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The safe sex message has been drummed into us for years, but not everyone is getting it. More and more Kiwis are being diagnosed with sexually transmitted infections, Rebecca Palmer writes. Beethoven, van Gogh, Oscar Wilde and Guy de Maupassant had more than great art in common ? they are among famous men thought to have suffered from the dreaded disease syphilis.

Friday, 06 Apr 2007
Syphilis: the fallout from unsafe sex

The safe sex message has been drummed into us for years, but not everyone is getting it. More and more Kiwis are being diagnosed with sexually transmitted infections, Rebecca Palmer writes.

Beethoven, van Gogh, Oscar Wilde and Guy de Maupassant had more than great art in common ? they are among famous men thought to have suffered from the dreaded disease syphilis.

But though it might sound like something from another age, syphilis is unfortunately not consigned to the history books. Once almost extinct, it has become a growing problem in New Zealand.

Jane MacDonald, of Wellington's Sexual Health Service, says the clinic diagnosed 19 cases last year. "Before 2002, we would not have seen virtually any infectious cases."

Those infected greeted their diagnosis with shock. As she puts it: "People in Africa get syphilis and people in the 15th century get syphilis."

The concept is even foreign to many medical professionals. Dr MacDonald has been working to increase awareness among GPs, and last week she gave a presentation at Wellington Hospital. "Most of the people in medical practice now didn't learn about syphilis in medical school."

She wants doctors to add it to their list of possible diagnoses.

The fact it can mimic other diseases makes it less likely to be detected. "If someone presents with a rash all over their body, the first thing you think about is not going to be syphilis."

Syphilis is a bacterial infection that can be transmitted by having vaginal, anal or oral sex without a condom. It can also be spread from pregnant women to their babies.

It is highly infectious, Dr MacDonald says, and particularly dangerous because a third of people will not have any symptoms. Another third will have some symptoms but these disappear quickly, and these sufferers fail to seek medical help.

The "classic symptom" is a painless ulcer on the genitals. "After that, they may develop a body rash, swollen glands, feel generally unwell or they may develop more specific symptoms."

Syphilis is easily cured in its early stages, requiring only an injection of penicillin.

If untreated, it can lie latent for years eventually causing damage to almost all the internal organs, including the brain.

Dr MacDonald says most of the Wellington cases have involved men who have sex with men. In Auckland, about half the cases have involved heterosexual people. Having sex overseas was found to be a risk factor.

Men who have sex with other men anonymously but do not consider themselves gay are particularly at risk of syphilis and other sexually transmitted infections, she says. They are less likely to seek medical help and more likely to pass an infection on to a female partner.

Both Dr MacDonald and Family Planning Association national nurse adviser Rose Stewart are concerned people appear to have become complacent about safe sex.

"We've been banging on about it for a long time. I think people just want to have fun. They don't want to worry about all that stuff," Mrs Stewart says.

She repeats some familiar advice. "It's condoms, condoms, condoms . . . If everyone just used them all the time, then it would really reduce the burden of STIs."

Oral dams ? thin squares of latex placed over the vaginal or anal area during oral sex ? are also available from family planning clinic and some pharmacies.

Though syphilis may be the most dramatic sounding of the sexually transmitted infections, other nasties also appear to be on the rise.

The STIs to watch out for:
HIV

Last year, 177 people were newly diagnosed with HIV, according to figures issued by Otago University's Aids Epidemiology Group.

Seventy were men infected through having sex with other men and 85 were heterosexual. Two were children born overseas and infected by their mothers. For others, the cause was unknown.

2006 was the second-worst year in New Zealand's HIV/AIDS history ? just behind 2005. It saw the highest number of heterosexuals and also the highest number of women diagnosed in any one year ? though most were infected overseas.

Mrs Stewart says HIV continues to be a serious threat, even though publicity has died down. "The epidemic hasn't happened the way everyone thought it would . . . The reason we haven't had a real epidemic of HIV, I think, is because the gay community took hold of it and managed it."

However, she warns that it could take off. As treatment has become more effective, HIV-positive people look healthier than they used to, Dr MacDonald says. "People may see HIV as treatable."

Five women tested HIV-positive through antenatal screening last year.

The Health Ministry plans to introduce routine antenatal HIV screening nationwide and Waikato District Health Board was the first to begin the programme. Dr MacDonald says it has already picked up two HIV-positive women who did not fit the high-risk picture and would not otherwise have been diagnosed.

"They will now have the opportunity to reduce the risk of transmission to their babies from about 30 per cent to less than 2 per cent."

CHLAMYDIA

Genital chlamydia, a bacterial infection, is New Zealand's most commonly diagnosed sexually transmitted infection. According to Environmental Science and Research figures, the number of people diagnosed at sexual health clinics rose by 39 per cent between 2000 and 2005.

"It's a very large burden of disease in this country," Mrs Stewart says. Chlamydia is often asymptomatic and many only discover they have it when they come in to Family Planning clinics for something unrelated.

However, symptoms for women can include pain in the lower abdomen, during intercourse or when urinating and a discharge or abnormal bleeding from the vagina. Men may have a discharge from the penis or pain when urinating.

In women, it can lead to pelvic inflammatory disease if not treated, which can cause infertility. It can also cause ectopic pregnancy ? where the foetus grows in fallopian tubes instead of the uterus.

Babies born to mothers with chlamydia can get eye and lung infections. The good news is that it is easily treatable ? usually with a single dose of antibiotics.

GONORRHEA

This is a bacterial infection of the genitals, throat or rectum and can be caught through unprotected vaginal, anal and oral sex. The number of people diagnosed is increasing. Like chlamydia, you may be unaware you have it.

However, symptoms for women include pain during sex, vaginal discharge, lower abdominal pain and heavier periods. Men might have discharge from the penis or rectum, pain in the testicles or when urinating.

It can be treated with antibiotics, but if untreated, can cause infertility in both men and women.

GENITAL HERPES

Genital herpes is caused by the herpes simplex virus (HSV), which comes in two varieties. HSV-1 is usually associated with infection on the mouth and lips (cold sores) and HSV-2 usually causes genital herpes. The first attack of genital herpes is often the worst, causing a painful blister, ulcers or sores. "It's painful and recurrent in a lot of people," Mrs Stewart says. However, you may not get any symptoms and unwittingly pass the virus on to someone else. Herpes is incurable at present but medication can help shorten an outbreak. Vaccines are being investigated.

GENITAL WARTS

Genital warts ? small, flat lumps on the genitals that may be itchy ? are caused by human papilloma virus (HPV), the most commonly diagnosed sexually transmitted virus. "They are very, very common and people feel appalled when they realise they've got warts on their genitals," Mrs Stewart says. Fortunately, specialists can remove them by using liquid nitrogen, heat or chemical paint. Some types of HPV are strongly linked to cervical cancer but genital warts are caused by different strains.

Unprotected sex is also one of the ways of contracting hepatitis A and B and, very rarely, hepatitis C.

Who gets STIs and who needs testing?

Under-25s have the highest rates of chlamydia, gonorrhea, genital warts and genital herpes. However, Dr MacDonald says: "There's an older group who are coming out of long-term relationships and don't have safe sex."

Family Planning is developing a website about sexual issues specifically for that group, Mrs Stewart says. She has also noticed more young men are turning up at Family Planning clinics ? an encouraging sign.

Dr MacDonald says: "I think that people who are sexually active with new partners or more than one partner should think about getting a check-up. Sexually active gay men should probably have a check-up every year."

She says women should be proactive in asking for a sexual check-up when they become pregnant, to avoid passing infection on to their babies.

Kiwis tend to have a "she'll be right" attitude to STIs. "They don't think that they are going to be the unlucky ones."

Mrs Stewart says: "The people who don't need a sexual health check are ones who haven't had any kind of sexual activity at all."

In the Wellington region, people can get confidential sexual health check-ups from Family Planning, the sexual health service, GPs, student health clinics and youth services Vibe and Evolve.

Source Stuff New Zealand