SEXUALLY TRANSMITTED DISEASES AND SAFER SEX

Transcription

1 1 SEXUALLY TRANSMITTED DISEASES AND SAFER SEX 1 SEXUALLY TRANSMITTED INFECTIONS (STIS) 1.1 WHAT ARE STIS? THEY ARE INCREASINGLY COMMON INFECTIONS SPREAD VIA SEXUAL CONTACT WITH AN INFECTED PARTNER. SEXUALLY TRANSMITTED INFECTIONS CAN BE CAUSED BY: Bacteria Viruses Parasites The mst cmmn are: Chlamydia Gnrrhea Genital warts Herpes Trichmnas vaginalis Pubic lice Less cmmn are: Syphilis Hepatitis B (mre cmmn amng injecting drug users) HIV STI s ften have n visible symptms. Smetimes peple can tell they are infected, fr example by the appearance f an unusual discharge frm the penis, vagina r anus, a burning sensatin while urinating, sres r blisters n the penis, vagina, anus r muth r an itch arund the genitals r private parts.

2 2 1.2 HOW DO PEOPLE GET A STI? STI s are spread thrugh unprtected vaginal, ral r anal sexual cntactwith smebdy wh is infected. As yu might have nticed, the inside f the muth, vagina, anus, and penis is lined with a special skin. This lining is called the mucus membrane. Bacteria and viruses that cause diseases live n this lining. When yu have unprtected sex they can mve frm ne persn s mucus membrane t the ther persn s. And that s all yu need fr infectin t take place. A mther infected with a STI can pass the disease n t her baby during the pregnancy r delivery. Peple wh are infected may nt have any symptms. They can still pass a STI n t thers. 1.3 WHAT HAPPENS WHEN SOMEBODY HAS A STI? Mst STI s are cmpletely treatable, and the individual will suffer n lng-term effects. Hwever, the cnsequences f untreated STI s can cause serius health prblems, and presents a significant public health prblem. Chlamydia is a well established cause f pelvic inflammatry disease, ectpic pregnancy and infertility. The presence f a STI can als increase the risk f HIV infectin. Sme sexually transmitted infectins can recur spntaneusly. Fr example, herpes and genital warts will disappear after treatment but may cme back later. 1.4 HOW CAN YOU AVOID INFECTION? Practice safer sex. Attend a sexual health clinic/prisn medical service fr regular check-ups. Nrmal daily scial cntact presents n risk f infectin. 1.5 IN THE INSTITUTION If yu have any symptms r think yu have been infected with a STI, yu can see the prisn medical service t have yurself tested and pssibly treated. 2 CHLAMYDIA This is the mst cmmn bacterial sexually transmitted infectin. It infects the cervix (neck f the wmb) in wmen and the urethra, rectum and eyes in bth men and wmen. 2.1 TRANSMISSION: Having sex with an infected partner. Mther t baby during childbirth. Transfer f the infectin frm genitals t eyes by fingers. 2.2 SIGNS AND SYMPTOMS: Wmen Mst wmen experience n symptms at all. Pssible symptms include: Increased vaginal discharge Lwer abdminal pain

3 3 A need t pass urine mre ften Pain n passing urine Irregular menstrual bleeding Painful sexual intercurse Pain and swelling f the eyes if infected Men Men are mre likely t experience symptms, but many dn t. These include: Discharge frm the penis Pain and/r a burning sensatin when passing urine Pain and swelling f the eyes if infected 2.3 TREATMENT Chlamydia is easily treated with antibitics. Any sexual partner(s) will als need t be treated. It is advisable t avid sexual cntact until treatment f yuself and any partner(s) is cmpleted. Cmplicatins in wmen Pelvic inflammatry disease (PID), which in turn can cause infertility. Ectpic pregnancy (pregnancy utside the wmb). Premature birth r miscarriage f pregnancy. Can als lead t chrnic (lng-term) pelvic pain. Cmplicatins in men Inflammatin f the testicles, which can cause infertility In men and wmen Reiters syndrme can be due t chlamydial infectin, causing inflammatin f the eyes and jints and smetimes a rash n the genitals and sles f the feet. 2.4 PREVENTION Using a cndm r dental dam (r equivalences) reduces the risk f infectin.

4 4 3 GONORRHOEA Gnrrhea is a bacterial infectin infecting the cervix in wmen, and the urethra, rectum, anus and thrat in bth men and wmen. 3.1 TRANSMISSION Sexual cntact with an infected partner. 3.2 SIGNS AND SYMPTOMS Wmen These might include: Men Vaginal discharge that may be yellw r greenish in clur, and with a strng smell Pain r burning sensatin when passing urine. Irritatin and/r discharge frm the anus. These might include: Yellw r white discharge frm the penis. Irritatin and/r discharge frm the anus. 3.3 TREATMENT Gnrrhea is easily treated with antibitics. Any sexual partner(s) will als need t be treated. It is advisable t avid sexual cntact until treatment f yurself and any partner(s) is cmpleted. Cmplicatins in wmen Pelvic inflammatry disease (PID) if left untreated, which can cause infertility. Ectpic pregnancy (pregnancy utside the wmb). Painful sexual intercurse. Infectin f baby during childbirth. This can result in an eye infectin causing blindness. Cmplicatins in men Inflammatin f the testicles and prstate gland, which culd cause infertility.

5 5 3.4 PREVENTION Using a cndm r dental dam reduces the risk f infectin. 4 GENITAL WARTS Genital warts are a sexually transmitted infectin that can appear anywhere in the genital area. They are caused by a virus - the Human Papillma Virus (HPV). There are mre than 60 types f HPV, sme f which cause genital warts, thers cause warts n different parts f the bdy. 4.1 TRANSMISSION Sexual cntact with an infected partner. 4.2 SIGNS AND SYMPTOMS Symptms can take several mnths t develp but may include: Small pinkish/white lumps r large cauliflwer-shaped lumps n the genital area. Itching. If present n the cervix (neck f the wmb) in a wman, she may ntice slight bleeding, r mre rarely an unusual vaginal discharge. 4.3 TREATMENT Use f a brwn liquid - Pdphylin - painted nt the warts and washed ff after 4 hurs. Freezing the wart r laser treatment is als cmmn. Any sexual partner(s) shuld als attend a clinic fr a sexual health check and treatment if necessary. 4.4 PREVENTION Using cndms will ffer sme prtectin, but nly if they cver the affected area. 5 GENITAL HERPES Herpes is caused by the herpes simplex virus (HSV). It can affect the muth, the genital area, and the fingers. The virus lives in the nerve fibres, ften causing n symptms at all. There are 2 types f HSV: Type 1 usually infects the muth r nse, and is referred t as ral r facial herpes. It increasingly infects the genital area as a result f ral sex Type 2 usually infects the genital and anal area 5.1 TRANSMISSION Skin cntact Kissing

6 6 Vaginal, anal and ral sex 5.2 SIGNS AND SYMPTOMS Itching and tingling sensatin in the genital r anal area Painful ulceratin (blisters) f the affected area Pain when passing urine Flu-like illness, swllen glands, fever, backache 5.3 TREATMENT If left untreated, herpes will clear up by itself, althugh the symptms can be very uncmfrtable and distressing. There is an anti-viral treatment available which can alleviate the symptms f herpes, but this needs t be taken within 72 hurs f the nset f symptms. Any sexual partner(s) experiencing symptms shuld als have a sexual health check up. 6 TRICHOMONAS VAGINALIS (TV) TV is a sexually transmitted infectin caused by a parasite. It infects the vagina in wmen, and smetimes the urethra in men. 6.1 TRANSMISSION Vaginal, anal r ral sex. Thrugh rare, sharing f wet twels, jacuzzis r ht baths. 6.2 SIGNS AND SYMPTOMS Wmen Symptms, thugh nt always present, may include Sreness, inflammatin and itching f the vagina Pain when passing urine. Thin, frthy, yellw/green vaginal discharge, which may have a musty/fishy smell. Painful sexual intercurse.

7 7 6.3 TREATMENT TV is easily treated with antibitics. Any sexual partner(s) shuld als be treated. It is advisable t avid sexual cntact until treatment is cmpleted. 6.4 COMPLICATIONS Cmplicatins with TV are rare. 6.5 PREVENTION Using a cndm reduces the risk f infectin. 7 PUBIC LICE (CRABS) These are small parasitic insects that live in hair f the pubic area, abdmen, chest, underarms and legs. 7.1 TRANSMISSION Sexual cntact with an infected partner. Clse physical cntact. Sharing bedding and twels. 7.2 SIGNS AND SYMPTOMS Itching. Smetimes the lice are visible n the skin. Lice drppings in underwear that lks like black pwder. Nits (eggs) n the hair. 7.3 TREATMENT They are easily treated using a special ltin prescribed by a dctr, r available frm a pharmacy. Any sexual partner(s) shuld als be treated. It is advisable t avid any sexual cntact until treatment is cmpleted. 8 SYPHILIS Syphilis is caused by a bacteria. 8.1 TRANSMISSION Sexual cntact with an infected partner.

8 8 Infected mther t her unbrn child. 8.2 SIGNS AND SYMPTOMS These are the same fr men and wmen. They very ften g unnticed and can take up t 3 mnths t shw. There are several stages, but the primary and secndary stages are the mst infectius. Primary stage: painless ulcers arund the genital area mainly, but can appear anywhere n the bdy. They usually appear arund three weeks after infectin, and are very infectius. Secndary stage: if untreated, this stage ccurs 3-6 weeks after the appearance f the ulcers. A rash cvering the whle bdy r in patches: Hair lss Flu-like symptms, swllen glands, lss f appetite 8.3 LATENT STAGE This is untreated syphilis. Symptms have disappeared and the infectin can remain undetected fr several years. A bld test can diagnse infectin. If it remains untreated, syphilis can cause damage t the heart and nervus system, which may be irreversible. 8.4 TREATMENT Syphilis can be treated with antibitics at any stage. Current and frmer sexual partners will need t be tested and receive treatment if apprpriate. Children brn t wmen wh have syphilis may als need t be tested. 9 SAFER SEX IN PRISON Sexual activities ccur inside prisns, just as they d utside. Sexual experiences and pleasure are part f being human. In the same way that prisns are nt drug free, neither are they sex free. In additin, prisn life prduces cnditins that encurage the establishment f hmsexual r lesbian relatinships within the institutin. The prevalence f sexual activity in prisn is based n such factrs as whether the accmmdatin is single-cell r drmitry, the duratin f the sentence, the security classificatin, and the extent t which cnjugal visits are permitted. Several studies have prvided evidence that significant rates f risky sexual behaviur ccur in crrectinal settings. Despite the availability f cndms in prisns, knwledge f sexual risk behaviur and individual risk preventin is pr. Tdts et al. (1997) reprts that nne f a grup f Belgian prisners wh were having sexual cntacts while in prisn used cndms. Preventin ffers have nt been accepted. The reasn might be that men having sex with men is nt generally accepted by mst f the prisn ppulatin and prisns d nt ffer enugh privacy where this behaviur des ccur.

9 9 Sexual transmissin f HIV, hepatitis B r ther sexually transmitted diseases in prisns is a cmplex phenmenn, with tabs fr all cncerned: prisn authrities, health persnnel, and prisners as well. Penetrative sex between male prisners can take place in a whle range f situatins, and nt just between gay inmates: Self-identified hetersexual men having sex with men True hmsexual sex Cnsensual sex Circumstantial sex (prisners pay with what they have) Cercive sex Rape and gang rape Male sex wrk There are many misrepresentatins abut the nature f sexual cercin inside prisns, and a lack f awareness f the prblem. Making cndms accessible t inmates may be useful fr sme cases, but will certainly nt prevent the sexual transmissin f HIV in mst cases f s-called cnsensual prisn sex (see als Reyes 2000). 9.1 CONDOM AVAILABILITY IN PRISONS The WHO guidelines n HIV infectin and AIDS in prisns (1993) recmmend:...since penetrative sexual intercurse ccurs in prisn, even when prhibited, cndms shuld be made available t prisners thrughut their perid f detentin. They shuld als be made available prir t any frm f leave r release. It shuld be added that cndms shuld als be made available at cnjugal visits (bth fficial and unfficial). The availability f cndms in Eurpean prisns differs widely in practice regarding the prvisin f and access t cndms. In 1991, a WHO study fund that 23 f 52 prisn systems surveyed prvided cndms t prisners (Harding & Schaller, 1992). By 2001, 18 f the 23 prisn systems in the preexpansin Eurpean Unin were making cndms available (Stöver et al., 2001). Tday, many prisn systems, including in Australia, Brazil, Canada, Indnesia, the Islamic Republic f Iran, Suth Africa, sme cuntries frm the frmer Sviet Unin, and a small number f jail and prisn systems in the United States, prvide cndms (WHO 2007). Fr further infrmatin n cndm use in prisn, make reference t: WHO, Evidence fr Actin Technical Papers - Effectiveness f Interventins t Manage HIV in Prisns Prvisin f cndms and ther measures t decrease sexual Transmissin, WHO Different plicies are applied in Eurpean prisns. Access via Scial wrkers Medical unit Priests Prisn shps On prescriptin, where the prisn dctr believes that there is a risk f STD transmissin. (England/Wales)

10 10 Thrughut the wrld, cndm availability is a cntrversial issue due t the the fact that sexuality is the secnd majr tab in prisn (after drug use). In 1995 in Australia, 50 prisners launched a legal actin against the state f New Suth Wales (NSW) fr nnprvisin f cndms, arguing that it is n prper part f the punishment f prisners that their access t preventative means t prtect their health is impeded. Since then, at least in part because f the legal actin, the NSW gvernment has decided t make cndms available. Other Australian systems have als made cndms available. Others (Suth and Western Australia) sanctin the prvisin f cndms but dn t actually prvide them. 9.2 GENERAL INFORMATION ABOUT CONDOMS Cndms, if used prperly, are a gd way t have sex safely r make lve in a safe way. Althugh nt 100% safe, cndms can prevent mst STIs and unwanted babies. Different types f cndms are generally available (but rarely in prisns): With and withut lubricant Many peple prefer t use a cndms in cmbinatin with a lubricant as the chance f tearing r slipping ff is reduced. Often, a water-based lubricant is already put n the cndm. With cndms suitable fr anal sex, extra water-based lubricant is smetimes packaged separately. Flavured cndms Mst f the flavured cndms marketed are nt designed fr vaginal use. Flavured cndms are nt lubricated and are mst suitable fr use in blw jbs. (fellati). Female cndms and dental dams These cndms are nt available in all Eurpean Unin member states and nt at all in prisns. They are expensive everywhere. Nevertheless, the female cndm can be cnvenient fr several reasns. It is inserted in the vagina, and a rubber ring inside the cndm helps t keep the cndm in the right psitin. The majr advantage f the Femidm is that it can be inserted lng befre actual intercurse takes place. Extra strng cndms Extra-strng cndms are ften referred t as gay cndms, which is actually incrrect because anal sex is als cmmn amng hetersexuals. Extra strng cndms are specially designed fr anal sex. This type f cndm is nt

11 11 cnsidered 100% safe. The pssibility f an accident, such as tearing f the cndm, is cnsiderable if it is nt used prperly. This type f cndm is best used with extra lubricant. 9.3 INSTRUCTION ON CONDOM USE Check if yu have the right cndm: Is it intended fr vaginal r anal use? Fr anal use, nly special, thicker cndms are suitable. Is it big enugh? Is it an apprved brand? Check the expiry date Open the package carefully in the middle: D nt use teeth r scissrs t avid tearing the cndm Take ut the cndm: Be extra careful if yu have lng fingernails Make sure that yu dn t hld the cndm inside ut Pinch (squeeze) the semen reservir at the tip f the cndm, s that there is n air left. We d this because: The chance that it will tear is smaller because the reservir des nt cme under pressure If the cndm has n reservir yu can make ne yurself by squeezing the air ut f the tp f the cndm (1-3 cm). Put the cndm n tp f the penis and unrll it carefully t the base f the penis Wait until the penis is cmpletely hard befre putting the cndm n. When fully unrlled, there is less chance that the cndm will slip ff Again, be careful with lng nails Be sure t use water-based lubricants Always use lubricant fr anal penetratin A nn-water-based lubricant will disslve the cndm. S d nt use hand cream, bdy ltin, vaseline, il r butter. If nne f these things are available, use saliva instead! Withdraw the penis carefully immediately after ejaculating While withdrawing, hld the cndm at the pening t avid it slipping ff

12 12 If yu wait t lng the penis becmes flabby, the cndm slips ff and semen drips ut Dispse the cndm by putting it in a bin Wash hands Avid using the tilet because cndms can stp up the drain Use a new cndm each time yu start fucking. Never use tw cndms n tp f each ther as this can cause the cndms t tear!

13 13 REFERENCES Harding, T. W., Schaller, G. (1992): HIV/AIDS and Prisn. Wrld Health Organizatin. Reyes, H. (2000): HIV Preventin in Prisns: Hw useful exactly is cndm distributin? Oral presentatin at the cnference Encuraging Prmtin fr Drug Users within the Criminal Justice System frm Nvember 2000 in Hamburg. Stöver, H. (2001): Assistance t Drug Users in Prisns. EMCDDA scientific reprt. Lisbn Tdts et al. (1997): Tuberculsis, HIV hepatitis B and risk behaviur in a Belgian prisn. In: Arch. Public Health, 1997; 55: WHO (1993): The WHO guidelines n HIV infectin and AIDS in prisns. Wrld Health Organizatin. Geneva. WHO (2007): Evidence fr Actin Technical Papers - Effectiveness f Interventins t Manage HIV in Prisns Prvisin f cndms and ther measures t decrease sexual Transmissin,