts or ulcers in the genital area; unusual vaginal bleeding; painful urination; or anal symptoms if you have had anal sex – then the context changes to being a diagnostic assessment. </p>
<p>STI checks for asymptomatic people fall into the realm of “opportunistic health screening” – think blood pressure checks for hypertension, blood sugar tests for diabetes and other scenarios where you’re offered a test but have no symptoms. However, the STI check is not one-size-fits-all, nor does a “full STI check” actually test for all possible STIs.</p>
<p>So, which STIs are relevant to your own personal STI check? These are determined by your sexual history, what is known about the patterns of STIs in different populations, as well as the technical reliability of the tests. </p>
<p>The STIs tested include one or more of the following: <a href="https://playsafe.health.nsw.gov.au/sti/chlamydia">chlamydia</a>, <a href="https://playsafe.health.nsw.gov.au/sti/gonorrhoea">gonorrhoea</a>, <a href="https://playsafe.health.nsw.gov.au/sti/syphilis">syphilis</a>, <a href="https://playsafe.health.nsw.gov.au/sti/hepatitis-b">hepatitis B</a> and <a href="https://playsafe.health.nsw.gov.au/sti/hiv-aids">HIV</a> (human immunodeficiency virus). In some populations, it might also include <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Hepatitis_C_the-facts">hepatitis C</a>, <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Trichomoniasis?open">trichomoniasis</a> or <a href="https://playsafe.health.nsw.gov.au/sti/bacterial-vaginosis">bacterial vaginosis</a>. </p>
<p>Here’s what your doctor or nurse might ask you to help guide the STI check: </p>
<ul>
<li>your age and gender</li>
<li>whether you are Aboriginal or Torres Strait Islander, or a recent migrant (if so, from where), or travelled recently</li>
<li>your recent sexual encounters, including the number of partners you have had in the past three months</li>
<li>the gender of your sexual partners ever (male, female, both)</li>
<li>the nature of your sexual practices (vaginal intercourse, anal intercourse, oral sex)</li>
<li>whether and how often you have used condoms</li>
<li>whether you’ve had an STI check before and when</li>
<li>whether you’ve ever been diagnosed with an STI. </li>
</ul>
<p>To give a fuller picture of STI risk, you could be asked whether you have ever paid or been paid for sex, been in gaol, injected substances, or had tattoos or piercings done overseas or at home.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/62705/original/d4h8d7p3-1414125623.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For heterosexuals up to 29 years, an annual chlamydia test is recommended.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-177322637/stock-photo--young-woman-reading-brochure-in-doctor-s-waiting-room.html?src=B0L3JUlROUvWFrA1eqQqMQ-1-27">diplomedia/Shutterstock</a></span>
</figcaption>
</figure>
<p>Although potentially daunting, most people believe that their GP is the right person with whom to discuss their sexual health. A GP or nurse who makes you feel comfortable is likely to be one who explains confidentiality, asks questions sensitively and gives you clear explanations of what the STI check will involve. They will also explain that choosing whether to answer questions is up to you. </p>
<p>When it comes to the tests, the good news is that technology has done away with the once-uncomfortable, or downright painful, swab up into the urethra of men, or the need for a woman to have a speculum inserted into her vagina.</p>
<p><a href="https://playsafe.health.nsw.gov.au/sti/chlamydia">Chlamydia</a> and <a href="https://playsafe.health.nsw.gov.au/sti/gonorrhoea">gonorrhoea</a> tests can be done on urine samples in men and women or self-collected vaginal swabs in women. If there is a concern about anal sex transmission, you can collect your own swab from your rectum. Gay men having unprotected oral sex are advised to allow the doctor or nurse to collect a throat swab.</p>
<p><a href="https://playsafe.health.nsw.gov.au/sti/syphilis">Syphilis</a>, <a href="https://playsafe.health.nsw.gov.au/sti/hepatitis-b">hepatitis B</a> and <a href="https://playsafe.health.nsw.gov.au/sti/hiv-aids">HIV</a> are tested for on blood samples, as is <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Hepatitis_C_the-facts">hepatitis C</a> (this is an infection mainly passed on through sharing needles).</p>
<p><a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Trichomoniasis?open">Trichomoniasis</a> mainly affects Aboriginal and Torres Strait Islander women living in remote and regional Australia and can be tested for on a urine sample or vaginal swab.</p>
<p><a href="https://playsafe.health.nsw.gov.au/sti/bacterial-vaginosis">Bacterial vaginosis</a> (BV) is not strictly an STI but is much more prevalent in women who have sex with women. BV is diagnosed via a vaginal swab, usually collected by the doctor or nurse.</p>
<p>If you need an examination, it should be explained beforehand that you can request a chaperone in the room (such as a nurse present while the doctor examines you). A curtain and sheet for privacy are standard. </p>
<p>The recommended frequency of STI checks also varies. In heterosexuals up to 29 years, an annual chlamydia test alone is recommended. In men who have sex with men who have additional risk factors (such as any unprotected anal sex, ten or more partners in six months) testing every three months is recommended. Some people want an STI check when they embark on a new relationship and can request one.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/62706/original/9t5btyyg-1414126068.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/62706/original/9t5btyyg-1414126068.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/62706/original/9t5btyyg-1414126068.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/62706/original/9t5btyyg-1414126068.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/62706/original/9t5btyyg-1414126068.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/62706/original/9t5btyyg-1414126068.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/62706/original/9t5btyyg-1414126068.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your doctor or nurse will ask you whether and how often you have used condoms.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-168231869/stock-photo-safe-sex-concept-hand-with-condom.html?src=iLU5QfWoUDMCZ-e1aawxng-1-118">chingyunsong/Shutterstock</a></span>
</figcaption>
</figure>
<p>It might be helpful to know that two of the most common STIs are <em>not</em> included in the STI check: <a href="http://www.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-hpv">human papillomavirus</a> (HPV) and <a href="http://www.cdc.gov/std/herpes/stdfact-herpes.htm">herpes simplex virus</a> (HSV). This is related to the reliability of the tests and the way in which these infections spread in populations, making routine test unhelpful. If you have particular concerns about these infections, because of a known contact for example, it’s best to discuss this specifically with your doctor.</p>
<p>Follow-up is an important part of the STI check. Discussing the most reliable way of contacting you is part of pre-STI check counselling. You might opt for an SMS, or prefer a return appointment to go through everything. </p>
<p>If you do have a positive test, appropriate treatment will be recommended, supportive counselling provided, and notifying sexual partners will be discussed. Depending on the STI, you will be asked to try to contact sexual partners from the past two to 12 months. Your doctor, or a public health unit, can help and it can be done anonymously. </p>
<p>For some STIs, including the most common – chlamydia – you will be asked to re-test some time after treatment to make sure it has cleared and you are not reinfected. Many STIs are notified to central health surveillance units, an important part of managing communicable diseases.</p>
<p>STI checks are a way of being proactive and preventive when it comes to health. If sex and health are an important part of your life, then try to think of the STI check as something that will contribute to your enjoyment of both.</p><img src="https://counter.theconversation.com/content/32160/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Melissa Kang does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sexuality is a means of pleasure, fulfilment and intimate connection with other humans. But it can also be a source of anguish. So it’s perhaps no surprise that of all the areas in health care, the “STI…Melissa Kang, Senior Lecturer, Department of General Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.