STIs

Sexually Transmitted Infections (STI) Hit List

What can a lesbian catch (besides a beautiful woman)?

Current data on STI transmission between women is patchy at best. What we do know is that transmission of STIs between women does occur. We are not really sure of the risk level, however it is generally agreed that the risk in most sexual activities between women is lower than during heterosexual intercourse. However, low risk does not equal no risk.

The most common STI symptom is no symptoms at all, so it is important to have a regular STI check. Most STIs can be cleared up easily if treated quickly. There have only been a few studies that provide information about sexually transmitted infections and blood borne viruses in lesbians and other women who have sex with women. 

Up close with sexually transmitted infections

There have only been a few studies that provide information about sexually transmitted infections and blood borne viruses in lesbians and other women who have sex with women.

All sexually active women (including women who have sex with women) are at risk of contracting an STI. And if you or your partner has any sort of sexually transmitted infection, or blood borne virus, the potential is there to pass it on.  

So testing and specific advice about reducing the risk of passing infections on are all part of prevention.

The trouble is, some infections don’t have any symptoms

Some sexually transmitted infections, like chlamydia, and even viruses like HIV, can have very few symptoms at first, or any at all, before complications occur.  

The only way to find out about some infections early is to get a check-up, so you can get appropriate treatment and reduce the risk of serious complications and of passing the infection on to your sexual partners.

What happens at a sexual health check-up?

First of all, you will be asked about symptoms, and then for some details about your sexual history and sexual practices.  How much you are asked depends on the clinician.  How much you disclose depends on you.  Whilst the questions will probably seem intrusive, they can help guide testing and the interpretation of your results.  It might be easier to disclose your sexuality or sexual practices early on rather than when the questions get tricky.  It is even better if you already have a doctor who knows about your sexuality, and who you can talk to easily.

If you have symptoms:

If you have any symptoms, such as a vaginal discharge, or if you are due for a Pap smear (remembering that lesbians and women who have sex with women need Pap smears too), you will be offered an examination.  This will include looking at your genital area for signs of infection or skin irritation, and taking vaginal or cervical swabs for testing.  And a Pap smear if it’s due.  If you agree to testing for blood borne viruses (see below), you will need a small blood test.

If you have no symptoms:

Even if you have no symptoms it is still important that you have a regular sexual health check (especially if you have a change of sexual partner) because many STIs have no symptoms. For a regular sexual health check when you have no symptoms you will not need an examination. Testing for chlamydia and gonorrhoea can be done with a urine sample or a self-collected vaginal swab that you will be asked to do in the privacy of the toilet.  Other STIs and blood borne viruses are tested with a small blood test.

Things that a check-up can miss:

It’s not possible to routinely test for genital warts or herpes. 

Genital warts are diagnosed only if you get them – small lumpy or grainy warts that are visible anywhere on the genitals. Genital warts are fairly easily treated. Your doctor can discuss treatment options with you. This include paints, creams, and freezing. It is important not to use over the counter wart treatment on the vulva or vagina without talking to a doctor or nurse first.  

Genital herpes often has no symptoms but if they do occur then it is usually diagnosed by a doctor examining the area at the time and taking a swab of the affected area to confirm the diagnosis.  Herpes is not curable but very effective treatment is available.

A word about blood tests and “window periods”

 A blood test cannot always detect infection as soon as a person has been exposed to the infection.  It can take a while for the body to develop an antibody or immune response to an infection, which is then detected on blood testing.  This delay is known as the “window period”, which can be up to 3 months for HIV, 6 months for Hepatitis B, and as much as a year (although often less) for Hepatitis C.  Your doctor or nurse will ask about recent sexual contact to advise you if the window period applies to your tests.

HIV

Blood, body fluids, skin-to-skin contact & sexually transmitted infections

Chlamydia
Chlamydia is the most common bacterial STI in Australia, and rates are increasing, especially in young heterosexually active people.  We don’t know much about rates of chlamydia in lesbians, and there are no specific guidelines about testing.  Generally, women up to about 30 years old and who are sexually active are most at risk, and it is good to play it safe and include lesbians and women who have sex with women in this.  It is worth having a test once a year or so to check you don’t have chlamydia, especially if you have changed partners since your previous test. You could also ask to have a chlamydia check with your next Cervical Screening Test.  Chlamydia usually has no symptoms early on, but if left untreated, chlamydia can cause pelvic infection, with long-term complications including chronic pain and infertility. Chlamydia is easily treated with antibiotics.

> > More information on Chlamydia is available on SHFPACT’s website.

Gonorrhoea
Gonorrhoea is another bacterial STI. It is less common then chlamydia but is increasing in Australia. It can also go unnoticed in women until it causes serious complications. These can include pelvic infection, and difficulties in pregnancy. Gonorrhoea is treated with antibiotics.

> > More information on Gonorrhoea is available on SHFPACT’s website.

Trichomonas
“Trich” is a little bug that is easily transmitted through body fluids or close contact.  It is uncommon in urban regions in Australia but still occurs.  It causes a vaginal discharge and sometimes a change in odour. Trich is also treatable with antibiotics.

> > More information on Trichomonas is available on SHFPACT’s website.

Genital warts

There are lots subtypes of the Human Papilloma Virus (HPV).  Some of these can cause genital warts.  These viruses are passed on by close skin-to-skin contact. There is no test for genital warts, they are diagnosed by looking at them. An early diagnosis of genital warts means early treatment to help clear them up.

The Gardasil vaccine (also called the HPV vaccine) was introduced in Australia in 2007. It has been given in first year of high school to girls since then, and to all young people since 2013. Gardasil is effective against the two types of HPV that cause most genital warts. As a result there has been a very significant drop in the occurrence of genital warts in vaccinated people.

> > More information on Genital warts is available on SHFPACT’s website.

Genital herpes

Herpes is caused by the herpes simplex virus (HSV). There are two types of HSV-HSV 1 which causes almost all oral herpes (cold sores) and about half of all genital herpes, and HSV 2 which causes the remainder of genital herpes. Herpes is very common and is easily passed on between female partners from oral sex and genital skin-to-skin contact. It is important to avoid any skin to skin contact when there are symptoms present (such as a cold sore on the lips). Transmission can be reduced by the use of dams and condoms and other safer sex practices.

There is no routine test for genital herpes, it is diagnosed by having an examination and swab when symptoms are present. Many people with genital herpes do not have any symptoms. Genital herpes is not curable however, there is very effective treatment available that can reduce the frequency and severity of episodes.

> > More information on Genital herpes is available on SHFPACT’s website.

Candida and Bacterial Vaginosis

Candida (“thrush” or “yeast” infection), and bacterial vaginosis (BV) are not classed as sexually transmitted infections, but they do cause genital symptoms. 

With BV, there is often an increase in vaginal discharge and a change in odour (which can smell unpleasant or “fishy”), sometimes with irritation of the genital skin as well.  It seems to be more common in lesbians and women who have sex with women, but it’s not certain why.  Medication can help settle symptoms, although recurrence is common.

Vaginal thrush is very common and is caused by an overgrowth of a normal vaginal organism. If you have persistent symptoms of itch, irritation, and a thick white lumpy vaginal discharge see a doctor for a proper diagnosis. Once confirmed thrush is usually easily treated with over the counter cream or medication.

Hepatitis A
This is spread through faeces (poo), so anal sex, or kissing and licking around the anus (rimming), could pass this on.

> > More information on Hepatitis A is available on SHFPACT’s website.

Hepatitis B
Hepatitis B causes a viral infection of the liver. If Hepatitis B is around, it is fairly easy to catch both from body fluid and blood exposure.  Vaccination to protect against Hepatitis B is available and is highly effective.  Since 2000 Hepatitis B vaccination has been routinely given to all babies. If you believe you have not been vaccinated talk to your doctor or nurse about this. If you come from a country where hepatitis B is very common and you think you have not been vaccinated talk to your doctor about being tested.

> > More information on Hepatitis B is available on SHFPACT’s website.

Hepatitis C
Hepatitis C is rarely sexually transmitted, although contact with the menstrual blood of a partner with Hepatitis C would increase the risk.  The main risk for Hepatitis C is shared injecting equipment.

> > More information on Hepatitis C is available on SHFPACT’s website.

HIV

HIV is transmitted in body fluids and blood. The number of women with HIV is slowly increasing (mostly women whose risk seems to have been heterosexual intercourse, with a man they did not necessarily know was infected).  The risk of transmission between women seems to be relatively low, but it is possible. Blood to broken skin contact increases the risk of transmission between women, so be careful during menstruation and with sexual practices more likely to cause small grazes or bleeding. Cuts or abrasions on your hands or mouth also increase the risk. There have been case reports of transmission believed to be due to shared sex toys, so using condoms for sex toys, or not sharing toys is recommended. Transmission through oral sex is very rare.> > More information on HIV is available at:

Syphilis
Syphilis can be transmitted by skin to skin contact, genital to genital contact, and oral sex.  Syphilis is relatively uncommon in women in Australia although is more common in Aboriginal and Torres Starit Island women who live in rural and remote regions. The small sore that comes with initial infection isn’t painful and can be easily missed.  Syphilis is diagnosed with a blood test and is easily treated with antibiotics if detected in the early stages.

> > More information on Syphilis is available on SHFPACT’s website.

Where can I have a sexual health check-up?

Having a check-up from time to time is a good idea. This can be done with your GP, at a Family Planning Clinic, (shfpact.org.au) or at your local sexual health centre. Not everything can be checked for though, and it’s worth trying to understand the basics of what can be tested for, and what can’t.

I find it really hard to find a doctor or nurse that I’m comfortable with!

You might like to have a look at “Opening the Window - A Guide to Lesbian Health”. It’s a great booklet put together by ACON (AIDS Council of NSW).  It’s  full of hints to guide lesbians through the health care maze, with information on looking for the right health care providers and a range of health issues including:

  • Cervical screening and breast checks;
  • sexual health, HIV, safe sex;
  • relationships and parenting;
  • alcohol, smoking and other drugs; and
  • gambling and violence.

> > Go to acon.org.au and search for lesbian health to download the booklet or phone ACON for a copy.

Unplanned pregnancy
It’s not uncommon for lesbians and women who have sex with women to also have sex with men. Don’t forget that emergency contraception can be taken to reduce the risk of unplanned pregnancy. Available from chemists, without a prescription it should be taken as soon as possible and ideally at the latest within 72 hours. If you have an unplanned pregnancy and need non-judgemental, non-directive, pro-choice information, counselling or support contact SHFPACT regarding their unplanned pregnancy counselling service.

> > More information on Emergency Contraception is available on SHFPACT’s website.

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