Why you should get tested
If there’s a possibility you may have an STI, it’s important to get tested. Don’t wait for obvious symptoms to appear. Chlamydia, for example, has few recognisable symptoms, especially in women. You can be infected and not know.

Those particularly at risk of infection are young people who’ve had several partners and men who have sex with other men.

You can reduce the risk of infection by always using a condom, but not all STIs are just passed on by penetrative vaginal or anal intercourse. Some can be picked up through oral sex too, while genital herpes, HPV and even sometimes infections such as gonorrhoea can be transferred by intimate contact, so condoms don’t protect against all infections.

Growing problem
The number of STIs has increased recently, especially in the past two years. According to the Health Protection Agency, the number of new cases diagnosed in specialist clinics in the UK in 2008 rose to 399,738 – that’s six per cent six more compared to 2006, and a massive 50 per cent up from ten years ago.

One of the most common infections is Chlamydia, which is rapidly increasing. In 2008, more than 1230,000 new cases were diagnosed in the UK, up eight per cent per cent from 2006 and 115 per cent up from 10 years ago.

Where to get tested
See your GP or make an appointment at the genito-urinary medicine (GUM) clinic at your local hospital.

To find a GUM clinic:

Call the Department of Health’s sexual health helpline on 0800 567 123
Use the fpa’s GUM clinic search

There are also special rapid testing clinics. Some services are aimed specifically at younger people, such as Brook.

All these services are confidential. You’ll be asked your name, address and GP’s name, but you don’t have to give your real name and you can ask them not to contact your GP.

Diagnosis and treatment
The clinic will ask for a urine sample to check for gonorrhoea and chlamydia and, for women, a vaginal swab ( you may be given this to do yourself as it is very easy to do). If you have ulcers or warts the nurse or doctor will examine you and may take more specific swabs A blood test may also be necessary for diseases such as syphilis, HIV and hepatitis.

It can take a week for test results to come back, so many clinics will diagnose you from symptoms alone (if there are any) and start treatment immediately.

Treatment can range from antibiotics (for chlamydia, gonorrhoea and syphilis) to creams (for genital warts).

You’ll be advised not to have sex until you’ve finished the treatment. It’s also important to finish any antibiotics to ensure the infection doesn’t return. Most treatments are highly effective if taken properly.

Some infections, such as hepatitis B and genital herpes, can’t be cured. In both cases, the virus remains in your body. But you can be vaccinated against hepatitis B – ask your GP for details.

Herpes flares up from time to time. When it does, you can treat the sores with an over-the-counter cream, avoiding sex until they’ve gone. Using a condom won’t offer 100 per cent protection as it doesn’t cover the entire genital area.

If tests show you have HIV, you’ll receive specialist advice, counselling and treatment.

Telling your partners
If you do have an infection, you’ll be asked to contact anyone you’ve recently had sex with, so they can get treatment.

If you don’t want to do that yourself, clinic staff will contact them. They won’t give your name, but will say they believe a former partner has an infection and they should seek treatment.

Screening programmes
The Department of Health has introduced an England-wide screening programme for chlamydia, offering tests to those who seek contraceptive advice and through youth clubs. To find out if this is happening in your area, call the sexual health helpline on 0800 567 123 or find your local scheme by logging on to www.condomessentialwear.co.uk.

In some areas testing kits are available free by post. Some pharmacies, are also providing free NHS chlamydia screening for 16 to 24-year-olds in certain regions across the UK.

Advice and support
fpa
Tel: 0845 122 8690
Website: www.fpa.org.uk

Sexual Health Helpline
Tel: 0800 567 123
Website: www.condomessentialwear.co.uk

Sexwise
Tel: 0800 282 930
Website: http://www.nhs.uk/Livewell/Sexandyoungpeople/

Hepatit

Hepatitis A – What Increases Your Risk

What Increases Your Risk

People who practice certain behaviors or have certain jobs are at higher risk for hepatitis A. If you are a member of a high-risk group, you should receive the hepatitis A vaccineClick here to view a form.(What is a PDF document?) .

Risk factors for hepatitis A include:

* Eating food that has been prepared by someone who is infected with the hepatitis A virus and who has poor hygiene.
* Eating raw or undercooked shellfish (such as oysters or clams).
* Eating uncooked food (such as unpeeled fruits or vegetables) or drinking tap water or well water while traveling in countries where hepatitis A is common.
* Living in a community where hepatitis A is common and outbreaks occur (largely a risk factor for young children).
* Living in a household with someone who has hepatitis A.

Lifestyle factors that increase your risk for hepatitis A include:

* Traveling to countries where hepatitis A is common.
* Being a man who has sex with men.

Hepatitis C – Topic Overview

What is hepatitis C?

Hepatitis C is a disease caused by a virus that infects the liver. In time, it can lead to permanent liver damage as well as cirrhosis, liver cancer, and liver failure.

Many people do not know that they have hepatitis C until they already have some liver damage. This can take many years. Some people who get hepatitis C have it for a short time and then get better. This is called acute hepatitis C. But most people who are infected with the virus go on to develop long-term, or chronic, hepatitis C.

Although hepatitis C can be very serious, most people can manage the disease and lead active, full lives.
What causes hepatitis C infection?

Hepatitis C is caused by the hepatitis C virus. It is spread by contact with an infected person’s blood.

You can get hepatitis C if:

* You share needles and other equipment used to inject illegal drugs. This is the most common way to get hepatitis C in the United States.
* You had a blood transfusion or organ transplant before 1992. As of 1992 in the United States, all donated blood and organs are screened for hepatitis C.
* You get a shot with a needle that has infected blood on it. This happens in some developing countries where they use needles more than once when giving shots.
* You get a tattoo or a piercing with a needle that has infected blood on it. This can happen if equipment isn’t cleaned properly after it is used.

In rare cases, a mother with hepatitis C spreads the virus to her baby at birth, or a health care worker is accidentally exposed to blood that is infected with hepatitis C.

Experts are not sure if you can get hepatitis C through sexual contact. If there is a risk of getting the virus through sexual contact, it is very small.

You cannot get hepatitis C from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drink.
What are the symptoms?

Most people have no symptoms when they are first infected with the hepatitis C virus. If you do develop symptoms, they may include:

* Feeling very tired.
* Joint pain.
* Belly pain.
* Itchy skin.
* Sore muscles.
* Dark urine.
* Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people go on to develop chronic hepatitis C but still do not have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed.
How is hepatitis C diagnosed?

Many people find out that they have the virus by accident, when their blood is tested before a blood donation or as part of a regular checkup. Often, people with hepatitis C will have high levels of liver enzymes in their blood.

If your doctor thinks you may have hepatitis C, he or she will talk to you about having a blood test. If the test shows hepatitis C antibodies, you have had hepatitis C at some point. A second test can tell if you have hepatitis C now.

When blood tests show that you have hepatitis C, you may need a liver biopsy to see if the virus has caused scarring in your liver. During a liver biopsy, a doctor will insert a needle between your ribs to collect a small sample of liver tissue to look at under a microscope. See a picture of the placement of the needle for a liver biopsy.

Some people prefer to find out on their own if they have been exposed to hepatitis C. You can buy a home test called a Home Access Hepatitis C Check kit at most drugstores. If the test shows that you have been exposed to the virus in the past, be sure to talk to your doctor to find out if you have the virus now.
How is it treated?

You and your doctor need to decide if you should take antiviral medicine to treat hepatitis C. It may not be right for everyone. If your liver damage is mild, you may not need medicine.

If you do take medicine, the best treatment is a combination of two medicines that fight infection: peginterferon and ribavirin. How well these medicines work depends on how damaged your liver is, how much virus you have in your liver, and what type of hepatitis C you have.

Taking care of yourself is an important part of the treatment for hepatitis C. Some people with hepatitis C do not notice a change in the way they feel. Others feel tired, sick, or depressed. You may feel better if you exercise and eat healthy foods. To help prevent further liver damage, avoid alcohol and illegal drugs and certain medicines that can be hard on your liver.

Hepatitis C – Symptoms

Symptoms

There are two forms of hepatitis C. The first form is called acute hepatitis C, which means that you recently became infected with the virus. The second form is called chronic hepatitis C, which means that you have had an infection for more than 6 months.

Most people who are infected with hepatitis C develop chronic hepatitis C. But even people who have been infected for a while usually do not have symptoms. This makes it common for people to have hepatitis C for 15 years or longer before it is diagnosed. Many people find out by accident that they have the virus, such as when donating blood or having a routine physical exam.

If symptoms do develop, they may include:

* Fatigue.
* Joint pain.
* Belly pain.
* Itchy skin.
* Sore muscles.
* Dark urine.
* Jaundice, a condition in which the skin and the whites of the eyes look yellow.

Hepatitis C damages your liver very slowly. Approximately 25% of people who have long-term (chronic) hepatitis C will go on to develop severe liver damage and scarring (cirrhosis) after a period of about 20 years or more.1 If you develop cirrhosis, you may have:

* Redness on the palms of your hands caused by expanded small blood vessels.
* Clusters of blood vessels just below the skin that look like tiny red spiders and usually appear on your chest, shoulders, and face.
* Swelling of your belly, legs, and feet.
* Muscle shrinking.
* Bleeding from enlarged veins in your digestive tract, which is called variceal bleeding. Variceal bleeding can be very serious even though you may not have previous symptoms of the problem.
* Damage to your brain and nervous system, which is called encephalopathy. Encephalopathy can cause symptoms such as confusion and memory and concentration problems.

Many other health problems are associated with long-term cirrhosis. For more information, see the topic Cirrhosis. There also are many other conditions with similar symptoms.

Hepatitis B – Topic Overview

What is hepatitis B?

Hepatitis B is a virus that infects the liver. Most adults who get hepatitis B have it for a short time and then get better. This is called acute hepatitis B.

You can have hepatitis B and not know it. You may not have symptoms. If you do, they can make you feel like you have the flu. But as long as you have the virus, you can spread it to others.

Sometimes the virus causes a long-term infection, called chronic hepatitis B. Over time, it can damage your liver. Babies and young children infected with the virus are more likely to get chronic hepatitis B.
What causes hepatitis B?

Hepatitis B is caused by the hepatitis B virus. It is spread through contact with the blood and body fluids of an infected person.

You may get hepatitis B if you:

* Have sex with an infected person without using a condom.
* Share needles (used for injecting drugs) with an infected person.
* Get a tattoo or piercing with tools that were not cleaned well.
* Share personal items like razors or toothbrushes with an infected person.

A mother who has the virus can pass it to her baby during delivery. If you are pregnant and think you may have been exposed to hepatitis B, get tested. If you have the virus, your baby can get shots to help prevent infection with the virus.

You cannot get hepatitis B from casual contact such as hugging, kissing, sneezing, coughing, or sharing food or drinks.
What are the symptoms?

Many people with hepatitis B do not know they have it, because they do not have symptoms. If you do have symptoms, you may just feel like you have the flu. Symptoms include:

* Feeling very tired.
* Mild fever.
* Headache.
* Not wanting to eat.
* Feeling sick to your stomach or vomiting.
* Belly pain.
* Diarrhea or constipation.
* Muscle aches and joint pain.
* Skin rash.
* Yellowish eyes and skin (jaundice). Jaundice usually appears only after other symptoms have started to go away.

Most people with chronic hepatitis B have no symptoms.
How is hepatitis B diagnosed?

A simple blood test can tell your doctor if you have the hepatitis B virus now or if you had it in the past. Your doctor will also be able to tell if you have had the vaccine to prevent the virus.

If your doctor thinks you may have liver damage from hepatitis B, he or she may use a needle to take a tiny sample of your liver for testing. This is called a liver biopsy.
How is it treated?

In most cases, hepatitis B goes away on its own. You can relieve your symptoms at home by resting, eating healthy foods, drinking plenty of water, and avoiding alcohol and drugs. Also, find out from your doctor what medicines and herbal products to avoid, because some can make liver damage caused by hepatitis B worse.

Treatment for chronic hepatitis B depends on whether your infection is getting worse and whether you have liver damage. Most people with chronic hepatitis B can live active, full lives by taking good care of themselves and getting regular checkups. There are medicines for chronic hepatitis B, but they may not be right for everyone. Work with your doctor to decide whether medicine is the right treatment for you.

Sometimes chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.
Can hepatitis B be prevented?

The hepatitis B vaccine is the best way to prevent infection. The vaccine is a series of three shots. Adults at risk and all babies, children, and teenagers should be vaccinated.

A combination vaccine (Twinrix) that protects against both hepatitis B and hepatitis A also is available.

To avoid getting or spreading the virus to others:

* Use a condom when you have sex.
* Do not share needles.
* Wear latex or plastic gloves if you have to touch blood.
* Do not share toothbrushes or razors.

Hepatitis C – Treatment Overview

Treatment Overview

Being diagnosed with hepatitis C can change your life. You may feel angry or depressed about having to live with a long-term (chronic), serious disease. You may have a hard time knowing how to tell other people that you have the virus. It can be helpful to talk with a social worker or counselor about what having the disease means to you. You also may want to find a support group for people with hepatitis C. If you do not have a support group in your area, there are several on the Internet.

You may or may not receive treatment for hepatitis C, depending on how damaged your liver is, other health conditions you have, how much virus you have in your body, and what type (genotype) of hepatitis C you have. Treatment is not always an option, because the medicines used to treat hepatitis C have serious side effects, are expensive, and do not work for everyone.

The goal of treatment for hepatitis C is to eliminate the virus from your body early, to prevent serious liver problems. The length of treatment for hepatitis C depends on whether you have a short-term (acute) infection or a long-term (chronic) infection. It may also depend on the type of hepatitis C virus causing the infection and how well the medicine seems to be working.
Treatment of short-term (acute) hepatitis C

Most people with acute hepatitis C do not get treated, because they do not know they have the virus.

If a person knows that he or she may have been exposed to the virus—such as a health care worker who is stuck by a needle—acute hepatitis C can be identified early. Most people who are known to have an acute hepatitis C infection get treated with medicine. In these cases, treatment for acute hepatitis C may help prevent long-term (chronic) infection, although there is still some debate over when to begin treatment and how long to treat acute hepatitis C.3, 4
Treatment of long-term (chronic) hepatitis C

It is common for people to live with hepatitis C for years without knowing they have it, simply because they do not have symptoms. Most people diagnosed with hepatitis C find out that they already have long-term, chronic infection. If your blood tests and liver biopsy show that you have chronic infection but no damage to your liver, you may not need treatment. If you do have some liver damage, you may be treated with a combination of medicines that fight the viral infection.

Whether or not you take medicines to treat hepatitis C, you will need to have routine blood tests to help your doctor know how well your liver is working.

If you decide not to be treated with medicines, your doctor will want to monitor you closely and may want to do a liver biopsy every 4 or 5 years to check for damage in your liver.

Some people who originally decide not to have treatment for hepatitis C later decide they want to try antiviral medicines.

Antiviral medicines for hepatitis C may not be recommended if you:

* Drink alcohol or use IV drugs. (Although you cannot take antiviral medicines if you use IV drugs, you can take antiviral medicines if you are using methadone.)
* Have advanced cirrhosis.
* Have severe depression or other mental health problems. The antiviral medicines used to treat hepatitis C can make mental health problems worse.
* Are pregnant or might become pregnant. Two forms of birth control must be used during treatment and for 6 months after treatment, because the medicines used to treat hepatitis C can harm a fetus.
* Have an autoimmune disease such as lupus, rheumatoid arthritis, or psoriasis, or certain medical problems such as advanced diabetes, heart disease, or seizures.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy.

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration (FDA) for use in children ages 3 to 17 years.

Antiviral medicines to treat hepatitis C include:

* Peginterferon and other interferons, which are similar to a protein your body makes to fight off infection.
* Combination antiviral therapy with interferons and ribavirin, which increases your chances of getting rid of the virus in your body.

Peginterferon—a newer, longer-acting form of interferon—combined with ribavirin is now considered better than standard interferon combined with ribavirin. Peginterferon is given as a weekly shot, and ribavirin is taken as a pill 2 times a day.

The length of your treatment depends on what hepatitis C genotype you have. Genotype 1 generally is treated for 1 year and genotypes 2 and 3 generally are treated for 6 months. The amount of virus in your body (viral load) will be checked while you are being treated. If you have genotype 1 and your viral load does not improve after 3 months of treatment, your treatment may be stopped.

Even if medicines are recommended for you, they may not work or they may not work long-term. Chronic hepatitis C infection is cured or controlled in about half of people who are treated with a combination of peginterferon and ribavirin.6 Studies have shown that treatment works for up to 50% of people with genotype 1 and up to 80% of people with genotype 2 or 3.7

Sometimes, treatment does not permanently lower the amount of virus in your blood. But some studies have shown that treatment may still reduce scarring in your liver, which can lower your chances of developing cirrhosis and liver cancer.5, 2

Medicines for hepatitis C are expensive and can cause many serious side effects, such as constant fatigue, headaches, fever, nausea, depression, and thyroid problems.

It is important to weigh the benefits of medicines for hepatitis C against the drawbacks. You most likely do not need to make a quick decision about treatment, because hepatitis C progresses very slowly. Talking with your doctor can help you decide whether medicines are right for you. For more information, see:

Should I have antiviral therapy for hepatitis C?

Treatment of relapse or nonresponse

Sometimes, you can take more medicine if your first round of treatment did not work very well. The decision to try treatment again is based on how well you tolerated the first treatment, how well the first round of treatment worked, the dose of the first treatment, and the genotype of your virus. Talk to your doctor about whether you might try medicines again.
Treatment if the condition gets worse

Severe liver damage caused by chronic hepatitis C usually takes 20 or more years to develop. If you have hepatitis C, there are certain factors that may help you predict your risk of severe liver damage.

If your hepatitis C continues to get worse, it can cause your liver to stop working, a condition called end-stage liver failure. In this case, a liver transplant may be the only way to extend your life. But if you are using alcohol, are sharing needles to inject drugs, or have severe depression or certain other mental illnesses, liver transplant may not be an option.
End-of-life issues

Most people with chronic hepatitis C will not die from the disease. But between 1% and 5% of people with severe liver damage from chronic hepatitis C will die due to hepatitis C.8 Even if a liver transplant is done as a last possible treatment, there can be complications that lead to death. For more information about death and dying, see the topic Care at the End of Life.
What To Think About

If you have chronic hepatitis C, you can help keep the disease from getting worse. You can do this by not drinking alcohol, not sharing needles for drug use, eating well, and not taking any herbal supplement unless your doctor tells you it is okay.

There is no vaccine for hepatitis C, but there are vaccines for hepatitis A and hepatitis B. Your doctor may recommend that you have these vaccines to help protect you from more liver problems.

The U.S. National Institutes of Health has made recommendations on who should receive antiviral treatment for hepatitis C.5 For example, treatment is recommended for people who are at least 18 years old, have detectable levels of the virus in their blood, and have significant liver damage confirmed by a liver biopsy. If you do not meet these criteria, your decision to try antiviral treatment is more complicated.

Antiviral therapy is expensive, and the medicines can cause many serious side effects, including constant fatigue, nausea, headaches, depression, and thyroid problems.

Researchers are working to develop other treatments, including gene therapy and medicines that help control the immune system. A new medicine called viramidine is also being studied as a substitute for ribavirin. Viramidine may cause less anemia than ribavirin causes.9

Hepatitis B – Cause

Cause

Hepatitis B is a liver disease caused by infection with the hepatitis B virus (HBV). Hepatitis B is one of the most common forms of viral hepatitis, which includes hepatitis A, B, C, D, and E. But hepatitis has many other causes, including some medicines, long-term alcohol use, fatty deposits in the liver, and exposure to certain industrial chemicals.
How HBV is spread

HBV is spread when blood, semen, or vaginal fluids (including menstrual blood) from an infected person enter another person’s body, usually in one of the following ways:

* Sexual contact. The hepatitis B virus can enter the body through a break in the lining of the rectum, vagina, urethra, or mouth. Sexual contact is the most important risk factor for the spread of HBV in North America.
* Sharing needles. People who share needles and other equipment (such as cotton, spoons, and water) used for injecting illegal drugs may inject HBV-infected blood into their veins.
* Work-related exposure. People who handle blood or instruments used to draw blood may become infected with the virus. Health care workers are at risk of becoming infected with the virus if they are accidentally stuck with a used needle or other sharp instrument contaminated with an infected person’s blood. Infection also can occur if blood splashes onto an exposed surface, such as the eyes, mouth, or a cut in the skin.
* Childbirth. A newborn baby can get the virus from his or her mother during delivery when the baby comes in contact with the mother’s body fluids in the birth canal (perinatal transmission). But breast-feeding does not transmit the virus from a woman with HBV to her child.
* Body piercings and tattoos. HBV may be spread when needles used for body piercing or tattooing are not properly cleaned (sterilized) and HBV-infected blood enters a person’s skin.
* Toiletries. Grooming items such as razors and toothbrushes can spread HBV if they carry blood from a person who is infected with the virus.

In the past, blood transfusions were a common means of spreading HBV. Organ transplants could also spread the disease. Today, all donated blood and organs in the United States are screened for the virus, so it is extremely unlikely that you could become infected with the virus from a blood transfusion or organ transplant.
Contagious and incubation periods

Symptoms appear an average of 60 to 90 days (although they can appear 45 to 180 days) after you have contact with the hepatitis B virus (incubation period). Blood, semen, and vaginal fluids (including menstrual blood), whether fresh or dried, are highly contagious (HBV can be easily spread) during this period and for several weeks after the onset of symptoms.

* Blood contains the highest quantities of the hepatitis B virus.
* Blood and other body fluids that contain the virus can remain contagious for at least a week and possibly much longer, even if they are dried.

If you have a short-term HBV (acute) infection, you usually cannot spread the virus after antibodies against the surface antigen of HBV appear. This generally takes several weeks. If you have a long-term (chronic) HBV infection, you are able to spread the virus as long as you have an active infection.