STIs and the GUM / sexual health clinic

Ooh, where to start?

Of course one of the popular misconceptions about escorts is that we are all disease-ridden. What Joe Public fails to realise is that we probably take more care in our sexual health practices than your average good-time girl-about-town on a Saturday night. How can we say that? Well, many reasons, not least of which is that out livelihood could depend on it.

For those starting out, we'd recommend getting yourself a hepatitis jab which is routinely offered to the likes of policeman and paramedics and others who come into close contact with people. You can get this done at your local GUM (Genito Urinary Medicine) clinic for free. They will also give you health advice and free condoms too*.

(*There is a school of thought that believes that ladies earning in the region of a £100+ an hour shouldn't be using the NHS to supply basic tools of their trade, which condoms undoubtedly are. Rather than going to Boots to buy a small pack at a time, you can but in bulk online. The best thing to do is use Google to search for "bulk condoms" and compare brands, types and prices across the most popular sites. And don't forget as a necessary business expense, condoms are tax deductible.)

Regular checks are important for you and your clients and all of us in the industry. Remember: guys may well see lots of different girls so take responsibility for yourself and don't be embarrassed to attend a clinic. At some clinics, you will have to ask for an HIV test as it is not seen as a routine test but do it, if only for peace of mind. The same also applies to throat swabs – particular important if you offer oral without a condom (OWO).

Some girls go for clinic checks monthly, others three-monthly, some 6-monthly; your health advisor will give you an idea of what is right for you. You don't have to give your real name but we would strongly suggest you let them know what you do for a living, as that will help them to give you the right level of support. In the vast majority cases you won't be judged in a harsh way by your health advisor but they are of course human so be prepared and stick to your guns – you are doing nothing wrong or illegal. Ask for a different health advisor if you do not feel comfortable with the first one you see.

You can find details of your nearest clinic in the phone book under genito-urinary clinic or on the web at www.nhs.uk.

So, on to the nasty stuff! It really does pay to know what is what. There are sites around the net which have pictures of bits of anatomy in various states of infection – those alone will be enough to make you want to take every precaution you can. If you need further convincing, this article contains some details below which Melanie has put together about various sexually transmitted infections.

Oh, and if you want more info AND pictures go here (pdf file).

Herpes

Herpes is a highly contagious STI that is recurring and incurable. There are two types of herpes virus:

Type 1 usually occurs around the mouth and appears as fever blisters and cold sores.

Type 2 usually occurs in the genital area and appears as painful lesions. However, infection with either of these viruses can occur anywhere on the body e.g. around the mouth, genitals, and eyes – are the most vulnerable. It would be interesting to note that Type 1 can lead to Type2.

Herpes is usually transmitted through direct contact with an active lesion and/or infected secretions. During the first outbreak, which is very painful and extremely contagious, small bumps appear. In a few days, these small bumps become fluid-filled blisters, which will eventually open up and heal. At this time, the herpes virus will travel and remain dormant in nerve endings at the spinal cord until the next occurrence.

Herpes can be transmitted even without experiencing any symptoms. Usually a person with herpes will experience symptoms, such as tingling or itching near the infected area. Although there is no cure for herpes, it is treatable with an antiviral drug, which will limit the duration of an outbreak.

Genital ulcer diseases, such as herpes, can occur in genital areas that are covered or protected by condoms. They can also occur in areas that are not covered or protected by a latex condom. Latex condoms, when used consistently and correctly, can reduce the risk of herpes, only when the infected areas are covered or protected by the condom.

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Genital HPV

Genital HPV infection is an STI that is caused by human papilloma virus. HPV includes a group of more than 70 viruses. Certain types of HPV are transmitted sexually and some of these may cause warts on the genitals, such as the vulva, labia, anus, and/or the tissues of the vagina and cervix. Although the amount of people affected by the virus can be high less than 1% seem to develop visible warts. Most people with genital HPV experience no symptoms. Therefore, most infected people don't know they are infected and may unknowingly infect a sexual partner.

Although most types of HPV are harmless, some types may cause cervical lesions that, over time, develop into cervical cancer in infected women. Annual Pap smears and careful medical follow-up, with treatment if necessary, will help ensure that abnormal cells in the cervix caused by HPV infection do not develop into cervical cancer.

Genital HPV is spread through skin-to-skin contact. Genital HPV infections can occur in genital areas that are covered or protected by a latex condom. They can also occur in areas that are not covered or protected. Latex condoms, when used consistently and correctly, can reduce the risk of genital HPV, only when the infected areas are covered or protected by the condom.

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Syphilis

Syphilis, a curable STI, is caused by the bacterium "Treponema pallidum." Syphilis, which is transmitted through direct contact with a lesion on an infected partner, can and will progress through at least four stages if left untreated. The symptoms determine the stage of the syphilis infection. The stages are primary, secondary, latent, and late syphilis. The symptoms of primary syphilis can take between 10 days to three months to appear.

The first symptom is usually a painless ulcer, called a chancre, which occurs where the infection takes place. It is very easy not to notice the first lesion, especially if it is in the vagina or on the cervix. If left untreated, the lesion usually disappears after a few weeks. This does not mean that the syphilis has disappeared. In two to 12 weeks after the chancre is gone, the symptoms of the secondary stage can appear. These symptoms can range from a red, non-itching rash over the entire body (including the palms of the hands and soles of the feet), fever, sore throat, joint aches, headaches, fatigue, nausea, wart-like lesions in the genital area, and weight loss. During both primary and secondary phases, the infected person is highly infectious to partners. The symptoms of secondary syphilis are so common that they can be mistaken for other medical conditions, for example, flu or an allergic reaction. If the symptoms are overlooked and left untreated, syphilis will progress to the next stage, which is called latent syphilis.

Anyone with latent syphilis can live many years without experiencing any more symptoms and the only way to detect that he/she is infected with syphilis is through a blood test. Left untreated, syphilis progresses to the most destructive and final stage, late syphilis. The late stage involves serious damage to the internal organs, including the heart, brain, bones, liver, skin, and kidneys, to name a few.

Genital ulcer diseases, such as syphilis, can occur in genital areas that are covered or protected by a latex condom. It can also occur in areas that are not covered or protected. Latex condoms, when used consistently and correctly, can reduce the risk of syphilis only when the infected area is covered or protected by the condom.

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Gonorrhea and Chlamydia

Gonorrhea and chlamydia are two of the most common STI's in women and men. They are transmitted from person to person through vaginal, oral, and/or anal sex. Women and men with gonorrhea and/ or chlamydia experience few or no symptoms. Some common symptoms in women include a yellowish vaginal discharge, painful or frequent urination, redness, swelling, or soreness in the genital area, pain during sex, lower abdominal pain and/or vaginal bleeding. Some common symptoms in men include discharge from the penis and pain and burning during urination. Some people infected with gonorrhea or chlamydia may not have any symptoms. Therefore, it is important to have an annual examination if you are sexually active. Untreated, gonorrhea and chlamydia can cause serious complications, such as pelvic inflammatory disease and infertility. Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhoea and chlamydia.

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Pelvic Inflammatory Disease

Pelvic Inflammatory Disease (PID) is usually caused when gonorrhea and/or chlamydia are left untreated. PID is an infection that spreads upward into the pelvic area and effects the uterus, fallopian tubes, and ovaries. Unfortunately, PID can occur without causing any noticeable symptoms. When symptoms do appear, they may be mild or severe. A woman may experience pain in the pelvic area, vaginal discharge, painful urination, or abnormal bleeding. More severe cases may be accompanied by fever, chills, nausea, and vomiting. Antibiotics are given to treat PID.

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Hepatitis

Hepatitis A (HAV) is a virus spread from person to person by anal/oral contact, by putting something in the mouth that has been contaminated with infected faeces, and faecal contamination of food and water.

Infection with hepatitis A is confirmed when the blood test for hepatitis A, called the IgM hepatitis A antibody test, is positive.

Symptoms may include feelings of illness, experiencing jaundice, fatigue, nausea, vomiting, abdominal pain, dark urine/light stools, and fever.

An infected person can transmit the virus to others as early as two weeks before symptoms appear and one week after. There is no specific treatment for hepatitis A. An infection will clear up in a few weeks to a month and the recovered individual is then immune and will never get HAV infection again.

Some individuals (1 in 100) suffer from an infection (fulminant) that may require a liver transplant. HAV Vaccines are recommended to men who have sex with other men among other groups of people at a higher risk. The HAV vaccine is highly effective in preventing hepatitis A.

Hepatitis B (HBV) is a disease that causes inflammation to the liver. Although 90-95% of adults recover within six months and will not contract HBV again, blood tests will always show that they have been infected with HBV and blood banks will not accept their blood.

Many people with acute hepatitis B have no symptoms at all, or they may be very mild and flu-like symptoms. About 25-35% of patients may notice dark urine, yellowing of the skin and eyes (jaundice), or light coloured stools.

HBV is transmitted through contact with body fluids containing HBV, such as blood, semen and vaginal fluids. It is mostly passed on from person to person through sexual contact. HBV tests will not show positive during the incubation period (1-12 weeks). There are three standard HBV tests:

1) HbsAg – when the test is positive or reactive you are positive and infectious.

2) Anti-HBc – when you test positive it means you are currently infected or have been infected some time in the past.

3) Anti-HBs – when the test is positive it means that you are immune to HBV either as a result of having had the disease or from having been vaccinated.

People who have not cleared HBV from their blood within 6 months are considered to be chronically infected.

Hepatitis C (HCV) causes inflammation of the liver. People who are in high risk situations for Hep C include anyone who has had a blood transfusion prior to 1992, those with tattoos, those with multiple sexual partners, and IV drug users. Individuals with body piercing and those who have snorted cocaine are also at risk.

The virus in found in the blood. It is not clear whether it can be transmitted through saliva or breast milk.

All people with HCV are potentially infectious.

There is NO VACCINE for HCV. It is also interesting to note there are various strains of HCV and the virus undergoes mutations. Also, there is no effective immune globulin preparation. Most infected people do not have symptoms. The incubation period varies but averages about 7-8 weeks. The virus in the blood can cause liver damage. If symptoms are present, they may be very mild and flu-like. Most people do not have jaundice, however it can sometimes occur along with dark urine.

HCV may identified by anti-HCV testing in approximately 60% of people as soon as 5-8 weeks after exposure. Few people are able to clear the virus from their blood. Over 80% of cases each year become chronic. Chronic infections refer to those cases that do not clear up in within 6 months. Currently there are three forms of treatment. Avoiding contact with blood of an infected person and practising safer sex decreases the risk of contracting HCV.

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AIDS

Acquired Immune Deficiency Syndrome otherwise known as AIDS is caused by a virus called HIV (Human Immunodeficiency Virus) , that weakens the body's immune system so that it loses the ability to fight off infection and illnesses. Some medicines can lengthen the lives of people with AIDS, but there is no cure.

How can you get HIV? You can get HIV through direct contact with blood, semen (cum), vaginal fluids, and breast milk. You can get the virus by exchanging blood, semen, and vaginal secretions through vaginal, oral, or anal intercourse with someone who has HIV. During vaginal intercourse, the risk of becoming infected is higher for women than men, because HIV is more easily transmitted from man to woman.