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STIs and GUM Clinics

Sexually Transmitted Infections and Genito-Urinary Medicine Clinics

This leaflet gives some brief information about sexually transmitted infections (STIs) and what you are advised to do if you suspect that you have an STI. This leaflet also gives some information about genito-urinary medicine clinics (GUM clinics), sometimes called sexual health clinics. For example, how you can find a GUM clinic, and what you can expect when you go to a GUM clinic. There are separate leaflets that deal with each infection in more detail.

Some brief information about STIs

What is an STI?

A sexually transmitted infection (STI) is an infection that can be passed from person to person when having sex. You can get an STI by having vaginal sex, anal sex, or oral sex. There are several different types of STI.

What are the main STIs?

The ten most common STIs in the UK are: anogenital warts, chlamydia, genital herpes, gonorrhoea, HIV, hepatitis B, hepatitis C, public lice, syphilis and trichomonas. These are briefly described below. (Separate leaflets give more details for each of these infections.)

Anogenital warts are small lumps that develop on the genitals and/or around the anus (back passage). They are sometimes just called genital warts. They are caused by a virus called the human papillomavirus (HPV). However, most people infected with HPV do not develop visible warts. You can be a 'carrier' of the virus without realising it, and you may pass on the virus to others who then develop warts. Treatment options include applying chemicals to the warts or freezing the warts to destroy them.

Chlamydia is caused by a bacterium (germ) called Chlamydia trachomatis. It is the most common STI in the UK. Symptoms include a vaginal discharge in women, and a discharge from the penis in men. You can be infected with chlamydia for months, even years, without realising it as it often causes no symptoms. However, even if you have no symptoms, you can still pass on the infection and complications may develop if it is left untreated (such as pelvic infection and infertility in women). A short course of an antibiotic clears chlamydia in most cases.

Genital herpes is caused by the herpes simplex virus. Once you catch this virus it stays with you for life but lies dormant without causing symptoms for most of the time. In fact, many people who are infected with this virus never have symptoms. If symptoms occur, they can range from a mild soreness to many painful blisters on the vulva or penis and surrounding area. A first episode of symptoms can last 2-3 weeks, but may be shorter. Recurrent episodes of symptoms then develop in some cases from time to time, but are usually less severe than the first episode. (It is similar to having 'cold sores' on the genitals from time to time.) Antiviral medication can ease symptoms when they develop.

Gonorrhoea is caused by a bacterium called Neisseria gonorrhoeae. Symptoms include a vaginal discharge in women, and a discharge from the penis in men. Again, some people infected with gonorrhoea do not develop symptoms. However, even if you have no symptoms, you can still pass on the infection and complications may develop if it is left untreated (such as pelvic infection and infertility in women). A short course of an antibiotic clears gonorrhoea in most cases.

HIV (human immunodeficiency virus) is a virus that is most commonly passed on by sexual contact. HIV attacks cells of the immune system. Over time (usually several years) the immune system 'weakens' so that you cannot defend your body against various bacteria, viruses and other germs. This is when AIDS develops (acquired immunodeficiency syndrome). Many infections and conditions can develop if you have AIDS. Treatment with antiretroviral drugs can reduce the 'viral load' of HIV and allow your immune system to work effectively. However, treatment does not clear the virus from the body. Therefore, if you are infected with HIV you will need monitoring for the rest of your life, and treatment is long-term.

Hepatitis B is a virus that primarily attacks the liver. The virus is mainly passed on by sexual contact, sharing contaminated needles to inject 'street drugs', or from an infected mother to her baby. The hepatitis B virus can cause a short term (acute) infection, which may or may not cause symptoms. Following an acute infection, some people develop a persistent infection called chronic hepatitis B. Many people with chronic hepatitis B remain well, but can still pass on the virus to others (as they are 'carriers'). Some develop serious liver problems. If needed, antiviral medication may prevent or reduce the severity of liver inflammation and liver damage.

Hepatitis C is is a virus that primarily attacks the liver. Most cases occur in people who share needles to inject 'street drugs' that are contaminated with traces of infected blood. There is a small risk that an infected person can pass on the virus whilst having sex. Some people clear the infection naturally. Some people with persistent infection remain free of symptoms, but some have symptoms. After many years of infection some people develop cirrhosis (a severe scarring of the liver), and a few develop liver cancer. Treatment is difficult but it can clear the infection in up to half of cases.

Pubic lice (often called 'crabs') are tiny insects about 1-2 mm long (smaller than a match-head). They lay eggs which hatch into lice after seven days. Pubic lice attach strongly to hairs, and do not wash or brush off with normal cleaning. Pubic lice are passed on by close bodily contact, especially when having sex. The main symptom is itch, usually in the pubic hair area. However, you may not have any symptoms, but may still pass on the lice to others. Treatment with a lotion or cream usually clears the lice.

Syphilis is caused by a bacterium called Treponema pallidum. If it is not treated, it can spread in the bloodstream from the genital region to cause various symptoms and problems in different parts of the body over many years. A short course of antibiotics usually clears syphilis infection.

Trichomonas is a protozoan, which is a tiny germ similar to bacteria. It can cause an infection that is not normally serious but symptoms can be unpleasant. Symptoms include a vaginal discharge in women, and a discharge from the penis in men. Some people infected with Trichomonas do not have symptoms but can still pass on the infection. A course of antibiotics usually clears Trichomonas infection.

There are some other STIs that are uncommon in the UK. For example, donovanosis and chancroid.

Other conditions that are sometimes thought of as STIs

Scabies

Scabies is a common skin rash that is caused by a mite (a tiny insect). It is usually very itchy. You need close skin-to-skin contact with an infected person to catch scabies. Most cases are probably caught from holding hands with an infected person. The hand is the most common site to be first affected. However, sleeping in the same bed, and sexual contact are other common ways of passing on the mite which is why some people regard scabies as an STI.

Molluscum contagiosum

This is a common skin rash that is caused by a virus. It is passed on by skin-to-skin contact. The rash consists of small lumps which are pearly-white or slightly pink. Each lump ('molluscum') looks like a small wart and is round, firm, and about 1-5 mm across. Sometimes the virus is passed on during the close contact of having sex which is why some people regard molluscum contagiosum as an STI. However, many cases are not caused by a sexual contact but by simply touching other affected people. If it is passed on whilst having sex then the first mollusca to appear tend to be on the skin around the penis or vagina.

What are urethritis, pelvic inflammatory disease, balanitis and vulvitis?

These terms describe the site of a problem rather than a particular cause of the problem.

Urethritis

Urethritis means inflammation of the urethra. The urethra is the tube that passes out urine from the bladder. If you have urethritis you may develop a burning sensation when you pass urine, and men may have a discharge from the end of the penis.

Urethritis is usually caused by a sexually transmitted infection, but not always. For example, it can be caused by chlamydia or gonorrhoea (see above) but can be caused by injury and some other causes.

Pelvic inflammatory disease (PID)

PID is an infection of the uterus (womb). Bacteria that cause the infection usually travel into the uterus from the vagina or cervix (neck of the uterus). An STI is a common cause of PID. Most cases are caused by chlamydia or gonorrhoea. However, some cases are not due to an STI.

Symptoms of PID include pain in the lower abdomen, fever, abnormal vaginal bleeding and a vaginal discharge. Possible complications include: infertility, persistent pain, and an increased risk of an ectopic pregnancy if you become pregnant.

Balanitis

Balanitis means inflammation of tip of the penis. Balanitis is sometimes caused by an STI. However, it is most commonly caused by non-sexually transmitted infections, and skin conditions. Balanitis is common in young children due to non-sexually transmitted infections.

Vulvitis

This means inflammation of the vulva. (The vulva is the 'lips' and skin just outside the vagina.) There are various causes of vulvitis including some STIs.

Conditions that are not STIs

The genitals (vagina and vulva in women, penis in men) can be affected by various other conditions. Some people are confused as to what is and what is not caused by a sexually transmitted infection. For example, the following are not usually due to a sexually transmitted infection:

Thrush. This is an infection caused by a yeast called Candida. Small numbers of Candida commonly live on the skin and around the vaginal area. These are usually harmless. However, when conditions are good for Candida, it multiplies and may invade the vagina and cause symptoms such as a vaginal discharge.
Cystitis (bladder infection).
Bacterial vaginosis. This is a common condition of the vagina. It is caused by an overgrowth of various bacteria that are normally found in the vagina. It is the most common cause of a vaginal discharge.

What are the symptoms of an STI?

Symptoms of each STI can vary from local symptoms affecting the genitals, to symptoms that affect various other parts of the body. The following is not a full list of all possible symptoms. However, these are the common symptoms to look out for:

A vaginal discharge.
Abnormal vaginal bleeding.
A discharge from the penis.
A sore, ulcer, rash, or lump that appears on the penis or around the vagina, vulva or anus.
Pain when you have sex.
Pain when you pass urine (although the common reason for this is a urine infection and not an STI).
Swelling of the glands in your groin.

But remember, in many cases of STI, no symptoms may develop. However, you can still pass on the infection to others even if you have no symptoms. Therefore, if you think that you may have an STI, it is best to get it checked out.

What should I do if I suspect that I have an STI?

If you have a symptom that you think is due to an STI, or if you have no symptoms but are worried you have caught an STI, then you should see a health professional. You can:

See your own GP. Your GP can give advice and may examine you. However, if your GP suspects that you may have an STI, he or she is likely to refer you to a GUM clinic (genito-urinary medicine clinic). Some GPs may do tests and manage the situation without a referral to a GUM clinic, ...OR
Go to a GUM clinic directly. You do not need a referral from your GP to go to a GUM clinic.

Until you are checked out, and treated if necessary, you should not have sex. This is to prevent you passing on any infection.

What are GUM clinics?

GUM clinics are special clinics that help people who have, or may have, an STI or certain other problems with their genitals or urine system. There are over 220 GUM clinics throughout the UK. Staff in most GUM clinics include doctors, nurses and sexual health advisors. Many GUM clinics are attached to hospitals. Some are based in community settings. Other names that have been given to GUM clinics include: STI clinics, STD clinics (STD is short for sexually transmitted diseases), VD clinics (VD is short for venereal diseases), and Sexual Health clinics.

Most STIs are diagnosed and treated at GUM clinics. Some people are diagnosed with an STI in another type of clinic. For example, at a GP surgery, or in a family planning clinic. In these situations you are still likely to be referred to a GUM clinic for treatment, and for any follow up or counselling that may be required.

Anyone can attend a GUM clinic. You do not have to be over 16. If you want, you can take a friend or relative with you when you attend. You can go to any GUM clinic - it does not have to be the one nearest to you.

Do I need to make an appointment to attend a GUM clinic?

This may vary depending on the clinic. For many, you do not need to make a prior appointment but can just turn up. However, you may have to wait some time to be seen depending on how busy it is. It may be best to give the clinic a call in advance to check if you can just turn up without an appointment, and the times the clinic is open. Some clinics can become quite busy.

How do I find a GUM clinic?

There are various ways of finding out where clinics are located, and their times of opening. Your local clinic may be listed in the phone book under 'Genito-Urinary Medicine'. Or, the receptionist at your GP's surgery can usually give you details of the nearest clinic. Or, you can call NHS direct on 0845 4647 to find out details of local clinics.

Some websites (listed at the end of this leaflet) also have a list of GUM clinics throughout the UK giving details of their phone numbers and opening times.

What can I expect when I attend a GUM clinic?

Registration

When you arrive at a clinic you will have to register. You will be asked your name, address, date of birth, contact telephone number, and name of your GP. This information is treated confidentially. The clinic will not contact you at home or contact your GP without your permission. Also, any records from GUM clinics will not go on your main medical record without your permission.

However, if you have a concern, you do not have to give any details. You can even give a false name. The important thing is that whatever name you do use, you should use the same name for any follow up appointment to avoid any confusion. For example, when you return for the result of any tests. To help identify you as the correct person for any follow up, you will be given a card with your clinic number on which you should bring back to any follow up appointment.

Initial assessment

You will be seen initially by a doctor, or nurse, or sexual sexual health adviser. They will ask you some questions to try to assess the situation and to determine what tests (if any) you may need. Examples of questions that you may be asked include:

What symptoms and concerns do you have?
If you do not have any symptoms, what concerns do you have?
How many people have you had sex with in the last few weeks and were they male or female?
What type of sex have you had - vaginal, oral, anal sex?
Have you previously had an STI?
What is the state of your general health?
Do you take any regular medication?
Do you have any allergies?

If you are a woman you may be asked about the date of your last period and whether there is a chance that you may be pregnant as this might affect treatment options.

Examination

A doctor will usually examine you. You can ask for a male or female doctor, but you may have to return at a different time (or even to a different clinic) if a doctor of a particular sex is not currently available. The examination includes looking carefully at your genitals for signs of discharge, redness, lumps or ulcers. The doctor may also feel your groins (the top of your legs) to check for enlarged or tender lymph nodes (glands). If necessary, the doctor may also do a general examination to check on your general health.

Tests

Depending on the initial assessment and examination, the doctor may advise on some tests and ask for your consent to do the tests. Tests may include:

A urine test. This can detect some infections of the urethra such as chlamydia. For this test you will be asked to pass some urine into a sterile pot. (It is best not to go to the toilet just before attending a clinic in case you are asked for a urine sample.)

Swabs. A swab is a small ball of cotton wool on the end of a thin stick. It can be gently rubbed in various places to obtain a sample of mucus, discharge, or some cells. The sample can be looked at under a microscope and sent away to the lab for testing.

Depending on what is suspected, a swab can take a sample from: just inside the urethra, inside the vagina, the cervix (neck of womb), throat, and rectum (back passage). For women, to see the cervix and to make sure the swab sample is taken from the correct place an instrument called a speculum is used. This is a small plastic or metal device that is gently pushed into the vagina to hold open the vagina whilst the swab sample is taken from the cervix. Swabs are used to detect chlamydia, gonorrhoea, trichomonas and genital herpes. A swab sample can also detect thrush, bacterial vaginosis and various other bacteria which may not be sexually transmitted infections.

Blood tests. A sample of blood from a vein may be taken. This is mainly used to test for syphilis, hepatitis B, hepatitis C and HIV. Note: sometimes you may be advised to delay having a blood test. For example, following an initial infection of HIV it can take several weeks for a blood test to become positive. So, for example, if you had sex with someone who is HIV positive within the last few days, you may be advised to wait several weeks to have a blood test to see if you have become infected.

Diagnosis

Sometimes a doctor will be able to diagnose an STI from the examination. Sometimes you will need to wait for the results of some tests. The result of some tests can be available quickly - during your time in the clinic. For some tests it takes a few days for the results to come back from the lab. You may be given an appointment to come back for the results of tests, or in some situations you may be able to phone for the results.

Advice about sexual partners

If you are diagnosed with an STI then the clinic will encourage you to tell any current or recent sexual partners that you have an infection. You are not obliged to do this or to give out any information about other people. However, it is best that any recent sexual partners should know that they might also be infected. They should be offered testing, and treatment if necessary, to prevent the infection being spread any further. This telling of sexual partners is sometimes called 'contact tracing'. If you prefer, clinics can contact people anonymously if you do not wish to tell them yourself.

Treatment

The treatment that you will be offered depends on what STI is found. For example, a short course of antibiotics can usually clear away chlamydia, gonorrhoea, syphilis, and trichomonas. A cream or lotion can clear pubic lice and scabies. Topical treatments can usually clear most anogenital warts. Treatments for genital herpes, hepatitis B, hepatitis C, and HIV are more involved and complex. You will be given advice about what treatment options you have and given time to ask questions. Also, there are separate leaflets for all of these conditions that gives details about treatment options.

If you are prescribed antibiotics then it is important to finish the full course of tablets, or else the infection may not be fully cleared. If you develop side-effects then seek advice from the GUM clinic or from your GP as to what to do. Do not simply stop taking the medication. For some infections you will be asked to return after a course of treatment to check that the infection has gone.

Do not have sex again until the time advised by the clinic. Depending on the infection, this may be for a certain length of time after treatment is finished or it may be until you are given the 'all clear' from a repeat test. The aim is to prevent you from passing on the infection to others.

Advice from a sexual health adviser

Most clinics will have a sexual health adviser. You are likely to be seen by the advisor in addition to being seen by a doctor or nurse. A sexual health advisor is specially trained and can:

Tell you more about STIs and how to avoid catching them in future. For example, the risk of infection increases with the number of changes of sexual partner. Wearing a condom during sex helps to prevent against STIs.
Give you tips on how to cope with any current symptoms.
Offer you free condoms which can help to prevent STIs.
Give advice about what to tell your sexual partner or previous partners.
Help you with contacting previous sexual partners who should be tested or treated. For example, you may be given a card with a number on it, plus a printed message advising the person who is given the card to visit the clinic and to bring the card along. This helps to match them with your notes.

Other services

In addition to diagnosing and treating STIs, if needed, a GUM clinic can also usually:

Do a pregnancy test.
Arrange counselling if you are pregnant and are not sure what to do.
Arrange counselling about the decision to have an HIV test.
Provide advice about contraception.
Provide emergency contraception.
Do a cervical smear test on women if one is due.
Diagnose and treat some other conditions of the genitals that are not sexually transmitted. For example, a urine infection, thrush, and some skin conditions affecting the genital area.

Further help, information and advice

Sexual Health Information Line

Helpline: 0800 567 123 Textphone: 0800 521 361
Provides information on all aspects of STIs including contact details for GUM clinics.

fpa

Helpline: 0845 310 1334 Web: www.fpa.org.uk
Provides information and advice on all aspects of contraception and sexual health.

British Association for Sexual Health and HIV (BASHH)

www.bashh.org
BASHH is a professional association but their website includes contact details of GUM clinics.

References

Prodigy Guidance Several guidanaces related to STIs. Various dates.
British Association for Sexual Health and HIV STI Guidelines. Various dates.

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