Sexual Health for Sex Workers - A Guide

 

Throughout history sailors, soldiers and sex workers have been popular public figures of blame for the spread of disease, sometimes justifiably. Columbus and his crew, for example, may have been responsible for bringing syphilis to Europe in 1493, and it’s widely agreed that syphilis spread by prostitutes working in both camps nearly destroyed the French and Neapolitan armies in 1495. Public health ‘initiatives’ to control the spread of disease in brothels date back to 1161, when brothels in London were forbidden to house women “suffering from the perilous infirmity of burning” (probably gonorrhoea). The French went one step further in 1256 and banished prostitutes with “burning” from the kingdom. Regular examination, liscensing and monitoring of sex workers dates back to the Napoleonic Wars, and continues in some countries to this day.

Although the public perception of sex work – particularly street-based sex work – isn’t always as enlightened as we’d like, the facts are that sex workers in Scotland are probably at no higher risk for STIs than the general population. In fact, there’s some anecdotal evidence that they’re less likely to have STIs, certainly compared to some of the higher risk age groups. There is no mandatory or enforced sexual health testing for sex workers in the UK, but for the sake of your own health you should get tested regularly. Many STIs are treatable and have no long-term effects on your health if they are caught early on. Condoms will protect you, but they can’t provide a cast iron guarantee that you won’t be exposed to something. If you do test positive for an STI, you may be asked to do ‘contact tracing’ to notify your former partners. This will involve giving the clinic what details you know of anyone you have slept with in a certain time scale (depending on the STI), so that they can be anonymously notified that they should be tested. Your name will never be revealed to anyone that is contact traced. You don’t have to participate in contact tracing, and you don’t have to tell them you’re a sex worker. 

As GUM clinics are anonymised (you are assigned a number, which is attached to your samples) the only STIs that do require your confidentiality to be breached are the Hepatitis viruses (A,B & C). These are Notifiable Diseases, which means that the clinic must send a form with your name, age, gender, home address and the date you first had symptoms off to Health Protection Scotland. This information is then anonymised down to your postcode, age and gender before it is used for statistics.  The only reason your anonymity would ever be breached by a GUM clinic would be if you tested positive for an STI, were booked in for treatment and/or follow-up testing and didn’t turn up, in which case they will call you, send a registered letter to your home address and, if they still can’t reach you, they will then get in contact with your GP.

Public Health

There are a variety of testing methods used for sexually transmitted infections (STIs) or diseases. What type of test is used will depend on your symptoms and which STI you are most likely to have, but it’s often worth asking to be checked for other STIs as some infections can leave you more vulnerable to others. There are a number of places you can get tested for STIs in Edinburgh, in addition to your own GP. For simplicity’s sake, we’ll refer to all clinics as GUM clinics. See the Services section for information on specific clinics.

What happens at a GUM clinic? 

Some clinics are walk-in, but for others you do need to book in advance. When you go, you’ll be asked for your name, date of birth and contact details and you will be registered as a patient. Some clinics will give you an ID number which will be used to identify your samples. A nurse will usually do an assessment which will include asking you why you’ve come to the clinic and a ‘sexual history’. They will ask questions like when you last had sex, who you have had sex with and whether you used condoms. They will also ask whether you have had any STIs before and whether you are on any medication. You do not have to tell them that you are a sex worker.

What does testing involve?

Urine Samples.  You may be given a sample bottle to fill at home and bring back, or asked to do a urine sample there. For some infections, such as Chlamydia, you will need to avoid peeing for 1-2 hours, or overnight, before doing a sample. It’s safe to assume that you’ll probably need to do a urine sample, so you should avoid peeing for at least 2 hours before you go to the clinic.

Blood Tests.  A sample of blood may be taken to test for syphilis, HIV, Hepatitis B and Hepatitis C. Some tests look for the disease, others look for the antibodies (signs that your body is fighting an infection). These can take some time to show up in your blood after you’ve been infected, so you may need to go back for more tests.

Swab Tests.  You might be asked to collect a swab sample from inside your vagina yourself or a doctor or nurse will use a swab to collect cells from the cervix or vagina during an internal examination. Men may have a swab sample taken from just inside the opening of the urethra at the tip of the penis. Contrary to popular mythology, nothing is inserted inside the penis during testing. If you have symptoms of an anal or oral infection a swab may be used to collect cells from your rectum or throat, although this is not very common. If you have open sores, a swab sample may be taken to test for genital herpes. A swab looks like a smaller, more rounded Cotton bud. It is wiped gently over the parts of the body that might be infected and collects discharge and cells. Swab tests are rarely painful (unless you have a severe inflammation or open sores), but they can be a little uncomfortable.

the outside...

The vulva is the name for all of the bits on the outside of the body. From top to bottom, and front to back:  The pubic mound (also known as the mons pubis or mound of Venus) is the soft fatty mound of flesh, covered in pubic hair, that splits into the two lips of the Labia. The Labia is actually made up of two parts, the labia majora (1), the outer lips that cover the vagina when the legs are closed, and the labia minora (2), which are two smaller soft folds of skin on either side of the opening of the vagina. The clitorisis located where the two lips of the labia majora meet. Most of the clitoris is actually inside the body - the only visible bits are the clitoral hood (3), which is similar to the foreskin of the penis, and the clitoral glans (4), the head of the clitoris. This has a lot of nerve endings and is extremely sensitive.   Beneath the clitoris, the area between the lips of the labia minora is called the vulval vestibule. In it is the opening of the urethra, the small opening that you pee through, and the opening of the vagina (5)itself. Slightly below and on either side of the vagina are the Bartholin's glands. No one really knows what they do - they secrete tiny amounts of mucus just before orgasm. Some women also have tiny glands called Skene's glands just above the vagina. Again, no one really knows what they're for, and not all women have them, but they might have something to do with female ejaculation and the G-spot. The area of skin between the vagina and the anus is called the perineum

On the inside...

 

The vagina is a tube of muscle that leads from the outside of the body up into the uterus (womb). It is actually a collapsed tube that gets longer and wider when you become sexually aroused. About 5 centimetres up the vagina on the anterior (front) side is where some women have a G-spot. No one has been able to prove whether the G-spot is part of the vagina, or the effect of pressure on the Skene's glands that lie just on the other side of the vaginal wall at about this spot, or if the G-spot exists at all. The narrow opening between the vagina and the uterus called the cervix. The cervix secretes mucus that keeps sperm out of the uterus until you have ovulated and keeps the uterus healthy. The bladder sits nestled in the crook where the vagina meets the uterus, which is why it can be uncomfortable to have sex when you need to pee and why, when you're pregnant, you never do anything but pee. At the top of the uterus, on either side, fallopian tubes lead to the ovaries

How it works

The vagina is a self-cleaning organ - it has a healthy balance of bacteria that keep each other in check. Sometimes the balance gets thrown out, and you can develop infections like thrush, but it usually keeps itself in perfect shape. Douching is generally discouraged nowadays, because it interferes with the vagina's ability to keep itself balanced and actually seems to cause more infections.

Discharge

It is normal to have some discharge from the vagina. The vagina keeps itself moist as part of its self-cleaning, and most discharge is a result of this cleaning cycle – it contains a lot of dead cells and bacteria. Most women notice that their discharge changes during the month. This is actually a result of the changes in the mucus plug that the cervix makes to keep the uterus clean and healthy. The plug thickens up right after your period, so you will have very little, but quite thick, discharge. When you ovulate the plugs loosens up and you may notice a lot of thin, slippery ajd clear discharge that turns a yellowy-brown on your underpants. Normal discharge doesn’t smell, and doesn’t cause any irritation or itching. Some common discharge problems and possible causes are:

  • Fishy smell: bacterial vaginosis or trichomonas/trichomoniasis
  • Thick and white (like cottage cheese): thrush
  • Yellow or green: gonorrhea, trichomonas
  • Foul smelling: forgotten tampon or sponge, gonorrhea
  • Thin and watery and/or white or grey: bacterial vaginosis
  • Bleeding (not period): Chlamydia, gonorrhea
  • Thick: PID, trichomonas
  • Itching or irritation: Thrush, trichomonas

 

Please remember these are only possible causes - if you are worried about any discharge you should see a GUM clinic or your GP to get a diagnosis. There is an information page on each STI in this section where you can find out more about treatment and testing options.

Douching

What is it?

Some women douche to clean the vagina before or after sex, or to keep it tight – but douching is only 15-25% effective as a contraceptive and here is no evidence that it prevents STI transmission. In fact, because douching can force bacteria from the vagina (where there is a healthy and balanced bacterial system) into the uterus and fallopian tubes, it can actually cause fertility problems.

Why shouldn’t I?

Douches and betadine pessaries contain ingredients which are harmful to you, and there is no guarantee that they will provide any benefits. Vaginas are self-cleaning and there is evidence to suggest that douching prevents this and can lead to irritation, infection and pelvic inflammatory disease. Regular douching will give you a dry vagina, which will make you more susceptible to infection. And increased discharge could be caused by an STI, so if you’re experiencing this, you should get it checked out. There are also links between douching and ectopic pregnancy as douching after sex can force the sperm further inside the womb. Some women douche to prevent yeast infections – but it doesn’t work. In fact, there is a lot of evidence to suggest that douching increases your chances of getting infections. If you wear cotton underwear and don’t use panty liners, you’ll reduce the risk of a yeast infection. See the section on Thrush for more information on how to prevent, and treat, yeast infections.

What about anal douching?

Never douche the anus, as this can cause cuts and abrasions in the sensitive intestinal walls that will increase your risk of infection.

On the outside...

Unlike the female reproductive system, most of a man’s genitalia are out on display. This makes sense when you realize that the human penis is much, much bigger in proportion to the body than those of the other great apes, which means that penis size is something that men have been sexually selected for in the past. The male bits are, from front to back: The penisis made up of three columns of tissue, the 2 layers of the corpus cavernosa, which fill with blood to make the penis hard during erection, and the corpus spongiosum, which surrounds the urethra and prevents it from being crushed. The glans penis (also called the head of the penis) is the sensitive bulb at the end of the penis; this is covered by the foreskinwhen the penis is not erect. Circumcised men have had the foreskin removed, usually as a baby. The area on the underneath of the penis where the foreskin is attached is called the frenulum or frenum. The meatus is the opening of the urethra at the tip of the penis.   The scrotal sachangs beneath the penis and contains the two testicles. The sensitive area of skin between the testicles and the anus is called the perineum.

 

 

 

On the inside...

The testicles (testis or testes) produce sperm and male hormones like testosterone. Sperm that is made in the testes moves into the epididymis, a series of tightly coiled tubes, where it is stored until the penis becomes erect. When a man becomes aroused, sperm begins to move along the vas deferens and is eventually ejaculated out through the urethra. The seminal vesicle lies where the vas deferens meets the urethra coming from the bladder; this produces some of the fluid that makes up semen.   The prostrate gland also lies where the urethra meets the vas deferens; the prostrate makes a milky white substance that also forms part of semen, and contains muscles that help push the sperm out during ejaculation. There is also a small gland, called Cowper’s gland (not labelled) that sits below the prostrate and makes pre-cum.

 

 

Bacterial Vaginosis

What is it?

Bacterial vaginosis (BV) is not a STI; it is a condition inside the vagina caused by changes in the levels of bacteria – too little of the normal, healthy vaginal bacteria and too much of other kinds.  It is very common, more than thrush (yeast infections) - between 10-64% of women have it at any given time.

What are the symptoms? 

Around half of women who have BV get no symptoms at all, or don't get them severely enough to notice. When they appear, the main symptom is changes to your vaginal discharge - more than usual, thin and watery, white/grey in colour and, most noticeably, with a strong, unpleasant, fishy smell, particularly after sex. Most women do not get any itching or irritation with BV (this is more typically a symptom of thrush)

How can I avoid it?

While it isn't a STI, it is more common in women who are sexually active, especially if they have changed partners recently, so sex workers are at a higher risk. It also seems to be more common in black women, smokers and women who use IUDs for contraception. Things that change the pH balance inside the vagina, for example scented soaps, bubble baths, douching, semen, etc, can increase your chances of getting BV. 

How is it treated?

BV can go away on its own - but if it is left untreated it can raise your risk of developing pelvic inflammatory disease or catching an STI. It may also cause complications during pregnancy. Also, the main symptom of BV in women is abnormal discharge, which is also a symptom of a number of other STIs. So it's worth getting checked out by a doctor or a nurse. BV is diagnosed by a swab test at your GP or GUM clinic, and they might also check the pH balance of your discharge using a special paper. Once you have been diagnosed, you will be put on a course of antibiotic tablets or given a vaginal cream or gel, to use as a single dose or for between 5-7 days.  As with all antibiotics, the treatment for BV can interact with the combined pill and contraceptive patch, and you should talk to the doctor or nurse about how long you will need to take other precautions. Treating BV with antibiotics is about 80% effective. If the symptoms don't clear up after treatment, or go away and then come back, you should go back to the clinic. Some women are prone to recurring BV - no one really knows why. If this is the case, you might be offered reatment on a longer-term basis, or to use on certain days before and after your period. If you're prone to bacterial or yeast problems in your vagina, you should also try to avoid scented soaps, bubble baths, washing your underwear in strong detergent, douching, vaginal deodorants or putting antiseptics in your bath. Live yoghurt or lactobacillus acidophilus are sometimes used as home treatments for BV, but there is no evidence that they actually work.

Can I work while I have it? 

Yes.  Men cannot catch BV, and you are unlikely to have any discomfort during sex (although you may get more, and stronger-smelling, discharge afterwards).  

What does it look like?

The most common symptom is a change in vaginal discharge. 

Balanitis

 

What is it?

Balanitis is an inflammation of the head of the penis and foreskin. It is common, and occurs slightly more often in men who have not been circumcised. It is rarely serious and can usually be controlled by good hygiene. Balanitis is generally a symptom of something else, namely:

  • Skin conditions, such as eczema or psoriasis
  • Allergies or skin irritation
  • A yeast or bacterial infection
  • Some STIs: herpes, Chlamydia and syphilis

 

How can I avoid it?

Balanitis itself is not sexually transmitted. However, it can be caused by yeast or bacterial infections, which you could catch through unprotected sex. At the same time, if you have a thrush or bacterial infection, you could pass this to your partner and they could develop balanitis as a result.  If you do encounter a client with balanitis, it is worth remembering that it can be a symptom of sexually transmitted infections like herpes, syphilis and chlamydia. Always use a condom.

How is it treated?

Balanitis is usually diagnosed through a swab test, and is treated based on what caused it. Treatments include steroid cream, antifungal creams and antibiotics. These creams can cause condoms to break.

Can I work while I have it?

If you’re a male sex worker, that depends on what caused it. If your balanitis came from eczema, psoriasis, allergies or skin irritation, then you can work while you have it. If it was caused by herpes, chlamydia or syphilis, then see the section on those STIs. If your balanitis was caused by a yeast infection, you can pass that on through unprotected sex, so use a condom. Women cannot have balanitis, but can get thrush, so it is a good advert for safe sex – balanitis is linked to all sorts of nasty things you can catch, such as herpes, yeast infections, syphilis, bacterial infections and chlamydia. It can also be a sign of poor hygiene or sensitive skin, so a client with signs of irritation on his penis might appreciate a non-latex condom.

What does it look like?

Symptoms of balanitis include red skin, swelling and soreness or irritation around the head of the penis, and lumpy discharge under the foreskin.  

What are the symptoms? 

Balanitis does not affect women, but men may experience:

  • Red skin around the head of the penis
  • Swelling of the tip of the penis
  • Irritation/soreness in the head of the penis
  • Thick, lumpy discharge under the foreskin
  • A rash or ulcers around the penis
  • Itchiness around the head of the penis
  • An unpleasant smell
  • A tight foreskin that won’t pull back
  • Pain when peeing

Bartholin’s Cysts

 

What does it look like?

You are unlikely to be able to see Bartholin’s cysts, because of their position inside the vagina.

What are the symptoms? 

Most cysts don't cause any symptoms, although if they grow too large they can become uncomfortable and you may feel them during sex or while walking. If they develop into abscesses they will probably be very painful, tender to touch, red and inflamed and you may develop a fever as a result of the infection. If you have any other symptoms, like itching, discharge or pain, you will need to get checked out for other STIs.

What is it?

Bartholin's cysts occur when the Bartholin's glands - two pea-sized glands just inside the vagina - get blocked up and filled with pus. These cysts can become infected and develop into abscesses.

How can I avoid it?

No one really knows what causes Bartholin's cysts, although sometimes they can be caused by certain STIs, like gonorrhea or chlamydia. Using condoms, femidoms or dental dams will protect you from STIs and may lower your chances of getting Bartholin’s cysts.

How is it treated?

Bartholin’s cysts are usually diagnosed by a doctor – your GP or GUM clinic – after an internal examination. If there is a chance you also have an STI they may do other tests to diagnose this. If you are post menopausal they may also want to do a biopsy of the cyst to rule out the possibility of vulval cancer, a rare cancer that may look like a cyst. If the cyst is small and not causing any problems, you will probably not need any treatment. If it becomes an abscess, however, you will need to go on antibiotics and possibly have the cyst drained.

Can I work while I have it?

Yes, as long as the cyst isn’t causing any discomfort. If there is a chance you have an STI as well, you should always use a condom during sex – even when you’re not working - and check with the doctor to see what other precautions you need to take. Sometimes a catheter can be inserted to drain the abscess and maybe left in for up to six weeks. You can of course continue to have oral or anal sex and give hand jobs.

Chlamydia

What is it?

Chlamydia trachomatis is an infection caused by bacteria which thrive in moist warm parts of the body, such as inside the throat, anus, vagina and penis. It is the most common sexually transmitted infection in the UK and can affect both men and women.

How can I avoid it?

Chlamydia is most commonly transmitted through unprotected vaginal, oral and anal sex, or through sharing sex toys without covering them with a condom. Using femidoms, condoms and dental dams, and cleaning sex toys and covering them with a fresh condom between partners, will greatly reduce your chances of catching chlamydia. See the page on Sex Toys in the Maximising Your Income section for information on how to use sex toys safely.

How is it treated?

Chlamydia can be diagnosed from a urine sample or swab (see the page on Testing in this section) and the tests are about 90% accurate. False positive results are rare. Chlamydia can be treated with a course of antibiotics. Once you start on antibiotics most symptoms will clear up quickly, but you will need to wait 6 weeks after treatment if you want to check to make sure the infection is gone. Antibiotics can stop the combined contraceptive pill and the contraceptive patch from working – if you’re depending on either of these to avoid pregnancy you should speak to the doctor or nurse about how long the effects may last.

Can I work while I have it?  

If you have a vaginal or anal chlamydia infection, you should not to have vaginal or anal sex while getting treated and for a week afterwards, even with a condom. This will give your mucous membrane a chance to rest and heal. After the infection has cleared you can start working normally again. If you can’t avoid working altogether, give hand jobs and blow jobs instead. But if the infection is in your throat, you shouldn’t have oral sex until it has been treated. 

What does it look like?

Chlamydia infections in men are rarely obvious. The only outwardly visible symptom could be a clear or cloudy discharge from the tip of the penis, but most men show no symptoms.

What are the symptoms? 

Chlamydia infections are not always obvious–70-80% of women and over 50% of men have either no symptoms at all or symptoms so mild they don’t cause concern. Symptoms might show up 1-3 weeks after infection, months later, or not at all. Women may experience:

  • Bleeding between periods
  • Very heavy periods
  • Bleeding after sex
  • Pain and/or bleeding during sex
  • Pain in the lower abdomen (pelvic pain)
  • Abnormal vaginal discharge 
  • Pain while peeing

 

These are pretty vague symptoms which can be caused by other infections and diseases, so if you have any these, go to see a GP or GUM clinic and ask for a chlamydia test. If chlamydia is left untreated, it can cause Pelvic Inflammatory Disease (PID), infertility, inflammation of the cervix, pelvic pain and ectopic pregnancy. A chlamydia infection in the rectum rarely shows any symptoms, but you might experience some pain and discharge.

Genital herpes

 

What is it?

Genital herpes is a viral infection caused by the herpes simplex virus, the same virus that causes cold sores on the mouth. It is usually a long-term condition that may recur frequently in the first two years. After the first episode outbreaks are less severe, but the virus will still be in your body (inside the nerve endings) and you will still be able to pass it to other people. You are more likely to give it to someone else when you have symptoms, but you can pass the virus on even when it seems dormant. 

How can I avoid it?

Genital herpes is highly contagious and is passed through close contact, such as vaginal, anal and oral sex. Using a condom or dental dam is your best protection against catching herpes, but you should be aware that herpes can be present on the skin in areas not covered by condoms, such as the base of the penis, anus and upper thighs.

How is it treated?

There is no cure for genital herpes, although the symptoms can be controlled with antiviral medication. This is usually given in 5 day courses, although it can be prescribed longer-term if outbreaks are very severe. If you think you have herpes, you should get to a GUM clinic as soon as possible. They may be able to diagnose it from a swab test of a blister or ulcer if you attend as soon as possible. Usually, herpes will be diagnosed as a result of recurring outbreaks. Saline baths and painkillers can help relieve symptoms.

Can I work while I have it?                     

If you have genital herpes you should avoid having sex, including oral and anal, while you have any symptoms, particularly blisters or ulcers, as it will be especially contagious at this point. You should always use a condom (including with your partner) if you have been diagnosed with herpes, even after the symptoms have gone. You need to be aware, however, that if herpes is present on your anus or the surrounding area, it can still be passed through vaginal sex because of the close contact.

 

What does it look like?

Herpes outbreaks in men can be quite obvious, with red blisters or ulcers on and around the penis, rectum, upper thighs and buttocks. However, they may show no symptoms at all and still be carrying the virus. 

What are the symptoms? 

Herpes is dormant (or inactive) most of the time. At least 80% of herpes carriers have no idea they have it, because there are often few or no initial symptoms. Symptoms may not appear for months or even years. If you do get symptoms immediately, they usually appear 4-7 days after infection. Women may experience:

  • Painful red blisters on the vagina, cervix, rectum, thighs and buttocks, which burst and become ulcers
  • Abnormal vaginal discharge
  • Pain while peeing
  • Fever
  • Generally feeling unwell

 

These symptoms can last for up to 20 days. The ulcers will eventually dry up and heal without leaving scarring. Once the initial symptoms have gone, you will still have the virus, which will be ‘reactivated’ from time to time and cause fresh outbreaks of blisters and ulcers. Sometimes you may get a tingling or burning feeling around your vagina before a fresh outbreak. Recurring infections are usually shorter and less severe than the first episode.

Genital warts

What is it?

Genital warts are an infection caused by the human papilloma virus (HPV) which has also been linked to cervical cancer. They

affect the skin around the genital and anal area, and the lining of the cervix, vagina and rectum.  There are about 30 kinds of HPV virus that live around the genitals, but only two are linked to genital warts.

How can I avoid it?

Genital warts are spread by skin-to-skin contact, such as vaginal or anal sex, but they can also be spread by sharing sex toys. Condoms may provide some protection, but warts can affect the area around the penis that is not covered by a condom. It is most contagious when warts are present but can still be passed on after they have disappeared. It is also possible, but rare, to get genital warts on your lips and mouth after oral sex.

How is it treated?

You will need to see your GP or a GUM clinic to confirm that you have genital warts. They will usually do this just by looking at the warts. They may need to do an internal exam of your vagina or anus. Very rarely, they will take a sample of a wart for a biopsy. Most people who catch it don’t develop any visible warts, and the virus goes away on its own. You will only be offered treatment if you have visible warts, and it will depend on what the warts look like, where they are and how many you have. Treatment is aimed at removing warts, and can take the form of applying cream or liquid, burning the warts off with heat or freezing, or surgery. If left untreated, genitals warts may disappear, stay the same, or get bigger and spread. There isn’t any health risk to leaving them alone, but you may find them uncomfortable and unpleasant-looking, and there is a higher risk of passing them onto someone else.

Can I work while I have it? 

You should avoid sex until the warts have cleared up, to protect the area from friction and help it heal. If you can’t avoid sex altogether make sure you use femidoms, condoms or dental dams, clean all sex toys thoroughly between uses and cover them with condoms, or you could give hand jobs and blow jobs instead. You should also continue to use condoms whenever you have sex (including with your partner) for the first three months after the warts have gone.

What does it look like?

Genital warts in men show up on the penis, scrotum, urethra, upper thighs and anus.

What are the symptoms? 

Most people with genital warts don’t actually develop any visible warts, so you may not know that you have it. If warts do appear, they usually how up between 2 weeks and several months after catching the virus. Warts appear as small fleshy growths, bumps or skin changes around or inside your vagina or anus. On women they can appear on or inside the:

  • Vulva
  • Cervix (the opening to the womb)
  • Vagina
  • Upper thighs
  • Anus

Gonorrhoea

What is it?

Gonorrhoea (the clap) is an infection caused by bacteria that is mainly found in semen and vaginal fluid. It is usually  spread through unprotected vaginal, oral or anal sex, or by sharing sex toys. In women who have gonorrhoea, it can spread to the anus through vaginal discharge – you do not need to have had anal sex. It is the second most common STI in Britain, and 40% of women who test positive for it also have chlamydia.

How can I avoid it?

Gonorrhoea is most commonly transmitted through unprotected vaginal, oral and anal sex, and through sharing sex toys or using them unsafely.  Using condoms, femidoms, and dental dams, cleaning sex toys and covering them with a fresh condom between uses will all greatly reduce your chances of catching it. 

How is it treated?

Gonorrhoea is diagnosed from a swab taken from the cervix (see the page on Testing) and from the throat or anus if you have had oral or anal sex. It can be treated with a single dose of antibiotics, either as a pill or an injection. If you have gonorrhoea in your throat you will need to return a week later to check that treatment has worked. Antibiotics can interact with the combined pill and the contraceptive patch, so if you use either of these, speak to the doctor or nurse about other precautions you will need to take. Most symptoms will clear up quickly, usually within a few days.  You will be strongly encouraged to tell current or recent sexual partners that you have gonorrhoea. The clinic can arrange for anonymous contact tracing to be done, which will not have your name on it. They may contact you to make sure that you have taken the antibiotics and that your partner(s) have been treated.

Can I work while I have it?

Gonorrhoea is extremely easy to spread, so it is generally recommended that you avoid having any kind of sex until you’ve been given the all-clear. 

What does it look like?

90% of men get symptoms from gonorrhoea, which can include thick white, yellow or greenish discharge from the tip of the penis.

What are the symptoms?          

Symptoms usually show up 1-14 days after infection. Symptoms include:

  • Strong, unpleasant smelling, yellow or green,thick vaginal discharge
  • Burning sensation while peeing
  • Pain or tenderness in the lower abdomen
  • Frequent need to pee
  • Irritation or discharge from the anus
  • Bleeding between periods
  • Very heavy periods

 

50% of women experience no symptoms after infection, which means it can be left untreated. This can lead to serious health problems later, including pelvic inflammatory disease (PID).  See the section on PID for more information. A rare but serious complication of untreated gonorrhoea is the risk that it may spread to other parts of your body.

Hepatitis B

 

What is it?

Hepatitis B (Hep B) is a virus that causes inflammation of the liver. It is carried in blood and other bodily fluids, such as saliva, semen and vaginal fluids, and it is very easy to catch – it is 100 times more infectious than HIV.

How can I avoid it?

There is a vaccine available for Hep B, that consists of a course of injections, followed by a blood test to make sure you have immunity. The vaccine is very effective and has few side effects, but you will need to remember to get regular blood tests to see if you need a booster shot.  Hep B is generally passed on through unprotected sex, sharing needles, or from a mother to her baby during childbirth. Using condoms, femidoms and dental dams will all reduce your risk of catching Hep B. There is a risk can that you can catch Hep B from used razors, toothbrushes, scissors and used tattoo equipment – if you use anything like this in a sex work setting (for example, some BDSM practices) you should be very careful about coming into contact with any blood. There is also evidence that Hep B and Hepatitis C can be caught from sharing paraphernalia used to snort drugs such as cocaine.

How is it treated?

Hep B is diagnosed from a blood test that looks for antibodies (signs that your body has fought an infection), so you will test positive even if you have cleared the infection from your system. If you test positive and the virus is active, your doctor will probably want to do another blood test called a liver function test to see how your liver is doing. Depending on the results, other tests may be required. There isn’t usually any treatment or an acute infection of HBV other than rest, a healthy diet, and no alcohol. Many people have no symptoms, or recover completely, within a few months. If you do go on develop chronic HBV, there are treatments available, such as interferon, that will be provided by a specialist liver doctor. If you have a very severe case of chronic HBV and develop liver damage, you may be offered a liver transplant.

Can I work while I have it?  

If you have HBV, whether acute or chronic, then you can easily pass the virus on to others if you are not very careful. Using condoms, femidoms and dental dams will all reduce the risk of passing HBV, but there may still be a small chance that you could pass it on. You should be especially careful when you have your period or if you have any cuts of sores around your mouth or vagina, and you should avoid unprotected oral sex and rimming. Anal sex, because of the high chance of bleeding, is particularly high risk for passing HBV.

What are the symptoms?          

HBV has a 1-6 month incubation time - the time between catching the virus and developing an acute infection. Many people get no symptoms at all with HBV, although they can still pass the virus on to others. Symptoms of acute infection include:

  • Flu-like illness, such as tiredness, aches and pains, headache and fever
  • Loss of appetite, vomiting, nausea or diarrhoea
  • Abdominal pain
  • Jaundice, which makes your skin and the white of your eyes turn yellow, causes your pee to be very dark and can make your shit turn pale

 

Very rarely, some people go on to develop fulminant HBV, which causes severe jaundice, swelling of the abdomen and collapse. Fulminant HBV can be fatal if not treated quickly. 90-95% adults who catch HBV will clear the infection and become immune to it, but others will develop chronic (long-term) HBV, which means they carry the virus in their systems and can pass it on to others. Of these, two thirds will have no symptoms, and may not even know that they carry it. The remaining third will get recurring infections like the symptoms above and may develop serious liver problems, such as cirrhosis (scarring of the liver), liver cancer and liver failure.

Hepatitis C

 

What is it?

Hepatitis C (Hep C) is a blood-borne virus which can – rarely – be transmitted through unprotected sex. It is most commonly transmitted through sharing needles or coming into contact with infected blood. Its effects vary widely – some people will clear it from their systems, others will have no symptoms and some will develop mild, moderate or severe liver damage, often 10 or more years down the line.

How can I avoid it?

Your best bet for protecting yourself against catching Hep C is to use condoms, femidoms and dental dams. As with Hepatits B, Hep C can be caught from used needles, razors, toothbrushes, scissors, tattoo equipment and sharing paraphernalia for snorting drugs– if you use anything like this in a sex work setting (for example, some BDSM practices) you should be very careful about coming into contact with any blood.

How is it treated?

Hep C is diagnosed from a blood test. It can take up to 6 months after infection for the antibodies to show. Your Hep C test will be positive if you have cleared the infection in the past, so you will need another test to see if the virus is active. If you test positive, your doctor will probably want to do another blood test called a liver function test to see how your liver is doing, and they may want to run further tests depending on those results. There is no vaccine for Hep C, but it can be treated. Treatment options depend on which the strain of the virus you have. Even if treatment does not clear the infection, it can often slow the damage being done to your liver by the virus. The drugs used for treating Hep C have a lot of side effects, which some people struggle to cope with. Because of this, you will not be offered treatment if you are pregnant, continue to drink a lot of alcohol or inject drugs, or have certain medical conditions that could be badly affected by the medication.

Can I work while I have it?  

Yes, as long as you always use a condom, femidom or dental dam. The risk of passing Hep C through protected sex is miniscule. You should be careful in any situation where your blood could come in contact with anyone else – for example if you have your period or open sores in your mouth. You should also bear in mind that Hep C can live for long periods of time in dried blood. If you have Hep C, you should also be vaccinated against Hepatitis A and B to prevent further damage to your liver.

What are the symptoms?          

Most people don’t develop any symptoms when they first get infected with HCV. If there are any symptoms, they usually take the form of a mild flu-like feeling, including tiredness, loss of appetite, pains in the joints and nausea. 20% of people clear the infection naturally from their systems, but the remainder will continue to carry HCV (this is called chronic Hepatitis C) and can pass it on to others. Some people with chronic Hepatitis C will get no symptoms and experience no liver damage, but most will get some symptoms of liver damage, including:

  • Weight loss
  • Muscle aches
  • Tiredness
  • Nausea
  • Intolerance to alcohol
  • Pain around the liver
  • Jaundice
  • Jaundice makes your skin and the white of your eyes turn yellow, causes your pee to be very dark and can make your shit turn pale.

 

20% of people who become infected with HCV will develop cirrhosis (scarring) of the liver and may go on to have liver cancer or complete liver failure.

HIV and AIDS

What is it?

HIV (Human Immunodeficiency Virus) is a retrovirus that attacks the body’s immune system – the system that fights against disease and nfection. AIDS (Acquired Immune Deficiency Syndrome) is a name for the later stages of HIV infection, when the body’s immune system has been severely weakened. The term AIDS is no longer widely used, as it doesn’t really describe the wide range of problems that can develop with what is now called late-stage or advanced HIV infection. HIV is a global pandemic, which means that it has spread across the world. About 73,000 people in the UK have the virus, and as many as 30% do not know they carry it.

How can I avoid it?

HIV is transmitted through the exchange of bodily fluids such as blood, semen and vaginal fluid, but is NOT carried in saliva, unless blood is present. It is usually spread through unprotected oral, anal or vaginal sex, sharing needles or from a pregnant mother to her baby. Your best protection is to use condoms, femidoms and dental dams. There is a treatment available called Post- Exposure Prophylaxis (PEP) which can sometimes stop HIV if started within 72 hours of infection. It is only offered to people who know they have been exposed to HIV, for example if a condom bursts with a partner that you know has HIV.

How is it treated?

Because the initial symptoms of HIV infection can be easily mistaken for other illnesses, it is worth getting tested regularly. HIV is diagnosed through a blood test, which will only test positive 3 months after infection. You may be advised to return for regular testing while you continue to work. Evidence suggests that if treatment begins soon after infection, the damage to your immune system can be reduced. Treatment can be very complicated and will depend on the state of your immune system. HIV cannot be cured but it can be treated, and there is no reason why you cannot live a relatively normal life.

Can I work while I have it?  

Legally, probably not. Knowingly infecting someone with HIV is a criminal offence (reckless injury), and in theory there is a chance you could be done for reckless endangerment even if they did not become infected. Consistent condom use or consent can be used as a defence – but there has never been a case involving a sex worker. Any condom failures will endanger you and your clients. If they have a different strain of HIV it could cause ‘cross-infection’ which could make you more vulnerable. If you contract another STI it is easier to pass your HIV on to someone else.

What are the symptoms?          

The first symptoms of what is called primary HIV infection usually show up 2-6 weeks after infection. They include:

  • Fever
  • Sore throat
  • Tiredness
  • Joint pain
  • Muscle pain
  • Swollen glands
  • Blotchy rash on the chest 

 

These symptoms are usually very mild and can easily be mistaken for a cold, flu or glandular fever. After these symptoms go, HIV may not cause any symptoms for several years, although the virus continues to reproduce and damage your immune system. Left untreated, HIV will weaken your immune system until it stops working – normally around 10 years after infection – and it is inevitable that you will develop a serious infection. Possible symptoms include:

  • Persistent tiredness
  • Night sweats
  • Unexplained weight loss
  • Persistent diarrhoea 
  • Blurred vision
  • White spots on your tongue and mouth
  • Dry cough and/or shortness of breath
  • A fever over 37˚ that lasts for weeks
  • Swollen glands lasting more than 3 months

 

Human Papilloma Virus

 

What is it?

There are over 100 strains of human papilloma viruses (HPV) that can affect the skin and moist membranes in the body, including the lining of the throat and mouth, the cervix and the anus. Some HPV can cause changes in the cells of the cervix or the lining of the throat and mouth, which increases the risk that these cells will become cancerous. There are also links between HPV and vaginal and vulval cancer, although both are rare. Other types of HPV cause warts and verrucas, including genital warts, and are generally regarded as low risk. HPV is extremely ommon and most people will have it at some point in their lives. In most instances it causes no symptoms and goes away without any treatment.

How can I avoid it?

HPV is spread by certain types of contact with someone who has it, depending on the kind of HPV. HPV that affects the skin is passed by skin-to-skin contact, while HPV that affects the mouth and throat can be spread by kissing. Genital HPV is usually spread by close contact during sex. Using a condom can lower your risk but cannot prevent it completely, as it can spread through contact between areas that condoms don’t cover, like the scrotum and vulva. There is a vaccine available to prevent the kinds of HPV that can lead to cervical cancer. This is offered free to girls ages 12 to 13 but can also be paid for privately. You would need to be tested first to ensure that you did not already have HPV.

How is it treated?

HPV can be treated to get rid of any visible signs of HPV infection, such as warts, but not cured. In most people the virus disappears over time as the body builds up immunity, so many doctors in the UK recommend a “wait and see” policy. Your best defence against cervical cancer caused by HPV is to have regular cervical smear tests. Cervical cancer usually takes between 10 to 20 years to develop.

Can I work while I have it? 

Yes. In fact, the chances are good that you have worked while having some form of HPV in the past. If you have genital warts, you should wait until the infection has cleared up, to protect the area from friction and help it heal. If you can’t avoid sex altogether make sure you use condoms or dental dams and clean all sex toys thoroughly between uses, or you could give hand or blow jobs instead. You should also continue to use condoms whenever you have sex for the first three months after the warts have gone.

What does it look like?

Genital warts in men show up on the penis, scrotum, urethra, upper thighs and anus.

What are the symptoms? 

Some forms of HPV cause warts and verrucas but many do not cause any symptoms at all. Genital warts are caused by some forms of HPV. Many people don’t actually develop any visible warts, so you may not know that you have it. If warts do appear, they usually show up between 2 weeks and several months after catching the virus. Warts appear as small fleshy growths, bumps or skin changes around or inside your vagina or anus. On women they can appear on or inside the:

  • Vulva
  • Cervix (the opening to the womb)
  • Vagina
  • Upper thighs
  • Anus

 

Non-specific Urethritis (NSU)

What is it?

Non-specific urethritis (NSU, also known as non-gonococcal urethritis) is an inflammation of the urethra not caused by gonorrhoea. Chlamydia is responsible for about 40% of all cases of NSU, although there can be many causes, most commonly bacterial, viral or environmental (such as spermicides or antiseptic chemicals). Occasionally the trichomonas parasite can cause urethritis.

How can I avoid it?

Most cases of NSU are caused by sexually transmitted infections, so using condoms, dental dams and cleaning your sex toys between uses (including on different parts of the body) can hugely reduce your risk. The urethra can also be irritated by vigourous sex, masturbation (for men) and inserting objects, including sex toys, into the vagina. Some chemicals can also cause NSU, such as spermicide, antiseptic treatments like soap or tea tree oil and even bubble baths if you have an allergic reaction.

How is it treated?

If you have any of the symptoms of NSU, or have recently found out that you have been exposed to an STI (particularly chlamydia), you should visit your GP or local GUM clinic. NSU is usually diagnosed from a swab or urine test - see the section on Testing for details of what this involves. Both test results are checked under a microscope for the bacteria and viruses that are known to cause NSU. Some clinics may be able to give you the results in a few hours, whereas others may need to send the results to a lab, and may not have the results for a few weeks. If you need the results quickly, it may be worth calling around the local clinics to get an idea of how soon you will get your results before you go in.  If you are diagnosed with NSU, you will usually be offered antibiotic treatment immediately, even if your test results have not come back. This is because chlamydia and other bacterial infections are the most common cause of NSU. If your NSU has a different cause, antibiotic treatment may be discontinued.

Can I work while I have it?  

That depends on the causes of your case of NSU, but the NHS recommends that you should treat all cases of NSU as a STI, and not have sex until you are sure you are cured. This will also give your body a chance to heal, particularly if your NSU is caused by chlamydia. If you cannot stop working, you should at the very least use a condom and dental dam at all times, and take especial care cleaning your sex toys. You may want to avoid all vaginal sex and give hand jobs or blow jobs instead, particularly if you are experiencing pain.

Urethritis

 

What are the symptoms?          

The most common symptoms of urethritis in men include pain or burning when peeing, white or cloudy discharge from the penis, irritation, itching, tenderness or soreness at the tip of the penis and a frequent need to pee. For women, the symptoms include white or cloudy discharge from the vagina and burning or pain when peeing. NSU can also spread into other parts of the reproductive system, such as the womb or fallopian tubes, and can lead to pelvic inflammatory disease (PID). Symptoms of PID include thick or unusual vaginal discharge, bleeding between periods, fever and vomiting, pain in the rectum or anus, discomfort or pain during sex, and aching or pain in the lower abdomen. NSU does not always cause any noticeable symptoms in men or women, so if you find out that you’ve been exposed to a STI, it may be worth visiting a GUM clinic to be tested for STIs. An uncommon complication of NSU is Reiter’s syndrome, also known as reactive arthritis, which can develop in an estimated 1% of NSU cases. Reiter’s syndrome affects the immune system and causes the body to attack healthy tissue, rather than the bacterial causes of NSU. This can lead to joint pain, inflammation of the eyes (conjunctivitis) and recurring symptoms of NSU.

Pelvic inflammatory disease (PID)

 

What is it?

Pelvic inflammatory disease (PID) is the inflammation and infection of the reproductive organs, including the womb (uterus), fallopian tubes and ovaries. PID affects 1 in 50 women each year, usually those who are sexually active and between the ages of 15 -24. PID can have severe long-term consequences. When the inflammation spreads from the uterus into the fallopian tubes it can cause their lining to become swollen and narrower, increasing the risk of ectopic pregnancy and infertility.  Abscesses can develop inside the tubes, which can help the infection spread into the ovaries. The longer PID is left untreated, the more likely it is that it will cause permanent damage. Studies suggest that even a delay of a few days can make a real difference.  

How can I avoid it?

PID is usually caused by a bacterial infection in the vagina or cervix that spreads deeper inside, often a STI like gonorrhoea or chlamydia. PID is caused by bacterial infections, often by more than one kind of bacteria. Chlamydia is responsible for 50- 65% of PID cases, gonorrhoea for about 14% and 8% of women with PID have a combination of chlamydia and gonorrhoea. Using condoms will protect you against these STIs and greatly reduce your chances of developing PID.

How is it treated?

PID is usually diagnosed from the symptoms and from an internal examination and swab test by a doctor. Because it can be tricky to diagnose, you may also need a blood test or, less commonly, an ultrasound exam. Very rarely, you might need a laparoscopy - a minor surgery where a tiny microscope is inserted into the abdomen. If PID is diagnosed early enough, it can be easily treated with a combination of two or more antibiotics for 14 days. If you have a severe case of PID, you might need to go into hospital and get antibiotics through a drip. As with any antibiotics, they can interact with the combined pill and the patch - you should ask about how long you will need to take other precautions after treatment finishes. 20% of women who get PID will get it again, usually within two years. This can happen because the initial infection wasn't totally cured, or their partner wasn't tested and has re-infected them, or because PID has damaged their cervix and left them more open to infection.

Can I work while I have it?  

You shouldn't have vaginal sex while you're being treated for PID, to give your body a chance to heal. You can still have oral or anal sex, or give hand jobs. If you have a partner, you should also ask him or her to get tested to stop the infection from recurring - he or she may re-infect you with an STI that they don't even know they have.

What does it look like?

PID has no obvious visible symptoms on the outside of the vagina, so you will not be able to see that you have it. It is very important that you get checked out by your GP or a GUM clinic if you develop any symptoms that could be caused by PID or STIs like gonorrhoea and Chlamydia.

What are the symptoms?          

The symptoms of PID can be very similar to some STIs, so it is not always easy to diagnose. Some women who have it experience no symptoms at all, or only very mild symptoms. Symptoms can include:

  • Bleeding between periods
  • Fever
  • Vomiting
  • Pain in the rectum
  • Discomfort or pain during sex

 

Pubic lice

What is it?

Pubic lice, also known as crabs, are tiny blood-sucking parasitic insects that live in body and facial hair, usually pubic hair. They can also be found in the eyelashes, eyebrows, moustaches, beard, abdomen, chest and back hair. They are about 2mm long and yellow-grey in colour. They lay tiny eggs that are glued to the base of your hair, which hatch into more lice after 6-10 days. Females lice live for 1-3 months and can lay up to 300 eggs, so a few lice can quickly become an infestation.

 

How can I avoid it?

Pubic lice are most commonly spread through sex, and your chances of catching them are higher the more sexual partners you have. They can also be caught through close contact with someone who has them (ie hugging or kissing) or (more unlikely) through shared bedding, towels and clothes. Condoms can't protect you against pubic lice. There is really no way to avoid catching them if you have close contact with someone who is infested.

How is it treated?

Your GP can confirm whether you have pubic lice by looking for the lice or their eggs. Lice are difficult to get rid of, mainly because of their reproductive cycle. There are several different insecticidal lotions and creams that you may be offered, all of which need to be left on for 12-24 hours and repeated after a week. If you have severe itching, your doctor may also prescribe something to help. There is not a lot of evidence about whether or not lice can be transmitted via clothing and bedding, but you should probably wash everything on a 50˚ cycle to be safe.  Anyone who lives with you, or any regular sexual partners, should also be treated at the same time to avoid re-infection. 

Can I work while I have it?   

You really shouldn’t work until you’ve completed your treatment and cleared the lice infestation. 

What does it look like?

The most obvious visible sign of a pubic lice infestation is usually the red rash caused by the bites, although you may also be able to see their droppings or the lice themselves.

What are the symptoms?          

It can take several weeks after infection for symptoms to show up. The most common symptom is an itchy red 'pimply' rash, which is itchier at night. The itching is caused by an allergy to the lice, not by the lice bites. Some people are not allergic to the lice and may not notice they have an infestation. You may be able to see the lice themselves (they are about the width of a match-head) or tiny white eggs in your pubic, armpit or (less likely) eyebrow and eyelash hair or around the edge of the scalp. You might also be able to see their droppings - dark brown or black powder on your skin or in your underwear. If you are pale, you might see their bites, which appear as blue spots on your skin where the lice are living.

Scabies

 

What is it?

Scabies is a skin condition caused by tiny mites that burrow into the skin. It is highly contagious and pretty common - about 1 in 1000 people will develop a scabies infection every month. Although people think of scabies as something that comes from poor hygiene, there is really no evidence for this. Scabies is rarely serious, but the itching is very intense and unpleasant and too much scratching can sometimes lead to secondary skin infection.

How can I avoid it?

Scabies mites can't jump or fly, so they can only be transmitted through direct and prolonged contact, like hand-holding, sex or sharing a bed. Scabies mites can survive outside the body for up to 36 hours, so it is possible to catch scabies from bedding or clothing, although this is rare. Condoms don’t really offer protection against scabies. 

How is it treated?

Scabies is usually diagnosed by the appearance of your skin. Your GP or GUM clinic can do an ‘ink test’ that will show the presence of burrows. Occasionally a skin sample will be taken from the area. Some pharmacies can also diagnose scabies and give you over-the-counter remedies, but if this is the first time you’ve had it you should see a doctor, as other skin conditions can look similar. Scabies can usually be treated with special insecticide creams - the mites are resistant to soap and water. The cream needs to be applied to your whole body and left on for 8- 24 hours (depending on the cream), and repeated a week later.

Can I work while I have it?   

Not until you’ve applied the cream – scabies is highly infectious. On the day you apply the cream you should also wash all of your clothes, bed linen and bath towels at 50˚C or more, or put them into an airtight plastic bag for at least 72 hours. If you’re working in a sauna or flat, you will probably want to wash all of the towels and sheets – otherwise you will simply get re-infected over and over again. It may not make you popular, but neither will a mass scabies infestation.

What does it look like?

The most visible symptoms are small red blotches and lines.

What are the symptoms?          

Symptoms of scabies appear 2-6 weeks after the first infection, as the itchiness is actually your immune system reacting to the infection. If you have had scabies before, symptoms may begin within 48 hours. The itchiness tends to be worse at night and after a hot shower or bath. Scabies marks can appear anywhere, but the typical spots are between the fingers, around the wrists and waist, inside the armpits and elbow, buttocks, knees, shoulder blades, on the soles of the feet, around the breasts on women and around the genitals on men. Norwegian scabies is a massive scabies infestation that looks like thick crusty warts on the skin and will be very obvious. It is extremely contagious and requires treatment in hospital – but you will only catch normal scabies from someone who has it, as it is caused by the same mites. 

Syphilis

Image courtesy of Susan Lindsley VD, CDC

What is it?

Syphilis is a bacterial infection that is typically passed through unprotected sex, although it can also be passed through sharing needles, blood transfusions or from a mother to her unborn child. Syphilis is particularly dangerous because after some initial symptoms it can lie dormant for years before becoming tertiary syphilis, which causes serious damage and can be fatal.  

How can I avoid it?

Syphilis is usually transmitted through close contact with infected sores, normally during unprotected vaginal, anal or oral sex, or sharing sex toys. Use condoms, femidoms or dental dams and always wash and cover sex toys with condoms. Having syphilis also increases your chances of catching HIV. HIV will also change the usual course of syphilis, increasing the chances of developing tertiary syphilis.  

How is it treated?

Primary and secondary syphilis (see right) can be easily treated using a 10-14 day course of antibiotics. Antibiotics can interact with the combined pill and the contraceptive patch, so if you use either of these you should speak to the doctor or nurse about other precautions you will need to take. Once you have finished the course of antibiotics you will need to return to your GP or the GUM clinic for a follow-up test. Treatment for tertiary syphilis requires intravenous antibiotics through injections or a drip. While it will stop the infection, it cannot repair any damage that has been done to your body. You will be strongly encouraged to tell current or recent sexual partners that you have syphilis. The clinic can arrange or anonymous contact tracing to be done, which will not have your name on it.

Can I work while I have it?   

No. While using condoms and/or dental dams is your best way of avoiding catching syphilis, you should avoid any kind of close sexual contact while you have syphilis. If you really can’t stop working, you must use a condom.

What does it look like?

Symptoms begin with one or more painless, but very infectious, sores called chancres.  These vanish after 3-6 weeks, although they can recur during secondary syphilis.

What are the symptoms?          

Syphilis has three different stages, primary, secondary and tertiary syphilis. The symptoms of primary syphilis appear any time from 10 days to 3 months after infection. They include chancres (see above) and swollen lymph glands. If untreated, you will move into secondary syphilis. Secondary syphilis has numerous symptoms, which may disappear within a few weeks, or come and go over a period of several months. They include a non-itchy rash, often on the palms of the hands or soles of the feet, swollen lymph glands, tiredness and headaches. Less common symptoms include weight loss, fever, hair loss, pains in your joints, sores inside the mouth or on the vagina and penis.  Syphilis will then move into the latent phase, which means you will get no symptoms. You can still transmit it during the first year. The symptoms of tertiary syphilis can begin years or even decades after infection. Symptoms vary depending on which part of the body is attacked, but can include stroke, loss of coordination, numbness, paralysis, blindness, deafness and heart disease.

Thrush

What is it?

Thrush is a yeast infection caused by the candida fungus. This often exists normally in small amounts in the body, particularly warm moist areas like the mouth, vagina and under the foreskin of the penis. Normally the candida fungus doesn’t cause any problems, but occasionally it begins to multiply and causes irritation and swelling in the vagina and vulva.

How can I avoid it?

Thrush is not officially a STI, because so many people carry it normally in their systems, but it can be transmitted during vaginal sex. Using condoms should protect you from this. You are more likely to get thrush if you are pregnant, have diabetes that is not being controlled, have a weak immune system or if you are on certain kinds of antibiotics. Other possible risk factors include taking the combined pill, wearing tight-fitting clothing, using panty liners and having oral sex, although the evidence is not conclusive. 

How is it treated?

Thrush can usually be treated quickly and effectively. If you think you have thrush, you should see your GP, who will diagnose thrush based on your description of your symptoms. Thrush is treated with anti-fungal medication, in the form of pills, pessaries or creams. You can buy creams over the counter at your pharmacy, but they will only treat the external symptoms (like itching) – you will need to see your GP for a pessary or tablets to treat the internal infection. If your symptoms do not go away within 7- 14 days after treatment, your GP may need to take a sample of your discharge for testing, which will confirm whether you have thrush or something else. If you have thrush, you might find it helps to avoid perfumed soaps, shower gels, vaginal deodorants and douches, latex condoms, spermicidal creams, and tight-fitting or synthetic underwear.  If you are prone to thrush and the symptoms change, you should see your GP to rule out any other causes.

Can I work while I have it?   

Yes, although there is a chance that you could pass thrush to your partner, so always use a condom, femidom or dental dam. Some creams (like Canestan) can damage latex condoms and diaphragms, so you should use non-latex condoms for 5 days after using the cream for the last time.  You may also find that sex is uncomfortable or even painful before the infection clears.

What does it look like?

The main symptom of male thrush is balanitis (see below), but in severe cases there may be a visible white fungal growth.

What are the symptoms?          

The main symptom of male thrush is balanitis, which means inflammation of the penis (see section on balanitis for more information and a picture). Thrush can also cause the foreskin to swell and crack, most likely as a result of an allergy to the yeast. The symptoms of vaginal thrush can include:

  • Itching around the vagina
  • Soreness and irritation around the vagina
  • Vaginal discharge that is often white and
  • cheese-like or watery with pus.
  • Discharge doesn’t usually smell.
  • Pain or discomfort during sex or while peeing

 

You might also get inflammation of the vulva or vagina (vulvovaginal inflammation). Symptoms can include:

  • Redness of the vulva or vagina
  • Cracked skin in the vagina (in severe cases)
  • Oedema (swelling) (also in severe case)
  • Lesions (sores) around the vulva and vagina

Lesions are rare, but might also indicate other fungal infections or herpes.

Trichomonas vaginalis

 

What is it?

Trichomonas vaginalis (or trichomoniasis) is a common infection caused by a germ with the same name. In women it occurs in the vagina and urethra (the tube the urine passes through) and in men it occurs in the urethra and occasionally the prostrate gland. It rarely spreads anywhere else in the body.

How can I avoid it?

Trichomonas is spread through unprotected vaginal sex (not oral or anal) and, rarely, through sharing sex toys. Your best bet to avoid trichomonas is the same as with any other STI – use a condom at all times, and cover your sex toys with condoms as well as washing them between uses.

How is it treated?

Trichomonas is diagnosed by a simple swab test (see the section on testing) and a physical exam of the inside of your vagina (you may have red blotches inside). Trichomonas can be easily treated with antibiotics, usually a 5-7 day course of metronidazole, which is 85% effective. If you are not pregnant or breastfeeding, you might be offered a single dose treatment. Antibiotics can interact with the combined contraceptive pill and the contraceptive patch – if you depend on either of these to avoid getting pregnant, speak to the doctor or nurse about how long you will need to use condoms after treatment. If you have had trichomonas and been treated, you will not be immune to it and can get it again.

Can I work while I have it?   

Yes, as long as you use condoms. If your symptoms include discomfort during sex you may want to think about limiting yourself to oral and hand jobs. It is very important that you do not have unprotected sex while you are being treated, as you can both spread the infection and get re-infected yourself. 

What does it look like?

Men rarely have any symptoms with trichomonas. They may have a thin white discharge from the penis, pain after peeing or ejaculating, or discomfort during sex. Rarely, they may have an inflamed (red) foreskin.

What are the symptoms?          

Trichomonas can be difficult to diagnose, as around half of the people who get it will show no signs or symptoms, and when symptoms do occur, they can be very similar to other STIs. Symptoms tend to appear 5- 28 days after infection – or not at all. Women may experience:

  • Soreness and inflammation around and inside the vagina
  • Itching around the vagina or inner thighs
  • Changes in vaginal discharge:
  • Thicker or thinner
  • Frothy
  • Yellow or green in colour
  • More discharge
  • Unpleasant fishy smell
  • Discomfort during sex
  • Pain in the lower abdomen
  • Pain or discomfort while peeing

 

These are pretty vague symptoms which can be caused by other infections and diseases, so if you have any these, go to see your GP or GUM clinic and ask to be tested for trichomonas.


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