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Sexually Transmitted Infections And Diseases: What You Need To Know

Sexually Transmitted Infections And Diseases: What You Need To Know

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What are STIs and STDs?

Sexually Transmitted Infections (STI) and Sexually Transmitted Diseases (STD) are usually acquired by sexual contact. The bacteria, viruses or parasites that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids. However, these infections can be transmitted nonsexually as well. For instance, from mothers to their babies during pregnancy, childbirth, breastfeeding, blood transfusions or shared needles.

What is the difference between STIs and STDs?

It is the fundamental difference between an infection and disease. Most diseases start with infections. Infection occurs when the bacteria or virus first enters the body and multiplies, progressing it into a disease. Likewise, sexually transmitted diseases initially begin as sexually transmitted infections. 

There are more than 20 known types of STDs/STIs. In Sri Lanka, annual estimates of detected STI cases vary from approximately 60,000 to 200,000, of which government clinics report only 10-15%. About half of these are detected in people aged 15-24. Luckily, most STDs can be treated and cured.

What are the most common STIs/STDs in Sri Lanka?

  • Genital herpes
  • Gonorrhoea
  • Non-gonococcal urethritis (NGU)
  • Syphilis
  • Genital warts
  • Chlamydia infection

What are the most common symptoms of STIs/STDs?

Why is it important to prevent STIs/STDs?

Most STDs can be cured or treated with medication. However, the consequences of ignoring it can include infertility, cervical cancer,  pregnancy complications, congenital disabilities, pelvic inflammatory disease and an increased risk of HIV transmission.

How can the transmission of STIs/STDs be prevented?

The only effective way to completely prevent the transmission of STIs/STDs is abstinence. However, for sexually active persons, consistent and correct use of condoms is highly effective in preventing such infections or diseases.

Questions to ask your doctor?

There has almost always been a stigma around any STD, and it usually trickles down to anyone diagnosed with it. People also feel ashamed that they are somehow damaged. It is important to remember that only a few STDs could be life-threatening. However, with proper treatment, most of it has minimal health impacts. You can have a good life despite having an STD. The majority of it is treatable, and some are even curable. Those STDs for which there is not yet a cure, such as HIV, can still be manageable if adequately taken care of.

Here are a few questions you could ask your doctor:

  1. Should I be checked for STIs?

  2. Can I get an STI by open-mouth kissing?

  3. What if I am pregnant?

  4. Can STIs/STDs cause other health problems in women/men?

  5. How can I prevent having STIs/STDs?

Suppose you are experiencing any of the symptoms mentioned above or need any information on STIs and how to protect yourself or get tested. In that case, you can consult a Sexual Health specialist or an on-demand GP via the oDoc app.

Reference:

  1. What you need to know about sexually transmitted infections, MedicalNewsToday (2021)

  2. Sexually transmitted infections (STIs), World Health Organisation (2019)

  3. What is a sexually transmitted infection?, FPA Sri Lanka (2017)

  4. Types of Sexually Transmitted Infections, Healthy children.org (2015)

  5. How to Reduce Shame and Stigma When You Have an STD, Everydayhealth.com (2019)

  6. How Can You Tell If You Have HIV? HIV.gov (2020)

  7. STD vs STI: Common Types, Symptoms, and Treatment, State Urgent Care (2019)

  8. Sexually transmitted infections (STIs), NHS (2021)

  9. HIV/AIDS in Sri Lanka, The World Bank (2012)

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Family planning? Know your available contraception methods

Family planning? Know your available contraception methods

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Almost all women who are sexually active would have Googled contraception methods. Figuring out which method of contraception is the best for you and your partner can be frustrating. It isn’t spoken about freely and it can be difficult to find out what methods are available to you.  Below we’ve collected all the important information you need to know. We have also explored the pros and cons of each contraceptive method to help you compare your options easily. 

So, here we go.

Firstly, what is contraception?

Contraception, also known as birth control, is the use of artificial methods and techniques to prevent pregnancy.

Birth control – the different types 

There are 5 general types of birth control methods and each works in a different way. Some are temporary and some are more permanent. Some prevent the sperm from meeting the egg whilst some prevent the egg from releasing. Either way, the goal of all the contraception methods is to prevent unwanted and unplanned pregnancies.

It is also important to note that birth control and contraception is not the same as prevention of sexually transmitted infections (STI). Condoms are the only method that prevents the spread and transmission of STI’s so it is advised that you combine the use of condoms with other types of contraception. 

1. Short-acting hormonal contraception

Short-acting hormonal contraception methods adjust the hormone level in the woman’s body making pregnancy much less likely to happen. Some of the commonly used short-acting hormonal contraception methods are the daily use birth control pill and the hormonal injection. Both of these methods require a prescription from your doctor. 

The birth control pill 

There are 2 types of birth control pills available: the progestin-only pill and the combination pill (which contain both progestin and estrogen). 

The hormones released by the pill prevent the release of the egg, the thickening of the uterus and the cervical muscle making it harder for the sperm to enter the uterus. By taking the pill at the same time every day, you maintain a steady level of the hormones in your body, making it a very effective form of pregnancy prevention. 

With perfect use, it’s over 99% effective.

Pros

  • Easy to use
  • Highly effective if taken regularly 
  • Doesn’t interfere with sexual activity 
  • Helps with heavy and painful periods

Cons

  • Mood swings, headaches and other similar physical side effects 
  • Effectiveness is time-sensitive, you have to take it regularly at the same time every day for maximum effectiveness
  • Does not protect against STIs

The Hormonal Shot

The hormonal injection is administered by the doctor every 1 or 3 months to the woman. Like the birth control pill, this too prevents the release of the egg and thickens the cervical muscle making it difficult for the sperm to enter the uterus. 

Pros

  • Easy to use
  • Highly effective if taken regularly 
  • Doesn’t interfere with sexual activity 
  • Helps with heavy and painful periods

Cons

  • Mood swings, headaches and other similar physical side effects 
  • Once off the shot, it may take up to a year for your menstruation to return to normalcy
  • Does not protect against STIs 

2. Long-term contraception 

This is a good option if you want lasting contraception with little maintenance. Available options include an implant inserted into your arm or an intrauterine device (IUD) inserted into your uterus. These methods are 99% effective at preventing pregnancy. They’ll work for 3–10 years, depending on the particular method you choose. 

Implant

The doctor will place 1 or 2 silicone rods under the skin in the arm of the woman. The rods will release the hormone, progestogen into your bloodstream that prevents the release of egg into your uterus. The hormone also thickens the cervical muscle thus stopping the sperm from entering the uterus. Further, It thins the muscle of your womb making implantation of the egg less likely. 

Pros

  • The most effective type of contraception 
  • Long-term, can be kept for 3-5 years
  • Does not affect sexual activity 
  • Not time sensitive 
  • A good option for women who can’t take oestrogen pills

Cons

  • Requires medical attention to insert and remove
  • Does not protect against STIs
  • May have side effects such as headaches and breast tenderness
  • Your periods may be irregular or stop

Intrauterine Device (IUD) 

The IUD is a T-shaped copper device which is inserted into your womb by your doctor. There are 2 kinds of IUD you can get implanted, the hormonal IUD or the non-hormonal version. 

The hormonal version releases the hormone progestin, which prevents sperm from fertilizing an egg. It also thins the uterine lining making implantation of the fertilised egg less likely and thickens the layer of mucus over the cervix to help block sperm from entering in the first place. 

The non-hormonal device releases copper ions which has similar effects to progestin. The ion immobilises the sperm making it difficult for them to swim to the egg. 

Pros

  • One of the most effective methods to prevent pregnancy 
  • Requires no effort from you 
  • Long term, can be kept in for 5-10 years
  • Does not affect sexual activity

Cons

  • Requires medical attention to insert and remove
  • Does not protect against STIs

3. Single use barrier contraception 

Male and female condoms, spermicides and cervical caps are all types of single use barrier contraceptives. As the name suggests, they act as a barrier between the sperm and the egg, preventing the sperm from fertilising the egg.

Condoms

Condoms are a sheath-shaped barrier device made of latex or polyurethane. The male condom is placed over the erect penis and when ejaculation occurs the semen is collected in the condom acting as a barrier preventing the sperm from entering the uterus. The female condom is inserted into the vagina preventing the sperm from reaching the egg. Condoms when used properly are the only form of contraception that effectively prevents pregnancy and STI transmissions. 

Pros

  • They are hormone-free
  • Protects against STIs
  • Has no effect with other medications 

Cons 

  • Interfere with sexual activity and pleasure 
  • Chances of tearing during sex 

Permanent contraception 

If you plan on never having kids you can opt for the permanent contraception methods of Tubal ligation (for women) or vasectomy (for men). They are both simple procedures and they’re almost 100% effective at preventing pregnancy. Recovery time from these procedures usually takes only a few days and have close to no impact on your sex drive and sexual functions. 

During a tubal ligation, both the fallopian tubes are blocked or cut off and during a vasectomy, surgery cuts are made in the vas deferens ( a tube that transports sperms) preventing the sperm from reaching the semen in the testes. Women will still continue to have their periods every month after tubal ligation and men after vasectomy,  will continue to release semen during ejaculation but it will not contain any sperm. 

Pros

  • Permanent contraception 
  • Does not affect sexual activity

Cons

  • Both surgeries are reversible but does not guaranty fertility 
  • Does not prevent STIs

Emergency contraception 

Emergency contraception can help you prevent pregnancy if you have unprotected sex or your birth control fails. There are 2 kinds of emergency contraception pills you can take in Sri Lanka. Please note that emergency pills should not be used as a substitute for contraception.  

Postinor-1 

Postinor One (morning after pill) is a single dose oral emergency contraceptive pill that should be taken within 72 hours of unprotected sexual intercourse. The sooner you take the pill, the higher the effectiveness. Postinor-1 has releases levonorgestrel which delays ovulation and in turn, reduces the chances of fertilisation occurring. Several studies claim that Postinor-1 has the potential to stop 85% of anticipated pregnancies. The tablet is safe to take and does not alter fertility. 

This pill does not have any abortive effect, so if you are already pregnant it will not impact it. 

Postinor-2 

Postinor-2 is a double dose pill. Both the tablets can be taken at once or separately with a 12-hour gap between each. It works the same as Postinor-1. 

It should be noted that the emergency pill will not cause abortion and should not be used as a contraceptive method.

Wondering what the best contraceptive method for you is?

Well, that depends on you and your goal. Speak to your partner and your doctor to decide on the most convenient and most suited method for you. Also, remember there is no 1 method that suits all. Feel free to experiment with each method till you find one that suits your liking. 

If you want more information or would like to speak to a Gynaecologist on the best form of contraception you do so via the oDoc app. 

Sources

  1. FPA Sri Lanka. (2017, January 6). Contraception | Family Planning Association of Sri Lanka. http://www.fpasrilanka.org/content/contraception
  2. Tesch, D. (2021, July 23). 5 types of birth control options: which is best for you? HealthPartners Blog. https://www.healthpartners.com/blog/how-to-figure-out-which-type-of-birth-control-is-right-for-you/
  3. WebMD. (2016, November 18). FDA Explains Pros, Cons of Permanent Birth Control. https://www.webmd.com/sex/birth-control/news/20161118/fda-explains-pros-cons-of-permanent-birth-control
  4. Vasectomy: Treatment & Information – Urology Care Foundation. (202–12-01). Urology Health. https://www.urologyhealth.org/urology-a-z/v/vasectomy
  5. Johns Hopkins Medicine. (n.d.). Tubal Ligation. Retrieved August 3, 2021, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tubal-ligation
  6. WHO. (2020, June 22). Family planning/contraception methods. https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
  7. NHS website. (2021, March 12). Contraceptive implant. Nhs.Uk. https://www.nhs.uk/conditions/contraception/contraceptive-implant/
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Let’s Talk About HPV

Let’s Talk About HPV

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In Sri Lanka, sexual health is a topic rarely spoken about in the open. The taboo and social stigma surrounding this subject may inadvertently lead to sexually active Sri Lankans unaware of how to maintain a healthy sex life. Practicing safe sex is central to this as well as reducing the spread of sexually transmitted diseases (STDs), such as HPV.  

Perhaps you’ve heard about HPV but have been hesitant to ask about it with your loved ones or your doctor. Perhaps you’re sexually active and would like to know how to be safe with your partner, and having an understanding of HPV is one such way to do that.

Well, let’s talk about it!

What is HPV?

The human papillomavirus (HPV) is one of the most sexually transmitted infections in the world today. There are more than 150 different strains of HPV. Depending on the type of strain, HPV can cause warts anywhere on the body. Warts appearing on your genitals is very common. Up to 80% of sexually active adults will get an HPV infection of the genital area at some point in their lives, although many who carry the virus don’t even know it. 

You don’t need to panic if you find a wart on your body since the vast majority of warts are benign and non-threatening but speaking to a VOG doctor will ease your concerns. For a small number of women, certain strains of HPV can cause changes in the cervix that can become cancerous if not treated.

How do you get HPV?

HPV is spread by direct skin contact through vaginal, anal and oral sex with a partner who already has a genital HPV infection. Non-genital HPV infections can occur through skin to skin contact, such as shaking the hand of someone who has a wart on their finger.

What are the symptoms of HPV?

Symptoms of HPV, if they arise, typically appear in the form of a cauliflower-like growth called genital warts. They can also appear flat. Warts can be found around the vagina, anus, mouth and throat as well as the penis and groin. Symptoms usually take weeks or even months to develop after initial exposure. 

Non-genital warts can be found on the rest of the body, especially hands, face, neck, chest, and soles of feet. Some warts can be inside your body, therefore, impossible for you to notice. And in some cases, there might not be any symptoms at all.

How can your doctor diagnose HPV?

Your doctor can diagnose warts by examining the area. Most of the time, warts don’t need to be biopsied unless the doctor is concerned that the warts could be cancerous. A biopsy entails removing a small piece of tissue and examining under a microscope. 

If it’s possible that you have genital warts, your doctor will ask you about your sexual activity. 

  • For women, your VOG doctor will do a pelvic exam and pap smear. This includes removing cells from the cervix to test whether the cells are cancerous. An HPV test, which checks for the actual virus, can also be performed as well. 
  • For men, a physical exam can be performed. 

In the unlikely event that cancer is diagnosed, please speak to a doctor to further discuss the course of treatment.

How do you treat HPV?

Most warts can be treated at home with topical creams prescribed by the doctor. Other long-lasting methods of wart removal include:

  • Cryotherapy (freezing)
  • Cautery (burning)
  • Surgically removing the wart

In some cases, the wart may return. Therefore, you should take preventative measures to reduce the likelihood of getting an HPV infection.

How do you prevent an HPV infection?

Taking preventative measures is of critical importance when it comes to reducing your risk of infection or further spread of the virus. 

Practicing safe sex can greatly reduce the likelihood of getting an infection. This includes maintaining a low number of partners as well as the consistent use of condoms. 

The Centers of Disease Control and Prevention (CDC) recommends all children to be vaccinated before they become sexually active to prevent infection of high-risk strains of HPV. 

For all the ladies out there, an important preventative measure that you can take is visiting your VOG doctor on an annual basis for your routine check up. Your doctor may perform a pelvic exam to make sure everything is normal in your vagina, vulva, uterus, cervix, rectum, ovaries and fallopian tubes. Your VOG doctor might suggest performing a pap smear as well. Pap smears are important as it involves examining cells from the cervix under a microscope to identify any abnormal cervical changes such as precancerous cells. 

We hope you have a better understanding of HPVs now but if you have more questions or are concerned about other issues related to sexual health, you can get in touch with sexual health and VOG doctors on oDoc.

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Let’s talk about UTIs

Let’s talk about UTIs

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Chances are if you are a woman reading this, you’ve suffered from a urine tract infection (“UTI”) at some point in your life. Whether it has crept up on you or was caused by sex or other irritation, the constant urge to urinate, the pain and discomfort in the lower abdomen and seeing blood in the urine is enough to make anyone pretty miserable.

What is a UTI

Mayo Clinic defines a UTI as “an infection of any part of your urinary system (kidneys, ureters, bladder and urethra)”. More than half of all women are expected to suffer from a UTI at least once in their lifetimes and for some women, it can be a recurring, painful battle.     

Women are more prone to these bacterial infections as we have a shorter urinary tract compared to men so bacteria and toxins can cause trouble easily. An infection can start off in the bladder (cystitis) and move up to the kidneys & ureter (uretheritis).

What are the most common symptoms of a UTI?

UTI infection symptoms include the constant urge to pee, a burning sensation when peeing, passing small (to no) amounts of urine, cloudy urine (sometimes rosey coloured with blood) and pelvic pain. 

Older people with UTIs can present with confusion whilst in young children, it often manifests as fever and/or wetting themselves.

Why they occur

  • There are numerous reasons why these infections occur but the most common is human anatomy: the female urinary tract is short, the space between the anus and the urethra is shorter than it is for a male and therefore the distance gut bacteria have to travel to enter the bladder is shorter. 
  • Sex could lead to UTIs due to bacteria from the genital area entering the urinary tract.
  • It’s sometimes found to be a predisposition caused by genetics where females in certain families are more prone to UTIs.
  • Dehydration and limited water intake results in poor flushing of urine from the bladder causing bacterial build up.
  • Material of underwear makes a difference where nylon, spandex and lycra materials reduce the breathability in the area.
  • Hygiene is an important factor where wiping from back to front has caused E.Coli (bacteria) to enter from the gut/anus to the urethra.
  • Pregnancy often causes UTIs as the growing foetus puts pressure on the bladder and urethra causing urine to leak. During pregnancy, a woman’s urethra expands resulting in increased bladder volume but reduced muscle tone causing urine to become more “still” and allowing bacterial growth.

When to contact a doctor

If you experience or are experiencing UTI symptoms, contact an on demand family doctor/GP on oDoc to obtain immediate medical advice and treatment.

How are UTIs treated

Your doctor would generally prescribe you a course of antibiotics to treat the infection. It is vital that you continue to take the antibiotics even after your symptoms subside so as to not build antibiotic resistance to the drug.

Your doctor may request a urine test to ascertain the type of bacteria and match treatment. You can conduct the test from the comfort of your own home via oDoc’s oLabs mobile lab service.

How to prevent a UTI

Anyone who’s experienced a UTI probably never wants to experience one again!

Follow these preventative steps to keep UTIs at bay:

  • Make sure to not hold your pee in, if you need to go, go!
  • Pee before AND after sex to ensure bacteria are flushed out of the system.
  • Avoid wiping back to front.
  • Drink water, especially if you are only in the fledgling state of a UTI. Avoid caffeine and alcohol but gulp down litres of water to flush out the bladder.
  • Although the science is out on this one, Cranberry juice and supplements are said to help ease symptoms and prevent UTIs.
  • Wear cotton underwear, especially given this tropical Sri Lankan climate.

Whilst we may never be able to fully protect ourselves from contracting a UTI, following these simple steps can significantly reduce our chances. If you do develop one or are currently suffering from one, speak to a Sri Lanka Medical Council registered GP or family doctor on oDoc and obtain medical advice, treatment and ultimately, relief!

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Sources

  • Medina, M et al. (2019). An introduction to the epidemiology and burden of urinary tract infections. Thev Adv Urol, 11.
  • Foxman, B., (2003) Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs., Elsevier.,49:53-70.
  • Hisano, M. et al (2012). Cranberries and lower urinary tract infection prevention., Clinics 67:661-667
  • Mayo Clinic, Urinary Tract Infections.
  • Platte, R. (2019) Urinary Tract Infections in Pregnancy., Medscape

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