Download - The Complications of Unprotected Sex
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Illustrated by imi Ridley
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this is an illustrated
guide and informative
issue about sexually
transmitted diease.
the purpose of this
issue is to hilight
the complications and
risks of having
unprotected sex with
an infected person.
inside is information
guideing you on what
could happen to your
body if you become
infected in and whatyou can do about it.
Sexual health is an
important part of
physical and mental
health as well as your
emotional and social
well-being. It’s
important to take care
of your sexual health
and, if you have
children, it’s good to
talk about sex and
relationships.
Intro
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Chlamydia
Gonorreha
Syphilis
Hepatitis
B
HIV
Herpes
HPV
(Gential
Warts)
Further
Help Links
p.4-7
p.8-11
p.12-15
p.16-19
p.20-23
p.32
p.28-31
p.24-27
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Chlamydia.the most common STI diagnosed in the uk.
You may have heard of chlamydia, but
many people are not sure what it is.
Chlamydia is an infeon caused by a kind
of bacteria that is passed during sexual
contact. About three million Brish women
and men become infected with chlamydia
every year. It is especially common among
women and men under 25.
What is chlamydia?
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Symptoms in
men
• White, cloudy or watery
discharge from penis
• burning or itching in
• urethra
• pain in tescles
• pain when urinang
chlamydia in men
What are the risks
in men?
if chlamydia is le untreated, the
infecon can cause swelling in
the epididymis (tubes that carry
sperm from the tescles) and the
tescles. This could aect your ferlity. In
extreme cases of chlymdia being le
untreated within males it can devel-
op into Reiters Rarely chlyamia leadsto a condion called reacve arthris.
Reacve arthris causes a varietWy of
condions, including swelling and pain
in the joints that can be disabling.
In both women and men,
chlamydia may cause the anus
to itch and bleed. It can also
result in a discharge and
diarrhea. If chlamydia infects
the eyes, it may cause redness,
itching, and a discharge.
If chlamydia infects the
throat, it may cause
soreness. Chlamydia symptoms
may only appear in the morning
and may be mild, especially for
men. That's why many people do
not realize they have an infecon.
chlamydia
symptoms in
men
The symptoms of chlamydia in men can be dicult to spot. Symptoms may be infrequent and
random, which somemes leads paents to believe that they are not caused by an infecon. Men
with chlamydia have 3 mes the normal level of DNA fragmentaon in sperm (which means that the
genec material is not packed ghtly enough and the long strands become suscepble to breakage).
Around
25 - 50% of
all male
chlamydia cases
go completely
unnoticed
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how can
chlaymdia be
treated?
Chlamydia can usually be treated easily
with anbiocs. You may be given some
tablets to take all on one day, or a longer
course of capsules to take for a week.
You shouldn’t have sex unl you and
your current sexual partner have
nished your treatment. If you hadthe one-day course of treatment, you
should avoid having sex for a week
aerwards. The two most commonly
prescribed anbiocs for chlamydia are:
azithromycin – given as two or four
tablets at once
doxycycline – given as two capsules a
day for a week
of chlamydia.
It’s important that your current sexual
partner and any other sexual partners
you’ve had during the last six months
are also tested and treated to help stop
the spread of the infecon.
Sexual health or GUM clinics can help
you contact your sexual partners.
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Gonorrhea.Also known as the 'Clap'.
What is Gonorrhea?
Also called the “clap” or “drip,”
gonorrhea is a contagious disease
transmied most oen through sexual
contact with an infected person.
Gonorrhea may also be spread by
contact with infected bodily uids,
so that a mother could pass on the
infecon to her newborn during childbirth.
Both men and women can get gonorrhea.
The infecon is easily spread
and occurs most oen in
people who have many sex partners.
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What are the risks for men?
In men, gonorrhoea can cause painful infecon in the tescles and prostate gland, which
may lead to reduced ferlity in a small number of cases. In rare cases, when gonorrhoea
has been le untreated, it can spread through the bloodstream to cause life-threatening
infecons in other parts of the body like sepcaemia. Occasionally, widespread or
disseminated gonococcal infecon may occur. this is where usually a skin rash has small
papules that turn into pustules on broad erythematous bases and necroc centres.
Symptoms in
men
gonorrhea in men
gonorrhea
symptoms in
men
The rst symptoms may appear about
a week aer transmission of the
disease and usually involve an infecon
of the urethra, which causes pain when
urinang (or a burning sensaon when
peeing). While the gonorrhea symptoms
may go away aer a few weeks, the infecon
remains in your system and can cause
further damage to your urethra
or other parts of your body. Less
common symptoms of gonorrhea in
men include pain in the tescles, and
possibly anal pain or discomfort if
the infecon spreads to the rectum
• greater frequency or urgency of
urinaon.
• a pus-like discharge (or drip)
from the penis (white, yellow,
beige, or greenish)
• swelling or redness at the
opening of the penis.
• swelling or pain in the tescles.
• a persistent sore throat.
90% of
men with
gonorrhea have
symptoms, which
makes it easierto identify the
infection
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if women
get symptoms
they are often
mistaken for
bladder
infections
gonorrhea in women.
• Greenish yellow or whish
discharge from the vagina
• Lower abdominal or pelvic pain
• Burning when urinang
• Conjuncvis (red, itchy eyes)
• Bleeding between periods
• Spong aer intercourse
• Swelling of the vulva (vulvis)
• Burning in the throat (due to
oral sex)
• Swollen glands in the throat
(due to oral sex)
symptoms in
women
gonorrhea
symptoms in
women
These symptoms in women can
go unnoced or be mistaken for
another type of infecon such as
a common yeast infecon, which
can be treated with over-the-
counter medicaon. However, an
abnormal vaginal dischargecan
be the sign of a variety of
condions and infecons
Untreated gonorrhea can spread into the uterus and fallopian tubes, causing pelvic
inammatory disease (PID), which may result in scarring of the tubes, greater risk of
pregnancy complicaons and inferlity. PID is a serious infecon that requires immediate
treatment. Women who have gonorrhea during pregnancy tend to have higher rates of
miscarriage, infecon of the amnioc sac and uid, preterm birth, and preterm premature rupture of membranes (PPROM),
although prompt treatment reduces the risk of these problems. An untreated gonorrhea infecon makes you more
suscepble to HIV and som other sexually transmied infecons (STIs), if you’re exposed to them, and raises your risk of a
uterine infecon aer you have your baby. If you have a gonorrhea infecon when you go into labor, you can pass the
bacteria to your baby. Gonorrhea in newborns most commonly aects the eyes, and babies may eventually go blind if le
untreated.
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how can
gonorrhea be
treated?
In most cases, treatment involves having
a single anbioc injecon (usually in
the buocks or thigh) followed by one
anbioc tablet. It's somemes possible
to have another anbioc tablet instead
of an injecon, if you prefer.
If you have any symptoms of
gonorrhoea, these will usually improve
within a few days, although it may take
up to two weeks for any pain in your
pelvis or tescles to go away completely.
Bleeding between periods or heavy
periods should improve by the me of
your next period.
Aending a follow-up appointment a
week or two aer treatment is usually
recommended, so another test can be
carried out to see if you're clear of
infecon.
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Syphilis.a highly contagious diseasespread by sexual activity.
Syphilis is a sexually transmied infecon (STI). There are
four stages of the disease: primary, secondary, latent, and
terary (also known as neurosyphilis). Primary syphilis is
the rst stage of the disease. It causes one or more small,
painless sores in or around the genitals, anus, or mouth
Syphilis is a highly contagious disease spread primarily by
sexual acvity, including oral and anal sex. Occasionally,
the disease can be passed to another person through
prolonged kissing or close bodily contact. Although this
disease is spread from sores, the vast majority of those
sores go unrecognized. The infected person is oen
unaware of the disease and unknowingly passes it on to his
or her sexual partner.
Early or primary syphilis. People with primary syphilis will
develop one or more sores. The sores are usually small
painless ulcers. They occur on the genitals or in or around
the mouth somewhere between 10-90 days (average three
weeks) aer exposure. Even without treatment they heal
without a scar within six weeks.
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primary
symptoms of
syphilis
syphilisprimary stage • In men, a chancre oen appears inthe genital area, usually (but notalways) on the penis. These sores are
oen painless.
• In women, chancres can develop on
the outer genitals or on the inner
part of the vagina. A chancre may
go unnoced if it occurs inside the
vagina or at the opening to the
uterus (cervix). The sores are usually
painless and are not easily seen.
• Swelling of the lymph nodes may
occur near the area of the chancre.
• A chancre may also occur in an area
of the body other than the genitals.
• The chancre usually lasts for 3 to
6 weeks, heals without treatment,
and may leave a thin scar. But even
though the chancre has healed,
syphilis is sll present and a person
can sll pass the infecon to others.
During the primary stage of
syphilis, a sore (chancre) that is
usually painless develops at the
site where the bacteria entered
the body. This commonly occurs
within 3 weeks of exposure but
can range from 10 to 90 days.
A person is highly contagious
during the primary stage.
Men suffer
1.5 times
more
of syphilis
than women.
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Syphilis
can be spread
from an infected
mother to
her unborn
baby. Syphilissecondary stage
secondary
symptoms of
syphilis
The symptoms of secondary
syphilis develop two to eight weeks
aer a person rst becomes
infected with primary syphilis. The
secondary stage is usually marked
by a nonitchy rash. The rash might
be conned to one part of your
body, or it could spread over
several parts. The appearance of
the rash varies. One common man-
ifestaon is rough, reddish-brown
spots on the booms of your feet
and on the palms of your hands.
Other symptoms of secondary
syphilis include:
• sore throat
• fever
• swollen lymph glands
• headaches
• fague
• muscle aches
• wart-like patches around skin
folds or genitals
• loss of appete
• joint pain
• enlarged lymph nodes
If you don’t receive treatment duringthis inial appearance of symptoms,
the bacterium that caused this STI
will spread through your
bloodstream, and you’ll soon have
secondary syphilis. Without
treatment, your syphilis will l ikely
connue to progress. It can be 10 or
20 years before you experience the
worst eects. Eventually, untreated
syphilis will lead to damage to the
brain, eyes, heart, nerves, bones,
joints, and liver. You could also
become paralyzed, blind, demented,
or lose feeling in the body. Untreated
syphilis can also lead to sllborn or
developmentally delayed babies.
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A short course of anbiocs can
usually cure syphilis. These are only
available on prescripon, so you’ll need
to be tested for syphilis to get them.
The type of treatment you need
depends on how long you’ve hadsyphilis.
• Syphilis that has lasted less than
two years is usually treated with
an injecon of penicillin into your
buocks, or a 10-14 day course of
anbioc tablets if you can’t have
penicillin.
• Syphilis that has lasted more than
two years is usually treated with
three penicillin injecons into your
buocks given at weekly intervals, or
a 28 day course of anbioc tablets if
you can’t have penicillin.
how can
syphilis be
treated?
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Hepatitis B.likely to effect people who inject drugs and who
have unprotected sex with multiple partners.
Hepas B is a virus that infects the liver. Most adults who
get it have it for a short me and then get beer. This is called
acute hepas B. Somemes the virus causes a long-term
infecon, called chronic hepas B. Over me, it can damage
your liver. Babies and young children infected with the virus
are more likely to get chronic hepas B.
how can
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You can have hepas B and
not know it. You may not havesymptoms. If you do, they can
make you feel like you have
the u. But as long as you have
the virus, you can spread it to
others. It's causeby the
hepas B virus. It is spread
through contact with the blood
and body uids of an infected
person.
You may get hepas B if you:
• Have sex with an
infected person without
using a condom.
• Share needles (used for
injecng drugs) with an
infected person.
• Get a taoo or piercing with
tools that weren't sterilized.
• Share personal items like
razors or toothbrushes with
an infected person.
how can
you get
Hepatitis B?
Injury to the liver by hepas B
virus is caused by the body's immune
response as the body aempts to
eliminate the virus. Those who acquire
the infecon in childhood are much
more likely to have chronic infecon.
Chronic hepas B may lead to cirrhosis
or liver failure. Approximately 15% to 25%
of people with chronic infecon will die
prematurely as a result of the infecon.
Hepatits Bliver damage
Most
people who
have chronic
infectionshave no
symptoms
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what are the
symptoms
hepatitis B?
if you do have symptoms, they may
include:
• Extreme redness.
• Mild fever.
• Headache.
• Loss of appete, nausea, and
voming.
• Constant discomfort on the
right side of the belly under the
rib cage. (That’s where the liver
is located.)
• Tan-colored bowel
movements (stools).
• Dark urine.
• Jaundice. This means that the
skin and whites of the eyes look
yellow. Jaundice is a major sign
of liver damage.
You may get infected without knowing it. You may not nd out that you
have an infecon unl you have a roune blood test or donate blood.
Finding out that a family member or someone you live with is infected
also may cause you to be tested. Some people never know they havehepas B unl a doctor nds that they have cirrhosis or liver cancer.
A mother who has the virus can pass it to her baby during delivery.
Medical experts recommend that all pregnant women get tested for
hepas B. If you have the virus, your baby can get shots to help
prevent infecon with the virus.
Hepatits BSymptoms
It is
spread
through contact
with the blood
and body fluids
of an infected
person.
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how can
hepatitis B
be treated?
In most cases, hepas B goes away onits own. You can relieve your symptoms
at home by resng, eang healthy foods,
drinking plenty of water, and avoiding
alcohol and drugs The hepas B vaccine
is the best way to prevent infecon. The
vaccine is a series of 3 or 4 shots. Adults
at risk and all babies, children, and
teenagers should be vaccinated.
A combinaon vaccine (Twinrix) that
protects against both hepas B and
hepas A also is available.
To avoid geng or spreading the virus to
others:
• Use a condom when you have sex.
• Don't share needles.
• Wear latex or plasc gloves if you have
to touch blood.
• Don't share toothbrushes or razors.
• Don't get a taoo, or make sure that
the needles used have been cleaned
properly and are sterile.
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HIV.an incureable disease that weakens yourability to fight infections and disease.
HIV is a virus that aacks the immune system, and weakens your ability to ght infecons and
disease. It's most commonly caught by having sex without a condom. AIDS is the nal stage
of HIV infecon, when your body can no longer ght life-threatening infecons. With early
diagnosis and eecve treatment, most people with HIV will not go on to develop AIDS.
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The u-like illness that
oen occurs a few weeks aer
HIV infecon is also known as
seroconversion illness. It's
esmated that up to 80% of
people who are infected withHIV experience this illness.
The most common symptoms
are:
• fever (raised temperature)
• sore throat
• body rash
Other symptoms can include:
• redness
• joint pain
• muscle pain
• swollen glands (nodes)
what are the
symptoms of
HIV? HIV
inital symptomsThe symptoms usually last one to two weeks but can be longer. They are
a sign that your immune system is pung up a ght against the virus.
We all have lymph nodes throughout our bodies, including the neck,
back of the head, armpits, and groin. As part of the immune system, our
lymph nodes fend o infecons by storing immune cells and ltering for
harmful substances. As the HIV infecon begins to spread, the
immune system kicks into high gear. The result is enlarged lymph nodes,
commonly known as swollen glands. It’s oen one of the rst signs of HIV.
Highest
rates of HIV
are gay and
bisexual men and
heterosexual
BlackAfricans
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Aer the inial symptoms
disappear, HIV will oen not
cause any further symptoms for
many years. During this me,
known as asymptomac HIV
infecon, the virus connues to
be acve and causes progressive
damage to your immune system.
This process can take about 10
years, during which you will feel
and appear well.
Factors that may shorten the
me between HIV and AIDS:
• Older age
• HIV subtype
• Co-infecon with other
viruses (like tuberculosis or
hepas C)
• Poor nutrion
• Severe stress
• Your genec background
HIV
asymptomaticinfection
During the third stage of HIV
infecon there is usually a lot
of damage to your immune
system. At this point, you
are more likely to get serious
infecons or bacterial and
fungal diseases that you
otherwise would be able to
ght o. These infecons are
referred to as ‘opportunisc
infecons’. If a person is
experiencing opportuisc
infecons they are
now said to have AIDS
Once the immune system
becomes severely damaged
symptoms can include:
• weight loss
• chronic diarrhoea
• night sweats
• skin problems
• recurrent infecons
• serious life-threatening
illnesses
what are the
syptomatic
symptoms of
HIV?
An
estimated
17% of people
with HIV do not
know they areinfected.
h HIV
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how can HIV
be treated?
There is no cure for HIV, but there are
treatments to enable most people with
the virus to live a long and healthy life.
Treatment is usually recommended to
begin when your CD4 cell count falls
towards 350 or below, whether or not you
have any symptoms. In some people with
other medical condions, treatment may
be started at higher CD4 cell counts. When
to start treatment should be discussed
with your doctor. The aim of the treatment
is to reduce the level of HIV in the blood,
allow the immune system to repair itself and
prevent any HIV-related illnesses. If you are
on HIV treatment, the level of the virus in
your blood is generally very low and it is
unlikely that you will pass HIV on to
someoneelse.
HIV treatment can have side
eects. If you get serious side eects
(which is uncommon) you may need
to try a dierent combinaon of ARVs.
Common side eects include:
• nausea
• diarrhoea
• skin rashes
• sleep dicules
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Herpes.is a common infection caused by the herpessimplex virus (HSV)
Genital herpes is a chronic (long-term) condion. The virus remains in your body and
can become acve again. The average rate of recurrence is four to ve mes in the
rst two years aer being infected. However, over me, it tends to become acve less
frequently and each outbreak becomes less severe.
h i
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There are two types of herpes simplex virus (HSV), type 1 and type 2. Both types
are highly contagious and can be passed easily from one person to another by
direct contact. Genital herpes is usually transmied by having sex (vaginal, anal or
oral) with an infected person. Even if someone with genital herpes doesn't have
any symptoms, it's possible for them to pass the condion on to a sexual partner.
Genital
herpes is a
common condition,
especially in
people from
20 to 24
years old.
herpes
primaryinfectionMost people who get a
primary aack directly
following the infecon
experience symptoms
within 1-2 weeks aer exposure
(sexual intercourse with
an infected partner).
During this so-called incubaon
period, the virus mulplies
inside your cells, unl its
presence causes an outbreak.
During the rst aack, the
early symptoms of genital
herpes include the following:
• Fever & u-like symptoms
• Nausea or feeling sick
• Muscle aches
• Painful urinaon• Tingling, burning or itching
sensaon in the area where
blisters will appear
the primary
stage
symptoms of
herpes?
th t
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Aer the inial ngling and
itching, one or more clusters of
small blisters (somemes painful)
appear, which are lled with
slightly cloudy liquid. The blisters
can be located in dierent areas:
In men:
• genital herpes sores can
appear inside or on the
penis, scrotum, groin & thighs,
buocks and around the anus
In women:
• these blisters can appear
on the labia, inside the
vagina, groin & thighs, on the
buocks and around the anus
Through dierent sexual acvies
it is possible to get genital herpes
in the mouth, tongue, lips and on
other parts of the body. However,
this type of transmission is quite
rare and it is most likely to happen
when the virus is very acve – i.e.
when blisters or sores have
appeared or are about to form.
Although the inial symptoms of genital herpes clear up, the
virus remains dormant (inacve) in a nearby nerve. The virus may
be reacvated from me to me, travelling back down the nerve
to your skin and causing recurrent outbreaks. Recurrent outbreaks
are usually shorter and less severe. This is because your body has
produced protecve anbodies (proteins that ght infecon) in
reacon to the previous infecon. Your body now recognises the
virus and mounts a response that is able to ght HSV more eecvely.
herpesrecurrent
infections
the recurrent
symptoms of
herpes
Up to 50%
of herpes is
caused by the
oral cold sore
type of herpes
simplex
how can
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how can
herpes be
treated?
Treatment for genital herpes will
depend on whether you have the
infecon for the rst me (a primary
infecon) or your symptoms keep
coming back (a recurrent outbreak)
If you have genital herpes for the rst
me, see your GP or visit your local
GUM clinic (also called sexual health
clinics). They may prescribe anviral
tablets, such as aciclovir, which you will
need to take ve mes a day.
You should visit your GP if you have
been diagnosed with genital herpes
before and are experiencing a recurrent
outbreak. If the symptoms are mild,
your GP may suggest things you can do
at home to help ease your symptoms
without the need for treatment.
• Keep the aected area clean using
either plain or salt water. This will
help prevent blisters or ulcers from
becoming infected and may encour-
age them to heal quicker. It will also
stop aected areas from scking
togethe
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Genital Warts (HPV).fleshy growths that appear
on or around the genitals.
Genital warts are very common. In England,
they are the second most common type
of sexually transmied infecon (STI) aer
chlamydia. Genital warts are the result of
a viral skin infecon caused by the human
papilloma virus (HPV). They are usually
painless and do not pose a serious threat to
health. But they can be unpleasant to
look at and cause psychological distress.
There is no evidence that yourferlity will be aected by genital warts.
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The HPV is not a single virus, but a family of more than 100 dierent strains of viruses.
Dierent strains usually aect dierent parts of the body, including the hands or feet.
Although around 30 dierent types of HPV can aect the genital skin, most cases of
infecon with HPV cause no visible symptoms. Around 90% of all cases of genital warts are
caused by two strains of the virus – type 6 and type 11
genitalwarts inmen
genital wart
symptoms in
men
Warts are usually painless,
although on some people
they can become itchy and
inamed. If a wart becomes
inamed, it may lead to
bleeding from the urethra,
vagina or anus.The urethra is the
tube connected to the bladder,
which urine passes through.
Warts that develop near or
inside the urethra can also
disrupt the normal ow of urine.
The most common places for
genital warts to develop in
men are:
• anywhere on the penis
• on the scrotum• inside the urethra (tube
where urine comes out)
• around or inside the anus
• on the upper thighs
about one
in 100
sexually
active adultshave genital
warts
Warts can
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genital
warts inwomen
genital wart
symptoms in
women
The warts may appear as small,
eshy growths, bumps or skin
changes anywhere on the
genitals or around the anus. In
some cases, the warts are so
small they are dicult to noce.
A person can have a single wart
or clusters of mulple warts that
grow together to form a kind
of "cauliower" appearance.
The most common places for
genital warts to develop in
women are:
• around the vulva (the
opening of the vagina)
• on the cervix (the neck of the
womb)
• inside the vagina
• around or inside the anus• on the upper thighs
Most people who have an HPV
infecon will not develop any
visible warts. If genital warts
do appear, it can be several
weeks, months or even years
aer you rst came into
contact with the virus. One study
has shown having both herpesand HPV infecon may increase
the risk of cervical cancer, aer
taking into account HPV infecon
and the number of sex partners
women had and their use of
the pill.
vary in
colour, from
pink to brown
depending
your skin.
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how can
genital warts
be treated?
Treatment for genital warts depends on
the type of warts you have and where
they are located. You do not need
treatment if there are no visible warts.
There are two main types of treatment
for genital warts:
• applying a cream, loon or chemical
to the warts (topical treatment)
• destroying the ssue of the warts by
freezing, heang or removing them
(physical ablaon)
Most topical treatments tend to work
beer on soer warts, and physical
ablaon tends to work beer on harder
and rougher-feeling warts. Somemes,
a combinaon of topical treatments
is recommended. For some people,
treatment can take several months to
remove the warts, so it is important to
persevere.
Sexual Health &
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Sexual Health &
STI Help links
NHS - Sexual Health Line
hp://www.nhs.uk/Livewell/Talking-
aboutsex/Pages/Ineedhelpnow.aspx
Condenal advice (anonymous if
required) about sexual health,
including informaon about local
centre for Sexually Transmied Infec-
ons. Helpline: 0300 123 7123 (lines
open 9am-5pm)
GUM Clinics Northern Ireland
hp://www.nidirect.gov.uk/genitouri-
nary-medicine-gum-clinics (opens in a
new window)
Emergency Contracepon –Morning Aer Pill.
hp://www.nhs.uk/condions/
contracepon-guide/pages/
where-can-i-get-emergency-contra-
cepon.aspx (opens in a new win-
dow)
NHS informaon on emergency con-
tracepon ( morning aer pill) andwhere to get it.
Live Well
hp://www.nhs.uk/Livewell/Sexu-
alhealth/Pages/Sexonholiday.aspx
(opens in a new window)
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