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Written by Dr Angela Robinson, consultant in sexual health
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What are 'genitourinary' diseases?
These are conditions usually caused by infections that can
affect the genital area and urinary system.
-
Some infections are caught from another person, usually during
sex.
-
Other cases are caused when organisms (bacteria or yeast),
which are usually present in small numbers, overgrow and cause symptoms.
-
Some genitourinary (GU) diseases are caused by bacteria that do
not cause problems in their usual home in the body, but do if they get into
another place.
These diseases are often managed best at a genitourinary
medicine (GUM) or sexual health clinic.
Who is at risk of sexually transmitted infections?
Young people are at greatest risk of
sexually transmitted
infections.
-
They are very unlikely to have been exposed to any sexually
transmitted infections before they start having sex, so they have no chance to
build up immunity (when the body can fight off an infection by itself).
-
In young women, the cervix (neck of the womb) is immature and
is easier to infect. In general, women are more likely to be infected by a man
than vice versa.
-
Younger people may have more partners or change partners more
frequently than older generations. Sexual behaviour is the most important
influence on whether you get a sexually transmitted infection. If you have sex
with someone who is infected then you are likely to get the infection yourself.
The more partners you have the more likely you are to have sex with someone who
is infected.
How do I know if I've got an infection?
Some infections, particularly those that are sexually
transmitted, can produce no symptoms at all. But they might lead to
complications that cause symptoms that prompt you to seek help. Even if
sexually transmitted infections do not cause symptoms, they can still be
transmitted to sexual partners.
-
Some infections cause very similar symptoms. For example,
vaginal discharge in
a woman can be due to non-sexually transmitted infections such as thrush, but
can also be due to sexually transmitted infections. Non-specific symptoms of
change in vaginal discharge and pain on passing urine cannot tell you the type
of infection. To make a diagnosis, tests usually need to be taken. Similarly in
men,
urethral discharge
(from the tube in the penis) can be caused by more than one infection.
-
Sometimes symptoms occur but disappear rapidly. This does not
necessarily mean that the infection has gone away. Often the infection remains
hidden in the body and, if it is sexually transmitted, the infection can be
passed on to a sexual partner.
What are the commonest GU diseases?
Below is a list of the commonest diseases encountered in the
United Kingdom:
-
chlamydia trachomatis
-
gonorrhoea
-
genital herpes
-
non-gonococcal (or non-specific) urethritis
-
pubic lice ('crabs')
-
pelvic inflammatory disease
(PID)
-
trichomoniasis
-
genital warts
-
bacterial vaginosis *
-
cystitis *
-
scabies (passed on through close
contact, not necessarily sexual) *
-
thrush (candida). *
* Note: These diseases are not usually sexually transmitted, but
sex can make the symptoms worse, or sometimes even initiate
symptoms.
Less common GU diseases
The conditions listed below are sexually transmitted and can be
very common in some parts of the world. Therefore, if you have sex without a
condom abroad you are at risk of getting infected. Some of these diseases are
increasing in the UK, particularly HIV and syphilis.
-
Chancroid.
-
HIV.
-
Syphilis.
-
Other causes of genital ulcers: donovanosis, lymphogranuloma
venereum.
Common genitourinary diseases
Bacterial vaginosis (BV)
BV is caused by an overgrowth of bacteria that normally live
in the vagina in small numbers. Although this condition is not strictly
speaking sexually transmitted, BV is uncommon in virgins. The more sexual
partners you have had, the more likely you are to get it. Sexual intercourse
may produce symptoms or worsen the symptoms. Products that affect bacteria in
the vagina can cause the condition or encourage recurrences, including products
added to baths (bubble baths, antiseptics), douches, or forgetting to remove
tampons.
What are the symptoms?
Sometimes women do not have any symptoms, and the condition
is found only when they have a check for sexually transmitted diseases or a
smear test. If symptoms are present they are usually:
-
a greyish white discharge with an offensive fishy smell.
-
a burning sensation or soreness is more common than itching
although this can also occur.
-
there is usually no redness of the genital skin.
Often the diagnosis is missed by a GP, either because thrush
is presumed to be the cause and the woman is not examined, or because the
correct tests are not taken. Make sure you tell the doctor all your symptoms
when you attend surgery and don't presume that you have a condition such as
thrush. At least you can then discuss with your doctor the likely causes of
your symptoms.
How is it treated?
The condition can resolve by itself but often antibiotics
from a doctor are generally needed. Washing the genital area in mild salt water
(1 teaspoon per ½ litre of water) can reduce the soreness and amount of
bacteria present on the vulva (external female genital area) and in the vagina.
Unfortunately even with antibiotic treatment the condition can recur. Treating
the sexual partner makes no difference. Occasionally male partners of women get
infection under the foreskin that gives a strong smell and excess smegma, which
may need treatment.
Chlamydia trachomatis
Infection with bacteria called Chlamydia
trachomatis can cause different GU conditions, including pelvic
inflammatory disease in women and non-gonococcal urethritis in men. The
infection is often called 'chlamydia', although there are other types of
chlamydia that affect other parts of the body (eg, lung and heart).
-
Chlamydia trachomatis is sexually
transmitted and is the second most common sexually transmitted infection in the
UK.
-
In women, the bacterium can infect the cervix and/or the
urethra (urine tube). It can also spread up into the uterus (womb) and
Fallopian tubes (which conduct eggs from the ovaries to the womb), where it
causes complications of pelvic infection (pelvic inflammatory disease - see
PID).
-
Pelvic infection with Chlamydia
trachomatis can lead to infertility (see PID).
Sometimes doctors do not have the facilities to test for
this infection, and if they do, some of the tests are unreliable. Get checked
out at a GUM clinic if you suspect you have this infection.
What are the symptoms?
In women:
-
often women have no symptoms.
-
there may be a change in the quality and quantity of
vaginal discharge.
-
there is sometimes stinging on passing urine.
-
lower abdominal pain is often the first symptom of pelvic
infection (see PID).
In men:
-
Urethral discharge and/or stinging on passing urine or mild
irritation at the end of the penis (see non-gonococcal urethritis). Most often,
no symptoms are present.
Occasionally, chlamydia can cause inflamed joints - this is
more common in men.
How is it treated?
Antibiotics from a doctor are essential. These can be either
single-dose treatment with azithromycin (Zithromax) or a course, usually a tetracycline
antibiotic (such as doxycycline (eg Vibramycin) for a week).
If one partner in a sexual relationship is infected, it is
very important that the other partner is seen and treated to prevent
complications and avoid re-infection.
Cystitis
This is a term that means inflammation of the bladder, and
is another name for lower urinary tract infection. It occurs more in women than
men and the usual cause is infection with bacteria that are normally found in
the rectum (back passage). When these bacteria get into the urethra and then
the bladder they cause symptoms.
What are the symptoms?
-
There is pain, stinging and burning when passing urine,
sometimes only at the beginning or end.
-
There may be a desire to pass urine but only a small
dribble comes out. Afterwards there can still be the feeling that you need to
pass urine.
-
Sometimes the urine has blood in it which gives it a red
colour (you should always consult your doctor if this happens).
Remember that there are other causes of these symptoms apart
from a bladder infection (eg chlamydia) and the only way to make a definite
diagnosis is to have some tests taken.
Men rarely get bladder infections. Often, cystitis in men
can indicate some abnormality within the lower urinary tract that needs further
investigation.
How is it treated?
Products are available over the counter from the pharmacist
that alter the acidity of the urine. An attack of cystitis can be stopped by
using this medication and drinking plenty of fluid (3L a day) to keep the
bladder flushed out.
If the symptoms do not settle within a few hours then go to
your doctor. A urine sample might be sent off for further tests and a course of
antibiotics is usually prescribed.
During a severe episode, it is often more comfortable to
pass urine while in the bath. This tends to avoid the severe stinging.
Some women are prone to get repeated attacks of cystitis. To
avoid these:
-
try to drink plenty of fluid (not tea, coffee, or diet
drinks).
-
do not put off going to the toilet.
-
make sure that you completely empty your bladder when you
pass urine.
-
some women find drinking cranberry juice helps. A severe
attack can be stopped by taking an over-the-counter preparation to reduce urine
acidity as soon as there is any symptom.
Gonorrhoea
This is a sexually transmitted bacterial infection caused by
Neisseria gonorrhoeae. It is less common than chlamydia,
the incidence of gonorrhoea increased by about 30 per cent between 1998 and
1999, particularly in teenage males.
What are the symptoms?
Often women have no symptoms but the following may indicate
infection:
-
a change in vaginal discharge, particularly a change in the
colour from the normal colour of 'off-white' to yellow.
-
pain on passing urine.
-
abdominal pain.
-
like chlamydia, gonorrhoea can get into the uterus and
Fallopian tubes and cause pelvic infection, with longer-term consequences of
infertility.
Men may have urethral discharge and pain on passing urine.
Sometimes no symptoms are present but gonorrhoea tends to cause urethral
discharge more frequently than chlamydia.
How is it treated?
A single dose of antibiotics prescribed by a doctor.
Commonly, ciprofloxacin (eg Ciproxin)
or a penicillin called amoxicillin (eg Amoxil)
are prescribed by
GUM clinics. It is important to have a repeat test after you have taken the
course to make sure that you have been cured of gonorrhoea.
As gonorrhoea is sexually transmitted, it is vital that your
present sexual partners get treated to avoid re-infection and subsequent
complications. To avoid spread of infection, other recent sexual partners
should also be contacted and treated.
Genital herpes
Herpes simplex virus is the cause of genital herpes and of
cold sores. There are two types of virus, type one and type two; both can
affect the genital area.
Genital herpes is sexually transmitted but full penetration
is not required to transmit infection. Close contact is all that is necessary
when ulcers are present (though occasionally the infection is transmitted when
ulcers have not occurred). The virus can be transmitted through oral sex,
especially men to women. Your partner does not necessarily need to have an
attack of oral herpes (cold sore) to transmit the infection to your genitals
but this makes it more likely.
What are the symptoms?
The first sign can be a tingling in the skin followed by
small blisters that burst quickly to form ulcers which then scab over. The
ulcers are usually extremely painful and lumps in the groin (swollen lymph
nodes) are noticeable in most patients. In a first attack, there are often
several ulcers and you can feel unwell. An attack can also begin with pain on
passing urine and a change in vaginal discharge, sometimes with back and leg
pain.
In a first attack passing urine can sometimes be extremely
painful. By doing this in bath water it can be more comfortable. Very
occasionally you might find it difficult or impossible to pass urine. Attend a
doctor immediately if this is the case.
Once you have had an attack of genital herpes, the virus
stays within the body and can cause recurrences. The symptoms in a recurrent
attack are usually much less than the first attack, with one or two small
ulcers and splits in the skin. Occasionally, you can get a more severe
recurrence if you are very run down.
How is it treated?
A first attack of genital herpes is not a condition that you
should self-treat. You should go straight to a doctor, preferably within a GUM
clinic, as soon as you notice any ulcers. The earlier in an attack you start a
course of antiviral medicine, usually aciclovir (eg Zovirax tablets/suspension), the quicker the current
ulcers will heal and the more new ulcers will be prevented.
In recurrent attacks, there is usually no point in giving
treatment because the five-day treatment course usually reduces the symptoms by
only 12 to 24 hours. Keep the genital skin clean by washing in mild salt water
(a teaspoon full of salt to a pint of water). This will avoid 'superinfection'
of the ulcers with skin bacteria.
If there are multiple episodes of recurrence, antiviral
medication can be taken regularly (twice a day) to prevent further attacks.
This is usually given for six months in the first instance.
Genital herpes cannot be cured, which unfortunately means
that it can be transmitted to sexual partners at any time. Avoid sex if you
have any symptoms that suggest a recurrence. Condoms can cut down the risk of
transmission but do not eliminate it. Herpes simplex virus can less commonly
shed from the skin surface without ulcers being present (asymptomatic shedding)
so you cannot rely on symptoms to avoid transmitting the infection.
Non-gonoccocal (non-specific) urethritis (NGU or
NSU)
NGU is an inflammation of the urethra (urine tube) in men
that is NOT caused by gonorrhoea. The commonest cause is Chlamydia
trachomatis. However, in about half of affected men no specific
infection is found - hence the term 'non-specific urethritis' (NSU).
The infections that cause NSU are usually transmitted by
vaginal or anal sex although oral sex can sometimes transmit infection.
What are the symptoms?
Men can have NGU without knowing - if symptoms are present
they are tingling or burning during urination, and urethral
discharge.
Men can also suffer complications such as swelling of the
testicles (epididymitis). Occasionally, joints can also become inflamed.
How it is it treated?
A course of antibiotics - usually doxycycline (eg Vibramycin)
for one week
to cover chlamydial infection - can cure the problem.
If a man has this condition, his female partner should be
checked and treated. It is often not possible to detect a specific infection in
women. But women need treatment because some bacteria that cause NGU in men can
lead to pelvic infection in women. Also, if the woman is not treated then the
man can get re-infected.
Pubic lice ('crabs')
Lice are small insects that are particularly adapted to
living on pubic (genital) hair because the width of their gripping 'legs' are
the same width as the pubic hair. This means that pubic lice cannot infect head
hair but can be found on other body hair such as chest and armpit hair. You
need close contact to transmit pubic lice, not necessarily full penetrative
sex.
What are the symptoms?
Lice cause itching of the hair in the pubic region,
especially at night. Sometimes you can see the lice moving and when the eggs
are laid you can see specks that look like dandruff stuck onto the hairs. Lice
live by sucking blood so sometimes you can see blood spots on your
underwear.
How is it treated?
You need specific insecticide treatment in the form of
shampoo or lotion applied to the pubic area and other hairy areas. The shampoo
or lotion kills the lice and eggs. You can buy this treatment at the chemist
but follow the instructions carefully. Normal washing in soap and water does
not work. Shaving the hair can also get rid of the lice provided all the
affected areas are shaved.
Other information
Although lice can be self-treated, sexually transmitted
infections are often transmitted together. If you catch pubic lice you should
be checked for other infections.
Pelvic inflammatory disease (PID)
This condition that affects women is usually a result of a
sexually transmitted infection that is present in the vagina or the cervix but
goes up into the uterus and Fallopian tubes causing inflammation. It is often a
complication of untreated infection, particularly chlamydia and more rarely
gonorrhoea, which can be present for months before resulting in this
complication.
What are the symptoms?
The symptoms can vary from mild to severe. Pain in the lower
abdomen that is often crampy and like period pains, especially if made worse by
sex, can indicate PID. The pain can come and go and the tummy may be tender to
the touch. Sometimes you can feel tired and unwell and have a temperature. You
may have noticed a change in your vaginal discharge and/or abnormal bleeding
over the preceding weeks. This bleeding can be between periods (spotting) or
your periods can be heavier, longer or more irregular than normal.
Pelvic infection can be confused with other emergency
problems, such as appendicitis, so make sure you get help if you have any of
the symptoms. There are many different causes of abdominal pain and PID can be
difficult to diagnose. A doctor should examine you to try to find out the cause
of the abdominal pain, but they might still have to make a 'best guess' at the
diagnosis. If you are quite unwell, you might need further investigations such
as a laparoscopy (a small telescope examination through the tummy wall that
allows the doctor to look at the uterus and tubes). This investigation is
usually done only if the diagnosis is in doubt or if you have not responded to
standard therapy. If symptoms are severe, some women with PID need to stay in
hospital.
How is it treated?
If PID is likely, a course of antibiotics should be taken to
treat the most common cause of PID, Chlamydia trachomatis.
Rest and take painkillers to control the pain and cut down inflammation. You
must finish the course of antibiotics and avoid sexual contact until your
partner has been seen and treated.
After a single episode of pelvic infection, you have a small
chance of becoming infertile from blocked Fallopian tubes (about 1 in 10 women
have trouble getting pregnant). After a second episode, the risk of infertility
is much higher. Also there is a greater chance of being left with continuing
discomfort in the abdomen. So, you must ensure your partner gets treated to
avoid re-infection.
Scabies
This infection, also known as 'The itch', can be transmitted
by close contact and therefore is not necessarily sexually transmitted.
However, sharing a bed is a very efficient way of transmitting this infection!
Scabies presents itself as a skin problem caused by scabies
mites that burrow into the skin to lay eggs under the skin surface. The eggs
hatch into larvae and grow into adults that then lay eggs again. The itching is
due to an allergic reaction to the mites. Mites prefer particular areas of skin
such as wrists, finger webs or genitals but can burrow anywhere.
What are the symptoms?
The main symptom is intense itching, worse at night and
especially after a hot bath. Small lumps appear, which are due to the mites'
burrows. Scratching can cause damage that allows bacterial infections to
develop. This can alter the appearance of scabies and make the diagnosis more
difficult.
How is it treated?
An insecticide lotion (such as malathion) should be applied
from the neck downwards over the whole skin surface and kept on for 12 to 24
hours before washing. A repeat application may be necessary, depending on the
product used.
The itch may continue for up to a month after satisfactory
treatment. This is due to continuing allergy rather than continuing
infestation. There is no need to use more treatment but a course of
antihistamines can dampen down the itch until it eventually goes away.
There are often outbreaks in families. If one person within
the house has scabies, other members should also be treated. Sexual partners
must be treated.
Thrush (candida)
Thrush is a very common infection. It is not normally
sexually transmitted; you can get it without ever having sex. It is caused by
yeast called candida that are normally found in the vagina. Yeast grow well in
warm and moist places. Most women have a small amount of these yeast in the
vagina but do not get symptoms. When the yeast overgrow, symptoms can
develop.
What are the symptoms?
The most usual symptom is itching that can be very intense
and can affect the anus as well as the vulva. A lot of women notice an increase
in vaginal discharge. This can vary from thin and watery with white flecks in
it to thick 'cottage-cheese-like' discharge. You may notice a smell that is
different to normal although not unpleasant. The vulva can become red and
swollen in a bad attack. As you urinate the urine may sting as it touches the
lips of the vulva.
How is it treated?
Simple measures like washing in slightly saltly warm water
can reduce the itchiness and soreness until you can get to see a doctor. For
women, treatment is a choice of antifungal pessaries or cream, both of which
are inserted into the vagina (eg clotrimazole), or antifungal medicine taken by
mouth (eg fluconazole).
Some of the treatments are now available over the counter.
However, the first time you have vaginal discharge that you think is thrush, it
is important that you get a correct diagnosis by having an examination and
preferably some tests.
Some women get thrush recurrently. For these women, it may
be more convenient to buy over-the-counter medication. However, if you have
recently changed sexual partner or think you may be at risk of sexually
transmitted infections, you should have a check-up.
Women can transmit the yeast to their male partners,
especially if the man has a foreskin. It has not been proven that such men can
infect women - women are much more likely to get a recurrence of their own
thrush. Some women are particularly prone to thrush when taking antibiotics -
if this is the case, ask for an anti-thrush treatment alongside the
antibiotics.
Trichomoniasis
This infection is caused by a small parasite called
Trichomonas vaginalis (TV) that infects the vagina and
urethra. It is almost always transmitted by sexual contact.
What are the symptoms?
In women, the usual symptoms are a yellow or greeny
discharge that smells unpleasant. There is often a lot of discharge, which can
be frothy. Itching and irritation of the skin of the vulva are very common with
TV. Symptoms can start within a few days of catching the infection or can take
a few weeks to develop.
How do you treat it?
Antibiotics are required - you should get these from your
doctor.
As TV is sexually transmitted, partners must take treatment.
Men usually have no symptoms, although occasionally they get stinging on
passing urine. If your partner is not treated, you are at risk of getting
re-infected.
Genital warts
What are genital warts?
Genital warts are a condition of the genital skin caused by
a virus called human papillomavirus (HPV). There are many different types of
HPV, some of which prefer particular areas of skin (eg hands and feet). Other
wart virus types prefer the genitals.
Genital warts are transmitted by close contact between the
genitals of an infected person and those of a non-infected person, usually
during sex. The wart virus can be caught and then lie dormant in the skin
without causing any problems. Later, the wart virus may start to divide and
produce a wart. This can take from six weeks to many months, or even years.
Because the time from catching the virus to getting warts is very variable, a
previous partner could have infected you a long time before warts appear.
What are the symptoms?
Warts often go unnoticed because they do not produce many
symptoms and are difficult to see. Occasionally they itch or bleed. Sometimes
you can feel them as lumps that are gritty to the touch. Some warts are flat
and others are more fleshy. Warts can be found on any part of the genital skin
including around the anus even if you have never had anal sex.
How are they treated?
Many different treatments are available, which include
applying solutions directly onto the wart, freezing, burning or surgically
removing the warts. It is important to consult your doctor before applying any
solutions. Sometimes the solutions can cause the skin to become sore. Keep the
area clean by washing in very dilute salt water (1 teaspoon to a pint of
water).
Unfortunately, warts come back after treatment in about 30
per cent of patients. It is not because you have re-caught the infection but
because the wart virus remains in the skin. Eventually your body should develop
immunity to the wart virus and the warts will go away.
Warts commonly co-exist with other sexually transmitted
infections, so you must have a check-up to exclude other infections.
While you have warts you are infectious. Condoms offer some
protection but obviously they cover only the penis and there are other areas of
the skin that come into contact during sex.
Less common genitourinary diseases
Chancroid
Chancroid is a sexually transmitted infection common in the
tropics but rarely, if ever, caught in the UK. It is caused by
bacteria.
What are the symptoms?
Symptoms usually appear about two weeks after you have had
sex with an infected person. You get painful ulcers, usually several at a time.
You may also notice lumps in the groin, which are swollen glands (lymph
nodes).
What is the treatment?
You need to take a one to two week course of antibiotics. It
is very important to attend a GUM clinic so that proper tests can be taken to
make sure that you get the right treatment.
Syphilis
This infection, caused by Treponema
pallidum, is uncommon in the UK but becoming more common. It is much
more common in developing countries, the USA and also Eastern Europe. This
sexually transmitted infection is easily treated if detected but can be serious
if left untreated.
If not treated when first caught, the infection goes through
three stages. In all stages, the infected person may not have any symptoms.
Therefore, blood tests are taken routinely for syphilis screening in antenatal
clinics and GUM clinics.
What are the symptoms?
First stage: often a single small sore or ulcer is present
on the vulva, although the anus can also be affected. There are usually swollen
glands in the groin. The sore appears up to 12 weeks after contact with an
infected person and lasts approximately six weeks. It can heal without any
treatment.
Second stage: as the sore is healing, the second stage of
syphilis occurs, two to six months after contact with an infected person. The
symptoms are 'flu-like' with headache, fever, sore throat and swollen glands.
Usually a rash appears on the body that can affect the hands and feet.
Later stages: Treponema pallidum
organisms are present in the bloodstream and can get into the brain and spinal
cord. For several years, the infection may not cause symptoms (latent
infection, or 'third stage'). In late stages, the organism can affect the heart
and brain leading to permanent damage. This does not occur if the infection is
treated adequately and early enough.
What is the treatment?
A prolonged course of antibiotics, usually by injection, is
required for 10 to 21 days depending on the stage of infection. After
treatment, regular check-ups at yearly intervals are advised.
Previous and present partners should have a blood test for
syphilis. The organism can be transmitted up to two years after contracting the
infection. After two years of having the infection, you are unlikely to
transmit it to a sexual partner.
Human immunodeficiency virus (HIV)
HIV is the virus that without treatment usually causes AIDS
(acquired immune deficiency syndrome). Infection is uncommon among
heterosexuals in the UK, unless they engage in specific risk behaviours, such
as having sex with someone who has the infection already. More women are
becoming infected in the UK.
HIV is present in body fluids including blood, semen, and
vaginal and cervical secretions so it can be transmitted by sharing body
fluids: through sexual intercourse, sharing needles, blood transfusion, etc.
The virus is not just an infection of gay men but can be transmitted through
vaginal sex. Anal sex is particularly risky, and transmits the infection more
easily than vaginal sex. The virus is less likely to be transmitted through
oral sex than penetrative sex but transmission can occur, especially if there
is bleeding from the gums, or mouth ulcers are present. Although the virus is
found in saliva, kissing has not been found to transmit infection. HIV is not
passed on through everyday social contact such as sharing plates, cutlery,
towels, etc.
What are the symptoms?
When HIV infection is first caught, most people notice no
symptoms although many can later recall a mild flu-like illness. A few people
will feel feverish and unwell with swollen glands and often a skin rash. These
symptoms last a short time and then the infected person returns to full health.
People with HIV often look and feel well for many years but remain infectious
to others.
Eventually, most people with HIV will develop AIDS if left
untreated. AIDS consists of numerous infections and other illnesses that
involve many different body organs.
How it is it treated?
There is no cure or vaccine available for HIV infection.
Some treatments are available that can slow down the production of new virus
and delay the development of AIDS.
There are many different medicine combinations, all of which
have some side effects. Further information is available from helplines and
websites. HIV is a life-threatening infection and the only way to protect
yourself is by using a condom. You will also reduce the risk by knowing whether
your partner has HIV. Tests are readily available from GUM clinics.
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Last updated 05.10.2005
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