House of Commons – Health

House of Commons - Health

STIs (also referred to as STDs, or sexually transmitted diseases) are sexually transmitted infections that can be classed as either bacterial, viral or parasitic. Bournemouth had the region’s highest figures for gonorrhoea rates, and Torbay and Bristol the highest for chlamydia. If the latest statistics are anything to go by, the number of people affected by an STI  (a disease passed from one person to another through unprotected sex) – is on the increase. We have also paid some attention to the issue of sexual dysfunction, though we are aware that this neglected problem would merit an inquiry in itself. You can see more on Reporting Scotland at 1830 BST on BBC One Scotland, or listen to Good Morning Scotland on BBC Radio Scotland from 0600 BST. While little research has been carried out into the relationship between unintended pregnancy and social or ethnic grouping in older women as opposed to teenagers, statistics about abortion show that unintended or unwanted pregnancy affects the full age­range of women, although it is most common in the 20­25 age group. The peak age for an STI in women is between 19 and 20 and in men between 20 and 23.

Conclusions: Self help initiatives and awareness among homosexual men in 1983–4 contributed significantly to a fall in HIV transmission among MSMs, and the general campaigns of 1986–7 were associated with similar effects on all STI transmission. It also creates health inequalities for those living in areas where prevalence of stigma is higher than prevalence of HIV itself and where access to services and support is difficult. 27. They tend to affect areas such as the vagina, urethra, cervix, rectum, mouth and throat of the person that’s been infected, but can also spread to areas that are similarly mucosal, such as the eyes. In light of this evidence it is striking that few, if any, patients complain about the unacceptable conditions under which they seek and receive diagnosis and treatment. It is currently rising at a rate of around five percent each year, with the highest number of cases in women aged between 16-24. Primary Care Trusts need to make themselves aware of the patient’s experience of sexual health services and work to improve this experience.

Patient forums may be a route through which this could be undertaken. 28. Sexually transmitted infections (STIs) are infections whose primary route of transmission is through sexual contact. A period extending back to the start of the 1970s was investigated because changes in STI epidemiology were taking place in the 1970s and it was important to distinguish these longer term trends from those that might be attributed to AIDS awareness and campaigns in the 1980s and 1990s. STIs cause considerable reproductive morbidity and poor health outcomes, including pelvic inflammatory disease (PID), infertility, ectopic pregnancy, neonatal disorders, cervical cancer and death, and about 12% of women with untreated chlamydia develop infertility after a first episode of acute infection rising to 70% after three different episodes.[14] As well as the physical impact of the diseases there is also “significant psychological morbidity”[15] caused to patients, together with social problems arising from stigmatisation. The general level of social stigma attaching to these conditions makes people reluctant to come forward for treatment and demands high levels of privacy and confidentiality in treatment services. Although the most common types of viral infections like genital herpes and warts aren’t likely to be dangerous, HIV has the potential to cause very serious complications.

Chlamydia is the commonest bacterial STI in the UK. The symptoms that you may notice with gonorrhoea include an unusual discharge, pain during urination and bleeding between periods in women. If left untreated chlamydia in women can lead to PID, ectopic pregnancy[17] and infertility. Chlamydia can cause conjunctivitis in adults; babies born to infected mothers can develop conjunctivitis or pneumonia soon after birth. Symptoms in men include difficulties in urination, discharges from the penis, itchiness and tenderness.[18] The duration of the infection if untreated may be a year or more. Testing for chlamydial infection is by means of urethral samples in men and women, or cervical samples, urine samples or self-administered vulval swabs in women. The impact of the sexual component of the campaigns was examined by observing the trends in rates over narrower periods before, during, and after the most intense interventions of 1983 to 1984 (homosexual males) and 1986 to 1987 (general population).

31. This is an infection caused by the bacterium Neisseria gonorrhoeae. Sexually transmitted infections don’t cause symptoms in everybody who has them, which is why they are so easily spread between sexual partners. In men gonorrhoea causes pain on urination and a penile (urethral) discharge, but may occur without symptoms. In 95 percent of cases the virus is transmitted via unprotected sex, as it is found in the blood, semen and vaginal fluids of those who are infected. In women gonorrhoea may spread to the fallopian tubes and can cause PID. If left untreated this condition may lead to scarring of the fallopian tubes, ectopic pregnancy and infertility.

Rectal infection in men and women may lead to painful bowel movements, blood in the faeces, anal itching and discharge. Gonococcal infection can be transmitted during birth and cause conjunctivitis in babies. Although antibiotic treatment usually leads to a complete cure there is increasing concern about the development of antibiotic resistant strains of the bacterium. 32. Syphilis is caused by the bacterium Treponema pallidum. You may experience an increased need to urinate, pain while urinating or blood in your urine. Early syphilis has two stages, primary and secondary.

The incubation period for primary syphilis is approximately 9-90 days after sexual exposure. In the primary stage, lesions appear at the site of inoculation, which is normally the genital area. The lesion starts as a red spot which breaks down into an ulcer or chancre, which is often painless and unnoticed by patients. A secondary stage appears four to eight weeks after infection. The most common manifestation is a widespread red rash on the trunk, palms, leg, soles, face and genitalia. Again, some individuals will not be aware of symptoms. If primary and secondary stage syphilis are not treated about two thirds of patients will develop late effects of the disease, tertiary syphilis.

About 10% will develop infection of the central nervous system, a further 10% of the heart and 15% lesions of the skin and bone. Alcohol and drug abuse can make you more likely to make poor decisions because of the effect it can have on your reasoning. Syphilis in pregnant women often leads to miscarriage or stillbirth; live babies born to syphilitic mothers may show signs of congenital syphilis. Treatment is by antibiotics and long-term follow up is essential to ensure that the infection has cleared. 33. These are the commonest of all viral STIs and are almost always transmitted by sexual contact. They constitute an infection of the skin and mucous membranes caused by the human papilloma virus (HPV).
House of Commons - Health

Small lumps with irregular surfaces are found on the penis, scrotum, anus, rectum, vulva, vagina, cervix or in the mouth. Often these are small and not easily detected. They can cause itching and irritation. The commonest types of genital wart rarely lead to complications but the virus types HPV-16 and HPV-18 are associated with the subsequent development of cancer of the cervix. This is due to its asymptomatic nature, meaning that people do not know they are infected, and so an exact figure of infected individuals is not calculable. However, they are detected in smear tests. Treatment of genital warts is by the application of chemical paint to the wart or freezing of the wart.

Some treatments can be applied at home while others require a health worker. 34. This is a common infection caused by the herpes simplex virus type 2 or type 1 (the usual cause of cold sores). Genital HSV 1 herpes is commonly acquired through oral genital contact; type 2 typically affects the genital area and is most frequently a result of penetrative intercourse. Symptoms include small blisters in the genital area which rapidly break down to leave painful ulcers. Other symptoms include pain or difficulty in passing urine. Some patients may develop headache and fever.

Diagnosis statistics have shown a significant increase in people over the age of 45 over the last decade. A first episode of herpes during late pregnancy is potentially dangerous to the baby during labour. Herpes is a life-long chronic condition which cannot be cured; but the severity of infections, and likelihood of recurrent infections, can be decreased by the use of antiviral drugs taken daily in small doses. 35. Human Immunodeficiency Virus or HIV belongs to a group of viruses called retroviruses. Viruses infect cells by copying their genetic material into the genetic material of the human cells. HIV prevents the immune system from working properly by infecting CD4 cells (also known as helper T-cells) which coordinate the immune system’s fight against infection.

CD4 cells are a type of lymphocyte (a white blood cell) that helps to identify, attack and destroy specific bacteria, fungi, and other germs that infect the body. They help regulate the production of antibodies. 36. When you are certain of which STI you have, please refer to the relevant links on this page to discover which treatment you need. The first test to be conducted, usually on blood, but possibly on saliva, is an ELISA (enzyme linked immunosorbent assay) test which uses an enzyme to detect the presence of antibodies. Since this test can sometimes be positive even when someone is not infected—a ‘false positive’—a second enzyme test called the Western Blot is carried out. This test yields more detailed results but is not used exclusively because the ELISA test can be done much sooner after infection with HIV than the Western Blot test.

There are also a number of tests which can look for the virus or parts of the virus itself, for damage to the immune system, or for other aspects of the body’s response to the effects of the virus. The diagnosis of AIDS is only made when a patient develops an opportunistic infection or cancer which indicates the presence of severe underlying immune deficiency. Such opportunistic infections or cancers are usually diagnosed after a patient has been diagnosed as HIV positive. However some patients learn of their HIV positive status only when they become seriously ill with one of the opportunistic infections or cancers and present at hospital. 37. The major modes of transmission of HIV are through sexual transmission, vertical transmission (mother to child), and through blood and blood products including the use of contaminated needles by intravenous drug users. Once the virus has infected a human being there are three phases of HIV infection: Primary HIV infection; the long term (chronic) asymptomatic phase; and overt AIDS.

38. Primary HIV infection is a transient condition appearing two to four weeks after virus exposure. Although it can occur without symptoms, 40-90% of patients develop a symptomatic illness, which is flu-like but sometimes associated with rashes and more severe symptoms. Patients may be unwell for up to two weeks. During this period of time the patient may not have produced sufficient HIV antibodies to become HIV positive on the tests routinely used. Patients become HIV antibody positive from six weeks to six months (usually from six to twelve weeks) after exposure. 39.

Primary HIV infection is then followed by a long phase during which neither signs nor symptoms of illness are present. This is the long term (chronic) asymptomatic phase. The median length of time of this phase is around ten years. The patient is HIV positive but the levels of virus in the blood and the number of CD4 cells tend to be relatively stable and only change slowly over this period of time. As the immune system is slowly impaired the number of cells which help protect the patient from various disease entities and the CD4 cell count starts to drop below 200 cells per ml. At this point the risk of developing life-threatening opportunistic infections or tumours increases rapidly, and the patient may pass into the overt AIDS stage. These opportunistic infections and tumours, which would not normally arise in people whose immune systems are intact, are often called AIDS-defining illnesses.

41. It is now recognised there is a synergy between most STIs and HIV (particularly ulcerative and inflammatory conditions). The understanding that both HIV transmission and acquisition are enhanced by the presence of STIs has resulted in the development of overarching control programmes for sexual health which include both HIV and STIs. 43. The Strategy states that “Sexual health is not just about disease. Ignorance and risky behaviour can also have profound social consequences.”[23] Teenage pregnancy is frequently (although not always) unintended,[24] is generally perceived as a problem, and has well documented links with ill health, low educational levels and ongoing poverty. The focus in recent years on the issue of teenage pregnancy has tended to divert attention from the broader but equally problematic issue of unintended or unwanted pregnancy across all age groups.

Ian Jones, Chief Executive of the British Pregnancy Advisory Service told us that in 2000, some 79% of women having abortions were not in fact teenagers.[25] Unintended pregnancy at any age can have high social and economic costs and may result in abortion which can have adverse health effects for the patient, as well as being costly for the NHS. 44. Any type of sexual dysfunction is distressing and can affect either sex at any age. Most commonly, men are concerned about premature ejaculation, failure to obtain or maintain an erection and lack of libido. Women’s concerns are less widely publicised but cover problems such as sexual disinterest and failure to achieve orgasm. The pharmaceutical company Lilly UK cite US research data to suggest that up to 30% of the population will experience some form of sexual dysfunction and that as many as a third of men suffer from some form of erectile dysfunction.[26] Specialist services are scarce and have tended to focus on erectile dysfunction. The psychological distress caused by sexual dysfunction can be profound and the extent of this problem, we believe, needs to be recognised more openly.

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