The Better2Know Blog

A study based in four different settings in London found that by testing people (regardless of their risk profile) for HIV.  The HINTS study was conducted between August 2009 and September 2010, in an A and E dept, inpatients dept, a skin conditions clinic, and a large GP practice.

As reported in our blog on 18 May 2012 the FDA in the US has now approved an over the counter HIV test which can provide a result at home in 20 to 40 minutes.  The test uses saliva which does have a higher rate of false positives, but recommends that all positive tests are followed up with a blood test.

The Health Protection Agency (HPA) has called for everyone in the UK to be tested for HIV. The HPA’s Annual Report states that the number of people who are living with HIV in the UK is now just under 100,000, but more than 21,000 (I in 4) of these do not know that they have the virus.  Increasing the number of people who are tested would help early diagnosis, which has two benefits:

• early treatment and medical intervention is key to preventing the disease from progressing
• prevents new infections

Currently, 1 in 5 people attending a GUM clinic refuse an HIV test and are only tested for Chlamydia, gonorrhoea and syphilis.  This is because they are scared to know their status, or do not think it can happen to them. If you think you may be at risk of catching one STD, you cannot tell which one it might be, which is why Better2Know offers a comprehensive screening choice and range of tests.

The HPA also reported that the standard of care in the UK for people with HIV is excellent with excellent access to treatment and lower than expected CD4 counts (a measure of the progress of the infection).

Better2Know offers HIV testing at 10 days after potential exposure (such as unprotected sex) using an advanced technique looking for the actual HIV virus, and then the 28 days after potential exposure test called the H- Duo which looks for both the antibodies and the antigen (the body’s reaction to being infected with the virus).  The Terrence Higgins Trust recommends testing:

• immediately you are worried – to get initial peace of mind, but also help with contact tracing should you later be HIV+
• at 28 days with the H-DUO test
• at 3 months
• at 6 months

Better2Know only uses blood tests (not saliva which is less reliable) to test for HIV.  Instant (up to 20 minutes) tests for HIV are also available in some of our clinics.  HIV tests at 10 and 28 days post potential exposure are available at all our Nationwide clinics.

A new study published by the BMJ shows that the UK’s national screening programme for chlamydia which started in 2000, and aimed to test all 16-24 year olds, has meant a significant decreased in the prevalence of the infection.

The number of new cases of gonorrhoea rose 25% in 2011 from the year before in England.  There are now cases of gonorrhoea (a bacterial infection) in Japan and Europe which so far have failed to respond to antibiotics which are used to cure the Sexually Transmitted Infection (STI).

In a new survey of General Practitioners (GPs) in South East London, where more than 2 in 1,000 of the population is HIV+ (the highest in the UK), Family Doctors reveal why they do not routinely give their patients HIV tests:

The below is the abstract to a report which shows why men as well as women should be tested for Gardnerella.

Although the incidence of Hepatitis C in the UK is relatively low, A study conducted using residual sera collected as part of the HPA Sero-epidemiology programme suggested that around 106,000 individuals became infected with hepatitis C between 1986 and 2001 (HPA 2009 report Hepatitis in the UK).

Primary prevention of hepatitis C infection involves a variety of practical measures, some aimed particularly at risk groups, and other more general measures to ensure that the national blood supply is safe through donor selection and screening. Rates of HCV-related serious liver disease are increasing. Unfortunately, many people living with hepatitis C are unaware of their infection status, resulting in a silent reservoir of infection in society.

An important part of the overall strategy to control hepatitis C is to improve awareness of the infection and encourage testing in risk groups. Once diagnosed, effective treatment can help eliminate a persistent infection, in at least some patients, and so reduce the number of infected individuals. Treatment before the onset of recognisable disease reduces the progression to late complications of infection. Patients who respond to therapy by clearing the virus can avoid the risk of serious liver damage. Among patients who do not respond to therapy, the risk of developing long-term liver damage can be reduced by modifying other risk factors, such as alcohol consumption and avoiding infection with other hepatitis causing viruses.

Having a clear strategy is only the first step in achieving a real impact. Equally important is the delivery of interventions and review of their efficiency.

Progress made to date in the UK varies from country to country, reflecting the different stages of implementation of hepatitis C control programmes and the different approaches taken in the different administrations. A four nations approach will encourage the sharing of good practice and help to identify best practice.

The number of deaths in England due to end-stage liver disease (ESLD) or hepatocellular carcinoma (HCC) with any mention of hepatitis C on the death certificate continues to increase. The number of deaths registered has increased from 81 in 1996 to 230 in 2008. The majority of deaths are in men. The number of deaths in women has remained relatively stable over the last decade.

It is clear from the above facts and report from both the Hepatitis C Trust and the Health Protection Agency, that there is a very considerable health gain from the detection of a Hepatitis C infection. A gain to be enjoyed not only by the individual in whom the infection is detected, where if it had remained undiagnosed, might have lead to cirrhosis, cancer and possibly death, but gains also to society, where infection rates remain on the rise, are recognised by the HPA to be a national health risk, and for which detection of each case can lead to treatment, and the prevention of onward transmission of the disease.

Leaving Hepatitis C undetected can lead to severe complications.

HIV (Human Immunodeficiency Virus) is a retrovirus that can lead to Acquired Immunodeficiency Syndrome (AIDS), a condition in which the immune system begins to fail, leading to life-threatening infections we ordinarily would be able to fight naturally.

You can reduce your chances of catching and/or transmitting an STI or STD by following the suggestions:

A new report published by the National AIDS Trust calls for technology to become a greater part of  helping people newly diagnosed with an STI including HIV to tell their former partners.

New cases of gonorrhoea rose by 25% in the UK in 2011.  A report published by the HPA shows that gonorrhoea is now the second most common sexually transmitted bacterial infection in the UK behind Chlamydia.  There were 20,965 new cases in 2011.

Although bacterial vaginosis can often clear up without treatment, it is advised that all women with BV signs and symptoms be treated to avoid complications. Male partners do not usually require treatment. BV can spread between female sex partners.

It is important to remember that it is usually impossible to have entirely safe sex with another person.

But there are some other things you can do to help protect yourself from catching an STI / STD:

• The HPV vaccine can help protect some people against the HPV virus which causes genital warts and some cancers including cervical cancer.
• The Hepatitis B vaccine can help protect against the Hepatitis B virus.
• Some studies have indicated that Male circumcision can help protect against the transmission of HIV. Note this is NOT to be relied upon and the use of condoms is always highly recommended.
• Regular testing for all STD’s and STI’s has been proven to reduce the overall incidence of infections. Early detection can help in the treatment and outcomes of most infections and diseases.
• Sex with one partner (monogamy) if practiced faithfully is very safe (in regards to STD’s and STI’s). If one partner is unfaithful however, the risk of transmitting an STD or STI increases.
• Good communication is a very important and effective means of determining the risk of catching or transmitting and STD / STI. Partners should openly discuss their sexual habits and history and condoms or other protective barriers should be used. Couples entering into a sexual relationship should both be tested early in their relationship for the full range of STD’s / STI’s.

Other considerations

It is important to remember that most methods of birth control do not protect against STD’s and STI’s.

The birth control pill (The Pill), vasectomy, tubal ligation, contraceptive coils, diaphragms, contraceptive foams and gels, sponges and other contraceptive methods do not offer any protection against contracting and STD or STI. Whilst condoms (both male and female) do provide good protection against pregnancy and STD’s / STI’s) they are never 100% effective.

Pulling out prior to ejaculation (coitus interruptus) when the penis is withdrawn from the vagina, anus or mouth before ejaculation is not safe and does not prevent either pregnancy nor the possible transmission of STD’s / STI’s. Even before ejaculation, the penis can release pre-ejaculate fluid which can carry bacteria, viruses and other disease causing organisms, and it can also carry sperm which can lead to pregnancy.

Alcohol and other drugs

It is important to remember that if you have drunk to much alcohol or have taken drugs, your judgement may be impaired and your ability to resist having unsafe sex may be reduced.

Ureaplasma Urealyticum is a bacterium which occurs naturally in men and women.  Therefore, it is not considered a classic STI, although it can be passed on through sexual contact.  When a colony of Ureaplasma Urealyticum overgrows, it can cause irritation, discharge, inflammation, and red swellings and itching.

If untreated, ureaplasma can cause complications such as infertility and make giving birth much harder.

Ureaplasma is tested with a sample of urine.  You can test for Ureaplasma at Better2Know on its own or as part of our Platinum, Full and Comfort Screens.

Ureaplasma can be treated with a course of antibiotics.

24% of deaths of  HIV positive adults in the UK were due to late diagnosis of their HIV Status. These figures are according to National Audit Data.  One third of newly HIV positive people do not know their status within a year.  This makes them more likely to infect new partners.  HIV is no longer considered to be a life threatening condition, as long as it is detected early, and treatment started.  Knowledge really is power when it comes to managing HIV.

When you are worried that you may have an STD or STI, the idea of waiting for an appointment for an STD test can add to these concerns.

Not detecting Herpes can have the following consequences, as reported in The Guardian, Friday 19 August 2011:

Pass on herpes, go to jail?

Herpes is a common, manageable sexually transmitted infection. A 14-month sentence for transmission is draconian.

How should the criminal law respond to those who pass on sexually transmitted infections (STIs)? The answer to this question has become more pressing in light of the conviction of David Golding, who pleaded guilty at Northampton crown court to causing grievous bodily harm by passing on genital herpes to his former partner, Cara Lee.

Sentencing Golding to 14 months in jail, the judge said:
“Because it was in a relationship, it was particularly mean and one which amounted to a betrayal – a betrayal in a relationship in which you professed love … The injury you caused by this infection is at least or more serious than an injury leaving a scar because it carries continued recurrence, extreme discomfort and consequences for relationships she will have in the future.”

Granted, in this particular case the transmission of Herpes was wilful and done with malice, however it does illustrate that the courts are prepared to consider the transmission of diseases in a criminal context and take appropriate action against the individual for not taking a suitable level of care to protect their partner.

Another case is equally enlightening, featured in WebMD on May 22, 2000:

When a Partner Gives You Herpes: Can you sue? Perhaps. Just don’t expect an easy win.

Catherine Leleux of Louisiana was barely 18 years old in 1995 when she was seduced by her Navy recruiter, Petty Officer Paul Sistrunk. Several weeks later, she came down with a case of genital herpes. Leleux sought out a personal injury lawyer, Lamont Domingue. Struck by her calm, affable demeanour, he agreed to take the case, even though he knew that a sex-related lawsuit in politically conservative Louisiana would be “ugly and hard-fought.”

In filing suit, Domingue sidestepped Sistrunk and went after his employer, the federal government. After all, it had the deepest pockets, and it was vulnerable: Navy officials had discharged Sistrunk under “less than honourable conditions” after Leleux’s complaint came to light. Domingue thought she could collect a half-million dollars. But it was not to be: Last July, the U.S. Court of Appeals ruled that Leleux didn’t have a case.

Technically speaking, the court said, Sistrunk’s failure to disclose his herpes made the sex he had with Catherine non-consensual, because she would not have agreed to it if she had known about his disease. Reasoning further, the court held that if the sex was non-consensual, it was battery. And because battery is intentional, under federal law the U.S. government could not be held liable (as it would have been if the sex had resulted from its negligence).

Leleux packed her bags and moved to another state, marrying a man who knew her history and was willing to contract herpes from her (which he promptly did). Meanwhile, Domingue was left to ponder a sad truth: While it can take no more than a single night of sex to contract a sexually transmitted disease (STD), trying to collect damages for the hurt that follows can be a legal nightmare.

So there can be absolutely no doubt that herpes transmission whether wilful or not can and will be taken very seriously by the law and any individual caught up in such a case will suffer immeasurable harm and distress throughout the court proceedings and indeed for many years after. This can apply to both parties in the case who will suffer the trauma of a complicated legal case that will ultimately leave one side unhappy. The testing for and detection of Herpes will thus empower the individual to make appropriate decisions and ensure they do not expose themselves to the risk of any legal actions brought by a former partner.

In the last 10 years, new HIV infections have doubled according to the Wellness Protection Agency with around 2,000 new cases a year in 2000, to over 4,000 in 2010.  Most new cases were in men who had sex with men and amongst the black African community.

NICE (National Institute for Health and Clinical Excellence) have introduced new guidelines for doctors recommending that they test all men who register at a practice where there are more than 2 HIV+ per 1,000 of the population.  This will affect London (Islington, Camden, Lambeth) as well as Manchester and Brighton.

Early diagnosis is key in managing HIV and preventing new infections, and good management means that the condition no longer has to be life threatening.  Better2Know can do HIV tests from just 10 days post contact (with a test that is not available on the NHS) as well as the very reliable H-DUO test from 28 days post contact.  We also have tests with instant results at many of our STD testing clinics.

Some STDs and STIs can be passed on by sex toys which are used by more than one person.

If you and your partner use a sex toy, it is always a good idea to cover it with a condom. Replace the condom each time the toy is shared between you and your partner. Some toys are made of materials which can trap and hold bacteria and viruses which cause STDs and STIs. It is very important that all sex toys be thoroughly washed and disinfected both prior and after use by each person. It’s a good idea to use cleaners that are specifically made for cleaning sex toys. Sex toys made out of glass and other non-porous materials are more easily cleaned and sterilised between uses than some other materials.

Some sex toys such as whips, needles, restraints and other similar devices can draw blood and their use is not recommended.

What is Hepatitis C?

Hepatitis C is an infection with the hepatitis C virus (HCV). Estimates suggest over 250,000 people in the UK have been infected with hepatitis C, but 8 out of 10 don’t know they have it because they have no symptoms. About 75% of these people go on to develop a chronic hepatitis. Because it can take years, even decades, for symptoms to appear, many people (possibly 100,000 or more) remain unaware they have a problem. By the time they become ill and seek help, considerable damage has been done to the liver. This might have been prevented if the person had been diagnosed earlier. About 20-30 per cent of people clear the virus from their bodies – but in about 75 per cent of cases, the infection lasts for more than six months (chronic hepatitis C). In these cases, the immune system has been unable to clear the virus and will remain in the body long term unless medical treatment is given. Most of these people have a mild form of the disease with intermittent symptoms of fatigue or no symptoms at all.

About one in five people with chronic hepatitis C develops cirrhosis of the liver within 20 years. Hepatitis C virus is usually transmitted through blood-to-blood contact. One common route is through sharing needles when injecting recreational drugs – nearly 40 per cent of intravenous drug users have the infection and around 35 per cent of people with the virus will have contracted it this way. Similarly, having a tattoo or body piercing with equipment that has not been properly sterilised can lead to infection. Hepatitis C can be sexually transmitted, and it can be passed on through sharing toothbrushes and razors.

How is Hepatitis C treated?

Hepatitis C can be treated with pegylated interferon alpha and ribavirin. These drugs offer the best chance to clear the virus from the body, and are often used together as dual or combination therapy which has been shown to be effective in 55 per cent of cases. Some strains or genotypes of the hepatitis C virus are more likely to respond than others. Even if the virus isn’t completely cleared, the treatments can reduce inflammation and scarring of the liver. They may, however, cause side effects that some people find difficult to tolerate. Many people also find that complementary and lifestyle approaches help. There is little evidence these can reduce levels of the virus, but they may help to deal with symptoms and improve quality of life.

People with chronic hepatitis C infection should be seen by a hospital liver specialist who may recommend antiviral drug treatments either as single drug therapy or as combination therapy. Whether treatment is needed, and if so which type, depends on a number of factors. These include blood tests to identify which strain of hepatitis C infection is present and how well the liver is functioning, and a liver biopsy to establish whether cirrhosis is occurring.

If you want to know how to not catch an STI or STD, here are some top things to remember:

Not detecting Trichomonas can lead to the following complications:

Complications are rare with trichomoniasis. However, the infection can sometimes weaken the barrier of mucus in the cervix (the neck of the womb). This mucus barrier helps to protect women from developing infection in their reproductive organs. If the mucus is weakened, this increases your risk of developing HIV. It is therefore very important that you practise safe sex by always using a condom.

Source: NHS Choices

Gaydos and her colleagues study involved 7,593 U.S. women between the ages of 18 and 89 from women in 28 states and it is believed to be the largest and most in-depth analysis of the STD ever performed in the United States, complementing periodic national surveys of adolescents and individual city reports.

The test samples were collected from women in private clinics, emergency departments, hospitals, jails and community health STD clinics between July 1 and Dec. 30, 2010. Researchers used the latest genetic assay, a test that is almost 100 percent foolproof in detecting trichomonas, instead of traditional testing methods, which are only accurate about half the time.

Test samples showed women 50 and older had the highest trichomonas infection rate (13%), while women in their 40s were next (11%). The infection rate was 8.5% in women ages 18 and 19, dropping slightly to 8.3% for women in their 20s.

Overall, the survey results showed that 8.7% of all women tested positive for the STD. Infection rates were highest among black women of all ages, at 20%, more than three times the rate in white women (5.7%).

Source: Charlotte Gaydos, M.S., Dr.P.H., Johns Hopkins University

It is clear from the above that complications are thankfully rare, but untreated, the NHS itself makes clear that Trichomoniasis can increase the risk of contracting HIV, a life threatening condition.

Although the associated risks may be small, the incidence of this infection is relatively high. Better2Know is offering this test within the Platinum Screen to provide those patients selecting the Platinum Screen to be confident they know their status and can take appropriate measures to ensure they are not exposed to these risks at all.

Trichomonas Vaginalis is a protozoan, which is a small organisim similar to bacteria.  The Trichomonas protozoan can infect the vagina in women, and the urethra and occasionally the prostate gland males.  Trichomonas is normally passed on by sexual contact and is the third most common STI.

Trichomonas infection is one of the most common protozoal parasites and is a major cause of symptomatic vaginitis.  It is one of the most common yet curable STDs which can occur among sexually active men and women. The Trichomonas organism is most frequently transmitted through vaginal intercourse but can also be transmitted by vulva to vulva contact between two women.

Trichomonas can be tested with a urine sample and Better2Know can test for it on its own, or as part of our Platinum or Comfort Screens.

Trichomonas can be easily treated with a short course of antibiotics, and you can receive a prescription from a Better2Know doctor if you test positive.

Figures published by the HPA show the most common STIs and STDs in men who disclosed that they had sex with men.

The most common STI is Syphilis, which accounted for 2 in 3 of all positive diagnoses (so of those who did have an STI or STD, 2 out of 3 had syphilis).

40% of those who had and STI had gonorrhoea (therefore as you can see, some men will have had more than one infection), and around 10% had Chlamydia, syphilis, and genital warts.

There was a particularly high incidence in men who were HIV+ contracting further STIs and STDs, showing a worrying lack of precautions many men are taking to stop the spread of HIV and other STIs.

In the United States, the generation known as baby boomers (born between 1945 and 1965) have been urged to get a Hepatitis C blood test.  It is thought that less than a quarter of this generation have ever tested for the Hepatitis C virus.

In the USA, the Food and Drug Administration (FDA)‘s advisory panel has this week voted unanimously to take forward plans to allow an oral (using a saliva sample) to be sold over the counter in the United States. This test, made by Oraquick, takes 20 minutes to run, and although not as accurate as a blood test (such as those offered by Better2Know in the UK).