Treating sexually transmissible infections (STIs)

Treating sexually transmissible infections (STIs)Having an STI shouldn't be embarrassing and certainly isn't shameful. Dr Sarah Brewer explains what to expect from a check up at a genito-urinary medicine (GUM) clinic




A recent survey by the Family Planning Association (FPA) discovered that shame of having an STI prevents many people from seeking help. Twenty-eight per cent of those questioned said that embarrassment would prevent or delay seeking treatment. Almost one in five were put off by thoughts of a medical examination. While one in eight were worried about what the health professionals would think.

What if you think you have an STI?
Get it checked out at a genito-urinary medicine (GUM) clinic. Some people with an STI do not develop symptoms. While others notice problems, such as:

  • Increased vaginal discharge
  • Development of a penile discharge that stains underwear
  • An unusual or unpleasant odour
  • Soreness
  • Itchiness
  • A rash
  • Lump(s)
  • Ulcers

Unfortunately, many STIs do not cause obvious symptoms, so if you're at risk (for example, through unsafe sex), it's a good idea to have a general sexual health screen.

How do you find your nearest GUM clinic?

What happens in a GUM clinic?
The clinics are designed to be friendly places. Staff do not pass judgement or make you feel uncomfortable - if they did, they know you would be put off going again! The doctors, nurses and receptionists are trained to help put you at your ease and reassure you while screening for possible problems.

Treatment is confidential, and you don't have to give your real name. You will usually be referred to by your first name or by your clinic number. Your GP will only be informed about your attendance and test results if you give permission, and clinics will only write to your doctor if he or she referred you with a letter, which they will reply to out of courtesy.

What questions will they ask you?
When seeing the doctor you will be asked questions about your general and sexual health. After finding out about your past medical history and about any drugs you're on, the doctor will usually ask about your current symptoms (if any), when you last had sex, and how many partners you've had in the last few months.

Women will be asked about their menstrual and pregnancy history, method of contraception used, date of last period, and whether there is any risk of pregnancy (which might affect what treatment you receive).

The doctor may briefly ask about oral or anal sex, and whether your partner(s) is/are male, female or both. Don't be embarrassed by this - the doctor is not trying to judge, but needs to know what conditions you may need to be screened for. In the UK, any necessary treatment is supplied free of charge without needing to pay for a prescription charge.

What test will they carry out?
A number of tests are carried out during a GUM screen. You will need to remove the clothes covering the lower half of your body, although if your skirt or dress is easy to pull up you can do so. Some clinics ask you to lie on a couch with your knees bent up and your feet apart, while others ask you to lie down and rest your knees over special supports, or put your feet in stirrups.

Although inelegant, this is not uncomfortable and you should relax as much as possible. If you prefer to see a doctor of a particular sex, do ask as this is often possible - even if you have to come back to another clinic session.

Firstly, the doctor will carefully examine your external genitals for any obvious signs such as discharge, redness, lumps or ulcers. This will also help to pick up other conditions such as infected hair follicles, pubic lice or even thread worms. Most doctors will also feel at the top of your legs to check for enlargement or tenderness of the lymph nodes in your groin.

Swabs: what happens and what are the doctors looking for?
If painful sores are present on the external genitals, a viral culture may be taken to look for Herpes simplex infection. In women, further tests will usually be postponed until after the sores have healed. This is for two reasons - firstly, inserting a speculum may be very painful, and secondly this may transfer viral infection further up the vagina to the cervix and is best avoided.

If a painless ulcer is present, discharge from the sore will be examined under the microscope to look for the spirochete bacteria (Treponema pallidum) that cause syphilis.

Women: To perform an internal examination, the doctor or nurse gently insert a hinged metal or plastic speculum into the vagina to view the cervix. A high vaginal swab (HVS) and cervical swab are taken and sent to a lab to identify any infectious bacteria. First, however, the HVS and cervical swab are smeared onto two glass slides and stained with dyes for examination under the microscope. This will show the presence of any bacterial imbalance (bacterial vaginosis), Candida yeasts or the bacteria responsible for gonorrhoea. The HVS will also be dipped onto a glass slide containing a drop of water to look for the presence of a single-celled organism (protozoon) called Trichomonas.

A second cervical swab is also taken and sent for immunological testing to detect the presence of chlamydia. Most women also have a urethral swab taken to check for chlamydia.

Men: Urethral discharge in males is investigated by obtaining swabs from the end of the penis. These are cultured and smeared onto a glass plate, stained and examined under the microscope to look for gonorrhoea bacteria. A swab will also be sent for immunological analysis to detect the presence of chlamydia.

Routine blood tests: syphilis, HIV and Hepatitis B
A routine blood test to check for syphilis is usually offered to everyone attending a GUM clinic. You may also be offered routine blood tests to check for Hepatitis B and - after counselling - for human immunodeficiency virus (HIV).

Urine tests
Urine samples may be tested for the presence of a variety of substances by simply dipping in a reagent stick. This contains a series of small pads, each impregnated with a different chemical that changes colour in the presence of certain substances such as glucose, protein, white blood cells and haemoglobin.

Urine testing is a useful screening test for diagnosing urinary tract infections. Urine may also be examined under a microscope to look for cells (for example, white blood cells which suggest an infection). Immune testing of urine is now available to help detect chlamydia, even when no obvious discharge is present.

Visual inspection of urine is also important. Cloudiness that does not clear (when certain chemicals are added to dissolve any suspended crystals) suggests infection is present. The presence of threads (clumps of cells) suggests there is an inflammation of the urethra, which can occur in NSU (non-specific urethritis), especially if chlamydia infection is present.

Results of tests and swabs
After examining you and looking at the swabs under a microscope, the doctor will have a good idea of what is wrong, although the diagnosis may not be absolute at this stage. You may be prescribed treatments to improve symptoms or to treat a suspected infection. In other cases, the doctor may wait until the results of tests are available before prescribing any treatment. He or she will discuss this decision with you and also take your point of view into account.

Health advisor
After seeing the doctor, you will usually be offered an opportunity to chat to a health advisor. He or she is a nurse with special training who can:

  • Tell you about sexually transmissible infections
  • Give you tips on how to cope with symptoms
  • Advise about what to tell your partner
  • Tell you when you can have sex again
  • Offer you free condoms so you can practice safer sex once you're given the all-clear
  • Help you trace partners who need to be screened or treated - either because they could have infected you, or because you may have passed an infection on to them. This involves giving you a slip of paper with a number on it, plus a printed message advising the recipient to visit the clinic and to bring the paper along. This helps to match them with your notes. This contact tracing can be done anonymously and the health advisor will help.

If you're worried you have an STI or want to find out more, check out the symptoms, diagnosis and treatments for: