STI

What causes gonorrhea?
Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, also called gonococci. The bacterium is found in the urethra and vagina, and sometimes in the rectum and throat.

How is gonorrhea transmitted?Gonorrhea can be transmitted during unprotected vaginal and anal intercourse, during unprotected oral sex. Gonorrhea can also be transmitted during petting and rimming sometimes (if you lick someone’s rectal opening). In rare cases, the infection can also be transmitted to the eye. During childbirth, a woman can transmit the infection to her child, who can then suffer from severe eye inflammation.

How do you protect yourself against gonorrhea?
Using a condom correctly, meaning that it is on throughout the intercourse and does not break or slip off, greatly reduces the risk of infection.

Symptoms of gonorrhea
The incubation period for gonorrhea is short, from a few days to a few weeks. You may be symptom-free. Any symptoms usually appear as inflammation of the urethra, cervix, rectum, or throat. The first symptom for men is usually a burning sensation when urinating. Most often, there is also a discharge from the urethra that can appear in the mouth of the urethra or in the underwear. At first, this discharge is scanty, slimy, and thin, but quickly becomes thick, sticky, yellow-white, and profuse. For women, the symptoms can be reminiscent of a common urinary tract infection, i.e. it stings or itches when you urinate or you feel like you often need to urinate. There may also be a foul-smelling discharge from the vagina. If the infection is in the rectum, symptoms in both men and women can range from mild itching to severe pain. Infection in the throat can be completely symptom-free for both sexes, but can also resemble strep throat.

How are examination and testing done?Gonorrhea is diagnosed by taking a sample from the urethra, (for women from the cervix as well) from the throat and rectum. In some clinics, the sample can be assessed microscopically directly at the time of sampling. A culture sample for the presence of gonococci is always sent to a laboratory for resistance determination. Test results are normally received after approximately a week. The examination is free of charge.

Where can you get tested?
You can be tested at all health care centers, GP surgeries, youth clinics, skin and vein clinics, sex and intercourse clinics, and specialist clinics for sexually transmitted infections.

How to treat gonorrhea?
Gonorrhea is usually easily treated with antibiotics. The treatment is free of charge.

What can happen if you do not get treatment?
Untreated gonorrhea for women can cause inflammation in the fallopian tubes, which can also lead to sterility or ectopic pregnancy in the event of a future pregnancy. For men, it can cause inflammation in the epididymis which can lead to sterility. The infection can also cause eye infections, joint problems, skin rashes, and in the worst case blood poisoning.

How common is the disease?
Gonorrhea was a common sexually transmitted disease in Sweden until the 1980s, when it declined. It has started to increase again. The majority of the reported gonorrhea cases has been infected in Sweden. The domestic spread of infection occurs mainly in metropolitan areas. The disease is common in the rest of the world, both in Eastern and Western Europe, and many Swedes are infected every year in Southeast Asia. The bacteria is often resistant to many drugs if you are abroad and even in Sweden, a spread of resistant gonorrhea has been detected.

Infection tracking requirements according to the Infection Protection Act
According to the Swedish Infection Protection Act, gonorrhea is classified as a disease of general danger. This means that if you suspect that you have been infected, you are obliged to see a doctor to do the examinations and take the necessary samples. All examinations, care, and treatment are free of charge for you as a patient. Gonorrhea is a disease subject to infection tracing, which means that you must provide information about the person or persons the infection may have come from and the person or persons to whom it may have been passed on to. You can choose to contact your partners yourself or have a doctor or counselor do it. In that case, you are always anonymous to your partners through the confidentiality protection in the Infection Protection Act. Occurred cases are reported anonymously to the infectious disease doctor in the county council and to the Public Health Authority.

What causes the disease?
The disease is caused by a virus, Herpes simplex virus, HSV, which exists in two closely related variants, HSV-1 and HSV-2. Both virus variants can cause rashes and sores on the lips (oral herpes) and genitals (genital herpes). However, HSV-1 is more often the cause of oral herpes, while HSV-2 more often causes genital herpes.

How is herpes transmitted?
Herpes virus is mainly found in saliva and the liquid in the blisters that form. Research in recent years has shown that unconscious virus shedding without symptoms can occur and that you can therefore infect a partner without being aware that you are infected or contagious. Herpes virus is transmitted via direct contact, mucosa to mucosa, mouth to mouth, or mouth to mucosa. You can therefore get oral herpes, for example, through kissing and unprotected oral sex. Genital herpes is transmitted through unprotected vaginal and anal intercourse and unprotected oral sex and rimming (licking someone’s anus).

Once the virus has entered the body, it multiplies and spreads via nerve fibers up to nerve nodes at the lumbar spine or the cheek. There, the virus will remain for the rest of your life in the form of a latent or “dormant” infection.

How to protect yourself from herpes?Condoms significantly reduce the risk of infection, provided that they are intact and worn throughout intercourse. Good personal hygiene also reduces the risk of spreading infection. If you have symptoms, you should not share cutlery, food or lip balms with others.

What symptoms can you get?
The incubation period for herpes is usually stated as 2-20 days. However, most people who are infected with herpes initially have no symptoms at all. This applies to both oral herpes and genital herpes. Some of those who are sexually infected can have severe symptoms from their primary infection. The first signs are usually tingling, burning, and itching of the skin. After about a day, blisters appear which burst after a day or so and an oozing wound appears. These sores can be very painful. You can get a high fever, headache, and sore, swollen lymph nodes in the groin. Without treatment, it can take several weeks before you are fully recovered, and the wounds are healed.

After the first outbreak, some people do not have any further outbreaks of herpes infection. The virus that lies “dormant” in the nerve nodes will, however for some people, for various reasons, “wake up”, and be reactivated. They multiply and are transported out to the skin, which can result in a symptomatic outbreak with new blisters and sores. These recurrences are usually milder than the first infection. A relapse can also take place in the form of viral shedding that you don’t notice. The recurring outbreaks usually occur in the same place. Common causes of recurrence are lowering of the immune system such as other infections, menstruation, stress, or sunbathing.

How are examination and testing done?A herpes infection is usually so typical that no sampling is necessary. The diagnosis can be confirmed by taking secretions from a fresh blister or wound and sending them to a laboratory for virus detection.

Where do you turn if the problems are severe?
You can contact a health care center, GP practice, youth clinic, skin and vein clinic, or sex and cohabitation clinic for an examination. Telephone numbers and links to many of the country’s receptions can be found here.

How to treat herpes?
Most often, oral herpes does not require treatment, it is enough to keep the area clean and dry and avoid covering make-up and the like. Compeed® cold sore plasters can be used to hide the wound. There are a number of over-the-counter creams available in pharmacies, such as Anti®, Healip®, Vectavir® and Zovirax®, which can have a soothing effect and make the wound heal faster. For the best effect, the drugs should be started as early as possible. If you have severe and frequent outbreaks, you can discuss with your doctor about getting prescription drugs, for example, Zovirax® or Aciclovir Stada®.

What can happen if you go untreated?
The outbreaks of herpes can last longer if you do not treat it with the creams that are available. A pregnant woman with ongoing genital herpes can infect her child during childbirth, which is why a cesarean section is usually chosen in these cases.

How common is the disease?
Herpes is a very common infection. About 70% of the adult population is a carrier of HSV-1 and about 30% of HSV-2.

What does the Infection Protection Act say?
The disease is not notifiable according to the Infection Protection Act and you are not legally obliged to inform a partner about your infection.

The most commonly reported sexually transmitted infection in Sweden is Chlamydia. The disease does not always cause symptoms which means that many people can be infected without knowing.  Chlamydia is one of the more serious STIs. If left untreated, it can lead to sterility, among other things.

What causes the disease chlamydia?
The disease is caused by a bacterium, Chlamydia trachomatis. The bacterium is mainly found in the urethra, and for women, also in the vagina. It can sometimes be found in the rectum and in rare cases also in the pharynx.

How is chlamydia transmitted?Chlamydia can be transmitted during unprotected vaginal and anal intercourse, during unprotected oral sex, and sometimes during petting and rimming (if you lick someone’s rectal opening).

Important to test yourself
Chlamydia can cause serious complications if left untreated, especially for women (see below). It is important that you get tested if you suspect you might have contracted chlamydia. If you have a partner, he or she should get tested as well.

How do you protect yourself against chlamydia?
Condoms significantly reduce the risk of infection, provided that the condom is intact and worn throughout the intercourse.

What symptoms can you get from chlamydia?
More than half of all people who have been infected with chlamydia have no symptoms at all. For that reason, it is important that you always test yourself if you have had unprotected sexual contact. Those who develop symptoms usually have them after one to two weeks. The most common complaint is that it stings or itches when you urinate. This is because the bacteria has caused inflammation in the urethra. Other symptoms for women can be breakthrough bleeding and discharge, pain in the lower abdomen, and pain during intercourse. Men can sometimes have discharge from the urethra and swelling and pain in the scrotum.

How is examination and testing for chlamydia done?
Unlike an HIV test, a chlamydia test cannot be done anonymously. The test is free of charge and you will receive your test answer after about a week. The test involves providing a urine sample and taking samples from the cervix, rectum, and throat. In the laboratory, DNA determination or culture can then detect the bacteria. Before taking the sample, at least one week should have passed since the time of infection.

Where can you get tested?
You can be tested at all health care centers, GP practices, youth clinics, skin and vein clinics, sex and relations clinics, and specialist clinics for sexually transmitted infections. Telephone numbers and links to many of the country’s receptions can be found here. In some counties, you can order a home chlamydia test, which you send to a laboratory yourself and then get the answer online. If you live in Västra Götaland, Sörmland, Värmland, Gävleborg or Västerbotten, you can order a chlamydia test at home via www.klamydia.se. You can find other options to order home chlamydia tests online at www.klamydiatest.nu or at 1177.se. Via My Care contacts (Mina vårdkontakter), you should then be able to log in and find out your test result.

How to treat chlamydia?
Chlamydia infection is easily cured with antibiotics. You should not have intercourse or petting until the entire course of antibiotics has been completed. In some cases, a control sample is taken after the treatment to make sure that you are infection-free. The treatment is free of charge.

What can happen if Chlamydia is left untreated?
For women, chlamydia can cause fallopian tube inflammation, which can lead to sterility if the infection is left untreated. It is estimated that 50-60% of sterility in women is due to an untreated chlamydial infection. In the case of fallopian tube inflammation, there is also a risk of ectopic pregnancy in future pregnancy. The woman can also infect the child during childbirth so that the newborn child gets an eye infection and pneumonia. For men, chlamydia can cause inflammation of the epididymis, which can sometimes lead to sterility or reduced fertility.

Infection tracking requirements according to the Infection Protection Act
According to the Swedish Infection Protection Act, chlamydia is classified as a disease of danger for the public. This means that if you suspect that you have been infected, you are obliged to see a doctor to do the examinations and take the necessary tests. All examinations, care, and treatment are free of charge for the patient. Chlamydia is a disease subject to infection tracing, which means that you must provide information about the person or persons the infection may have come from and the person or persons to whom it may have been passed on to. You can choose to contact your partners yourself or have a doctor or counselor do it. In that case, you are always anonymous to your partners through the confidentiality protection in the Infection Protection Act. Occurred cases are reported anonymously to the infection control doctor in the county council and to the Infection Control Institute.

What causes the disease?
Condylomas, or genital warts, are caused by a virus that belongs to the group of human papillomaviruses, HPV. More than 100 different types of human papillomavirus have been described. About 40 of these are so-called genital human papillomaviruses and seek out mucous membranes, especially in the abdomen. Some of the HPV types that exist can cause condylomas, while other HPV types are the cause of cervical cancer.

How is the virus transmitted?Papillomavirus is transmitted through direct contact. Unprotected intercourse is the most common route of condyloma transmission. The information today is that you are only contagious when there are warts.

How do you protect yourself against condyloma?
Condoms reduce the risk of infection provided that it is intact and remain on throughout the intercourse. But since the condom does not cover all virus-infected genitals, you can still get infected.

There is now a vaccine that protects against both the most common HPV types that can cause condyloma and the most common HPV types that can cause cervical cancer. The vaccine should be given before the sexual debut for maximum effect. Today it is mainly recommended for young girls.

What are the symptoms?
Condylomas generally do not cause any symptoms other than the warts being felt or seen. The appearance of the warts can vary. Sometimes they are skin-colored, small, and lobed. Sometimes they can be flat and difficult to see without a special examination. The incubation period is often several months, but sometimes it can take a year or longer before warts appear.

For men, the warts are normally on the foreskin, glans penis, shaft of the penis, in the opening of the urethra, or in the rectal area. For women, the warts are seen on the labia, in the opening of the urethra, in the opening of the vagina, on the cervix, or around the opening of the rectum. Regardless of where the warts are located, the virus is likely everywhere in the mucous membranes of the genitals and also in the rectum.

Not everyone gets warts from the virus. You can therefore be infected without knowing.

How is the examination and the testing done?
Condyloma virus cannot be grown in laboratories and therefore it is not possible to tell who is carrying the virus or not. The large typical warts are easy to see and diagnose. If the warts are small or have a different appearance, a microscopic analysis of a wart is needed.

Where can I have an examination?
You can contact a health care centre, GP practice, youth clinic, skin and vein clinic, or sex and relations clinic for an examination. Telephone numbers and links to many of the country’s receptions can be found here.

How to treat condyloma?
There is no cure for the virus, but the warts can be treated. It is usually done by brushing with a caustic solution. They can also be burned or frozen off or removed through small surgical procedures. Like hand and foot warts, warts can be difficult to remove completely and new warts can appear. The infection heals on its own after a few years, but it is impossible to say when you are no longer contagious.

How common is the disease?
Condyloma is one of the most common sexually transmitted infections, but since the infection is not covered by the Infection Control Act, there are no reliable statistics.

What does the Infection Protection Act say?
Condyloma is not covered by the Infection Control Act.

What causes the disease?
LGV is caused by a type of Chlamydia trachomatis. It is the same bacteria that causes a chlamydial infection. This type of chlamydia bacterium is more aggressive than the usual one and is more difficult to treat.

How is LGV transmitted?
LGV is transmitted through unprotected vaginal and anal intercourse, during oral sex, and sometimes during petting and rimming (if you lick someone’s rectal opening).

How do you protect yourself against LGV?
Condoms reduce the risk of infection provided that it is intact and remain on throughout the intercourse.

What symptoms can you get?
There can be a long period of incubation, often up to a month or so. The disease begins with the appearance of superficial small sores on the mucous membrane of the genitals or rectum. These sores are painless and usually go unnoticed. Eventually, nearby lymph nodes begin to swell. This swelling can become very severe and is usually very painful.

How is the examination and testing done?
A diagnosis is made based on the clinical picture but is detected in the laboratory in the same way as ordinary chlamydia. In addition to a positive result for Chlamydia trachomatis, further typing is required.

Where can you get tested?
You can be tested at all health care centers, GP practices, youth clinics, skin and vein clinics, sex and relations clinics, and specialist clinics for sexually transmitted infections. Telephone numbers and links to many of the country’s receptions can be found here.

How is LGV treated?
The infection is treated with the same type of antibiotics as for regular chlamydia, but in a higher dose and for a longer period of time. Sometimes it is necessary to surgically drain a swollen lymph node or cut off a fistula.

What can happen if the infection is left untreated?
Without treatment, the lymph nodes can begin to “melt” and fistulas (founches) can form. If the infection is left untreated, the tissue destruction with its chronic scarring can become extensive and disabling. Because the lymph channels are destroyed, the genital tissue and even bones can sometimes swell and thicken. The area gradually acquires an “elephant-like” appearance both in size and skin texture (elephantiasis). A common complication can also be scarring with shrinkage around the rectum.

How common is the disease?
LGV is very rare in Sweden and in the Western soociety. The disease is most common in the tropical parts of Africa, Asia, and Central and South America. In recent years, however, several cases have been reported from various large cities in Europe and in countries such as Australia, Canada, and the USA. In Sweden, the first cases of LGV were reported in the category of men who have sex with men in Stockholm in 2004. Since then, sporadic cases have been reported, all in the category of men who have sex with men.

What does the Infection Protection Act say?
LGV, just like chlamydia, is classified according to the Swedish Infection Protection Act as a disease of public danger. This means that if you suspect that you have been infected, you are obliged to see a doctor to do the examinations and take the necessary samples. All examinations, care, and treatment are free of charge for the patient. LGV is a disease subject to infection tracing, which means that you must provide information about the person or persons the infection may have come from and the person or persons to whom it may have been passed on. You can choose to contact your partners yourself or have a doctor or counselor do it. In that case, you are always anonymous to your partners through the confidentiality protection in the Infection Prevention Act. Occurred cases are reported anonymously to the infectious disease doctor in the county council and to the Public Health Authority.

What causes the disease?
Syphilis (which is sometimes called lues) is caused by a spiral-shaped bacterium, a so-called gram-negative spirochete, called Treponema pallidum. The bacteria can survive almost anywhere in the human body and can spread quickly.

How is syphilis transmitted?
Syphilis is transmitted through vaginal and anal intercourse and during oral sex. The bacteria can sometimes also be transmitted via kisses if you have primary mouth ulcers. A pregnant woman who is infected can infect her fetus via the placenta. In early syphilis (the first two stages) one is highly contagious, in late syphilis the contagiousness is low or non-existent.

How do you protect yourself against syphilis?
The best protection against transmission is a condom, but since sores can occur in places on the body that are not protected by the condom, protection is not always complete.

What are the symptoms?
Syphilis is, together with tuberculosis and HIV, one of the great “disease imitators”. This means that, depending on the stage of the disease, one can show pretty much any symptoms. Syphilis is usually divided into four stages:

Primary syphilis: About three weeks after infection, a red oval wound (a so-called chancre) appears where the bacteria has penetrated the body (picture). For men, most warts are seen on the penis, anus, and rectum. For women usually on the vulva, cervix, and between the vagina and the anus. The wound often looks clean, is free of swelling, and does not hurt, but can develop into an ulcer that secretes clear mucus when irritated. There is also often a painful swelling of the lymph nodes on the inside of the thighs and groin. The wound usually heals on its own after four to eight weeks.

Secondary syphilis: In this stage, the bacteria spread through the blood to the skin, liver, joints, lymph nodes, muscles, and brain. A rash on the body may appear six to twelve weeks after the chancre has healed. (Picture.) The rash, which neither itches nor hurts, can cover any part of the body, but is usually seen on the palms of the hands or under the soles of the feet. Several painless lesions can also occur in the mucous membranes of the mouth and pharynx and on the skeleton and internal organs. Since the bacteria are found in the secretions of the lesions, the disease is highly contagious at this stage. The rash usually heals without treatment within two to six weeks. Other symptoms may include fever, sore throat, fatigue, headache, neck pain, joint pain, nausea, and patchy hair loss. A large number of infected people show no symptoms at all at this stage.

Latent Syphilis: This asymptomatic stage manifests itself in two phases: early (within one year of infection) and late (after one year) and is followed by secondary syphilis. Late latent syphilis is not contagious because the bacteria is inactive in the lymph nodes and spleen. The latent stage can last three to thirty years and need not progress to tertiary syphilis. About 30% of infected people remain in the latent stage.

Tertiary syphilis: The final phase begins three years or later after infection. In this phase, the person can no longer infect others, but the bacteria is reactivated, multiplies, and spreads in the body. Damage to the heart, eyes, brain, nervous system, bones, and joints can occur, as can tumors of the skin, bones, testicles, and other tissues. Cardiovascular symptoms such as herniated arteries and damage to the aortic valves can occur, causing the central nervous system to decay and cause dementia, tremors, inability to coordinate muscle movements, paralysis, and blindness. The damage cannot be repaired and in the worst case can lead to death.

How is the examination and testing done?
Diagnosis is made using an antibody test, i.e. a blood sample taken from the patient. A first test can be taken about six weeks after the time of infection. In the event of a negative test response, a final antibody test should be taken after a total of three months have passed. Suspected cases of syphilis must always be handled by a specialist. The test is free of charge.

Where can you test yourself?
You can be tested at all health care centres, GP practices, youth clinics, skin and vein clinics, sex and relations clinics, and specialist clinics for sexually transmitted infections. Telephone numbers and links to many of the country’s receptions can be found here.

How to treat syphilis?
Syphilis should always be treated by a venereological specialist.

Primary, secondary, and early latent are treated with injection Tardocillin on two occasions with an interval of one week. Tertiary, late latent, or latent of unknown age is also treated with injection Tardocillin but on three occasions at one-week intervals. If you are allergic to penicillin, treatment can be given with antibiotics, eg Doxyferm or Ery-Max. Control samples after injection treatment must be taken after three and six months and after one year.

People with neurological symptoms of syphilis need to be hospitalized. The treatment consists of benzylpenicillin intravenously for 10 days and then three injections with Tardocillin.

If the treatment was started with late syphilis, control samples must also be taken at intervals of two and three years.

How common is the disease?
Syphilis is unusual in Sweden, but has started to increase in recent years. The domestic spread is currently most frequent among men who have sex with men in big cities. Even globally, the incidence of syphilis is relatively low but occurs more widely in Southeast Asia, Russia, the Baltic countries, parts of Africa, and in large cities in America and Europe.

What does the Infection Protection Act say?
Syphilis is classified according to the Swedish Infection Protection Act as a disease of public danger. This means that if you suspect that you have been infected, you are obliged to see a doctor to do the examinations and take the necessary samples. Syphilis is a disease subject to infection tracing, which means that you must provide information about the person or persons the infection may have come from and the person or persons to whom it may have been passed on. You can choose to contact your partners yourself or have a doctor or counselor do it. In that case, you are always anonymous to your partners through the confidentiality protection in the Infection Protection Act. Occurred cases are reported anonymously to the infectious disease doctor in the county council and to the Public Health Authority.

Riksförbundet Noaks Ark

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