Sexually Transmitted Infections (STIs)

Genital herpes is a common sexually transmissible infection (STI) caused by the herpes simplex virus (HSV). There are two types of HSV: HSV1 and HSV2.

• HSV1 is usually found around the lips and mouth and is often referred to as cold sores.
• HSV2 commonly infects the genital and anal areas.

Both HSV1 and HSV2 can occur on the lips, mouth, genital or anal areas. It is possible for a person to be infected with both HSV1 and HSV2.HSV enters the body through the skin on the mouth, genitals and anus or small cuts in the skin elsewhere on the body. The virus lives in the nerves beneath the skin and may remain inactive and unnoticed for many years. It is not completely understood what causes the virus to activate and cause blisters. Isolated factors such as, menstruation (periods), emotional upset, and sexual activity, have been known to trigger an episode. Sunburn can also trigger a herpes episode (or cold sore) on the face or lips.

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‍Signs and Symptoms: An episode of herpes usually occurs in several stages over seven to ten days these include:

• A mild tingling or itching, which lasts 12 to 24 hours.
• Glands located in the groin may become swollen and tender.
• Small blisters accompanied by irritation, pain redness and swelling of the affected area.
• The formation of shallow ulcers (usually a couple of days after the blisters break) once the ulcers are healed, there is a residual area of red or peeling skin (for a few days).
• Often people do not experience any signs or symptoms before or during the primary episode or consequent herpes episodes. . In these instances, it is possible for the infected person to pass the virus to sexual partners and not be aware that they themselves are infected
• Other people will experience a small outbreak of blisters, low level discomfort and related symptoms with the primary episode of herpes only.
• There are a small number of people who experience more severe symptoms during the primary and recurrent episodes, these may include some or all of the following: flu like symptoms, generally feeling unwell, fevers, joint pains, groin discomfort, tingling or itching and painful blisters followed by ulceration of the affected area
• Ulcers can form in the vaginal opening, anus, penis or scrotum and may be accompanied by pain when passing urine and/or a bowel motion.
• In more severe cases, to can take up to three weeks for the blisters to heal and associated symptoms to disappear.
• It is advisable for people to attend a sexual health clinic or visit a doctor once the blisters appear to discuss management of the condition.

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Treatment:

‍Currently, there is no cure for herpes. There are antiviral drugs to manage the virus, and if taken at the beginning of an episode, they can help reduce the duration and severity of the episode. The antivirals do not kill the virus; they act on the body to decrease the amount of virus present which decreases the likelihood of future herpes episodes and the risk of transmission between partners.

• Keeping the area as dry as possible.
• Wearing loose non-restrictive clothing.
• Using anesthetic gels to help reduce pain (monitor the skin when using these creams as to not irritate the skin in the genital area).
• Avoiding soap on the affected area, instead bathing the affected area with salt water when lesions are present.

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Transmission:

• There is a high risk of the virus spreading between sexual partners before, during, and for the week following an episode. Even when a person has no symptoms, herpes can be directly spread to their partner, if the infected person is currently "shedding" the virus at the time of sexual intercourse or oral sex.

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Both HSV1 and HSV2 can be passed through close body contact. This means:

• Oral herpes can be transferred to the genital area of a sexual partner via a cold sore on the lip when engaging in oral sex.
• Genital herpes can be transferred to the mouth of a sexual partner when engaging in oral sex (this is not common).
• Genital herpes can be spread through the rubbing of genital skin that is not protected by a barrier (condom) during sexual activity.

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Prevention:

‍If a person is aware of a potential herpes episode they should take extra precautions to protect their sexual partner from infection. There is potential to pass on the virus even if there are no symptoms or visible signs of an outbreak.

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‍To help reduce the risk of transmission:

• Avoid sexual intercourse if you feel an episode coming on.
• Avoid kissing, oral sex and sexual intercourse if herpes lesions are present on the mouth, lips, genital or anal areas.
• It is advisable to follow these suggestions until one week after the sores have healed and ulceration is completely gone.
• Wearing condoms during sexual intercourse will help to prevent the spread of herpes, but not prevent this from happening completely. Herpes can be spread through skin to skin contact from the genital area that is not covered by the condom. If a person engages in oral sex with a man condoms should be used. Dental dams should be used for oral sex (activity involving the mouth and anus or vulva). This is the case for both genders.
• If a person has been infected with herpes, it is important to manage the condition through, healthy diet, adequate rest, sleep and minimum daily stress. Unfortunately, it is not possible to predict how or when a herpes episode will occur in an individual. Some people may never experience visible signs or symptoms; others may only experience one episode, whilst a minority of people will have recurrent episodes. These episodes will vary between people, in general, after a person has the initial episode, recurrences are less severe, usually involve more rapid healing of the affected area and longer intervals between episodes.

Health outcome:

‍Unfortunately, it is not possible to predict how or when a herpes episode will occur in an individual. Some people may never experience visible signs or symptoms; others may only experience one episode, whilst a minority of people will have recurrent episodes. These episodes will vary between people, in general, after a person has the initial episode, recurrences are less severe, usually involve more rapid healing of the affected area and longer intervals between episodes.

Information adapted from: http://conditions.health.qld.gov.au/HealthCondition/condition/14/188/62/Genital-Herpes

The first recorded case of HIV/AIDS in Australia was in October 1982, and the first Australian death from AIDS occurred in July 1983. Because the disease was identified predominately among homosexual men, people with blood disorders requiring transfusions, and injecting drug users, it soon became incorrectly stereotyped and people in these communities were often judged as being HIV positive, regardless of their true status. As a result, far, ignorance, discrimination and persecution soon followed.

The world-wide communities affected by HIV were all diverse which displayed that every person was at risk of HIV and not just particular communities. However, in Australia, ignorance still saw the virus as a disease that only affected same sex attracted me and people who injected illegal substances.

The horrific numbers of gay men that were losing their lives to AIDS led to the Lesbian, Gay, Bisexual and Transgender (LGBT) community taking the lead in developing a response in the forms of care services, support groups, and health promotion initiatives aimed at educating the community how to prevent the transmission of HIV.

Because of the communities that were classed as high risk for infection many heterosexual identifying people in Australia were immune to the devastation and loss of life that HIV/AIDS caused. The preventative actions taken by the LGBT communities resulted in protecting the virus from being wide-spread through the entire Australian community.

Thankfully, over the decades, the infection rates of HIV/AIDS in Australia has improved, in part through the introduction of antiretroviral drug treatments with post-exposure prophylaxis treatments reducing the possibility of infection and minimising the likelihood of HIV progression to AIDS As a result of HIV transmission in Australia predominately being through unprotected sex and injecting illegal substances, many people have a heightened fear of being diagnosed as HIV positive in comparison to other serious illnesses. In reality, HIV is just another health condition that people experience and that no one wants. Many still to this day would be less likely to inform others of their HIV status due to fear of negative reactions. This can be viewed as a reflection of the embarrassment and judgements that people place on sexual activities and sexuality in general. People diagnosed with cancers, cardiovascular and other serious health conditions are more likely to share their diagnosis with others, because they expect sympathy and support. For the person who has HIV it can be a very lonely journey until they gain the strength to put the health condition into perspective and reach out for support.

Transmission of HIV:

In Australia, HIV is most commonly transmitted through anal or vaginal sex without condoms or other protection methods, such as PrEP (an HIV prevention drug) or ‘undetectable viral load’ (when a person with HIV has very low levels of the virus in their body). It is much less commonly transmitted through sharing needles, syringes and other injecting equipment.People with HIV who are on treatment and have an undetectable viral load cannot transmit HIV.For people who do not have HIV, condoms used with lubricant is the easiest way to prevent HIV transmission. For those at greater risk of HIV, PrEP (pre-exposure prophylaxis) is a medication that, when taken daily, is more than 99 per cent effective at preventing HIV.

‍How is HIV transmitted?

‍Some of the ways HIV is transmitted include:

• Anal or vaginal sex without condoms or other protection, such as pre-exposure prophylaxis (PrEP) or undetectable viral load.
• Taking bodily fluids such as semen in the mouth when you have ulcers, bleeding gums and abrasions.
• Sharing any needles, syringes, or other injecting equipment
• From mother to child during pregnancy, childbirth, or breastfeeding when the mother does not know she has HIV, or is not on effective treatment.
• Through tattooing or other procedures that involve unsterile or reused equipment.

HIV cannot be transmitted by ordinary contact like hugging, kissing, shaking hands, sharing items such as cups and cutlery, or through toilets seats, swimming pools, pets, or insects.

People with HIV who are on treatment and have an undetectable viral load cannot transmit HIV. It is perfectly safe to consume food and drinks prepared by a person with HIV, regardless of whether or not they’re on treatment.

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‍Unreliable risk reduction strategies

‍Some people use other, unreliable, methods to reduce their risk of HIV. These include:

• Serosorting – having sex only with people who have the same HIV status as them
• Strategic positioning – where the HIV negative partner penetrates the HIV positive partner (and not the other way around)
• Withdrawal – when the ‘insertive’ partner pulls out before ejaculating (coming).

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None of these strategies are reliable, and do not reduce risk by much.

In fact, having sex only with people with the same HIV status is extremely risky. A person may think they do not have HIV, but may have been exposed to it since their last test, or may never have been tested at all. Using a combination of proven, reliable strategies – like condoms, PrEP, and undetectable viral load – is the best way to prevent HIV transmission.

‍HIV Testing

‍Getting an HIV test is easy and convenient. Tests for HIV and other STIs are available from your regular doctor, or from your local sexual and reproductive health clinic.

Regular testing for HIV helps identify an infection earlier, which enables you to get on treatment sooner. Not only does this protect your own health and wellbeing, but it also helps prevent the transmission of HIV to other people.

How often you should get tested depends on your personal practices, risk behaviours, and how often you engage in them. For most people, it is recommended to get a full sexual health test at least once per year, including tests for HIV, chlamydia, gonorrhea, and syphilis. Even people who always use condoms should get tested annually, as condoms don’t provide 100 per cent protection against HIV and STIs.

People at greater risk of HIV should test more often. Gay, bisexual, and other men who have sex with men should get tested every three months, or four times per year. This may vary depending on how many sexual partners you have during the year, so talk with your doctor or sexual health specialist for advice. Your doctor can also provide information about how to reduce your risk for HIV and other STIs.

‍Blood tests for HIV

‍Blood tests are the most common and most reliable tests for HIV. There is a short period of time between exposure to HIV and the ability for tests to detect HIV or its antibodies. This is often referred to as the 'window period,' and is between two and 12 weeks. Most tests used in Australia can detect HIV as early as two to four weeks after infection.

If your blood test shows that HIV or its antibodies are present, you are infected with HIV (also known as being 'HIV-positive'). If you have no antibodies in your blood (HIV-negative), it is possible you are not infected with HIV. But a negative result might also mean you are in the window period, so you might need a follow-up blood test to make sure.

Unlike rapid tests (see below), blood tests for HIV are covered by Medicare, which means your doctor can order the test free of charge for you. If you are not eligible for Medicare, you may also be able to cover some of the testing costs through health insurance cover. People who do not have private insurance or a Medicare care can still receive free confidential testing at sexual health clinics and hospitals.

‍Rapid tests for HIV

‍Rapid HIV tests are a convenient tool for people at greater risk of HIV who need to test more frequently. The test involves taking a drop of blood from a finger prick, and can provide reliable results in about 20 minutes. For most people, however, standard blood tests are the best choice for regular testing.

Rapid tests aren’t as reliable as blood tests, and have a longer window period. For this reason, your doctor should give you a blood test at the same time to ensure the result is accurate.

In Australia, rapid HIV tests are not currently subsidised under Medicare. A limited number of doctors and other health providers may offer rapid testing for a small fee.

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‍Getting your HIV test results

‍Most HIV test results are available within 10 days.

A positive result can lead to feelings of shock, anger, distress, anxiety, and depression. It is a legal requirement for services that offer HIV testing to also offer counselling both before and after testing.

Before you are tested, talk with your doctor, nurse, or peer tester about your level of risk, the likelihood that the result may be positive, and about what a positive test may mean for you.

Post-test counselling is also important, regardless of the outcome. If the test is positive, counselling can provide emotional support, further information about living with HIV, and referrals to support services. If the test is negative, counselling can provide education about HIV and how to reduce your HIV risk in the future.

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‍Positive test results

‍A positive result is ideally provided in person except in extenuating circumstances (e.g. the possibility that the patient may not return for the result and/or may engage in risky behaviour based on the incorrect assumption they are HIV negative).

Adapted from: https://www.betterhealth.vic.gov.au/

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‍Undetectable viral load

‍The viral load of most, but not all, people with HIV can become undetectable with treatment. Even if a person doesn’t reach the strict threshold for undetectable viral load, any reduction in their viral load (the amount of virus in their body) can dramatically reduce the risk of HIV transmission.

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‍PrEP

‍PrEP (pre-exposure prophylaxis) is the use of anti-HIV medication to prevent HIV in people who do not have the virus. When taken daily, PrEP is more than 99 per cent effective at preventing HIV. PrEP is available with a prescription from any doctor, for a low monthly payment (known as a co-payment, or ‘co-pay’ – the Pharmaceutical Benefits Scheme pays for the rest) for people with a Medicare card.

For people without a Medicare card, or who cannot afford the co-pay, PrEP can be imported through online pharmacies, or through compassionate access schemes. More information is available from your local hospital sexual health clinic.

If you are starting PrEP, you will have an HIV test and full STI test at your first appointment. It is recommended that you then return to your doctor every three months for repeat HIV and STI tests and for a new prescription.

If your doctor is unfamiliar with PrEP or what’s involved in prescribing it, they can call  your local sexual health service or AIDS Medical Centre.

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‍PEP

‍PEP (post-exposure prophylaxis) is another way to use anti-HIV medication to prevent HIV. Unlike PrEP, PEP is taken after a known or suspected exposure to HIV.

PEP is taken for 28 days, and must be started within 72 hours of an exposure to HIV.

Examples of known or suspected exposure to HIV may include sex without a condom or condom breakage with a person whose HIV status you don’t know, or who is HIV-positive and not on treatment, or sharing needles or other injecting equipment.

If you think you have been exposed to HIV, call the PEP hotline at 1800 889 887, or visit www.getpep.info to find out your nearest PEP access site. Your PEP provider will ask you a series of questions to determine your risk and whether PEP is appropriate. If your exposure to HIV is through a person with HIV who has an undetectable viral load, PEP is not recommended, as there is no risk of transmission.

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‍Safer injecting

‍Using clean injecting equipment (such as needles and syringes) prevents HIV and other blood-borne viruses, like hepatitis B and hepatitis C. Never share or re-use injecting equipment. This includes all injecting equipment: needles, syringes, spoons, swabs, filters, water, ties, or tourniquets.

Clean injecting equipment is available from needle and syringe program (NSP) sites throughout Australia including most pharmacies. Many of these sites can offer more information about HIV and hepatitis, safer injecting, and referrals to doctors.

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‍Regular testing

‍Regular testing for HIV and other STIs can help find infections earlier, get them treated sooner, and prevent them from being transmitted to others. HIV tests are available from any doctor, with results usually available within ten days.

‍Symptoms of HIV infection

‍Many symptoms of HIV are similar to those for a number of other illnesses. However, not everyone shows symptoms when they contract HIV.

If you think you have been exposed to HIV, and you have any of the signs below (or a combination of them), consult your doctor. Initial HIV symptoms usually occur between one and three weeks after exposure to HIV.

Symptoms of HIV can include:

• Flu-like symptoms
• Extreme and constant tiredness
• Fevers, chills, and night sweats
• Rapid weight loss for no known reason
• Swollen lymph glands in the neck, underarm, or groin area
• Continuous coughing or a dry cough
• Diarrhea
• Decreased appetite.

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Warning: Psychological stress from fearing a HIV infection can lead to exhibiting many of the symptoms listed above. The only way to be sure is to have a test. Scared? Dave Wells can support you before, during, and after without any pressure or judgement.

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HIV testing and your rights

‍Testing for HIV is voluntary and carried out only with your informed consent, except in exceptional circumstances. Before you are tested, you will be provided with information about what is involved in the test, what the results might mean for you, and how to prevent HIV transmission in the future. All people who request an HIV test must receive this information from the test provider.Under Australian law, it is unlawful to discriminate against anyone who has HIV. Test results, as well as the fact that you have been tested at all, are strictly confidential. It is illegal for any information about a person being tested or a person with HIV to be disclosed without their explicit permission.

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‍Summary

• HIV is a virus that can damage the immune system and make it difficult for the body to fight off simple infections.
• HIV is usually transmitted through anal or vaginal sex without a condom or other protection, or by sharing injecting equipment like needles and syringes.
• HIV cannot be transmitted through: saliva or kissing; casual contact like hugging and shaking hands; mosquito bites or by eating food prepared by a person living with HIV.
• PrEP (pre-exposure prophylaxis) is the use of anti-HIV medication to prevent HIV in people who do not have the virus. When taken daily, PrEP is more than 99 per cent effective at preventing HIV.
• HIV transmission can be prevented by: using condoms during anal or vaginal sex; using clean, sterile injecting equipment or by taking pre-exposure prophylaxis (PrEP) – a medication that prevents HIV in people at greater risk of the virus.
• People living with HIV who are on treatment and have very low levels of the virus in their bodies cannot transmit HIV.
• It is recommended that everyone get tested for HIV at least once as part of routine health care.
• It is recommended that anyone with risk factors, such as multiple sexual partners, get tested for all sexually transmissible infections (STIs), including HIV, at least twice a year.
• Undetectable viral load is the term used when a person with HIV who is on treatment has very low levels of the virus in their body. When a person’s viral load is undetectable they cannot transmit the virus. For people with HIV, getting on treatment as soon as possible helps protect their health and wellbeing, and helps their viral load become undetectable faster, preventing HIV transmission.

Information taken from: https://www.health.qld.gov.au

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‍How can Dave Wells support you?

‍Dave Wells has over 20 years professional experience in the HIV/AIDS and Sexual Health sectors. A majority of his experience has been in the area of health promotion developing and implementing HIV prevention education in the community and to service providers, however he also has a broad knowledge and experience with providing support services for people who live with HIV/AIDS. Dave Wells can assure you confidential, non-judgmental support to assist you to navigate through a HIV diagnosis, its impacts on relationships, and any other hurdles that come up for you as a result.