Infection Testing

HIV is a sexulally transmitted virus which attacks the body's immune system.

A healthy immune system provides a natural defence against disease and infection. HIV infects special cells, called CD4 cells, that are found in the blood and are responsible for fighting infection. After becoming infected, the CD4 cells eventually decline and the immune system stops working. This leaves the person infected with HIV at a high risk of developing serious infection and disease.

Many people are aware of the need to test for HIV, although an HIV test may not show positive until three months after infection, using traditional antibody HIV tests. For this reason a donor should have two tests three months apart before donating sperm. The donor should also avoid any risk of catching the HIV virus within the three months, by either celibacy or following strict safe sex practices.

HIV Duo test or HIV 28 day test

The HIV antibody/p24 antigen Duo Test is an excellent, accurate and inexpensive HIV test that reliably detects HIV infection that occurred just 28 days prior to the test. This HIV test is known as the 'Duo' because it tests for both HIV antibodies as well as the 'HIV P24 antigen'. The HIV p24 antigen is a core HIV viral protein which becomes detectable at approximately 10 days post exposure, peaks at 16 days or so and then remains at high level for 8 to 10 weeks post exposure. It will then fluctuate over the rest of the course of the illness. HIV p24 antigen is extremely useful in combination with an HIV antibody test in determining early on whether an individual has been infected with HIV. The HIV DUO test is extremely accurate at 28 days and is now the test recommended by the new UK Guidelines on HIV testing 2008. 

HIV Antibody test or HIV 90 day test

The rapid HIV test allows for results within 60 seconds via a simple prick of blood from the finger tip. This test is very accurate from 90 days post Contact for detecting HIV antibodies. This test can give immediate peace of mind if risk of infection was more than 90 days ago but is no recommended as a definitive test. It should be proceeded by a HIV Duo test for confirmation. 

HIV PCR test - results from 10 days

You may also have heard of HIV PCR testing. This is the most sensitive HIV test available and aims to test for HIV 1 infection that occurred as little as 10 days prior to the test. This HIV PCR test is not 100% reliable but it is a guide for those that are desperate for some peace of mind at the earliest opportunity. We recommend that this HIV test is followed-up with an HIV Duo Test at 28 days after the suspected infection. Like the HIV Duo test, a blood sample is sent to the laboratory and the results should be with you in 5-7 working days. This test will help allay fears over the possible early symptoms of HIV. This is the most expensive of the three tests and is not normally available via NHS GUM clinics or GPs. 

Which test is recommended? 

The new UK Guidelines on HIV Testing published in September 2008 have emphatically recommended the use of 4th generation combined HIV p24 antigen and HIV antibody tests (HIV DUO tests) as the test of first choice, citing the very distinct benefit of the earlier diagnosis of HIV using these tests as opposed to the older 3rd generation HIV antibody tests. The 4th generation combined tests will shorten the time from infection to diagnosis by 1-2 weeks over the older 3rd generation HIV tests. The older 3rd generation tests are excellent and will still identify the majority of new HIV infections by 6 weeks. 

Hepatitis B is an infection of the liver caused by the hepatitis B virus. 

It can cause inflammation (swelling) of the liver, and sometimes significant liver damage. 

Many people do not even realise they have been infected with the virus, because the typical flu-like symptoms may not develop immediately, or even at all. 

You can become infected with hepatitis B if you are not immune (resistant) to the virus and have been exposed to the blood or body fluids of an infected person (see below). 

A vaccine is available to protect against hepatitis B. 

How do you catch it? 

The hepatitis B virus is present in body fluids such as blood, saliva, semen and vaginal fluid. It can be passed from person to person through unprotected sex (without using a condom) or by sharing needles to inject drugs, for example. 

Hepatitis B is 100 times more infectious than HIV. 

Infected mothers can also pass the virus to their baby during childbirth, often without knowing they are infected. 

The incubation period (time from coming into contact with the virus to developing the infection) is between one and six months. 

Chronic illness

In some people, the hepatitis B virus will go on to cause a chronic (long-term) illness, where it lasts for longer than six months. This is very common in babies and young children, but it can also occur in 2-10% of infected adults. 

If you develop chronic hepatitis B, you may not have symptoms and pass on the virus without realising you are infected. If you do have symptoms, these may come and go. There is a chance you may develop serious liver damage. 

How common is it? 

Hepatitis B is not very common in the UK: approximately one in 1000 people are thought to have the virus. 

However, in some inner-city areas with a high percentage of people from parts of the world where the virus is common, as many as one in 50 pregnant women may be infected. 

Worldwide, the occurrence of hepatitis B is highest in sub-Saharan Africa, south-east Asia and the Pacific islands, such as the Hawaiian islands, the Solomon islands and Fiji. 

The lowest incidence of hepatitis B is found in Australia, New Zealand, northern and western Europe, and North America. There are approximately 350 million carriers of the virus around the world. 

Outlook 

The vast majority of people who are infected with hepatitis B are able to fight off the virus and fully recover from the infection within a couple of months. 

However, most babies infected with hepatitis B have a poorer outlook, as their infection usually becomes chronic.

Symptoms of hepatitis B  

The vast majority of people who are infected with hepatitis B are able to fight off the virus, meaning their infection never becomes chronic (long-term). 

They may remain healthy and do not have any symptoms while they clear the virus from their bodies. Some will not even know they have been infected. 

However, until the virus has been cleared from their body, they can pass the virus on to others. 

Common symptoms 

Other people will have symptoms similar to those of hepatitis A, which include: 

• flu-like symptoms, such as tiredness, general aches and pains, headaches and fever,
• loss of appetite and weight loss,
• nausea or vomiting,
• diarrhoea,
• stomach pains
• jaundice

Chronic infection 

Hepatitis B is said to be chronic when you have been infected for longer than six months. 
The earlier the disease is contracted, the greater the chance of developing chronic viral infection. Therefore, babies and children are particularly at risk of developing chronic disease. 

It is less common in adults: only 2-10% of those with hepatitis B will go on to have a chronic infection in the UK. 

If you have chronic hepatitis B you may not have symptoms, and may carry on spreading the virus without realising you are infected. 

If you do have symptoms, these may come and go. There is a chance you will go on to develop permanent scarring of the liver, called cirrhosis, and you may eventually develop liver cancer. 

Fulminant hepatitis B 

Very rarely, a serious type of hepatitis called fulminant hepatitis B occurs. Symptoms include collapsing, severe jaundice and swelling of your stomach, and it can be fatal. You can become infected with hepatitis B if you are not immune (resistant) to the virus and you come into contact with the blood or body fluids of an infected person. 

Many people with hepatitis B do not even realise they are infected. 

The risk of hepatitis B for tourists is considered to be low. However, this risk will increase with certain activities, such as unprotected sex or receiving medical or dental treatment in a developing country. Therefore, travellers are advised to get vaccinated against hepatitis B before visiting any country where this is a problem. 

Exposure to infected blood 

You are at risk of catching hepatitis B if you: 

• inject drugs and share needles and other equipment, such as spoons and filters, 
• have an open wound, cut or scratch, and come into contact with the blood of someone with hepatitis B,
• have medical or dental treatment in a country where equipment is not sterilised properly,
• work closely with blood (for example, healthcare workers and laboratory technicians are at increased risk of needlestick injury when the skin is accidentally punctured by a used needle),
• have a blood transfusion in a country where blood is not tested for hepatitis B,
• have a tattoo or body piercing in an unsafe, unlicensed place (see Risks of body piercing), or
• share toothbrushes, razors and towels that are contaminated with infected blood.

Exposure to infected body fluids 

You are also at risk of catching hepatitis B if you have vaginal or anal intercourse with an infected person and do not use a condom. 

Generally, your risk increases if you are sexually active and have unprotected sex with several different partners. 

Diagnosing hepatitis B  

Hepatitis B is diagnosed by a blood test that shows a positive reaction to hepatitis B surface antigen (the outer surface of the hepatitis B virus that triggers a response from your immune system). 

Your GP may also request a liver function test. This is a blood test that measures certain enzymes and proteins in your bloodstream, which indicate whether your liver is damaged. These will often show raised levels if you are infected with the hepatitis B virus. 

Hepatitis B tests

There are routinely two main tests for Hepatitis B, an antigen test which looks for current infection, and an antibody test which looks to see if a patient has immunity because of a past infection or vaccine.

HBsAg (hepatitis B surface antigen) 

This refers to the outer surface of the hepatitis B virus that triggers an antibody response. A "positive" or "reactive" HBsAg test result means that the person is infected with the hepatitis B virus. This can be an "acute" or a "chronic" infection. Infected people can pass the virus on to others through their blood. 

HBsAb or anti-HBs (hepatitis B surface antibody) 

This refers to the protective antibody that is produced in response to an infection. It appears when a person has recovered from an acute infection and cleared the virus (usually within six months) or responded successfully to the hepatitis B vaccine shots. A "positive" or "reactive" HBsAb (or anti-HBs) test result indicates that a person is "immune" to any future hepatitis B infection and is no longer contagious. 

Please consult your GP for further clarification of these tests.

Hepatitis C is an infection with the hepatitis C virus. Although there is no vaccine to protect against infection, there is effective treatment available. 

Estimates suggest over 250,000 people in the UK have been infected with hepatitis C, but eight out of ten don’t know that they have it because they have no symptoms. Worryingly, about 75% of these people go on to develop a chronic hepatitis. But because it can take years, even decades, for symptoms to appear, many people (possibly 100,000 or more) remain unaware that they have the problem. By the time they become ill and seek help, considerable damage has been done to the liver. This might have been prevented if the person had been diagnosed earlier. 

Elsewhere in the world, hepatitis C is even more common – the World Health Organisation estimate that three per cent of the world’s population (about 170 million people) have chronic Hepatitis C, and up to four million people are newly infected each year. 

Symptoms of Hepatitis C

In most cases, the initial infection doesn't cause any symptoms. When it does, they tend to be vague and non-specific. 

Possible symptoms of hepatitis C infection include: 

• Fatigue
• Weight loss
• Loss of appetite
• Joint pains
• Nausea
• Flu-like symptoms (fever, headaches, sweats)
• Anxiety
• Difficulty concentrating
• Alcohol intolerance and pain in the liver area

The most common symptom experienced is fatigue, which may be mild but is sometimes extreme. Many people initially diagnosed with chronic fatigue syndrome are later found to have 
hepatitis C. 

Unlike hepatitis A and B, hepatitis C doesn't usually cause people to develop jaundice. 

About 20-30% of people clear the virus from their bodies - but in about 75% of cases, the infection lasts for more than six months (chronic hepatitis C). In these cases the immune system has been unable to clear the virus and it will remain in the body long term unless medical treatment is given. Most of these people have a mild form of the disease with intermittent symptoms of fatigue or no symptoms at all. 

About one in five people with chronic hepatitis C develops cirrhosis of the liver within 20 years (some experts believe that, with time, everyone with chronic hepatitis C would develop cirrhosis but this could take many decades). 

Causes and risk factors of Hepatitis C

Hepatitis C virus is usually transmitted through blood-to-blood contact. One common route is through sharing needles when injecting recreational drugs - nearly 40% of intravenous drug users have the infection and around 35% of people with the virus will have contracted it this way. 

Similarly, having a tattoo or body piercing with equipment that has not been properly sterilised can lead to infection. 

People who have ever injected drugs even if it was only once in their lifetime, or had a tattoo should be tested for Hepatitis C infection. 

Before 1991, blood transfusions were a common route of infection. However, since then all blood used in the UK has been screened for the virus and is only used if not present. 

Hepatitis C can be sexually transmitted, but this is thought to be uncommon. It can be passed on through sharing toothbrushes and razors. It is not passed on by everyday contact such as kissing, hugging, and holding hands - you can't catch hepatitis C from toilet seats either. 

If someone needs a blood transfusion or medical treatment while staying in a country where blood screening for hepatitis C is not routine, or where medical equipment is reused but not adequately sterilised, the virus may be transmitted. 

Most people diagnosed with hepatitis C can identify at least one possible factor which may have put them at risk but for some, the likely origin of the infection isn't clear. Because it can remain hidden and symptomless for so many years, it may be very difficult to think back through the decades to how it might have begun. 

There are a number of ways to reduce the risk of the infection being transmitted. Those most at risk of contracting the infection are injecting drug users, who should never share needles or other equipment. 

Practising safe sex by using condoms is also important. 

People with hepatitis C infection aren't allowed to register as an organ or blood donor. 

Although it is unlikely for Hepatitis C to be transferred through sperm donation, we do recommend that all sperm donors and co-parents are tested for Hepatitis C. 

Hepatitis C tests 

Hepatitis C testing begins with simple serological blood tests used to detect antibodies to HCV. Earliest detection of Anti-HCV antibodies is approx. 8 weeks after exposure to the virus, with 80% of patients detected within 15 weeks after exposure, >90% within 5 months after exposure, and >97% by 6 months after exposure. 

Overall, HCV antibody tests have a strong positive predictive value for exposure to the hepatitis C virus, but may miss patients who have not yet developed antibodies (seroconversion), or have an insufficient level of antibodies to detect. Rarely, people infected with HCV never develop antibodies to the virus and therefore, never test positive using HCV antibody screening. Because of this possibility, RNA testing (see nucleic acid testing methods below) should be considered when antibody testing is negative but suspicion of hepatitis C is high (e.g. because of elevated transaminases in someone with risk factors for hepatitis C). 

Anti-HCV antibodies indicate exposure to the virus, but cannot determine if ongoing infection is present. All persons with positive anti-HCV antibody tests must undergo additional testing for the presence of the hepatitis C virus itself to determine whether current infection is present. The presence of the virus is tested for using molecular nucleic acid testing methods such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), or branched DNA (b-DNA). All HCV nucleic acid molecular tests have the capacity to detect not only whether the virus is present, but also to measure the amount of virus present in the blood (the HCV viral load). The HCV viral load is an important factor in determining the probability of response to interferon-based therapy, but does not indicate disease severity nor the likelihood of disease progression. 

In people with confirmed HCV infection, genotype testing is generally recommended. HCV genotype testing is used to determine the required length and potential response to interferon-based therapy. 

Syphilis is a sexually transmitted infection caused by a bacteria known as Treponema pallidum. 

How is Syphilis passed on?

Syphilis is usually passed from one person to another during vaginal, oral or anal sex. It can be passed on by direct skin contact with someone who has syphilis sores or a syphilis rash, and by sharing sex toys.
Syphilis can also be transmitted by blood transfusion. All blood donors in the UK are screened to detect this before blood is used.

You can't get syphilis....from kissing, hugging, sharing baths or towels, swimming pools, toilet seats, cups, plates or cutlery

Syphilis can be passed from a pregnant woman to her unborn baby - this is known as congenital syphilis. All pregnant women are tested for syphilis.

What are the symptoms of Syphilis?

The signs and symptoms are the same in women and men, but they can be difficult to recognise and you might not notice them.

Syphilis can develop in three stages, known as primary, secondary and tertiary syphilis. If you do get symptoms, you might notice the following:

Primary syphilis:

• One or more sores (chancres) - usually painless, they appear where the bacteria entered the body, usually two to three weeks after you've come into contact with syphilis
• The sores can appear anywhere on the body - in women they're found mainly in the genital area and on the cervix, in men they're found mainly in the genital area and on the penis
• Less commonly, they may be found in the mouth, lips, tonsils, fingers or buttocks

The sores are very infectious and can take up to six weeks to heal. By this time, the bacteria will have spread to other parts of the body, becoming known as secondary syphilis.

Secondary syphilis:

• A painless, non-itchy, very infectious rash that can occur all over the body or appear in patches, mostly on the palms of hands and soles of feet 
• Flat, warty-looking growths on the vulva of women or anus in men and women
• Flu-like illness, tiredness and loss of appetite, with swollen glands, possible patchy hair loss and white patches in the mouth

Tertiary syphilis:

If left untreated, after many years syphilis can cause serious damage to the heart, brain, eyes and other internal organs, and lead to death. This is rare in the UK.

What's the treatment for Syphilis?

It's important to get tested quickly if you think you have syphilis. Testing is free on the NHS from genitourinary medicine clinics, sexual health clinics and from your GP.The test involves a blood 
test and an examination of the genital area and anus. Your body, mouth and throat will also be examined. 
A swab (like a cotton bud) will be used to take a sample of discharge and cells from any sore.

Treatment for primary and secondary syphilis involves either a single antibiotic injection, a course of injections, antibiotic tablets or capsules. Penicillin is the most common treatment, so tell your doctor if you're allergic to penicillin. Treatment usually lasts up to 14 days. 

Some antibiotics interact with the combined oral contraceptive pill and contraceptive patch, making them less effective, so check this with your doctor or nurse.

To avoid reinfection, any sexual partners should also be treated.

What happens if Syphilis is not treated?

Without treatment the infection can cause serious long-term damage and lead to death.

Advice and support

Go to your GP, a genitourinary medicine clinic or a sexual health clinic. All services are confidential.

How to avoid STIs

Make sure your donor has been tested recently for STI's and use artificial insemination - not 'natural insemination', as many STI's carry as higher risk of being transmitted through natural insemination (sexual intercourse).
 

Cytomegalovirus (CMV) is a common virus that is part of the herpes family of viruses. 

CMV is spread through bodily fluids such as saliva and urine, and can be transmitted from person to person through close bodily contact.

Like most other herpes-type viruses, once you're infected by CMV it will remain dormant in your body for the rest of your life. 

There is no cure for CMV. A possible vaccine for CMV is currently being researched and used in clinical trials but it's unlikely that a vaccine will become publically available before 2012 at the earliest. 

Types of CMV?

The three main types of CMV infections are: 

• Acquired (or primary) CMV: a CMV infection that is contracted for the first time.
• Reoccurring CMV: a previously dormant CMV infection that reoccurs due to a weakened immune system.
• Congenital CMV: a CMV infection that develops in pregnancy and can affect the unborn baby.

How common is CMV? 

CMV is one of the most common viral infections. It's estimated that 40-80% of all adults aged 40 or over have been infected by CMV. Most people develop a CMV infection during their early childhood. 

Outlook of CMV

Unlike other viral infections, CMV causes no, or very few, symptoms. Most people will be unaware that they've developed an infection. 

CMV only presents a public health problem when a CMV infection develops, or reoccurs, in certain vulnerable groups of people. There are two main groups of people who are at risk from CMV.

They are: 

• People with a weakened immune system , particularly those with HIV or who have recently received an organ or bone marrow transplant.
• Unborn babies.

CMV and HIV 

People with advanced HIV, who have a severely weakened immune system, can sometimes experience a reoccurrence of a CMV infection, which can lead to organ failure. Eye damage which can cause blindness often occurs in these cases. 

These types of infections were widespread in the 1980s, but are much less common now due to the more effective anti-HIV medicines introduced during the 1990s. 

CMV and Unborn babies 

If a woman who was previously uninfected by CMV becomes infected during pregnancy, there's a risk that she may pass the infection on to her unborn baby. This is known as a congenital CMV. It is estimated that one in every 200 babies will be born with congenital CMV. 

Only 10% of babies who are born with congenital CMV will have symptoms at birth. But these symptoms can be serious and may lead to long-term complications such as learning difficulties. 

A further 10% of babies who are born with congenital CMV will have no symptoms at birth, but will experience hearing loss in later life. 

See Prevention, above, for more information about how to prevent a CMV infection during your pregnancy. 

Symptoms of cytomegalovirus  

The symptoms of cytomegalovirus (CMV) differ depending on: 

• whether you have contracted a CMV infection for the first time (an acquired or primary CMV infection),
• whether a previously dormant CMV infection has reoccurred because you have a weakened immune system, or
• whether the CMV infection has developed in a newborn baby (congenital CMV).

Symptoms of acquired CMV 

In 90% of cases of acquired CMV there will be no noticeable symptoms. If you do experience symptoms, they will be similar to flu symptoms and include:

• fever (a temperature of 38°C (100.4°F) or above),
• fatigue,
• sore throat,
• swollen glands,
• muscle and joint pain, and
• loss of appetite.

These symptoms should only last for a couple of weeks. 

Symptoms of reoccurring CMV 

The symptoms of a CMV infection that reoccurs as a result of a weakened immune system are wide ranging. This is because the virus can quickly replicate and spread throughout the body, causing damage to one or more of your organs, in particular, the digestive system, lungs and eyes. 

Possible symptoms of reoccurring CMV include: 

• fever (a temperature of 38°C (100.4°F) or above),
• diarrhoea,
• shortness of breath,
• large painful ulcers in your mouth, and
• visual disturbances such as blind spots, blurring and floaters (a black spot or ‘web’ that appears to be floating in your field of vision).

If you have a weakened immune system and experience one or more, of these symptoms, immediately contact your treatment team and/or your GP. 

Symptoms of congenital CMV 

Hearing loss 

Around 90% of babies born with congenital CMV will experience no symptoms at birth. However, of these, one in 10 will develop varying degrees of hearing loss, usually during the first six months after birth. The level of hearing loss can range from mild to total. 

Around half the children who develop hearing problems will only have problems in one ear, and half will have problems in both ears (bilateral hearing loss). Children with bilateral hearing loss are likely to experience speech and communication difficulties as they grow older. 

Symptoms at birth 

Symptoms of CMV that develop at birth include: 

• jaundice: yellow coloured skin and yellowing of the whites of the eyes,
• pneumonia (lung infection),
• red spots under the skin,
• enlarged liver and spine,
• low birth weight, and
• seizures.

While some of these symptoms can be treated, 85 to 90% of babies who are born with congenital CMV will have one or more physical and/or mental disabilities. 

These include

• hearing loss,
• impaired vision,
• blindness,
• seizures,
• learning difficulties,
• lack of physical coordination,
• autism, and
• epilepsy.
• Causes of cytomegalovirus  

Acquired cytomegalovirus 

The cytomegalovirus (CMV) is spread through bodily fluids. These include: 

• saliva,
• semen,
• blood,
• urine,
• vaginal fluids, and
• breast milk

Close physical contact 

CMV infection can be spread through close physical contact. For example, when small droplets of infected saliva are transmitted from one person to another when an infected person coughs or sneezes. 

You can also contract the CMV virus by touching surfaces that have been infected with contaminated saliva or urine, and then touching the inside of your mouth or nose. CMV can also be spread during sexual intercourse. 
Most CMV infections occur in early childhood. In places where young children spend a lot of time in close contact with other children, such as daycare centres and nurseries, a rapid spread of a CMV infection can occur. 

However, do not avoid sending your child to daycare or nursery because by the time they're old enough to attend, their immune system should be strong enough to deal with an infection. 

If you do experience any symptoms of a CMV infection, they should pass quickly and the virus will then lie dormant in your body’s cells for the rest of your life. 

CMV will only become a problem if your immune system becomes severely weakened, leading to the virus ‘waking up’ and re-infecting your body’s organs. 

Your immune system may become weakened if:

• you're taking immunosuppressant medication because you've had an organ transplant,
• you have HIV,
• you are receiving chemotherapy,
• you have been taking steroid tablets (oral steroids) for more than three months.

CMV and breastfeeding 

CMV can be passed from a mother to a child through breast milk. However, the benefits of breastfeeding your child far outweigh any risk that is posed by CMV. 

The one exception to this is if a child is born prematurely. The immune systems of premature babies are often not strong enough to control a CMV infection. If your baby is born prematurely, your treatment team will be able to advise you about the best option for feeding your baby. 

Congenital CMV 

Most cases of congenital CMV develop when a pregnant woman is infected by the CMV virus for the first time during (or shortly before) pregnancy. 

In some cases, a previously dormant CMV infection can recur during pregnancy as a result of the mother having a weakened immune system. If this happens, the CMV virus can then be transmitted from the mother to the unborn baby. 

In the majority of cases where CMV is transmitted from a mother to her unborn baby, the virus doesn't cause any damage to the baby. But if a large number of virus cells (high viral load) is spread to the baby, it can interfere with the baby’s normal development, resulting in the symptoms and associated disabilities of congenital CMV. 

Testing for Cytomegalovirus 

Blood test

Cytomegalovirus (CMV) can be diagnosed by a blood test. If you're infected, or have been previously infected, your immune system will produce special cells, called antibodies, to fight off the infection. The blood test checks whether or not antibodies are present in your blood.

If you have a condition such as HIV, or are receiving a treatment that is known to weaken the immune system, such as chemotherapy, regular testing for CMV may be recommended.

Treating cytomegalovirus  

Acquired CMV 

If you experience symptoms after being infected with cytomegalovirus (CMV) for the first time, over-the-counter (OTC) painkillers such as paracetamol or ibuprofen can help relieve the symptoms of fever and pain. Children under 16 should not take aspirin. 

It is very important to drink plenty of water or unsweetened fruit juice, as this will help relieve the symptoms of fever and sore throat, and prevent dehydration. 

Congenital and reoccurring CMV 

Congenital CMV and CMV that recurs due to a weakened immune system can be treated with anti-viral medicines. These medicines can't cure it, but they can slow its spread. 

Ganciclovir is an anti-viral medicine that is often used to treat CMV. However, this medicine can cause a range of side-effects including:

• fever (a temperature of 38°C (100.4°F) or above),
• nausea,
• vomiting, 
• diarrhoea,
• abdominal pain,
• headache,
• confusion,
• hallucinations, and
• seizures.

It may be necessary to keep babies who are born with congenital CMV in hospital until their normal organ function, such as liver function, returns. 

Adults with a weakened immune system, who have extensive organ damage as a result of CMV, may also require admission to hospital. 

Preventing cytomegalovirus  

If you're pregnant, taking some basic precautions can reduce your risk of developing a cytomegalovirus (CMV) infection.

Wash your hands regularly using soap and hot water, particularly before preparing food, before eating, after close contact with children, or after changing nappies.

Avoid kissing a young child on the face. Hugging a child, or kissing them on the head, presents no extra risk.
Don't share eating utensils (forks and spoons) with young children, or drink from the same glass as them.
These precautions are particularly important if you have a job that brings you into close contact with young children, such as working in a daycare centre or nursery. 

If you have a job where you spend a considerable amount of time with young children, consider having a blood test to determine whether you have previously been infected with CMV. If the result of the test reveals that you have not had a CMV infection, you may wish to consider transferring to a role that limits your exposure to young children.

Chlamydia is a sexually transmitted infection (STI) caused by the bacterium chlamydia trachomatis.

In the UK, the number of new diagnoses has been steadily increasing each year since the mid-1990s, and it has now become the most commonly diagnosed STI.

Chlamydia is called the ‘silent’ disease because most people who get it do not experience any noticeable symptoms. Around 50% of men and 70-80% of women who get the chlamydia infection will have no symptoms and many cases of chlamydia remain undiagnosed.

How common is it?

Between 2007 and 2008, the number of confirmed cases of chlamydia rose from 121,791 to 123,018. Young people under 25 are most likely to be infected, 65% (80,258) of all new chlamydia diagnoses made in 2008 were in people between the ages of 16 and 24.

Outlook

The chlamydia infection can be easily diagnosed through a simple swab or urine test, once diagnosed it can be treated with antibiotics. Undiagnosed chlamydia can lead to more serious long term health problems and infertility.

Under 25s can get a free, confidential chlamydia test through the National Chlamydia Screening Programme. People over 25 can visit their GP or a local GUM (genitourinary medicine) or sexual health clinic to arrange a test.

Symptoms of chlamydia 

Chlamydia often goes unnoticed due to the lack of noticeable symptoms. Because of this, many cases of chlamydia remain undiagnosed.

Women

In women, genital chlamydia does not always cause symptoms. Signs and symptoms can appear 1-3 weeks after coming in contact with chlamydia, many months later or not until the infection has spread to other parts of your body.

Some women may notice:

• Cystitis (pain when passing urine),
• a change in their vaginal discharge,
• lower abdominal pain,
• pain and/or bleeding during sexual intercourse,
• bleeding after sex, or
• bleeding between periods or heavier periods.

If left untreated the chlamydial infection can spread to the womb, and cause Pelvic Inflammatory Disease (PID). PID is a major cause of infertility, ectopic pregnancy and miscarriage.

Men

Symptoms of genital chlamydia are more common in men than in women. Signs and symptoms can appear 1-3 weeks after coming in contact with chlamydia, many months later or not until the infection has spread to other parts of your body.

Some men may notice:

• a white, cloudy or watery discharge from the tip of the penis,
• pain when passing urine, or
• pain in the tesiticles.

Some men experience mild symptoms that disappear after two or three days. However, after the discomfort disappears, you may still have the chlamydia infection. This means that you can pass it on to a sexual partner and you are at risk of complications such as inflamed and swollen testicles, reactive arthritis and infertility.

Men and women

Very rarely the chlamydia infection may affect areas other than the genitals in both men and women, such as the rectum, eyes or throat. 

If the infection is in the rectum it can cause some discomfort and discharge. In the eyes it can cause pain, swelling, irritation and discharge (conjunctivitis). Infection in the throat is very rare and does not usually cause any symptoms.

Causes of chlamydia 

As chlamydia is a sexually transmitted infection (STI), it is transmitted (passed on) from one person to another during intimate sexual contact. You can catch chlamydia through having:

• unprotected vaginal sex,
• unprotected anal sex,
• unprotected oral sex,
• genital contact with an infected partner, or
• sharing sex toys if they are not washed or covered with a condom each time they are used.

If infected semen or vaginal fluid comes into contact with the eye, it can cause conjunctivitis.

It is not clear whether chlamydia infection can be spread by transferring infected semen or vaginal fluid on the fingers or by rubbing female genitals (vulvas) together.

As it is common for someone with the chlamydia infection not to have symptoms, it is possible for him or her to infect a partner without knowing.

Chlamydia can be passed from a mother to her baby during childbirth. Although no obvious symptoms are immediately apparent, the infection will often develop after birth, and can result in complications such as inflammation and discharge in the baby’s eyes (conjunctivitis) and pneumonia.

Testing for Chlamydia

The only way to be certain that you have chlamydia is to be tested. If you suspect you could have chlamydia, it is important not to put off having a test done.

Early diagnosis and treatment of chlamydia will reduce the risk of any complications developing. Complications that arise from long-term chlamydial infection are much more difficult to treat.

The accuracy of chlamydia testing depends on what kind of test is used. Recommended tests are over 90% accurate in picking up the infection, shop bought tests may be less reliable.

There are different ways to test for chlamydia:

Women

Women can be tested for chlamydia by taking a swab from the cervix (neck of the womb) or using a urine sample.

In recent years tests have been developed that allow women to carry them out at home, by using a urine sample, or by taking a swab themselves from the lower vagina. The sample is put into a container and sent to a laboratory to be tested. 

Routine cervical screening tests do not detect chlamydia. Ask your doctor or nurse if you also wish to be tested for chlamydia.

Men

In the past, the chlamydia test for men involved putting a swab into the opening of the urethra at the tip of the penis to collect a sample of cells. A urine test is now commonly used. This method is slightly less reliable than using a swab, but it is a much easier and less uncomfortable.

for non-genital chlamydia

If you have had anal or oral sex, a swab of calls may be collected from your rectum or throat, but this is not done routinely.

If you have symptoms of conjunctivitis, such as discharge from the eyes, a swab may be taken to collect cells from your eye.

When to get tested

Statistics from the National Chlamydia Screening Programme (NCSP) in England show that you are more at risk of becoming infected with chlamydia if you are under 25, have a new sexual partner, or have had more than one sexual partner in the past year and have not used condoms. 

It is recommended that you consider getting tested for chlamydia if:

• you or your partner think you have symptoms,
• you have had unprotected sex with a new partner,
• you or your partner have unprotected sex with other people,
• you have an STI,
• a sexual partner tells you that they have an STI,
• during a vaginal examination your nurse or doctor tells you that the cells of your cervix are inflamed or there is discharge, or
• you are pregnant or planning a pregnancy.

Where to get tested

There are a number of different places you can go to for a chlamydia test, you can chose the place most comfortable and convenient for you:

• a genitourinary medicine (GUM) or sexual health clinic,
• your GP surgery,
• a contraceptive and young people’s clinic, or
• pharmacists where you can buy a chlamydia test to do at home - some tests may be more reliable than others so it is best to ask your pharmacist for advice.

The National Chlamydia Screening Programme (NCSP) offers free tests to men and women under 25 who have been sexually active. The programme runs across the UK and can help you access local chlamydia screening services. The screening takes place in a variety of community settings, including GP surgeries, military bases, contraceptive clinics, sexual health and GUM clinics, pharmacies, gynaecology departments and youth centres. To find out more, visit the NCSP website or call the sexual health helpline on 0800 567 123. 

You can find details of your nearest sexual health or GUM clinic in the phone book, or by using the local health service search. You can attend these clinics at any age, even if you are less than 16 years of age (the age of consent for sex), and all results are treated confidentially.

Treating chlamydia 

The common treatment for chlamydia is a course of antibiotics.  If taken correctly it is more than 95% effective. The course of antibiotics can be either a single dose, or a longer course of up to two weeks.  
If there is a high chance that you have been infected with chlamydia, treatment may be started before you receive your test results. You will always be given treatment if your partner is found to have chlamydia.

The two most commonly prescribed antibiotics to treat chlamydia are:

• Azithromycin (single dose)
• Doxycycline (usually two capsules a day for a week)
• Other less commonly prescribed antibiotics include Ofloxacin, Amoxicillin and Erythromycin. 

It is important that you finish all the capsules prescribed to you. If you do not, the treatment may not be effective at getting rid of the infection.

You can discuss with your GP  which antibiotic is the most suitable for you. If you are pregnant, for example, some antibiotics may not be suitable, but alternatives are available. Azithromycin, Amoxicillin and Erythromycin are all suitable for pregnant women..

Antibiotics used to treat chlamydia may interact with the combined contraceptive pill and the contraceptive patch. If you use these methods of contraception, you can discuss with your GP or nurse which additional contraception is suitable for this time.

Side effects

The side effects of antibiotics are usually mild, the most common side effects include:

• stomach pain,
• diarrhoea, and
• feeling sick.

Occasionally, Doxycycline can cause a skin rash if you are exposed to too much sunlight (photosensitivity).

Sexual partners

Chlamydia is easily passed on through intimate sexual contact. If you are diagnosed with the infection, anyone you have recently had sex with in the last six months may also have it. It is important that your current partner and any other recent sexual partners are tested and treated.

Your local genitourinary medicine (GUM) or sexual health clinic may be able to help by notifying any of your previous partners on your behalf. A contact slip can be sent to them explaining that they may have been exposed to a sexually transmitted infection (STI) and suggesting that they go for a check up. The slip sometimes notes what the infection is but will not have your name on it, so your confidentiality is protected.

If you or your current partner is diagnosed with chlamydia, you should not have sex until you have both finished your course of treatment.

Complications of chlamydia 

If chlamydia is not treated it can spread to other parts of the body and cause long-term problems.

Women

In women, if chlamydia is not treated it can spread to other reproductive organs causing pelvic inflammatory disease (PID) and inflammation of the cervix (cervicitis), fallopian tubes (salpingitis) and Bartholin’s glands (Bartholinitis).

Infection with chlamydia during pregnancy may also be linked to early miscarriage or premature birth of the baby.

Pelvic Inflammatory Disease (PID)

Chlamydial infection is one of the main causes of pelvic inflammatory disease (PID) in women. PID is an infection of the uterus, ovaries and fallopian tubes that can cause infertility, persistent pelvic pain and an increased risk of ectopic pregnancy. The condition can be treated using antibiotics, and early treatment will reduce the risk of infertility. You should avoid having sexual intercourse while receiving treatment for PID.

Cervicitis

Cervicitis is an inflammation of the neck of the womb, the cervix. It often causes no symptoms but you may experience some discomfort, have a vaginal discharge containing pus or irregular bleeding. Some people also experience pain during intercourse and urinary symptoms, such as the need to urinate more often, and a burning pain when they urinate. When left untreated cervicitis causes the cervix to become enlarged and cervical cysts to develop, which may become infected. Chronic (long term) cervicitis can cause backache, deep pelvic pain, and a persistent vaginal discharge.

Salpingitis

Infection with chlamydia can cause a blockage of the fallopian tubes. This may prevent eggs from passing along, or entering the tubes. Even a partial blockage of the fallopian tubes will increase the risk of ectopic pregnancy occurring. This is when a fertilised egg is implanted outside of the womb, usually in a fallopian tube..Microsurgery can sometimes be used to effectively treat a blockage.

Bartholinitis

The glands that produce the lubricating mucus to make sexual intercourse easier are known as the Bartholin’s glands. They are situated on either side of the vaginal opening. Infection with chlamydia can cause the glands to become blocked and infected and lead to a Bartholin’s cyst. A cyst is usually painless but if it becomes infected it can lead to a pus-filled Bartholin's abscess. An abscess is usually red, very tender and painful to touch, and can cause a fever. An infected abscess  will need to be treated with antibiotics.

Men

Urethritis

Urethritis in men is inflammation of the urethra (the urine tube) that runs along the underside of the penis. Symptoms include a white or cloudy discharge from the tip of the penis, a burning or painful sensation when you urinate, the urge to urinate often and irritation and soreness around the tip of the penis. If left untreated a urethral stricture can occur, this can seriously interfere with the flow of urine and lead to back pressure which can damage the kidneys. Urethritis can be treated with antibiotics.

Epididymitis

Epididymitis is the inflammation of the epididymis, a long tube that connects the testes (where sperm are produced) to the vas deferens (a pair of ducts where sperm collect ready for ejaculation through the urethra).  An infected epididymis can become inflamed, causing swelling and tenderness in the affected area of the scrotum. Infection can lead to an accumulation of fluid in the area or even an abscess.  If left untreated epididymitis can lead to you becoming infertile.

Reactive arthritis

Reactive arthritis develops as a reaction to an infection, such as chlamydia. Symptoms include inflammation of the joints (arthritis), the urethra (urethritis) and the eyes (conjunctivitis). Although chlamydia can sometimes cause inflammation of the joints in women, reactive arthritis is more likely to occur in men. There is no cure for arthritis and although symptoms usually get better in three to 12 months, they can recur after this. Symptoms can be controlled by non-steroidal anti-inflammatory drugs (NSAIDs), such as ibruprofen.

Preventing Chlamydia

Chlamydia can be successfully prevented by:

• using condoms (male or female) every time you have vaginal or anal sex,
• using a condom to cover the penis or latex or plastic square (dam) to cover the female genitals if you have oral sex, and
• not sharing sex toys.  If you do share them wash them or cover them with a new condom before anyone else uses them.
• These measures can also protect you from other sexually transmitted infections (STIs), such as genital herpes and gonorrhoea.

If you are worried you may be at risk of having an STI or have any of the symptoms mentioned in the symptoms section, you should visit your local sexual health or GUM clinic to have them checked out. Find your local sexual health service here.

For information on all sexual health services, the fpa run a helpline called sexual health direct, on 0845 122 8690.

Gonorrhoea is a sexually transmitted infection (STI) caused by bacteria called Neisseria gonorrhoeae or gonococcus. It used to be known as 'the clap'.

The bacteria are found mainly in discharge from the penis and vaginal fluid from infected men and women. Gonorrhoea is easily passed between people through:

• unprotected vaginal, oral or anal sex, and
• sharing vibrators or other sex aids, that have not been washed or covered with a new condom each time they are used.

It can also be passed from a pregnant woman to her baby.

Typical symptoms are an unusual discharge from the vagina or penis and pain when urinating.

How common is it?

Gonorrhoea is a less common STI in the UK than chlamydia, genital warts or genital herpes, but over 16,500 new cases of gonorrhoea were reported in 2008. Young men and women aged 16-24 are the most affected: in 2008, they accounted for 47% of new gonorrhoea diagnoses.

Who is at risk?

Anyone who is sexually active can contract gonorrhoea, especially people who change partners frequently or do not use a barrier method of contraception, such as a condom, when having sexual intercourse.

Previous successful treatment for gonorrhoea does not make you immune from catching the infection again.

Outlook

Gonorrhoea can be easily diagnosed through a simple swab test and treated with antibiotics. If left untreated, gonorrhoea can lead to more serious long-term health problems and infertility.

Symptoms of gonorrhoea 

Symptoms of gonorrhoea usually show up after 1-14 days after you are infected. But sometimes symptoms may not appear until many months later, or until the infection has spread to other parts of your body.

About one in 10 infected men and half of infected women will not experience any obvious symptoms after contracting gonorrhoea, which means it can go untreated for some time.

Women

In women, symptoms of gonorrhoea can include:

• an unusual discharge from the vagina, which may be thick, and green or yellow in colour,
• pain when passing urine,
• pain or tenderness in the lower abdominal area (this is less common), and
• bleeding between periods or heavier periods (this is less common).

Men

Nine out of 10 men who contract gonorrhoea experience symptoms after they are infected, which can include:

• an unusual discharge from the tip of the penis, which may be white, yellow or green,
• pain or a burning sensation when urinating,
• inflammation (swelling) of the foreskin, and
• pain or tenderness in the testicles or prostate gland (this is rare).

Men and women

Both men and women can also catch gonorrhoea at other sites of the body, these include:

• infection in the rectum which may cause pain, discomfort or discharge,
• infection in the throat, this does not usually have any symptoms,
• infection in the eyes, which can cause pain, swelling, irritation and discharge (conjunctivitis).

Babies

Gonorrhoea can be passed from a mother to her baby during childbirth. Newborn babies normally show symptoms in their eyes during the first 1-14 days. The eyes become red and swollen, and have a thick pus-like discharge (conjunctivitis).

Gonorrhoea can be treated with antibiotics when you are pregnant or when you are breastfeeding. The antibiotics will not harm your baby.

Causes of gonorrhoea 

Gonorrhoea is a sexually transmitted infection (STI) caused by the  Neisseria gonorrhoeae bacteria. The bacteria are usually found in discharge from the penis and vaginal fluid of infected men and women, and are easily passed from one person to another through sexual contact.

During sex, the bacteria can infect the vagina or penis, as well as other places that come into contact with infected semen or vaginal fluid. The gonorrhoea bacteria can live inside the cells of the cervix (entrance to the womb), the urethra (tube where urine comes out), the rectum, the throat and, very occassionally, the eyes.

The infection is most commonly spread through:

• unprotected vaginal, anal or oral sex, and
• sharing sex toys if you do not wash them or cover them with a new condom after each use.
• If you are a woman, it is possible for gonorrhoea to spread from your vaginal secretions to your anus - you do not need to have had anal sex for this to happen.
• If you are pregnant, gonorrhoea can be passed from you to your baby during birth. This can lead to your newborn baby having an infection of the eyes (conjunctivitis), which can lead to blindness if not treated.

It is not clear if gonorrhoea can be spread by transferring the bacteria to another person on the fingers, or by female to female genital contact.

Testing for gonorrhoea

The only way to be certain that you have gonorrhoea is to be tested. If you suspect that you have gonorrhoea, or any other sexually transmitted infection (STI), it is important not to delay getting tested.

It is possible to do a gonorrhoea test within a few days of having sex, but you may be advised to wait up to two weeks after having sex before being tested. You can be tested even if you do not have any symptoms.
Early diagnosis and treatment of gonorrhoea will reduce the risk of any complications developing, such as pelvic inflammatory disease or infection in the testicles. Complications that arise from long-term infection are much more difficult to treat.

How you are tested

There are different ways to test for gonorrhoea:

Women

A doctor or nurse may take a swab to collect a sample from the cervix or vagina during an internal examination.

You may be asked to use a swab or tampon yourself to collect a sample from inside your vagina.
Cervical smear tests and routine blood tests do not check for gonorrhoea. If you are not sure if you have been tested for the presence of gonorrhoea, ask your nurse or doctor.

Men

You may be asked to provide a urine sample and will usually be asked not to pass urine for 1-2 hours beforehand.

Men and women

A doctor or nurse may take a swab to collect a sample from the entrance of the urethra (where urine is passed out).

If you have had anal or oral sex the doctor or nurse may need to take a swab from the rectum or throat.
If you have symptoms of conjunctivitis, such as red inflamed eyes with discharge, a sample of the discharge may be collected from your eye.

A swab looks a bit like a cotton bud but is smaller and rounded. It is wiped over parts of the body that may be infected, to pick up samples of discharge. Having a swab only takes a few seconds and is not painful, although it may be uncomfortable for a moment.

Some clinics may be able to carry out rapid diagnostic tests, when the doctor can view the sample through a microscope and give you your test results straight away. Otherwise, you will have to wait up to two weeks to get the results.

Who should get tested

You can only be certain you have gonorrhoea if you have a test. It is recommended you get tested if:

• you or your partner think you have symptoms of gonorrhoea,
• you have had unprotected sex with a new partner,
• you or your partner have had unprotected sex with other people,
• you have another STI,
• a sexual partner tells you that they have an STI,
• during a vaginal examination your nurse or doctor tells you that the cells of your cervix are inflamed or there is discharge, or
• you are pregnant or planning a pregnancy.

Where to get tested

There are a number of different places you can go to be tested for gonorrhoea:

• a genitourinary medicine (GUM) or sexual health clinic,
• your GP surgery,
• a contraceptive and young people’s clinic, or
• a private clinic.

It is possible to buy a gonorrhoea test from a pharmacy to do yourself at home. However, these tests vary in how accurate they are. It is recommended that you go to your local sexual health service. 

You can find details of your nearest sexual health or GUM clinic in the phone book, or by using the local health service search. You can attend these clinics at any age, even if you are under 16 years of age (the age of consent for sex). All results are treated confidentially.

All tests are free through the NHS, although if you choose to go to a private clinic you will have to pay. If you go to your GP practice, you may have to pay a prescription charge for any treatment.

Treating gonorrhoea 

It is important to receive treatment for gonorrhoea as quickly as possible. It is unlikely the infection will go away without treatment and, if you delay treatment, you risk the infection causing complications and more serious health problems. You may also pass the infection onto someone else.
Gonorrhoea is treated with a single dose of antibiotics, usually:

• ceftriaxone,
• cefiximine, or
• spectinomycin.

The antibiotics are either given orally (as a pill) or as an injection.

Recently, it has become apparent that some strains of gonorrhoea are becoming resistant to some antibiotics - particularly antibiotics that have been used heavily in the past, like penicillin - so these tend not to be used.
If there is a high chance that you have gonorrhoea, you may be given treatment before you get your results back. You will always be offered treatment if your partner is found to have gonorrhoea.

You should avoid sexual intercourse and intimate contact with other partners until you (and your partner) have both finished the course of treatment. This is to prevent reinfection or passing the infection onto anyone else.
Babies who display signs of a gonorrhoea infection at birth (such as inflammation of the eyes) or who are at increased risk of infection, because the mother has been diagnosed with gonorrhoea, will usually be given antibiotics immediately after birth. This is to prevent blindness and other complications developing and does not harm the baby.

Follow up

Treatment is at least 95% effective and you should only have to go back for a follow-up test if:

• the signs and symptoms do not go away,
• you had unprotected sex with your partner in the week following treatment,
• you think you have come into contact with gonorrhoea again,
• you had gonorrhoea of the throat, or
• your test was negative but you develop symptoms of gonorrhoea.

In these situations, you may need a repeat test.

Recovery

If the antibiotics have been effective, you should soon notice an improvement in your symptoms:

• pain and discharge when you urinate should improve within two to three days,
• pain and discharge in your rectum should improve within two to three days,
• bleeding between periods, or extra heavy periods, should improve by the time of your next period, and
• pain in your pelvis or testicles should start to improve quickly but could take up to two weeks to go away.

If you have pelvic pain or experience pain during sex that does not go away after treatment, you should see your doctor or nurse. You may need further treatment, or it may be necessary to investigate other possible causes of pain

Sexual partners

Gonorrhoea is easily passed on through intimate sexual contact. If you are diagnosed with the infection, anyone you have recently had sex with may also have it. It is important that your current partner and any other recent sexual partners are tested and treated.

Your local genitourinary medicine (GUM) or sexual health clinic may be able to help by notifying any of your previous partners on your behalf. A contact slip can be sent to them explaining that they may have been exposed to a sexually transmitted infection (STI) and suggesting that they go for a check up. The slip sometimes notes what the infection is but will not have your name on it, so your confidentiality is protected.
If you or your current partner is diagnosed with gonorrhoea, you should not have sex until you have both finished your course of treatment.

Complications of gonorrhoea 

If treated early, gonorrhoea is unlikely to lead to any complications or long-term problems. However, without treatment gonorrhoea can spread to other parts of your body and cause serious problems. The more times that you have gonorrhoea, the more likely you are to get complications:

• In women, gonorrhoea can spread to the reproductive organs and cause pelvic inflammatory disease (PID). PID can lead to long-term pelvic pain, ectopic pregnancy and infertility.
• In men, gonorrhoea can cause painful infection in the testicles and prostate gland, which can lead to reduced fertility.
• In rare cases, when gonorrhoea has been left untreated, it can spread through the bloodstream to cause infections in other parts of your body. In both men and women, this can cause:
• inflammation (swelling) of the joints and tendons,
• skin lesions (rash), and
• inflammation around the brain and spinal cord (meningitis), and the heart which can be fatal

Gonorrhoea can be successfully prevented by:

• using condoms (male or female) every time you have vaginal or anal sex,
• using a condom to cover the penis, or latex or plastic square (dam) to cover the female genitals if you have oral sex, and
• not sharing sex toys, (if you do share them wash them and cover them with a new condom before anyone else uses them).

These measures can also protect you from other sexually transmitted infections (STIs), such as genital herpes and chlamydia.

If you are worried you may be at risk of having an STI or have any of the symptoms mentioned in the symptoms section, you should visit your local sexual health or genitourinary medicine (GUM) clinic to have them checked out. 

Genital herpes is an infection of the genitals that is caused by the herpes simplex virus (HSV).

The herpes simplex virus can also affect the skin on the face, causing cold sores to develop, usually around the mouth area.

There are two types of HSV:

• type 1 (HSV-1), and
• type 2 (HSV-2).

Genital herpes is caused by type 1 and type 2 HSV equally.

In most cases, genital herpes is a chronic (long-term) condition. Many people with HSV have frequently recurring genital herpes, recurring an average of four to five times in the first two years after being infected. However, the incidence of genital herpes decreases over time, and the condition becomes less severe with each subsequent occurrence.

The herpes simplex virus (HSV)

HSV is highly contagious and it can be easily passed from person to person by close, direct contact. Genital herpes is usually transmitted by having sex (vaginal, anal or oral) with an infected person.

Once someone has been exposed to HSV, it remains dormant (inactive) most of the time. At least 80% of people who carry the virus are unaware that they've been infected because there are often few or no initial symptoms. However, every so often the virus can be activated, causing an outbreak of genital herpes. 

How is genital herpes treated?  

When genital herpes does cause symptoms, they appear as painful blisters on the genitals and surrounding areas. However, even if someone with genital herpes doesn't have any symptoms, it's possible for them to pass the condition on to a sexual partner.

There is no cure for genital herpes, but the symptoms can usually be effectively controlled using anti-viral medicines. The symptoms of genital herpes also tend to become less frequent and less severe with each recurring bout of the condition. 

Symptoms of genital herpes  

Most people with the herpes simplex virus (HSV) do not experience any symptoms of genital herpes when they are first infected and, as a result, do not know that they have the condition.

It is important to note that symptoms of genital herpes may not appear until months, or sometimes years, after you are exposed to HSV (usually by sexual contact with someone who already has the virus).

If you do experience symptoms when you are first infected, they will usually begin to appear between 4-7 days after you have been exposed to the virus. A case of genital herpes that occurs when you are first infected is known as a primary infection. If there are symptoms with a primary infection, they are usually more severe than those of recurrent infections.

Symptoms of a primary infection

If you have a primary infection of genital herpes, you may have several symptoms, including:

• painful red blisters, which soon burst to leave ulcers on your external genital area, rectum (back passage), thighs, and buttocks,
• blisters and ulceration on the cervix (lower part of the womb) in women,
• vaginal discharge (in women),
• pain when you pass urine,
• fever, and
• generally feeling unwell.

The symptoms of a primary genital herpes infection may last for up to 20 days. However, the ulcers will eventually dry out and heal without leaving any scarring.

Symptoms of recurrent infections

Once a primary infection of genital herpes has subsided, your symptoms will have gone, but HSV will still be present in a nearby nerve. It is likely that the virus will be 'reactivated' from time to time, travelling back down the nerve to your skin, causing recurrent infections.

If you have a recurrent infection of genital herpes, your symptoms may include:

• a tingling or burning sensation around your genitals before your blisters appear (this can signal the onset of a recurrent infection),
• painful red blisters, which soon burst to leave ulcers on your external genital area, rectum (back passage), thighs, and buttocks, and
• blisters and ulceration also on the cervix (lower part of the womb) in women.

Recurrent infections of genital herpes are usually shorter and less severe than primary infections. This is because your body has produced antibodies in reaction to the primary infection, and can now fight HSV more effectively.

Your symptoms may last for 7-10 days and, in most cases, you will not have any of the other symptoms of a primary infection, such as a fever, or generally feeling unwell. Your blisters and ulceration may occur in the same area each time you have a recurrent infection.

Over time, you should find that any recurrent genital herpes infections become less frequent and less severe. Genital herpes that is caused by type 1 (HSV-1) tends to recur less often than infections that are caused by type 2 (HSV-2).

Causes of genital herpes 

Genital herpes is caused by the herpes simplex virus (HSV). The virus is very contagious and spreads from one person to another through skin-to-skin contact, such as during vaginal, anal, or oral sex.

Whenever HSV is present on the surface of your skin, it can be passed onto a partner. The virus passes easily through the moist skin which lines your genitals, mouth, and anus. In some cases, you may also be infected by coming into contact with other parts of the body that can be affected by herpes simplex, such as the eyes and skin.

However, genital herpes usually cannot be passed on via objects, such as towels, cutlery or cups, because the virus dies very quickly when it is away from your skin.

Once you have been infected with HSV, it can be 'reactivated' every so often to cause a new bout of genital herpes. This is known as recurrence.

Why does genital herpes recur?

After you have been exposed to HSV, the virus stays within the nerves of your skin, even when you do not have any symptoms of genital herpes. Most of the time the virus is dormant (inactive), but it may become active again from time to time.

It is not completely understood why HSV is reactivated, but certain 'triggers' may be responsible for the symptoms of genital herpes recurring. For example, friction in your genital area, such as during sexual intercourse, may bring on a recurrence. Other possible triggers include:

• being 'run down', or ill,
• stress,
• drinking excess amounts of alcohol, and
• exposure of your genital area to strong sunlight.

Testing for primary infection of genital herpes

If you think that you may have genital herpes for the first time (primary infection), you should visit your local genito-urinary medicine (GUM) clinic as soon as possible. The condition can be diagnosed more easily and accurately when the infection is still present.

Wherever possible, an initial diagnosis of genital herpes should be made by a GUM specialist. If you cannot get to a GUM clinic, you should see your GP instead. They may refer you to a GUM specialist for a formal diagnosis and treatment. Before being referred for specialist, your GP will ask you about your symptoms and carry out an examination of your genital area.

If it is not possible for you to be referred to a GUM clinic, your GP will take a swab, which means that they will take a sample of fluid from a blister and send it to a laboratory to be tested for HSV. Your GP may also screen you for other sexually-transmitted infections (STIs).

It is important to be aware that even if your swab result comes back negative for the herpes simplex virus (HSV), you may still have genital herpes. Your GP may only be able to confirm a diagnosis of genital herpes by any recurrent infections that you may have.

Testing for recurrent infections of genital herpes

See your GP if you have previously been diagnosed with genital herpes and you think that you may have a recurrent infection.

Your GP will ask you about your symptoms, and about any previous bouts of genital herpes that you have had in the past year. They will ask you whether or not you have noticed any triggers, such as stress, or illness, that have set off your recurrent infections.

You will also need to have an examination of your genital area, so that your GP can assess the severity of your infection.

Pregnancy and weakened immune system

It is very important that you are referred for specialist treatment if you are pregnant, or if you have a weakened immune system - for example, if you are HIV positive, or receiving chemotherapy. See the 'complications' section for more information about genital herpes and pregnancy. 

Treating genital herpes 

The way that you receive treatment for genital herpes will depend on whether you have the infection for the first time, or whether you are experiencing a recurrent infection.

Treating a primary infection of genital herpes

In most instances, a first case of genital herpes (primary infection) will develop some time after you have been exposed to the herpes simplex virus (HSV). This may be months, or even years, after exposure. However, sometimes you may develop genital herpes 4-7 days after being exposed to HSV.

Treatment from a genito-urinary medicine (GUM) specialist

If you have genital herpes for the first time, you will normally receive treatment from a genito-urinary medicine (GUM) specialist, at a GUM clinic.

A GUM specialist will be able to provide specialist screening for genital herpes, and other sexually-transmitted infections (STIs), plus treatment, counselling, and follow up care.

Treatment from your GP

If you have a primary genital herpes infection, and it is not possible for you to see a GUM specialist, your GP may treat you for the condition. They may prescribe anti-viral tablets, called acyclovir, which you will need to take five times a day.

Aciclovir works by preventing HSV from multiplying. However, it does not clear the virus from your body completely, and does not have any effect once you stop taking it.

You will need to take a course of aciclovir for at least five days, or longer, if you still have new blisters and ulcers forming on your genital area when your treatment begins.

There are also several things that you may be able to do to help ease your symptoms of genital herpes. See the 'self help' section for more information about this.

Treating recurrent infections of genital herpes

If you have been diagnosed with genital herpes before, and you are experiencing a recurrent infection, you will probably receive advice and treatment from your GP. In most cases, you will not need to return to your local genito-urinary medicine (GUM) clinic.

If the symptoms of your recurrent infection are mild, your GP may suggest some things you can do to ease your symptoms, without the need for treatment. However, if your symptoms are more severe, you may be prescribed anti-viral tablets (acyclovir) which you will need to take five times a day, for five days.

Episodic treatment

If you have less than six recurrent infections of genital herpes in a year, your GP may prescribe a five day course of aciclovir each time that you experience symptoms. This is known as episodic treatment.

Suppressive treatment

If you have more than six recurrent infections of genital herpes in a year, or if your symptoms are particularly severe, and causing you distress, you may need to take aciclovir every day as part of a long-term treatment plan.

This is known as suppressive treatment, and it aims to prevent further recurrent infections from developing. In this instance, it is likely that you will need to take aciclovir twice a day, for 6-12 months.

It is important to note that while suppressive treatment can reduce the risk of passing HSV on to your partner, it cannot prevent it altogether. Your GP may refer you for specialist advice if you are concerned about transmitting the virus to your partner while you are taking suppressive treatment.

Once you have been taking aciclovir for 12 months, your GP will usually stop your suppressive treatment. You may continue to experience further recurrent infections of genital herpes after treatment is stopped.

As long as recurrent genital herpes infections are infrequent, and mild, you will only need to take a five day course of aciclovir as and when it is needed. You may also find that there are things that you can do to improve your symptoms without the need for aciclovir. 

If you have further genital herpes infections after stopping suppressive treatment, or if you have severe recurrent infections, your suppressive treatment may be restarted. Your GP may refer you for specialist treatment if you continue to have recurrent infections of genital herpes while you are taking suppressive treatment.

Helping yourself 

If your symptoms of genital herpes are mild, you may not need to have any treatment from your GP, or genito-urinary medicine (GUM) specialist. However, the advice listed below may help to ease your symptoms.

Painkillers, such as paracetamol, or ibuprofen, may help to ease any pain. However, you should not take ibuprofen if you have asthma, high blood pressure, kidney, or heart, problems, or if you have, or have had in the past, stomach problems, such as a peptic ulcer. 

Keep your genital area clean by using either plain, or salt water. This will help to prevent the infection from spreading to other parts of your body, and may also help any blisters, or ulcers, to heal more quickly.
Apply Vaseline, or an anaesthetic ointment, to any blisters, or ulcers, in order to reduce the pain when you pass urine. 

Drink plenty of fluids to dilute your urine. This will make passing urine less painful. Passing urine while sitting in a warm bath may also make urinating less painful by reducing the stinging sensation.

Avoid wearing tight clothing on your lower body because it may irritate your genital area further.
Avoid sharing towels, or flannels, with others to ensure that you do not spread the herpes simplex virus (HSV). 

Avoid having sexual intercourse, including vaginal, anal, and oral sex, until your GP, or GUM specialist, advises you to, or until all your blisters and ulcers have cleared.

If you have a recurrent infection of genital herpes, you should avoid anything that seems to trigger an infection, such as excess alcohol and stress.

Complications of genital herpes 

It is important to dispel some myths about genital herpes.

Genital herpes:

If your symptoms of genital herpes are mild, you may not need to have any treatment from your GP, or genito-urinary medicine (GUM) specialist. However, the advice listed below may help to ease your symptoms.Painkillers, such as paracetamol, or ibuprofen, may help to ease any pain.

However, you should not take ibuprofen if you have asthma, high blood pressure, kidney, or heart, problems, or if you have, or have had in the past, stomach problems, such as a peptic ulcer. Keep your genital area clean by using either plain, or salt water. This will help to prevent the infection from spreading to other parts of your body, and may also help any blisters, or ulcers, to heal more quickly. 

• does not affect fertility,
• is not hereditary (passed from parent to child), and
• is not associated with developing cervical cancer.
• In rare cases, the blisters that are caused by the herpes simplex virus (HSV) can become infected by other bacteria, potentially causing a skin infection to spread to other parts of your body.

Genital herpes and pregnancy

In some instances, the herpes virus can pose problems during pregnancy. If you had genital herpes before becoming pregnant, the risk to your baby is very low.

This is because during the last few months of pregnancy, your baby develops antibodies to all the infections that you have had in the past. The antibodies protect your baby during the birth, and for several months afterwards.

If you develop genital herpes for the first time during the first trimester (weeks 0-13), or second trimester (weeks 14-26) of pregnancy, the risk of passing the virus on to your baby is slightly increased. To prevent this, you may need to take anti-viral medicine, such as aciclovir, while you are pregnant.

If you develop genital herpes for the first time during the late stages of pregnancy, the risk of passing the virus on to your baby is considerably higher. This is because your baby will not have time to develop any antibodies, and the virus can be passed on just before, or during, the birth. Therefore, in order to prevent this happening, you may need to have a caesarean section delivery.

If you develop genital herpes during the latter stages of pregnancy, you will need to take anti-viral medicine continuously for the last four weeks of your pregnancy. However, this may not prevent the need for a caesarean.

There is also a risk of passing HSV on to your baby if you have recurrent infections of genital herpes during the third trimester (week 27 until birth). However, you will not need to have a caesarean section delivery unless you have blisters and ulcers on your genital area at the time of birth.

Preventing genital herpes 

The following advice can help to prevent the herpes simplex virus (HSV) spreading to others.

Avoid all sexual intercourse

If you have genital herpes, you should avoid having sex, including vaginal, anal, and oral sex, until after any blisters, or ulcers, around your genital area have cleared up. It is best not to have sex if you have symptoms of genital herpes because at this point the condition is very contagious (even from the first tingle, or itch).

Always use a condom

You should always use a condom while you are having any kind of sexual intercourse (vaginal, anal, and oral) even after your symptoms have gone. This is particularly important when having sex with new partners.
However, while using a condom may help to prevent spreading genital herpes, the condom only covers the penis. If the virus is also present on your anus, or the surrounding area, it can still be passed on through sexual contact.

As HSV survives within the nerves of your skin, there is a chance that the virus can be present on your skin, even after you no longer have symptoms. Therefore, there is still a chance that you could pass it on.

Advise your partner to be screened for genital herpes

If you have genital herpes, you should encourage your partner to visit a genito-urinary medicine (GUM) clinic to be tested for the condition, even if they do not have any symptoms of genital herpes. As a first case of genital herpes often develops some time after exposure to the virus, they may be unaware that they are infected.

Avoid sharing towels or flannels with others

Although it is very unlikely that HSV would survive on an object long enough to be passed on, it is sensible to take steps to prevent this. Therefore, you should avoid sharing towels or flannels, to ensure that you do not spread HSV on to others.

NAAT Testing for infections / PCR Testing

Newer more advanced testing for infections such as the Nucleic Acid Amplification Tests (NAAT) can detect infection within a matter of days instead of weeks or months with conventional testing methods. Because the risk is very low indeed when sperm is tested using NAAT tests for HIV, Hep B and Hep C, the HFEA regulations state that sperm does not need to be frozen and quarantined provided these tests have been performed by a regulated laboratory.

No long quarantine of sperm required

Some fertility clinics freeze the sperm for only 1 month instead of the normal 6 months. Others will use fresh sperm for treatment following the NAAT test, providing that you are aware of the low risk that HIV may have been caught a couple of days ago, and not shown as a positive result. A consent form may need to be signed. Please consult with your fertility clinic or GP for further information about the availability of these tests.
You may also hear this test called a "viral load," "PCR," or "RNA" test. Unlike standard or rapid HIV antibody tests, these types of tests detect the genetic material (RNA) of the virus rather than antibodies to HIV. The reason these tests are not used routinely is due to them being expensive and due to the fact that they are very sensitive tests, there is a higher chance of false positives.

HFEA regulations state:

'donor sperm must be quarantined for a minimum of 180 days, after which repeat testing is required. If the blood donation sample is additionally tested by the nucleic acid amplification technique (NAT) for HIV, HBV and HCV, quarantining of the gametes and re-testing of a repeat blood sample is not required. Quarantine and re-testing is also not required if the processing includes an inactivation step that has been validated for the viruses concerned.' 

Bacterial vaginal infections can affect chances of conception and maintaining pregnancy

Human bodies contain a large amount of bacteria, some good, some bad and most of the time they exist side by side in a state of balance. 

The same is true for the vagina where the dominant good bacteria (lactobacilli) keep the bad bacteria in check. They primarily do this through keeping the vaginal pH low (around 4.0). Their food source is called glycogen which they need to produce lactic acid. 

It is quite normal for this balance to be disturbed occasionally. In half of these cases you wouldn’t even realise it as there would be no symptoms. In the other half of cases you could experience any of/a mixture of: discharge, fishy odour, discomfort, itchiness. 

The latter is however more common in thrush and a lot of women mistake the symptoms for thrush and buy the wrong product. Thrush is a yeast infection and its treatment will not help a bacterial imbalance. 

Whilst this bacterial imbalance / infection is twice as common as thrush it is not as well known. Normally the body would resolve the issue by itself and in a day-to-day environment the symptoms could be a lifestyle issue and treatment is required.
 
It is very important to avoid a bacterial infection in pregnancy and when trying to conceive, even if there are no symptoms. The infection has been linked to early miscarriage and to preterm birth. Ongoing research continues to improve our understanding and further links have been suggested between the by-products that the bad bacteria produce and not achieving a pregnancy in a particular cycle. 

These links are: 

• A potential impact on the quality of the cervical mucus, whereby the mucus fails to respond to signals from the sex hormones at the time of ovulation. The mucus basically does not get the message that you are ovulating and remains like a plug so it won’t let sperm through. 
• A potential to coagulate sperm so that it can’t get through the cervical mucus. 
• A potential to prevent the development of the blastocyst after fertilisation took place. This then looks like an early miscarriage. 

The problem is that treatment has traditionally focused on killing the bad bacteria when they are suspected or detected. You would be given antibiotics like metronidazole. 

Studies show that bad bacteria build up by-products that can cause problems when they reach a certain level. Antibiotics won’t kill the by-products so the treatment may kill the bacteria but may be ineffective for the by-products that have already been built up. 

The approach of the Zestica Conception Kit is to help your body to maintain its vaginal pH to keep bad bacteria from developing and from producing their by-products. It also provides the glycogen that your good bacteria need to do this. 

Some studies show that up to 1 in 4 women trying to conceive will have the bacterial imbalance. Half of them would not even know it. 

The product has no side effects so the aim of Zestica Conception Kit is to help prevent a number of issues that could be the reason why in that particular cycle no pregnancy was achieved. 

When the cause of infertility is known then the product is unlikely to be the answer. In cases where the cause is unknown it may be a help for a number of couples. 

Bacterial infections and gay couples. 

It is a common misconception that bacterial infections are linked to heterosexual sex. Many recent initiatives focus on health information for lesbian and bisexual women. (1,2,3) 

The occurence of bacterial imbalance/infection is several times the rate in a heterosexual population. Studies have shown an incidence of 25-52% in lesbians. (4) As a lot of these studies are done in STD clinics, a UK study looked at the incidence in a community setting. Lesbians have a 2.5 fold increased risk of BV versus heterosexuals. (5) 

A lot of these would have no symptoms so they would be totally unaware. There would be no side effects and the body would recover.The problem is when these couples try to conceive. As explained above there could be issues with poor quality cervical mucus, sperm agglutination and/or early miscarriage. 

Looking after a healthy vaginal flora before ovulation is therefore even more important in lesbian couples trying for a baby. 

The Zestica Conception Kit focuses on achieving that balance and could help a number of couples for whom this has been the (unknown) problem. 
Buy Zestica Conception Kit

1) Lesbians, bisexual women and safe sex. 
www.avert.org/lesbians-safe-sex.htm 

2) National Women’s Health Information Center 
US Department of Health and Human Services, Office on Women’s Health 
“Lesbian Health.” 

3) “Barriers to Infectious Disease Care among Lesbians.” 
Jeanne M. Marrazzo 
Emerging Infectious Diseases, Vol10, No11, Nov 2004 

4) “Risks for Acquisition of Bacterial Vaginosis among Women who report Sex with Women: a Cohort Study.” 
Marrazzo JM, Thomas KK, Fiedler TL, Ringwood K, Fredricks DN 
Plos One, 5(6):e1139.doi:10.1371/journal.pone.0011139 2010 

5) “Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting.” 
Evans AL, Scally AJ, Wellard SJ, Wilson JD 
Sex.Transm.Infect., 2007 Oct;83(6):470-5 

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