and Blood Borne Infections
including HIV & Viral Hepatitis

Sexually transmitted diseases (STDs) or more recently sexually transmitted infections (STIs) are diseases that have a significant probability of transmission between humans by means of human sexual behavior, including vaginal intercourse, anal sex, and oral sex.

Some STIs can also be transmitted via the use of IV drug needles after its use by an infected person, as well as through childbirth or breastfeeding.

Most sexually transmitted infections have been well known for hundreds of years. Others like HIV and viral hepatitis have becaome more prevalent in recent times but they are all endemic world wide but are usually more prevalent in certain overseas destinations.

Sexually Transmitted Infections include:

Bacterial Vaginosis Chlamydia Gonnorhoea Viral Hepatitis Genital Herpes HIV/AIDS Human Papilloma Virus Pelvic Inflammatory Disease Syphilis Trichomoniasis Pubic Lice Scabies

If a traveller indulges in casual sex, the risk of infection with a sexually transmitted disease is high.

Gonorrhoea and syphilis may cause serious long-term disability, especially if treatment is delayed. Chlamydia is widespread throughout many countries including European countries and the UK and is often symptomless and goes unnoticed for some time. If untreated it can result in sterility. Hepatitis B and HIV are both also spread sexually and there is currently no cure for either infection.

Travellers should be aware that a person infected with an STD, HIV or Hepatitis B may appear perfectly healthy and may not even know that they are infected.

Casual sexual intercourse is risky. Unprotected sexual intercourse should avoided with anyone other than a regular partner. Always use good quality condoms and carry them rather than try to obtain them at the last minute. Remember, condoms provide good but not complete protection.

Alcohol weakens inhibitions and makes it easier to forget about taking precautions.

Any person who on return from travel has any reason to believe that they may have picked up an infection should get a thorough check up at their local VD clinic.

Whilst all STIs are potentially dangerous, the three most common (Chlamydia, Gonorrhoea & Syphilis) are dealt with in more depth here:

Chlamydia

Chlamydia is a common sexually transmitted disease caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man.

Chlamydia is the currently most frequently reported bacterial sexually transmitted disease in Western Countries. Under-reporting is substantial because most people with chlamydia are not aware of their infections and do not seek testing.

Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth.

Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection. Because the cervix (opening to the uterus) of teenage girls and young women is not fully matured and is probably more susceptible to infection, they are at particularly high risk for infection if sexually active.

Since chlamydia can be transmitted by oral or anal sex, men who have homosexual sex with other men are also at risk for chlamydial infection.

Chlamydia is known as a "silent" disease because the majority of infected people have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.

Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian tubes they may develop lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum.

Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon.

Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner.

If untreated, chlamydial infections can progress to serious reproductive and other health problems with both short-term and long-term consequences. Like the disease itself, the damage that chlamydia causes is often "silent".

Untreated infection can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease. Chlamydia can also cause fallopian tube infection without any symptoms but can lead to chronic pelvic pain and infertility.

Complications among men are rare. Infection sometimes spreads to the epididymis (the tube that carries sperm from the testis), causing pain, fever, and, very rarely, sterility.

Babies who are born to infected mothers can get chlamydial infections in their eyes and respiratory tracts.

Chlamydia can be easily treated and cured with antibiotics. A single dose of azithromycin or a course of doxycycline are the most commonly used treatments.

All sex partners should be evaluated, tested, and treated. Persons with chlamydia should abstain from sexual intercourse for 7 days after a course of antibiotics to prevent spreading the infection to their partners.

Gonorrhoea

Gonnorhoea is caused by a bacterium Neisseria gonorrhoeae, that can grow and multiply easily in the warm, moist areas of the reproductive system. It can also grow in the mouth, throat, eyes, and anus.

Gonnorhoea is a very common infectious disease and is spread through contact with the penis, vagina, mouth, or anus. Ejaculation does not have to occur for gonnorhoea to be transmitted or acquired. It can also be spread from mother to baby during delivery.

Any sexually active person can be infected with gonnorhoea. People who have had gonnorhoea and received treatment may get it again if they have sexual contact with an infected person.

Some men with gonnorhoea may have no symptoms at all. However, most have signs or symptoms that appear one to fourteen days after infection. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonnorhoea get painful or swollen testicles.

In women, the symptoms of gonnorhoea are often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonnorhoea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may cause no symptoms. Infections in the throat may cause a sore throat, but usually causes no symptoms.

Antibiotics can successfully cure gonnorhoea in adolescents and adults. However, drug-resistant strains of gonnorhoea are increasing in many areas of the world and successful treatment of gonnorhoea is becoming more difficult.

Syphilis

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.

Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex.

Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated.

Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infection.

The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, and tertiary).

The primary stage classically presents with a single chancre (a firm, painless, non-itchy skin ulceration), secondary syphilis with a diffuse rash which frequently involves the palms of the hands and soles of the feet, latent syphilis with little to no symptoms, and tertiary syphilis with neurological, or cardiac symptoms.

Syphilis is believed to have infected 12 million people worldwide in 1999, with greater than 90 percent of cases in the developing world.

Syphilis is easy to cure in its early stages. A single intramuscular injection of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Additional doses are needed to treat someone who has had syphilis for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Blood Borne Infections

HIV/AIDS

It is difficult to be sure about the risk of HIV infection in different parts of the world. However, it is clear that the infection is widespread and although the risk is high amongst homosexual and intravenous drug using groups, on a global scale, it is primarily a heterosexually spread disease. Large numbers of the population in many parts of Africa are infected and AIDS is common. Infection is also widespread in other countries in Asia and South America. High proportions of prostitutes are infected.

The greatest increase in the number of HIV cases in the UK are heterosexually acquired and about 75% of this figure can be attributed to sex with a partner abroad.

Human immunodeficiency virus (HIV) is a member of the retrovirus family that causes acquired immunodeficiency syndrome (AIDS), a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. Infection with HIV occurs by the transfer of blood, semen, vaginal fluid, pre-ejaculate, or breast milk.

Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells. The four major routes of transmission are unsafe sex, contaminated needles, breast milk, and transmission from an infected mother to her baby at birth. Screening of blood products for HIV has largely eliminated transmission through blood transfusions or infected blood products in the developed world.

From its discovery in 1981 to 2006, AIDS killed more than 25 million people. HIV infects about 0.6% of the world's population and in 2009 AIDS claimed an estimated 1.8 million lives including approximately 260,000 children.

A disproportionate number of AIDS deaths occur in Sub-Saharan Africa, retarding economic growth and exacerbating the burden of poverty.

The only way to know whether you are infected is to be tested for HIV. You cannot rely on symptoms alone because many people who are infected with HIV do not have symptoms for many years. Someone can look and feel healthy but can still be infected. In fact, one quarter of the HIV-infected persons in the United States do not know that they are infected.

Treatment with antiretroviral drugs reduces both the mortality and the morbidity of HIV infection but antiretroviral medication is still not universally available.

HIV infects vital cells in the human immune system such as helper T cells and when these cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections.

Most untreated people infected with HIV eventually develop AIDS. These individuals mostly die from opportunistic infections or malignancies associated with the progressive failure of the immune system. HIV progresses to AIDS at a variable rate but most will progress to AIDS within 10 years of HIV infection.

Treatment with anti-retrovirals increases the life expectancy of people infected with HIV. Even after HIV has progressed to diagnosable AIDS, the average survival time with antiretroviral therapy was estimated to be more than 5 years.

Without antiretroviral therapy, someone who has AIDS typically dies within a year.

Viral Hepatitis

"Hepatitis means inflammation of the liver and also refers to a group of viral infections that affect the liver . The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.

Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation.

Hepatitis A

is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces or stool of an infected person.

The best way to prevent Hepatitis A is by getting vaccinated.

Hepatitis B

is a contagious liver disease that results from infection with the Hepatitis B virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis B is usually spread when blood, semen, or another body fluid from a person infected with the Hepatitis B virus enters the body of someone who is not infected.

This can happen through sexual contact with an infected person or sharing needles, syringes, or other drug-injection equipment. Hepatitis B can also be passed from an infected mother to her baby at birth.

Hepatitis B can be either acute or chronic. Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body.

Chronic Hepatitis B is a serious disease that can result in long-term health problems, and even death.

The best way to prevent Hepatitis B is by getting vaccinated.

Hepatitis C

is a contagious liver disease that results from infection with the Hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the Hepatitis C virus enters the body of someone who is not infected. Today, most people become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, Hepatitis C was also commonly spread through blood transfusions and organ transplants.

Hepatitis C can be either “acute” or “chronic.” Acute Hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis C virus. For most people, acute infection leads to chronic infection. Chronic Hepatitis C is a serious disease than can result in long-term health problems, or even death.

There is no vaccine for Hepatitis C. The best way to prevent Hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use.

Intravenous Drug Abuse

Drug-taking, apart from being illegal, might also put the traveller in contact with people who are HIV positive and should be avoided. Needle sharing is very dangerous.

Sharing needles to inject drugs or steroids is another way that HIV can be passed to other people. Sharing of needles for tattoos, piercings, and body art can also lead to infection. Someone with HIV who shares a needle also shares the virus, which lives in the tiny amounts of blood attached to the needle. Sharing needles also can pass hepatitis and other serious infections to another person.

Tattoos, piercing and HIV / Aids infection

Australian health officials are urging travellers to avoid getting tattoos in developing countries after it was reported a West Australian man contracted HIV after getting etched in Bali.

When you think of having a tattoo done, first of all remember that it involves your skin being pierced and forming an open sore, and that blood will also be involved in this procedure.

Although body art and tattoos are very popular some safety measures must be taken. Since piercing the skin, and blood and needles are involved some warning lights should be going off, since working with open "wounds" and blood opens the entire Pandora's box of Aids and Hepatitis infection.

In saying this, the risk of HIV as well as hepatitis transmission exists if ANY of the instruments are not properly sterilized and disinfected. When having a tattoo, ask the person doing it what type of safety precautions are taken to prevent the spread of blood borne infections, such as HIV or hepatitis.

Unless you are absolutely certain that the equipment being used is sterile, skin-damaging procedures such as ear piercing, tattooing and acupuncture should be avoided.

Health standards in many developing countries are drastically different to those in more developed nations, and this should be kept in mind at all times.

Hepatitis C is spread by infected blood and infected needles, which is the virus' connection with tattooing. Tattoos involve lots of needles making lots of sticks in the skin. Each stick carries potential for contamination -- and not just with hepatitis, but also HIV.

The prospect of a cheap tattoo might sound good for the wallet, but the risks associated with it are just too high - it's just not worth it.

Aside from the health risks, some tattoos from developing nations use cheap inks, which can run and blotch after a short time - it's best to avoid it all together, and wait until you get to a parlour that offers certifiable health standards.

It is strongly recommended that people who have had tattoos whilst travelling abroad get a Hepatitis check as soon as possible. Hepatitis can lie unnoticed for many years while doing serious damage. The sooner hepatitis is detected the better the chances for survival. If you have a tattoo – get checked.

Medical Care

In many developing countries standards of infection control may be inadequate to prevent the spread of blood borne infections. Instruments may not be sterilised between patients and re-use of medical supplies, including needles and syringes is common.

Travel packs are available from chemists and travel clinics, containing sterile equipment for use in an emergency. These kits should be supplied with a certificate showing contents and the reason for its purchase, useful for customs clearance.

Blood transfusion: In most of Western Europe, North America, Japan and Australasia all donated blood is now screened for HIV antibodies.

However, in many developing countries there may be only the most basic blood transfusion services and much of the blood donated is unscreened. The risks from blood transfusion in such circumstances are high. Thus, points to consider are:

Accidents are the commonest reason for needing a blood transfusion so they should be avoided where possible by taking extra care and vigilance, e.g. driving carefully in foreign countries. Blood transfusion should only be accepted when essential. Pregnancy or any medical condition which may lead to heavy blood loss, should be taken into account before travelling to destinations where good medical facilities will not be available. Knowing your blood group in advance may make it easier to find a blood donor in an emergency.

 Hepatitis B Vaccine

Hepatitis B is a serious illness which is spread as described above. Symptoms include chronic fatigue, loss of appetite, fever and jaundice. In a small percentage of individuals the disease may cause permanent damage or liver cancer.

Fortunately there is a vaccine available which gives good protection against the disease. However, it can take up to six months to become effective.

Vaccination is recommended for those travelling to areas of high prevalence who plan to remain there for lengthy periods such as voluntary workers, who may be at risk from medical or dental procedures carried out in those countries.

Short term travellers are not generally at risk but may place themselves at risk by their sexual behaviour. It is given as a course of three 1ml intra-muscular injections, the second 28 days after the first and the third 6 months after the second.