HUMAN PAPILLOMAVIRUS (HPV)

Of >100 types of HPV, about 40 are sexually acquired and can infect the genital tract. Genital HPV infections are often asymptomatic, resolving without causing disease. Some can cause genital warts or cervical cancer. HPV vaccination was introduced in 2008 for girls aged 12 – 13 years. If offers protection against cervical cancer and genital warts, as well as other premalignant genital lesions (cervical, vulvar and vaginal). For 2014, the number of doses of HPV vaccine has changed from 3 to 2. Ideally the doses should be given 12 months apart (minimum 6 months, maximum 24 months). Girls who have not had their first dose of vaccine by the age of 15 should continue to be offered the 3-dose schedule.

Anogenital warts are not always visible but still transmit virus. Symptoms include:

• Genital lumps, hard or soft, solitary to multiple
• Bleeding, especially uretheral, occasionally itchy.

Sites:

• Women: vulva, perianal, cervix, vagina, urethra.
• Men: penis, urethra, perianal, rarely scrotum.

Cervical cancer prevention

Immunisation of girls aged 12-13 years against HPV 16 and 18 (associated with 70% of cervical cancer) is part of the UK immunisation programme See also Cervical cancer

GENITAL HERPES SIMPLEX

Genital herpes is almost exclusively a sexually transmitted infection, generally caused by HSV-2, although the prevalence of genital HSV-1 is increasing. Most transmission occurs via sexual contact with an individual who may be asymptomatic but is still shedding the virus. There is some evidence that genital HSV increases the risk of acquiring (and transmitting) HIV infection.

Genital herpes in pregnancy – in early pregnancy is associated with an increased risk of spontaneous abortion, fetal growth restriction, preterm labour and congenital herpes. In later pregnancy, genital herpes caries an increased risk of neonatal infection. Primary genital HSV infection may be asymptomatic and pass unnoticed. Symptoms start with mild soreness and groups of small, painful blisters on the genitals and surrounding areas, and last about 3 weeks. May also be systemic symptoms (fever, malaise, tender lymph nodes). Recurrent eruptions can occur, generally less severe and more localised, resolving in 3-4 days. Transmission is by direct contact with lesions.

Pubic lice (Pediculosis pubis, ‘crabs’)

Tiny (up to 3 mm), grey-brown blood-sucking insects that live in coarse human body hair, most commonly pubic hair (but also eyelashes/brows, beards/moustaches, hair on abdomen or back) and cause itching and red spots. Females lay eggs as head lice (see in Parasites). Pubic lice do not wash or brush off with normal bathing with soap and water. Spread by sexual contact.

TRICHOMONAS VAGINALIS (TV)

Protozoan infection of the genital area. Generally sexually transmitted, uncommon.

Women: 50% asymptomatic; others present with vaginal discharge (copious, yellow, thin, smelly discharge, may be frothty. Vaginal soreness (dyspareunia), dysuria. Men: usually asymptomatic; occasionally urethritis, balanitis, prostatitis.

URETHRITIS

Inflammation of the male urethra. Symptoms (dysuria and/or discharge and/or urinary frequency), intermittent or persistent, varying severity. Predominantly sexually acquired: contact tracing needed (best done by GUM clinic).

SYPHILIS

Infection with bacteria-like spirochete Treponema pallidum. Transmitted during sexual intercourse and from an infected pregnant woman across the placenta to a developing baby.

Symptoms

Primary: generally presents as a painless and indurated ulcer (chancre) discharging clear serum, and regional lymphadenopathy, 9–90 days after exposure.

Secondary: multisystem involvement with polymorphic rash (non–itchy).

Tertiary: 2-20 years after initial infection: granulomas in connective tissue

Quartenary: cardiovascular or neurological complications