Tell me about the symptoms of Acute Hepatitis B
The incubation period is 1 to 6 months. Chronic Hepatitis B is usually only picked up during routine STD testing. Most people will not have any symptoms of acute infection, and when symptoms do occur they are not specific:
- Fatigue, muscle aches, poor appetite
- Right upper abdominal pain
- Low Grade Fever
Around half of Australians with Hepatitis B are unaware of the condition – because they had no symptoms of Acute Hepatitis B, or the illness was just like a normal viral infection and not recognised as Acute Hepatitis B.
Rarely, severe acute hepatitis B requires hospital admission (“fulminant hepatitis”).
Tell me about the symptoms of Chronic Hepatitis B
Hepatitis B causes severe liver disease in around 20% of people with chronic hepatitis B infection. Antiviral medication is proven to reduce the risk of future liver disease considerably.
The symptoms of Chronic Hepatitis B in those unfortunate people who do develop chronic liver disease are the same symptoms that occur in liver cirrhosis:
- Fatigue, Jaundice, Right upper abdominal discomfort, nausea.
- Symptoms and Signs of severe chronic liver disease – the person will likely be very ill at this stage.
All babies are now included in the Australian Childhood immunisation schedule. Immunisation in adults is also discussed at a common request at The Travel clinic. For people who have not been immunised, STD Testing will usually include a check for Hepatitis B.
Tell me about the Symptoms of Acute Hepatitis C
Most Hepatitis C in Australia is caught up via injection of drugs but may be sexually acquired.
Only 15% or so of people who are exposed to Hepatitis C develop symptoms of Acute Hepatitis C. Like Hepatitis B, therefore, most people with Hepatitis C will not have an acute illness.
The symptoms of Acute hepatitis C, when they do occur are non specific:
- Fatigue, Nausea, reduced appetite
- Abdominal Discomfort
- Less than a quarter develop jaundice
Tell me about the Symptoms of Chronic Hepatitis C
So most people with Hepatitis C will carry the virus without having had any symptoms of Acute Hepatitis C Infection. Around 75% of people exposed to the virus will develop chronic hepatitis of whom around 6% develop cirrhosis after 20 years.
Symptoms of chronic Hepatitis C, when they do occur, are again non-specific:
- Abdominal discomfort in the upper right side of the abdomen
- Symptoms and Signs of Chronic Liver Disease in those who develop Severe Hepatitis or Cirrhosis
What are the symptoms of Acute HIV Infection?
HIV may cause an acute seroconversion illness within around 2 to 4 weeks of exposure. This illness occurs in up to 80% of people with Acute HIV Infection – more common than previously thought.
Symptoms are often similar to that of glandular fever – a fever, rash, achy muscles, sore throat, and sometimes ulcers in the mouth or genitals.
What are the symptoms of Chronic HIV Infection?
Chronic HIV infection may cause immunosuppression (AIDS). The symptoms are many and include:
- Fever, weight loss, diarrhoea
- Fungal infections that are widespread and difficult to treat
- Oral Thrush without any cause
- Extensive warts (simple warts or molluscum contagiosum)
- Rashes such as severe seborrhoeic dermatitis
- White patches on the side of the tongue (oral hairy leukoplakia)
People at risk of HIV – for example, having unprotected sex with an HIV positive partner, may consider PrEP (Pre Exposure Prophylaxis). This is currently not on the PBS and private scripts in Australia are very expensive. It is much cheaper to import generic versions of the PrEP directly into Australia.
How is The Diagnosis of genital herpes made?
The blisters may be swabbed to confirm the diagnosis. Antiviral medication needs to be started within 48 hours to have benefit and is usually started before any swab results are back.
I feel terrible having a diagnosis of genital herpes
Most people have in fact been exposed to HSV but only a minority have had ‘Herpes.’
Only 20% of people with genital herpes get classical symptoms. There’s definitely a lot of bad luck why one person gets symptoms of recurrent genital herpes when most people get no symptoms at all. Around 80% of adults have antibodies to type 1 HSV, and 12% of adults have antibodies to type 2 HSV.
What are the Symptoms of Chlamydia?
Chlamydia is really very common and most people have no symptoms.
When Symptoms do occur, they may include:
- Males: Pain on passing urine or discharge (yellow or white). Pain and swelling in the testicle or scrotum (orchitis / epididymitis).
- Females: Stinging on passing urine, discharge (yellow or white), abnormal vaginal bleeding, pelvic or lower abdominal pain, fever, pain during intercourse.
Infection may also occur in the throat, causing pharyngitis, or conjunctiva, causing conjunctivitis.
Why does Chlamydia matter when most people have no symptoms?
The main concern with chlamydia is infertility in women. How common is infertility after having chlamydia?
Around 15% of women with Chlamydia will develop pelvic inflammatory disease (PID). This occurs when the infection travels up to the fallopian tubes and typically causes abdominal and pelvic pain. The chances of developing infertility after PID caused by chlamydia is between 1% and 20% (frustratingly different figures hey?). PID may also lead to chronic pelvic pain, and there is an increased risk of pregnancy in the tube (ectopic pregnancy).
So there’s no need to panic because the chances of becoming infertile are still low. But on a population level, there are lots of women who have “tubal infertility” caused by chlamydia.
Chlamydia may also cause infection of the testicle or prostate in men.
What is The treatment for Chlamydia?
Chlamydia is so easy to treat with 2 x 500mg tablets of Azithromycin taken as a single dose. Side effects are uncommon but some people experience gastro type side effects such as nausea, vomiting, diarrhoea or abdominal pain. An alternative to Azithromycin is a 7 day course of doxycyline which is taken twice daily with food. Doxycycline may cause similar gastro side effects to Azithromycin. Doxycycline may cause sensitivity to the sunlight during the course, and it is recommended to try to stay out of the sun. A small print issue is that rectal chlamydia may be more resistant to azithromycin than doxycyline.
Do I need a test of cure?
Test of cure involves repeat testing at least 3 weeks after treatment. Antibiotics work around 97% to 98% of the time but are not 100% effective so it is reasonable to have a discussion about test of cure. In the publicly funded UK national health service, test of cure is “not routinely recommended for uncomplicated genital chlamydia infection.”
Gonorrhoea is treated with a course of antibiotics. Resistance to antibiotics is an important issue. Treatment guidance in this area is therefore changing. Currently, the Queensland health department’s Gonorrhoea guideline recommends a Ceftriaxone intramuscular injection with Azithromycin tablets.
Gonorrhoea that is not treated may cause complications similar to those of Chlamydia, including chronic pelvic pain, difficulties conceiving, and conjunctivitis. Men may experience infection of the testicle (orchitis) or prostate (prostatitis).
What are the symptoms of the different stages of syphilis?
The incubation period usually is 2-3 weeks (range up to 3 months).
The first stage (primary syphilis) is a genital ulcer that is usually painless. The ulcer is usually solitary and is described as having a rolled edge. Any such ulcer should be swabbed for Syphilis DNA which is a very sensitive test. Antibiotics may be started immediately when the diagnosis is considered very likely, or you might wait for the test results. The ulcer occurs at the area of exposure to the bacteria and may therefore occur pretty much anywhere.
You may wonder why anyone might develop secondary or tertiary syphilis when the primary stage manifests as an ulcer and may be treated easily. There seem to be two main reasons:
- The chancre may be in an area that is out-of-sight.
- The chancre is painless and goes on its own in 4 to 8 weeks without treatment – which may happen before the person sees a doctor.
The secondary stage typically occurs 3-5 months later with a widespread spotty rash. The rash of secondary syphilis usually involves the trunk. A rash also involving the palms or soles is a big clue. The person will generally feel unwell with symptoms such as sore throat, pains, fever, or headaches. Scalp hair loss may also occur. Rarely there are complications involving the eyes, nervous system, liver, bones or kidneys. Secondary Syphilis may recur for up to two years.
Tests for secondary and tertiary syphilis involve blood tests. The feared tertiary syphilis is quite rare but does still occur with infected nodules in various internal organs such as the nervous system or heart.
How is syphilis treated?
Primary or Secondary Syphilis is treated with a single dose of injected penicillin. There are other treatment options but the single injection is generally the best option.
Blood tests are repeated every 3 months after treatment to prove that the infection has resolved. The blood test is normally negative within 12 months of treatment.
What’s new in STD?
Pre-exposure prophylaxis (PrEP) describes the scenario where an HIV negative person takes regular anti-viral medication to reduce the risk of contracting HIV. The most widely used form of PrEP is a daily tablet. The medicare criteria for subsidised PrEP were broadened in April 2018. You can check the medicare eligibility by referring to Box 1 of the The Australian PrEP guidelines. Those not eligible may be directed to an online portal to obtain the prescription from overseas.