Sexual Health on Your Travels

Contents

Use these quick links to navigate Doctor Seb Kalwij's guide to sexual health on your travels.

Sea, Sun, Sand and STIs

There is no combination more ideal for meeting a new partner; sun, beach, cheap alcohol and nothing else to worry about. Sexually Transmitted Infections are on the rise, not just amongst young people back home, but even more so amongst young travellers.

Research has shown that over 50% of travellers have sex with more than two partners whilst out on the road. Some infections are more serious than others. Some infections produce symptoms straight away, like gonorrhoea. Others may linger on for many years without any symptoms, like chlamydia. Chlamydia can cause infertility many years later, when the holiday romance has long been forgotten.

Before you get passionate with you new found love, there should be one more thing on your mind: safe sex. Be sure to use condoms, so there is nothing more to worry about in your pants than the sand.


Chlamydia

What is it?

Chlamydia is caused by a bacterium called Chlamydia trachomatis. In men, chlamydia causes infection of the urethra, resulting in pain on passing urine or one sided scrotal tenderness and fever. In women, if left untreated it can lead to infertility as it blocks the fallopian tubes. You can pass it on to your partner for as long as it hasn't been treated. Infections can linger for many years without causing any symptoms. Also you can get infected over and over again...

How do I get it?

The only way to get this is by having unprotected sex with someone who has been infected. Condoms are the only way for you to protect yourself.

For the record: You cannot get chlamydia from toilet seats or by sharing towels.

How do I know if I've got it?

This is very difficult as in more than 70% of women there are no symptoms at all. Chlamydia can linger on for years without causing any symptoms. The best way to find out is to get screened. Many GP's in the UK offer this service - and so many others overseas. These tests are easy to take; a vaginal swab or urine test will be enough. If you do have symptoms like pain on passing urine or when having sex, abdominal pain or fever; you will need to get checked out by a doctor.

What can do I about it?

The only treatment is a course of antibiotics. Chlamydia will never ever just pass. Different countries use different antibiotics. It is best to discuss this with a doctor who knows about chlamydia. Don't just take any antibiotics as not all of them are equally effective and the last thing you want is to have a flare up weeks or months down the line.

Most importantly you will have to tell your sexual partner(s) about the infection, so that they can get treated too. You should not have sex until a week after the treatment and remember there is the possibility that you can get infected again, if your partner - or a new sexual partner - has not been treated.


Gonorrhoea

What is it?

Gonorrhoea is an infection caused by a bacterium called Neisseria gonorrhoea. The main symptoms are pain when passing urine and a creamy coloured discharge from the penis. In women, discharge is often less easy to see. If you choose to leave this infection untreated, it will only get worse and you may suffer from abdominal and pelvic pains too. Ultimately it will cause infertility as the fallopian tubes will get blocked. It can also cause abscesses and strictures of the urethra too.

How do I get it?

Gonorrhoea is most often contracted by unprotected sex. Even oral and anal sex will transmit the bacterium proving that you must use a condoms at all times, for all sorts of sex.

How do I know if I've got it?

The main symptoms are a heavy discharge from your penis or vagina which may leave stains in your underwear. Often there are few or no symptoms at all, especially the first few days. Most people will also complain of pain when passing urine or when having sex.

What can I do about it?

You have only got one choice, so do not wait around. Get checked, tested and treated. After this, get in touch with your sexual partner(s) and make sure they get treated too. You can't have sex for a week after treatment until all symptoms have cleared up.


HIV / AIDS

What is it?

AIDS is caused by infection with the Human Immunodeficiency Virus (HIV) type 1 or type 2. Both types cause the same symptoms.

Infection with HIV is serious. If left untreated AIDS will lead to death within 3 years of diagnosis. The complications are serious and difficult to treat. The number of people infected world-wide is increasing rapidly and AIDS is a global disaster.

How do I get it?

HIV can be transmitted through unprotected vaginal, oral and anal intercourse. Also HIV can be transmitted in non-sexual ways like: blood transfusion, hemodialysis, sharing needles amongst IV drugs users, acupuncture, tattooing and needlesticks (especially in medical personnel). All body fluids are infectious: blood, semen, vaginal excretions and saliva. Hence mutual masturbation, kissing and sharing sex-toys and even sharing razors or a toothbrush should be avoided. Pregnant women can transmit the virus through the placenta, during labour and after birth by breast-feeding. Toilet seats and normal physical contact are safe.

Insects, like mosquitoes, do not transmit HIV. Other coinciding genital infections, like gonorrhoea and chlamydia, increase the risk of HIV transmission.

How do I know I've got it?

Most people do not have any symptoms shortly after being infected. Some people experience a self-limiting flu-like illness, lasting two weeks. Further symptoms may take many years to develop. During this time one is able to pass on the infection.

HIV infects mainly the immune systems, though other organs may be infected too. Due to a weakening immune system, infections which are normally kept at bay can cause serious complications, and can lead to death within three years of diagnosis.

What do I do about it?

You need to seek professional help. Most big cities around the world have large university hospitals with specialists in HIV and AIDS. Delaying treatment is not an option, as during your travels you may become ill rapidly. Antiviral treatment and treating all opportunistic infections may delay death. A vaccine is not available. It is unlikely that a vaccine will be available in the near future. Developing a new vaccine is time-consuming and there are lots of issues, which make a vaccine for HIV very difficult to make.

If you are infected with HIV you have to discuss this with your partner(s) as the consequences are far-reaching. This may be very difficult. In most West-European countries people infected with HIV can lead a normal life though they have to take a large number of tablets each day. Most of these drugs have serious side effects and have to be taken forever.


Herpes

What is it?

Herpes is caused by a virus called: Herpes Simplex Virus. There are two types and both types can cause genital blisters and ulcers.

How do I get it?

The main reason for catching herpes is by having unprotected sex with someone who has it. The problem with recurrent episodes is that they are less obvious as the ulcers are less painful. The ulcers are not always easy to see - particularly in women - and so you may get herpes from someone who appears to be fine. The main problem is that even condoms don't give you a 100% protection.

How do I know if I have got it?

Not all blisters and ulcers are caused by herpes and often these ulcers appear only after a few days. If you notice any new lesions, it's best to get them checked at a local clinic. Swabs can be taken and tested, but these tests are heat sensitive and need to be done in specialised laboratories. Herpes can flare up from time to time.

What can I do about it?

To ease the pain you can bath in salt water use painkillers or a 2% lignocaine gel. Antiviral therapy is recommended if this is your first attack of herpes. Convince your partner(s) to get checked too. It is also important to avoid sex until all symptoms have disappeared.


Cystitis

What is it?

Cystitis is an infection of your bladder and left untreated it can cause infection of your kidneys, which is very serious. Several bacteria can cause cystitis, the main one being Escherichia coli.

How do I get it?

It is a very common infection in sexually active young women. It is hardly seen in men. Though sexual intercourse plays an important role in the infection, it is not strictly a sexually transmitted infection. Unfortunately condoms do not protect you from getting cystitis.

How do I know I've got it?

Many women may recognise the symptoms of a urinary tract infection. Any increase in frequency in passing urine, or pain when passing urine, or change in colour and smell of the urine is suspect. You will have to see your doctor who can examine your urine.

What do I do about it?

See a doctor and get treated with antibiotics. This is the only way to prevent complications of urinary tract infections Even after adequate treatment it is possible to get urinary tract infections over and over again. This can be very frustrating. It is also important to drink enough water especially in hot weather. Avoid sex until you are better.


Hepatitis B

What is it?

Hepatitis B is a viral infection caused by the hepatitis B virus. It is an infection of the liver and may lead to serious illness.

How do I get it?

Hepatitis B can be transmitted through unprotected sex. Also hepatitis B can be transmitted in non-sexual ways like: blood transfusion, hemodialysis, sharing needles amongst IV drugs users, acupuncture, tattooing and needlesticks (especially in medical personnel). All body fluids are infectious: blood, semen, vaginal excretions and saliva. Hence mutual masturbation, kissing and sharing sex-toys and even sharing towels, razors or a toothbrush should be avoided. Even household members risk getting infected.

How do I know I've got it?

Many infections go unnoticed. Only 30-50% of people develop jaundice, which leaves the white part of the eye yellow. Often symptoms are vague, like nausea and vomiting, lack of appetite, rash and joint pain. Fever may be mild. However complications are serious. Infection of the liver can cause liver failure and lead to death. Infection with hepatitis B is strongly linked with developing cancer of the liver. Infection with hepatitis B causes acute infection of the liver. Symptoms are the same in men and women. Pregnant women can infect the baby during delivery

What do I do about it?

The best prevention is to get vaccinated before you set out on your travels. You can combine hepatitis B vaccination with hepatitis A vaccination. Condoms do not offer enough protection. If you think you have been at risk for hepatitis B you should consult a doctor at once. Most big cities have got testing facilities and expert advice will be available.


Trichomonas

What is it?

Trichomas is caused by a protozoon called Trichomas vaginalis.

How do I get it?

Mainly by having unprotected sex. Trichomas can survive up to 45 minutes on toilet seats, washcloths, towels, clothing and bath water.

How do I know I've got it?

Many women infected with trichomonas have no symptoms. In some women it causes vaginal discharge which can be smelly. Other parts of the cervix and genitals can be involved, causing itchiness, redness and swelling.

Many men with trichomonas infection have no symptoms. In some it can cause pain on passing urine, and discharge from the penis. Other parts of the genitalia may be involved too.

What do I do about it?

Trichomonas will only clear up with antibiotics. Your partner will have to be tested and treated too. The problem is that you can get re-infected over and over again. So it is best to use condoms at all times.


Bacterial Vaginosis

What is it?

Bacterial vaginosis occurs when lactobacilli, which are normally part of the vaginal flora, are being replaced with a mix of Gardnerella vaginalis, anaerobic bacteria and Mycoplasma hominis

How do I get it?

Mainly through unprotected sex. Many people think that vaginal discharge is the result of poor hygiene. This is quite the opposite, douching of the vagina and washing the genital area with soap decreases the degree of vaginal acidity and can cause a flare up of bacterial vaginosis. So don't use any soap or shower gels near your private parts.

How do I know I've got it?

In women it is the most common cause of increased discharge. Though men can be infected it rarely causes symptoms. Most women do not have serious complications, though in some it can cause complications after certain surgical procedures. Bacterial vaginosis can coincide with other genital infections and therefore needs to be diagnosed and treated. In pregnant women it can cause serious complications: it increases the risk of miscarriage in the first trimester of pregnancy.

What do I do about it?

The only effective treatment is with antibiotics. All vaginal disinfectants, iodine / chlorhexidine sponges should be avoided. Gels to increase the acidity of the vagina are not effective. Tampons soaked in yoghurt are not effective. The lactobacilli found in yoghurt are of a different type and will not stay in the vagina long enough to restore the normal flora.

Recurrences do occur and re-treatment is necessary. Often this can be frustrating. It is important not to wash or douche the genital area. It is not necessary to treat male sexual partners


Pubic Lice

What is it?

Pubic lice are caused by an infection with the crab louse.

How do I get it?

By having sex or being intimate with someone who has got lice. This can be any form of intimate contact, sharing clothing, bedlinen, sleeping bags, combs, brushes and toilet seats. Lice hold on to the pubic hairs, and even can be found in the armpits. Using sex-toys and mutual masturbation should be avoided as well. Condoms and other barrier methods do not protect against pubic lice. Special treatment is available to get rid of the lice.

How do I know I've got it?

At first there are few symptoms as one hardly notices being bitten with little or no itching or redness. After five days an allergic reaction occurs. The main symptom is itching, which leads to scratching, redness, irritation and inflammation. If you have been bitten by a large number of lice over a short period of time you may develop mild fever, malaise and increased irritability. Crab lice have been reported to infest dogs.

Symptoms are the same in men, women and pregnant women. There is no risk for a newborn baby. Some immunity may develop. After repeated infection a person will stop noticing having lice. It is important to inspect your own and your partners body if you have been at risk.

What do I do about it?

Special treatment is available to get rid of the lice. Ordinary soap and shampoo are not sufficient. For advice on the best treatment visit a local clinic or pharmacy. Do not think that lice will go away after a swim in the sea or pool.


Scabies

What is it?

Scabies is caused by the scabies mite Sarcoptes scabei.

How do I get it?

Scabies can be transmitted not only through unprotected sex but also by any form of prolonged intimate contact, like sleeping in the same bed for a night, sharing clothing, bed linen or sleeping bags. Condoms do not necessarily protect but can protect you against other coinciding STDs.

How do I know I've got it?

Most people develop an itchy rash on the sites of infection. The itch only starts after four to six weeks if you are infected for the first time. However if you have had scabies before this will start within hours. Often lesions get secondary infected due to scratching. Symptoms are the same in men and women, and there is no specific risk to the baby in pregnant women. In children infection with scabies slow their growth and can develop eczema. It is important to rule out other genital infections as they often coincide.

What do I do about it?

Treatment is available, both over the counter and on prescription. Ordinary soap and disinfectants will not cure scabies. Close household contacts and all sexual partners of the last few months should be examined and treated. Resistance to treatment is common and therefore it is best to contact a local health centre for up-to-date advice on the best treatment. You should avoid sex until you have been treated successfully.


Non-specific Urethritis

What is it?

Urethritis is an inflammation of the urethra, which is the part of the urinary tract where the urine flows out. Different bacteria can cause urethritis, mainly gonorrhoea and chlamydia but also by a range of other bacteria.

How do I get it?

Mainly though unprotected sex. You won't get urethritis from toilet seats or by sharing towels. There has been some evidence that it can be caused by other ways apart from sexual, which is complex. This can be the act of sexual intercourse by itself or other minor trauma like in men who ride bicycles frequently.

How do I know I've got it?

The main symptoms are pain when passing urine and itchiness at the tip of the penis. Most men do not have any discharge from the penis, some do. If urethritis is caused by the herpes virus, pain on passing urine can be severe.

What do I do about it?

You need to see a doctor and get treated with antibiotics. It is best to tell your partner too as he or she should be tested too. Urethritis doesn't just go away by drinking lots of water and ignoring it. Also you may get re-infected time after time.


Syphilis

What is it?

Syphilis is caused by bacteria called Treponema pallidum. Worldwide, syphilis is the most common cause of ulcers in the genital area.

How do I get it?

Mainly through unprotected sex. You can also get syphilis from a blood transfusion and by sharing needles. Syphilis can also be transmitted through the placenta in pregnant women to the unborn baby. Syphilis is a rare STI in Europe and America, but through increased international travel the number of cases is rising. So you may put yourself at an increased risk when you meet an interesting partner on the road.

How do I know I've got it?

The first sign of syphilis is a painless hard ulcer in the genital area, anus, or on the lip. From there, syphilis can spread via the bloodstream and cause serious complications, affecting the heart and nervous system.

What do I do about it?

The only thing to do is seek medical attention. Also bear in mind that local health centres and doctors often have a very good knowledge of what kind of infections are around. Syphilis is a serious illness and treatment should be started as soon as possible. Antibiotics are the only choice. A doctor will have to advise you which ones to take, so don't experiment with your own supply of antibiotics from home. Tell your partner about it, as he or she needs to get checked too!