Martin Jones, MSc, RN, CNS.
Co-ordinator, Sexual Health, Eastbourne and County Healthcare NHS TrustThis Factfile focuses on the more common bacterial sexually transmitted infections (STIs), which are probably most relevant to nurses outside genitourinary medicine (GUM) departments.
Commonly known as chlamydia, genital chlamydia trachomatis infection replaced genital wart virus infection as the most common diagnosis in GUM departments in England, Wales and Northern Ireland in 2001, with 71 055 cases reported. The surge in new cases is probably multifactorial: more sex without condoms, increased public awareness, increased health professional awareness, the introduction of highly sensitive molecular tests, and so on.
The number of cases of gonorrhoea has risen since the mid-1990s, after a fall during the safer sex campaigns of the 1980s.
While the number of syphilis cases, compared with chlamydia and gonorrhoea, is much lower, recent years have seen a resurgence, with outbreaks in urban areas, including Bristol, London, Brighton and Manchester. The most recent have been seen in men who have sex with men, including HIV-positive men. With the possibility of genital ulcer disease, the risk of HIV transmission may be increased. All cases of adult syphilis should be referred to GUM departments.
Chlamydial infection is asymptomatic in 80% of women and up to 50% of men.
For some, the symptoms may be mild and/or transient. Women may notice:
Chlamydia is a laboratory diagnosis. The type of test and sample requirement varies according to local facilities and protocols. Enzyme immuno-assays (EIA tests) may have a sensitivity as low as 40%, and are being replaced by molecular tests with high sensitivity and specificity.
Neisseria gonorrhoeae, the causative organism, can infect the urethra, cervix, rectum, throat and eye.
In men, 85% with urethral gonorrhoea experience symptoms within 10 days of sexual intercourse. These usually include:
- Swabs for culture and sensitivity should be taken from relevant sites
Treatment is usually with one of:
Association for Genito Urinary Medicine (AGUM) and Medical Society for the Study of Venereal Diseases (MSSVD) Clinical Effectiveness Group. (2002a) National Guideline for the Management of Chlamydia trachomatis Genital Tract Infection. Available at: www.mssvd.org.uk
AGUM and MSSVD Clinical Effectiveness Group. (2002b) National Guideline for the Management of Gonorrhoea in Adults. Available at: www.agum.org.uk
AGUM and MSSVD Clinical Effectiveness Group. (2002c) National Guideline for the Management of Early Syphilis. Available at: www.agum.org.uk
AGUM and MSSVD Clinical Effectiveness Group. (2002d) National Guideline for the Management of Late Syphilis. Available at: www.agum.org.uk
Department of Health. (2001) The National Strategy for Sexual Health and HIV. London: DoH.
Department of Health. (2002) The National Strategy for Sexual Health and HIV: Implementation action plan. London: DoH.
Fenton, K.A., Korevessis, C., Johnson, A.M. et al. (2001) Sexual behaviour in Britain: reported STIs and prevalent Chlamydia trachomatis infection. Lancet 358: 1851-1854.
Public Health Laboratory Service. (2003) HIV and Sexually Transmitted Infections. Available at: www.phls.org.uk