The first thing to know is that STIs and STDs are, essentially, one and the same. STI stands for sexually transmitted infection while STD stands for sexually transmitted disease. In recent years, the term STI has become preferred usage; this is because STIs are often treatable and show no symptoms. Therefore the term ‘infection’ suits them better than ‘disease’. Many medical experts also believe that saying STI instead of STD reduces the stigma associated with the original acronym and helps clarify
that not all sexually transmitted infections necessarily turn into a disease. For example, about 90 per cent of women who contract HPV (human papillomavirus) do not go on to develop cervical cancer, and are rid of their infection within two years.

So, STD and STI essentially stand for the same thing, even though they are not, strictly speaking, the same. The distinction is that although all STDs are preceded by STIs, not all STIs result in the development of STDs. At WH&F, we’re all for talking about sexual health in a way that promotes the positive rather than the negative; so for the purposes of this article we will only be
referring to STIs.

CRUNCHING THE NUMB3RS

Research reveals numerous reasons for skipped STI tests: women are afraid of judgment, they dislike the invasion of privacy, they don’t feel they ‘need’ to get tested, they are under time pressures or they simply baulk at the cost. The truth is, STIs are associated with a palpable sense of shame and there’s still a taboo when it comes to talking about them. It’s not just talkingabout them, though – a lot of people don’t even want to think about them. Testing is likely to remain at a disturbing low so long as we allow this fear of negative stigma to maintain control.

We’ve enlisted the help of Dr Mitchell Tanner, head doctor at STI testing company Stigma Health, to explore which STIs are on the rise among women, what symptoms you should look out for, and why amazing advancements in technology are making
sexual testing cooler and more convenient. Yes, STIs may never be a barrel of laughs, but if you’re someone who’s sexually active and cares about your body, you do need to take them seriously. There’s a lot more to protecting yourself than simply rolling on a condom or taking the Pill.

CHLAMYDIA

Chlamydia, a bacterial infection that’s easily cured with antibiotics, is now the most commonly reported sexually transmitted infection in Australia. The Australian Annual Surveillance Report into sexually transmissible infections and blood-borne viruses released in November 2016 revealed that there were an estimated 260,000 new cases of chlamydia in 15- to 29-year-olds by the end of 2015. That works out to roughly one in 20 young Australians.

The University of NSW’s Kirby Institute, which produced the report, estimates that only 28 per cent of chlamydia cases are actually diagnosed in Australia – the rest remain undetected and untreated. In fact, according to data gathered from Medicare, the testing rate for chlamydia is only 15 per cent among those in the ‘at risk’ 15- to 29-year-old demographic.

“The biggest issue with STIs for Australian women is chlamydia,” says Dr Tanner. “The risk of chlamydia infection far outweighs the risk of other STIs. Unfortunately, 70 to 80 per cent of women experience no symptoms of chlamydia infection, which means that it can remain undiagnosed for years if women are not being tested. As a consequence, these women may develop pelvic inflammatory disease, which can cause serious damage to the fallopian tubes, leading to infertility or higher risk of ectopic pregnancies.”

The good news is that chlamydia can be treated very simply with a single dose of an antibiotic called azithromycin. But clearly you can’t be treated if you don’t know you’ve got it.

“We need to maintain the focus on more regular STI testing,” says Associate Professor Rebecca Guy, from the Kirby Institute. “It is imperative that all people at risk are screened at least once a year for chlamydia.”

If you’re at higher risk due to unprotected sex, then you should be tested every single time you change sexual partners. Some symptoms to keep an eye out for include pelvic pain, bleeding after sex or spotting between periods.

MYCOPLASMA GENITALIUM

Mycoplasma genitalium (MG) is a new STI on the block that has only recently started to gather serious attention in the field of sexual health. It’s not actually new, though; in fact, as many as 400,000 Australians may currently be infected.

“One of the reasons why this previously unappreciated STI has been hitting the headlines is that it rapidly develops antibiotic resistance, and therefore is being called a ‘sexually transmitted superbug’,” says Dr Tanner. “That means it’s drug resistant – and it’s not just the first line of antibiotics it’s resistant to, it’s the second and third line of antibiotics as well.”

“It is important to be aware of this STI because of its clinical consequences. However, there is not much you can do at this stage, as the testing is still awaiting Medicare approval,” says Dr Tanner. “Once it is approved, talk to your GP about whether you should get tested.”

“Research does indicate that its long-term side effects are similar to those of chlamydia, including the risk of infertility.”

MG has also been found to cause pelvic inflammatory disease, which involves pain, discharge and bleeding in women after sex. It has also been linked to spontaneous miscarriage and premature birth. Symptoms may include discomfort while urinating or during intercourse, unusual vaginal discharge and pelvic pain.

HERPES

Herpes is one of the most common STIs, although the actual statistics on women affected are not known. It is estimated that one in eight Australians are infected with the HSV-2 strain of the virus, which is responsible for genital infections, as opposed to the HSV-1 strain, which manifests orally in the form of cold sores.

“Herpes is spread by direct skin-to-skin contact during sexual activity,” says Dr Tanner. “But here’s the tricky part of the situation: many people who carry the virus don’t know they have it, therefore they don’t know that they can transmit it to other people. Even if they do know they have herpes, they won’t know when they are sharing the virus because they won’t always have signs of infection.”

So, without obvious symptoms, how are you meant to know if you have herpes? Simple. Get tested. The most common way to diagnose herpes is to have a swab taken from the relevant ulcer, skin split or itchy spot and have it sent to a laboratory for virus detection. The only catch is you’ll probably have to ask to be tested for it – most annual STI tests don’t screen for herpes.

Considering that herpes can cause potentially fatal infections in babies and may even play a role in the spread of HIV by making individuals more susceptible to HIV infection and HIV-infected individuals more infectious – it’s well worth doing.

INTO THE FUTURE

The internet and smartphones provide the perfect mediums to start removing barriers to STI testing. Stigma Health has just rolled out a predominantly online-based approach to STI testing that eliminates the need to see a doctor face to face, thus relieving the embarrassment factor during the initial consultation phase. Involving a readily accessible app, it’s also much more time efficient and cost effective than the traditional GP route.

Stigma Health’s process allows patients to order their STI testing pathology referral online and receive it (and the results) privately via the Medical Records app on their phone. They can then go to any pathology centre in Australia to get tested and have their results delivered within three to five business days.

“Patients answer a series of yes/no questions to determine their individual ‘at risk’ profile, then we provide an appropriate pathology referral for them via the app,” says Dr Tanner. “Patients can print their referral, have their testing done at any pathology centre in Australia, and securely receive their results via the app. Not only does this make testing more accessible in terms of price, it makes it less intimidating. While there are free sexual health clinics, not every Australian has access to one, and visiting them can be pretty scary if you don’t have a pathology referral yet.”

So far, Stigma Health has seen a repeat patient rate of 18 per cent, suggesting people engage well with the service and are open to using technology-based healthcare services to make STI testing easier and more convenient. And isn’t that how it should be? Imagine a day where no one tiptoes around avoiding the subject of sexual testing, not to mention the tests themselves. It’s just another thing we can do on our smartphone without a substantial financial outlay.

While the patient/doctor relationship is still important, using the technology at our disposal and having an app to streamline the STI testing process seems like a smart and frankly overdue idea.

“The fact of the matter is that many young women don’t have a GP they trust; or can’t afford the costs associated with seeing their GP just for an STI test, so they skip it,” says Dr Tanner.

“I like to say technology is not a replacement for the patient/doctor relationship, but rather an alternative for the people who want or need it. The statistics for STIs in Australia clearly demonstrate the need for a different approach, and I firmly believe that online-based testing has the power to make a significant difference to people’s health, and attitudes.”

AND ON THAT NOTE…

“Condoms are still the only means of protection against all STIs,” Dr Tanner warns. “Unwanted pregnancy may be the primary concern for a lot of sexually active young women, but Australia’s STI rates should serve as a reminder that condoms are still an essential component of looking after your sexual health.”