Sex is great. There's the intimacy, self-expression, orgasms, the release of dopamine, all those calories burned, making a baby (if heterosexual sex and traditional methods of reproduction are your jam) and did we mention, orgasms?
But like many great things in life, sex has a not-so-glamorous side. Sexually Transmitted Infections (STIs) are the uncomfortable (and sometimes painful and ugly) side effect of getting your freak on.
Transferred by oral, vaginal or anal sex, the exchange of sexual fluids -- as well as simple skin on skin contact in the case of certain STIs -- can transmit a gamut of sexual diseases between two (or more!) people.
What's worse, some STIs -- chlamydia, for example -- can lead to infertility in women and various cancers in both sexes, often without demonstrating any noticeable symptoms.
Because sexual fluids are the main way STIs are transmitted, wearing a condom can be a good strategy to avoid getting a nasty post-sex surprise. But it's not fail-safe.
"Some STIs are carried in the semen and some are from skin to skin contact," Sydney-based GP Dr Ginni Mansberg told The Huffington Post Australia.
"In an ideal world, you put a condom on perfectly and it doesn't slide down the penis at all, and there is zero contact between the skin of the penis and the skin of the vulva. But we all know that doesn't happen, and so you can still transmit (STIs) like Herpes and Genital Warts."
Indeed, many STIs are on the rise in Australia, suggesting we may be having a whole lot more unsafe sex. Or at the very least, failing in our efforts to use contraceptives successfully.
It's not a sexy world to navigate, but talking about and educating ourselves on STIs -- how to avoid contracting them, recognise symptoms, and the best forms of treatment -- is essential if you want to get down without getting, er, down about a diagnosis of a nasty genital infection afterwards.
Also known as: 'The Clam'
What is it? Chlamydia trachomatis -- Chlamydia claims the title of most reported STI in Australia, with 82,707 cases in 2012. Slightly more prevalent in women, Chlamydia can -- if left untreated -- lead to Pelvic Inflamatory Disease, which can cause scarring to the fallopian tubes and infertility in women. In men, it can lead to Epididymo-orchitis -- inflamation of the testicular area.
How you can contract it: Through vaginal or anal sex -- although using a condom reduces the risk. It is common in women who have sex with men, men who have sex with women and men who have sex with men. However, Sydney based family doctor, Dr Brad McKay, told HuffPost Australia that "women who have sex with women are also at risk of transmitting... Chlamydia".
Symptoms: 50 percent of men show no symptoms at all, 75 percent of women show no symptoms. However, if they do in women, pain during intercourse or while urinating can indicate Chlamydia. As can pelvic pain. In men, pain while urinating or discharge from the penis can be a sign of Chlamydia. The best way to detect Chlamydia is by asking your doctor to do a swab for Chlamydia during a pap smear -- or separately.
Treatment options: Sydney based GP, Dr Ginni Mansberg explained that the treatment for Chlamydia -- a course of antibiotics -- is relatively straightforward. "If you get tested (positive) for it, two antibiotics -- one dose of two pills -- and you get re-tested in three months," Mansberg said.
2. Genital Herpes
Also known as: Fever Blister, The Gift That Keeps On Giving
What is it? Herpes simplex viruses (HSV) types 1 and 2 -- HSV--1 is oral herpes. HSV--2 is genital herpes. 50 percent of cases of gential herpes are now caused by HSV--1.
How you can contract it: Vaginal, anal and oral sex, with Mansberg noting that she is seeing a rise in the latter. "Of the last six patients of mine who have caught it, the vast majority have caught it through oral sex," Mansberg said. However, Herpes also affects sexually active lesbian couples. "Women who have sex with women are also at risk of transmitting Herpes Simplex Virus," McKay said.
Treatment options: Symptoms and recurrance of Herpes can be treated with antiviral drugs, however it cannot be cured. "It never leaves the body. We can't eradicate it from the body but we can control a little bit. You often get a recurrence of it, even monthly in a worst case scenario," Mansberg said.
Also known as: The Virus
What is it Infection with human immunodeficiency virus -- "HIV is a virus that attacks the human immune system," McKay said. "White cells normally protect our bodies from harm by identifying infections, absorbing them, and destroying them. HIV is identified and absorbed into white cells, but instead of being destroyed, it takes over the cell and uses our own immune system to make more HIV."
"It is also transmitted vertically through pregnancy and childbirth. It's a virus that attacks the immune system." If left untreated HIV can lead to AIDS (Auto Immune Deficiency Syndrome).
Symptoms: Initial symptoms for both men and women include fever, rash, diaorrhoea and immune deficiency. HIV causes a reduction in CDT-4 cell count, which can lead to oral thrush, skin infections, weight loss and herpes zoster (better known as shingles).
How you can contract it: "HIV is most commonly contracted by sexual intercourse. In Australia, the highest population affected by HIV are gay males, but around the world the highest number of people affected are heterosexuals," McKay said.
"Various sexual activities carry different risks of transmitting HIV infection. Receptive anal sex (bottoming) has the highest risk, followed by receptive vaginal sex and a lower risk for insertive sexual partners (topping)," McKay said. He explained that HIV is not common in the lesbian community, it is unusual for women who have sex with women to transmit HIV infection."
Treatment options: "Highly Active Anti-Retroviral Treatment (HAART) is the recommended treatment for HIV. This medication blocks the ability for HIV to multiply in the human body," McKay said.
McKay explained that as HIV is a virus that rapidly mutates, it isn't stopped by using one or two medications. Patients need to regularly take three or more drugs that work on different parts of the HIV life cycle, in order to prevent its replication.
"We now have multiple medications contained within the same tablet. Many people living with HIV now only take one pill a day as treatment."
Also known as: The Clap, The Drip, The Dose
What is it? Neisseria gonorrhoeae -- an infection caused by bacteria -- "can go on to cause pelvic inflammatory disease, and can cause infertility," Mansberg said of the effect on women. For men, it can cause Epididymo-orchitis -- swollen and painful testicles. It's less common in heterosexual men and women, but still common in gay men.
Symptoms: Up to 80 percent of women have no symptoms, compared to only 10-15 percent of men. In women, symptoms include vaginal discharge, pain during intercourse, anal discharge and pain while defecating. Symptoms in men are similar, though they experience urethral discharge.
How you can contract it: "For Gonorrhoea, condoms are not strongly protective," Director of the Melbourne Sexual Health Centre, Professor Christopher Fairley said. This particular STI can also be transferred by oral sex and mutual masturbation. Fairley also told HuffPost Australia that "proper kissing" and saliva transmission will play a major role in the transmission of Gonorrhoea. "We've not gone so far to prove this, but we have certainly found lots of Gonorrhoea in saliva. And have shown that saliva that is used as a lubricant for anal sex that contains Gonorrhoea might be an important part of transmission from the throat to the anus."
Treatment options: "Gonorrhoea is treated with injections of antibiotics," Fairley said. Patients are advised to avoid sex for seven days after treatment.
Some lesbian women have the impression that they don't need to have regular Pap Smears if they're not having sex with men -- but this isn't true.Dr Brad McKay
5. Human Papillomavirus
Also known as: HPV
What is it? The Human Papillomavirus is a common virus with more than 100 different types. Eighty percent of men and women will contract a form of genital HPV in their lifetime. Many are harmless, but there are 40 types of genital HPV which are categorised as high-risk and low-risk -- both of which would be identified by an abnormal pap smear in women. The high-risk types can cause cervical, vaginal and anal cancers, while the low-risk types can cause genital warts.
"Genital warts have largely disappeared from Australian born heterosexuals because of the HPV vaccine programme," Fairley explained. However, Fairley said that genital warts are still a fairly common STI for men who have sex with men.
"Men who carry HPV don't get pap smears, so we can't know (if they carry it), said Mansberg. However, there are links between HPV and various types of cancers.
"Men can get it and it is linked to penile cancer. In men who have sex with men it can cause anal cancer and also throat cancer -- so contact between the penis and the back of the throat can cause (HPV) in the back of the throat and cause throat cancer," Mansberg said. HPV can also affect women who have said with women, said McKay.
Symptoms: Symptoms of HPV normally only occur when the virus persists and develops into a genital disease.
How you can contract it: HPV can be contracted through vaginal and anal intercourse. Though condoms can reduce the risk, HPV can also be transmitted through skin on skin genital contact.
Treatment options: "The pap test is excellent at detecting the presence of the virus on your cervix and allowing us to monitor that and treat it before it turns into cervical cancer, which is still the biggest cancer killer of women," Mansberg said.
"Some lesbian women have the impression that they don't need to have regular Pap Smears if they're not having sex with men -- but this isn't true," McKay said.
"HPV is readily spread between sexual partners, irrespective of gender, and can cause cervical cancer if the cervix is not regularly monitored with Pap Smears."
Also known as: The Pox, The Great Imitator
What is it? Treponema pallidum bacterium, subspecies pallidum -- "Syphilis was a big killer back in the day, before the invention of penicillin Syphillis killed lots and lots of people," Mansberg said. However, Fairley said that Syphilis is still a common STI for men who have sex with men.
Symptoms: Though 50 percent of people will have no symptoms, those who do may demonstrate primary or secondary symptoms. Primary symptoms include genital ulcers and chancres and enlarged Inguinal lymph nodes. Secondary symptoms include rashes, fever, malaise, headaches and lymphandenopathy.
How you can contract it: Vaginal, anal and oral sex, as well as skin rubbing. "If one person has got Syphilis and the other person doesn't -- they could potentially transmit (the infection) through mutual masturbation," Fairley said. "Condoms are not highly protective against syphilis transmission in gay men because oral sex plays such a major role."
Treatment options: Syphilis is treated with injections of penicillin.
Also known as: MG
What is it? Mycoplasma genitalium -- is a bacterial STI that has symptoms almost identical to Chlamydia, however it is much more resistant to antibiotics than the latter. Fairley told HuffPost Australia that Mycoplasma genitalium is being diagnosed more and more frequently. "It's not a notifiable infection, so it's hard to pull the numbers together to say how common it is or isn't," Fairley said. "But we expect it would be relatively common not only in Australia but throughout the world."
Symptoms: Like Chlamydia, men and women are often asymptomatic. However, Fairley said that symptoms are similar to those experienced with Chlamydia -- including discharge from the penis for men, and in women, abnormal bleeding (in between periods and after sex), vaginal discharge, pain after sex and abdominal pain.
How you can contract it: "MG is transmitted from the penis to the cervix and the cervix to the penis in heterosexuals," said Fairley. "For gay men it's really about transmission from the anus to the penis and back and forth." In both cases, condoms are very protective.
Treatment options: "MG often requires two different antibiotics to effectively treat it instead of the one, and those antibiotics may be up to 10 days or two weeks in some instances," Fairley said.
Considered to be a low level STI in Australia, Donovanosis is a form of genital ulceration. "It's so highly symptomatic, as soon as someone gets it they really don't have sex any more," Fairley said.
"We did see some in isolate aboriginal communities but it largely been eradicated from Australia now."
Hepatitis A and B
Both strains of Hepatitis virus are now vaccinated against. "If you are able to keep the proportion of the population that are at risk form that infection vaccinated to specific levels you will prevent outbreaks occurring. And currently that is the situation, there are enough people vaccinated to prevent outbreaks of those sexually transmitted forms of Hepatitis," Fairley said. He explained that most Hepatitis A and Hepatitis B are not transmitted sexually -- most Hep A is transmitted by Gastroenteritis and most Hep B is transmitted vertically from mother to child.
"Bacterial Vaginosis (BV) is more likely to occur in women who have sex with women," Mckay said. It's not technically considered a sexually transmitted infection -- but it's worth knowing about.
"There is a delicate balance of 'healthy' and 'unhealthy' vaginal bacteria, and BV occurs when the balance tips in favour of the 'unhealthy' bacteria. BV can cause vaginal discharge to have a fishy odour, but some women will have BV without symptoms. Abnormal vaginal flora causes inflammation of the walls of the vagina and makes it easier for other sexually transmitted infections to be transmitted."
Ectoparasites include scabies (known as crabs) and pubic lice. The former is associated with unclean living conditions, and the latter transmitted by contact between pubic hair (often during sex). None of the experts we spoke to identified Ectoparasites as the most prolific of STIs in Australia -- however, Dr Mansberg noted she had seen several cases in recent years. In 2011, pubic lice or crabs accounted for 4.2 percent of all diagnosed STIs contracted by women in Australia.
"They are parasitical lice that sit on the public hair and will feed on blood, and are transferred via contact between hair on pubic regions. (Pubic lice) need to transfer like Tarzan, and have one hand on your pubic hair and another hand on someone else's pubic hair," Mansberg said.
Seen as genital ulcers, it's now an extremely uncommon STI in Australia. "We haven't seen a case of Chancroid here for decades, it's another STI that's largely disappeared with the advent of antibiotics," Fairley said.
"An infection that is most commonly seen in women. It occurs in men as well but it doesn't last as long in men," Fairley said. Trichnomoniasis is often asymptomatic in men, and causes vaginal discharge and vaginal itching and discomfort in women. "You do see it in populations that have limited access to healthcare. We might see less that 1 in 1000 people here. In the 1950s before antibiotics for it became available we used to see 1 in 5 women with it at the centre, but it's very rare now."
This strain of Hepatitis is rare, but can occur in men who have sex with men.
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