Sexual health

At Skin & Medical Northbridge, we prioritise the private and discreet provision of sexual health screening and treatment, recognizing the sensitive nature of these concerns. Understanding the importance of regular testing for Sexually Transmitted Infections (STIs), we emphasise that testing not only provides peace of mind but also diminishes anxiety surrounding potential infections. It is crucial to note that many STIs may not exhibit noticeable symptoms, underscoring the significance of routine screenings.

Early detection through regular testing significantly enhances the chances of successful treatment, reducing the risk of complications that may arise from untreated infections. Beyond personal health, regular testing empowers individuals to make informed decisions about their sexual health and relationships. Proactive testing not only reduces the risk of transmission but also promotes responsible sexual behaviour and the adoption of safe sex practices. Our dedicated healthcare professionals create a safe space for individuals, offering professional advice to tailor screening and treatments based on individual needs, fostering an environment that prioritizes sexual health and overall well-being.

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What are the types of STIs or STDs?

Chlamydia (Chlamydia Trachomatis)
Gonorrhoea (Neisseria Gonorrhoeae)
Genital Herpes (Herpes Simplex Virus Type 1 or 2)
Molluscum Contagiosum
Genital Warts
Mycoplasma (Mycoplasma Genitalium)
HIV / AIDS
Syphilis
Hepatitis B and Hepatitis C
Candidiasis (Candida albicans)
Trichomoniasis (Trichomonas Vaginalis)
Scabies (Sarcoptes scabiei)
Pubic lice (Pediculosis pubic)

What are the common symptoms of STIs?

STIs can often be asymptomatic. The common symptoms include the following:

Unusual Genital discharge, either penis, vaginal or anus in smell, colour or texture
Pain or discomfort passing urine
Pain or discomfort during sex
Genital sores or ulcers, Genital blisters
A growth on genitals
Swelling of genital, either vaginal, penis, penile foreskin, anus)
Irritation, itchiness or rash in the genital area
Pain in the scrotum or testicle
Abnormal or unusual vaginal bleeding

Sexual health services

The type of test requested by the doctor depends on the symptoms and risk factors.
Polymerase Chain Reaction (PCR) testing is the gold standard testing for most of the STIs. The test is done on urine sample, vaginal swab, penile discharge swab, oral swab and anal swab.
Serum blood serology testing for HIV, syphilis, hepatitis B, hepatitis C infections.
At SMN, the STI test usually involves urine test, vaginal swab, penile swab, anal swab, oral swab or blood test. Most of these test results are available within 5 days of the testing. It is recommended for patient to follow up the results.
Some STI may take up to 12 weeks to show up in the blood test.

In clinic injection of antibiotic necessary for treatment of syphilis or gonorrhoea
Organising oral medications to treatment of chlamydia, gonorrhoea, mycoplasma, syphilis and herpes.
Non invasive cryotherapy for removal of genital lesions, genital warts and molluscum Contagiosum
Providing advise and vaccination for Hepatitis B, Human Papilloma Virus (HPV)

STIs are transmitted via sexual contacts, when infected bodily fluids is transferred from one person to the other’s genital tract. Some STIs can also be transmitted via oral saliva from a person’s mouth.

Occasionally, STIs can be transmitted through close skin to skin contact. Examples including genital warts, molluscum contangiosum, genital ulcers of herpes or syphilis, scabies and pubic lives.

Lastly, STIs can also be transmitted through blood contact in the settings of needle sharing or contaminated blood products.

Use protections / condoms for vaginal, anal and oral sex
Avoid exchanging body fluids if not protected
Get vaccinated for Hepatitis B and HPV.
Get tested regularly

The incubation period is variable and can range between 2 days to 3 weeks for most of the STIs to present with symptoms or show up during testing. Some STIs for example syphilis, HIV and hepatitis B and C can take up to 2 to 3 months to show up. The incubation period for HIV infections can take several years.

As a standard rule, urinary and swab test for most STDs can be perform from day 3 of potential exposure. Blood test for syphilis, HIV, hepatitis B and hepatitis C should be carried out after 4 weeks of potential exposure and a repeat conclusive test to be done at 3 months from potential exposure.

WHAT IS PRE-EXPOSURE PROPHYLAXIS (PREP)?

PrEP or HIV PrEP is the use of anti-HIV medications by HIV negative individual to reduce the risk of being infected with HIV, taken either daily or on-demand.

In 2015, The World Health Organisation recommended that HIV PrEP should be offered for people with increase risk of HIV infections. Sine 2018, HIV PrEP has been approved by the Australia’s Therapeutic Goods Administration (TGA) for use and is subsided by Australian Government through the Pharmaceutical Benefit Scheme (PBS).

The current regimen used for HIV PrEP consist of two anti-viral mediations, tenofovir and emtricitabine. The combination is highly effective in reducing the chances of HIV infection for HIV-negative patients. If taken correctly, PrEP is up to 99% effective at preventing HIV.

IS HIV PREP EFFECTIVE AFTER EXPOSURE TO HIV?

PrEPis meant to reduce the risk of HIV transmission. If you are not on PrEP and after potential exposure to HIV, you may be suitable for Post-Exposure Prophylaxis (PEP).

ARE THERE ANY SIDE EFFECTS WITH HIV PREP?

Most patients tolerate the medications very well without side effects. Some patients suggested headache, stomach upset and nausea as a side effect. Most side effects are self limiting.

HOW TO TAKE THE HIV PREP?

Daily PrEP: PrEP is very effective if taken daily. This is taken everyday with no breaks in between. The medications needs to be taken at least 7 days prior to maximum level of protection being achieved.

On-Demand PrEP: This involves taking double dose, which is two tablet of tenofovir/emtricitabine 2 to 24 hours before a potential sexual exposure to HIV, followed by a third tablet 24 hours after the first dose, and fourth tablet 48 hours after the first dose. If sexual activities continue after day 1, then one tablet is taken every 24 hours and continue for two days after last sexual activity.

DO I STILL NEED TO TEST TO HIV IF I AM ON PREP?

Yes, PrEP does not protect you from HIV 100%. Regular HIV testing is required and any positive results will require further treatment. In Australia, in order to obtain PBS subsidised pricing of the medications, it is required to have a recent negative HIV serology within 4 weeks of the prescription and a HIV serology testing every 3 months.

WHO IS SUITABLE TO USE PREP?

PrEP is recommended for HIV negative patients at risk of HIV infections.

1. Men who have sex with men (MSM) without using condoms
2. Anyone who are sexually active through vaginal or anal sex, especially with multiple partners and inconsistently using condoms
3. Having a sexual partner who is HIV positive and is not on antiviral medications.
4. Drug user who shares equipment and needles

WHAT IS HIV POST-EXPOSURE PROPHYLAXIS (PEP)

PEP is a short course of antiviral medications given the reduce the chance of HIV seroconversion after potential exposure. The medications is required to be initiated within 72 hours of potential exposure. The medication regimen is basically 30 days treatment with table consist of combination of Tenofovir and Emtricitabine, similar to the medications used for PrEP. The patient will require to have a HIV serology testing as baseline, at 1 month and at 3month. PEP is usually not given for exposures after the 72 hours mark.

The unwillingness to openly talk about STIs lead to various misinformation. These are the common myths and facts about STIs:

- STI testing is expensive? If you hold a valid Medicare Card, most of the STI test is bulk billed with no out of pocket expenses.
- STI testing hurts? No. Majority of the testing is done via urine or blood test. Occasionally a swab is required but they are usually not painful and minimally invasive.
- Having a STI test is embarrassing? It is more commonly done than you think and there is no shame for being responsible for your own health.
- STIs can go away on their own? In majority of the cases, it is unlikely for STI to resolve itself.
- You can catch STIs through sharing of food, utensils and toilet seats? The short answer is “No”. These bacteria, virus, fungus or Protozoa causing STIs usually cannot survive outside the human mucous membrane for significant amount of time.
- I don’t have sex with a lot of people, so I don’t need a STI check? You can get STI with one partner or have sex one time. It is always advisable to have regular sexual health screening and test. Commonly STIs are asymptomatic.
- STIs can be transmitted by kissing? It is uncommon for STIs to be transmitted through kissing. However, Chlamydia, Gonorrhoea, Herpes and Syphilis may be present in the mouth or throat of infected person.
- You cannot catch STIs from oral sex? You can catch STIs from oral sex. Chlamydia, Gonorrhoea, Herpes and Syphilis may be present in the mouth or throat of infected person.
- STIs can only be transmitted only via penetrative sex? No, STIs can be transmitted via vaginal sex, anal sex, oral sex, oralanal sex and also using sex toys.
- You always have symptoms if you have caught a STI? No, it is common for STIs to be asymptomatic. You won’t always be able to tell if you or your sexual partner has an infection.
- You can only transmit an STI if you have symptoms? No, STI can be spread with or without symptoms.
- Condoms are 100% effective against STDs? Condoms reduce the risk of STD considerably, however they are not 100% effective against all STD. Often condoms are only worn half way into the sexual activities, and some STI can be transmitted via oral to genital and skin to skin.
- Only teenagers get STIs? No, STIs is common in all age groups.
- I can only have one STI at one time? No, you can multiple STIs being present, even without symptoms.
- Once I have had an STI, I cannot catch it again? You do not develop immunity to most STIs. It is possible to become reinfected by the same STIs again.
- Contraception pills protect you from STIs? No, contraception pill does not protect against STIs.
- Pulling out before ejaculation protects you from STIs? No, vaginal discharge and penile pre-cum of an infected person can be transmitted. In addition, STIs can also be transmitted via oral contacts and skin to skin contacts.
- How long does it take for symptoms of STIs to appear? It is common for STIs to be asymptomatic. When you do get symptoms, most symptoms would appear between 2 days to 3 weeks. Some infections can take months or years to appear.
- All STIs are curable? Bacterial, Fungal and Protozoa causing STIs are curable. The sooner the treatment, the less chance for transmission and complications. Most Viral STIs are not curable and treatment is available for suppression.
- Can you get immunised for STIs? Vaccines are only available for Hepatitis B and HPV.
- Can you catch STI from Tattoo or body piercing? Yes, There is a risk of HIV, Hepatits B and Hepatitis C infection if the instruments used are not sterilised sufficiently.

Human Immunodeficiency Virus (HIV) is a virus that is spread via bodily fluids of a person with HIV. It is commonly transmitted during unprotected sexual intercourse of through sharing injection drug equipment. The virus attacks the body’s immune system.

If HIV is not treated, it can lead to AIDS ( Acquired immunodeficiency syndrome). AIDS is the late stage of HIV infections and at higher risk of opportunistic infections and organ failures.

There is now effective methods to prevent HIV infections, including PrEP and PEP.

Chlamydia is the most common bacterial STIs caused by the chlamydia trichomonas. The symptoms can be variable, from asymptomatic to any possible symptoms of STIs. The diagnosis is usually by urine, vaginal swab, penile swab, oral swab or anal swab test. Fortunately, chlamydia is usually easily treated with oral antibiotic.

Gonorrhoea is caused by Neisseria Gonorrhoeae. Gonorrhoea is usually symptomatic and the symptoms can range from oral and genital pain and discomfort to vaginal, penile or anal discharge. The diagnosis is usually by urine, vaginal swab, penile swab, oral swab or anal swab test. Treatment of gonorrhoea usually requires the combination treatment of injection antibiotic or oral antibiotic.

If left undiagnosed and untreated, chlamydia or gonorrhoea can

1. lead to Pelvic inflammatory Disease and associated potential complications of fertility and ectopic pregnancy, and also
2. Lead to long term or hit is or testicular infection and epididymitis for men.
3. Having chlamydia also increase the risk of HIV infections.
4. During pregnancy, increase the risk of premature birth and still birth, or transmission of chlamydia to the infant’s eyes and lungs during child birth.

Syphilis is a STI caused by the bacteria Treponema pallidum. The transmitting for syphilis can be through unprotected sexual contact, mother to child during pregnancy, blood transfusion with contaminated blood products and potentially also needle stick injuries. The symptoms and signs of syphilis is variable depending on the stages of infections.

Primary Syphilis: There may be no symptoms or symptoms mild and ignored, in the forms of painless or painful genital or oral sores/ulcers. Typically occurring between day 9 to 90 after exposure.

Secondary Syphilis: The symptoms can range from palms or sole rash, to swollen lymph nodes, to rash or lesions of genital or anus. Typically occurring from few weeks to exposure to up to 6months.

Latent Syphilis: This can occur between one to many years after initial infection. There is usually no symptoms but the patient is infectious and organ damage can continue to occur.

Tertiary Syphilis: This causes serious and permanent damage to various organs of the body, including the brain, nerves and heart, occurring years after initial infection.

Syphilis is diagnosed via blood test. Syphilis can also be effectively treated with injection antibiotics if diagnosed early and usually complete cure is expected. Hence regular checks and early diagnosis is vital in management of syphilis before the onset of permanent complications.

Herpes is caused by Herpes Simplex Virus (HSV). There are two types of HSV, HSV-1 and HSV-2. HSV-1 is very common, typically causing cold sores on the lips. Some patients have HSV-1 in their system but don’t present or don’t remember having episodes of cold sores. HSV-1 can be spread to genital from oral sex.

HSV-2 infection are usually spread through sexual contact and presented as genital infections.

Genital herpes therefore can be in the form of HSV-1 or HSV-2. The infection is spread by direct sexual contact, oral sex and sometimes during child-birth.

Majority of the cases of genital herpes, there is a genital lesion or lesions that are usually painful with or without blistering. Some patients may not remember their first attacks of herpes. Herpes is not curable, and patients may or may not have subsequent herpes attacks. The frequency of herpes attacks is also variable.

Genital herpes is confirmed through swab testing of a lesion or ulcer. There is an option of blood serological testing for HSV but the interpretation of results is difficult.

Genital herpes is not curable. It does not cause any complications in most patients. The treatment is aimed at treating outbreaks of reducing chances of outbreaks. Oral anti-viral medications is used for this purpose, either during outbreaks or as suppressive therapy.