STIs: symptoms, testing and when to see a urologist

STIs (sexually transmitted infections) are very common. In fact, about 20% of people in their 20s have experienced an STI.  

Usually, patients will first go straight to a GP or sexual health clinic for symptoms. However, if first-line treatment doesn’t work, patients may be referred to a genitourinary specialist (a urologist who also looks after the sexual reproductive system) to investigate the cause.

What are the most common STIs?

The most common STI is chlamydia, but gonorrhoea is on the rise. Syphilis is also on the rise and is a much more difficult STI to treat. All of these are mostly acquired through penetrative sex.

There is also trichomonas, which is caused by a parasite that is passed on mostly through penetrative sex. It’s quite common and affects many women, but it’s rarely transmitted to men. It’s generally asymptomatic (meaning there are no symptoms), but if the trichomonas bugs grow too much, a woman’s PH balance can change, which then causes symptoms.

Then there are STIs that don’t necessarily require penetrative sex and can be passed through activities like kissing and touching, such as the herpes virus and the lesser-known STIs of ureaplasma and mycoplasma; two types of bacteria that live inside the body.

30 Per cent of people have some form of herpes. Type 1 refers to oral herpes, which appears on the lips, and type 2 refers to the genital herpes virus. However, type 2 can also affect the mouth. Unfortunately, we can’t get rid of these and we can only manage the symptoms.

What symptoms suggest I have an STI?

Some STIs don’t have any symptoms but there are some general symptoms to always watch out for. If you experience any of the following, make an appointment with your doctor:

1. Stinging in and/or around the genitals
2. A burning sensation while passing urine
3. Blood in the urine (haematuria)
4. Frequent visits to the loo to pass urine

For men, there are additional symptoms of discharge from the penis and/or burning in the penis.

For women, it’s generally more difficult to detect STIs because most women won’t have symptoms until the STI has had a long time to progress, but occasionally they might have pain during intercourse or specific discharge from the vagina.

What tests are available?

Nowadays, we have a urine test for detecting STIs but unfortunately, this test can’t always be available on the NHS. Generally, what we like to do is a urine PCR (polymerase chain reaction) test to analyse the urine. We check for DNA fragments that are specific to these STI-causing bugs and a panel tells us if the DNA belongs to chlamydia, gonorrhoea, trichomonas, or herpes.

We can also take swabs. However, quite often STI test results are negative. In women, swabs for chlamydia (whether it’s a vaginal or urethral swab) can quite often result in a false negative. Actually, 40 per cent of the time tests can’t detect STI-causing bugs.

What happens if an STI test is negative?

In the case of a negative result, we might give the patient a course of treatment anyway because they have a high level of having an STI, or they have STI symptoms despite the negative test result. This is because our main goal is to treat each person’s symptoms and not simply follow the test result.

How often should people have STI tests?

Anyone who frequently has unprotected sexual intercourse is considered to have a high risk of catching STIs. These people shouldn’t wait for symptoms and instead, they should have regular screening because they are likely to harbour infectious bugs and pass them on.

Generally, if you’ve had unprotected sex and/or have symptoms of STIs, ask your doctor for an STI test.

And remember, the results are kept entirely private. No one can get the results except you, the patient.

What happens if STIs are left untreated?

STIs that have gone untreated for a long time can progress silently and have serious consequences throughout the body e.g. they can affect a woman’s fertility and cause them intense pain. In men, undetected and untreated STIs can also affect the prostate and cause prostatitis or pelvic pain.

When should people see a urologist for symptoms?

Normally, people with STI symptoms can be treated by a GP or at a sexual health clinic. Generally, a genitourinary medicine specialist (a doctor who looks at urology and sexual reproductive health) is not the first point of contact.  

If the treatment provided by a GP or sexual health clinic doesn’t work, you could be referred to a urologist or a genitourinary specialist to look at other possible causes, such as a UTI. You can also discover the risks factors for UTIs and how to prevent them in my other article: How to prevent and get rid of UTIs

Mr Mathias Winkler is at the forefront of his field and utilising the latest technologies and methods in his patients’ treatment. Arrange your first consultation with Mr Winkler via his profile.