Slogans such as ‘don’t be silly, wrap your willy’, ‘get tested’ and ‘reduce the rise of STIs’ are aimed at encouraging safe sex, as well as testing for and decreasing the prevalence of sexually transmitted infection (STI). Untreated, an STI can affect fertility by damaging the reproductive system, which is just one of the many reasons pharmacies should be spreading the word about safe sex and testing for STIs, and a GP should be consulted if customers are concerned about any symptoms.
Sexually transmitted infections are common in Australia, but those left untreated can adversely affect male and female fertility. Notifiable STIs include chlamydia, gonorrhoea, HIV and syphilis. One in six Australians has had a notifiable STI in their lifetime. In 2020, 57,500 new cases of notifiable STIs involved females and 67,400 involved males.1
In the federal Health Department’s ‘National Women’s Health Strategy 2020-2030’, sexual and reproductive health was identified as a priority area, specifically through improving information, screening services, self-education and self-management to encourage self-informing and help-seeking behaviours.2
Common STIs include chlamydia, herpes, gonorrhoea, hepatitis B and C, HIV and syphilis.
Chlamydia and gonorrhoea
Chlamydia and gonorrhoea are the most common notifiable STIs in Australia in both males and females. A report from UNSW Sydney’s Kirby Institute in 2021 stated that in the previous year around two-thirds of chlamydia notifications were among those aged 15-29. Further, more than half of the chlamydia notifications were among females.3
Gonorrhoea was more common in males, who accounted for two-thirds of notifications, with greater prevalence among males who have sex with other males, and those living in remote areas. However, chlamydia and gonorrhoea present significant risks in females, as they often are asymptomatic.4
Dr Skye McGregor from the Kirby Institute, one of the report’s authors, says encouraging testing remains a priority, pointing to the fact that both chlamydia and gonorrhoea often have no symptoms, but still have long-term health effects, such as infertility.
“Prior to the pandemic, we were seeing increases in chlamydia and gonorrhoea, but in 2021 we recorded a small decline,” she said. “We believe this reduction is a consequence of both reduced testing and reduced sexual activity with new or casual partners, due to social restrictions and lockdowns during 2020 and 2021.
“On the other hand, syphilis has been steadily increasing among women of reproductive age, gay and bisexual men and Aboriginal and Torres Strait Islander people. This reflects sustained and ongoing transmission across Australia, which is extremely concerning.
“People with chlamydia and gonorrhoea, the most common notifiable STIs, often don’t have any symptoms. But these STIs can still be passed on to others and cause serious long-term health concerns, like pelvic inflammatory disease in women and infertility in men and women.
“This is why regular testing and treatment are crucial for STI control. But based on Medicare testing data, between 2019 and 2021, the number of people aged 15 to 24 years getting a chlamydia or gonorrhoea test declined by 14 per cent in Australia. It’s important we encourage people who have deferred or interrupted their sexual health care to get tested.”5
Syphilis
While syphilis occurs in small numbers, diagnoses of this STI have been increasing in Australia since 2011. The Kirby Institute report also revealed a significant increase in syphilis among women of reproductive age in both Aboriginal and Torres Strait Islander women and non-Indigenous women over a 10-year reporting period.
“While the numbers among women in cities are still relatively small, the upward trend in this group over… 10 years has been substantial,” Dr McGregor said. “We’re particularly concerned about syphilis in women aged 15-44 years, due to the potential impact on pregnancy outcomes. The data tell us that we may need to focus on enhanced sexual health messaging about syphilis for all sexually active people who may be at risk, and ensure appropriate education for health providers.”
Congenital syphilis occurs when syphilis is transmitted during pregnancy to an unborn child. Between 2012 and 2019, diagnoses were low, ranging from zero to eight each year. In 2020 and 2021 there were 17 and 15 congenital syphilis diagnoses, respectively, representing a considerable increase. In 2021, 60 per cent of congenital syphilis diagnoses were among Aboriginal and Torres Strait Islander babies, who make up only five per cent of newborns in Australia.
“This is particularly worrying, as pregnant women should be tested regularly for STIs as part of pre-and antenatal health screening, but COVID-19 has put additional strains on health service delivery and access,” Dr McGregor said. “With timely screening, syphilis can be cured, so even one case of congenital syphilis is completely avoidable and unacceptable. At the Kirby Institute, we’re working with our partners to understand what proportion of pregnant women aren’t receiving adequate STI screening.
STIs and fertility
STIs can impact fertility in both males and females, but females are more likely to have their fertility impacted by an STI, because they are more commonly asymptomatic. Despite this, most STIs can be avoided and treated.
Pelvic inflammatory disease (PID) affects people with a vagina and is commonly caused by chlamydia and gonorrhoea. PID is an infection or inflammation of the organs in the pelvis, including the uterus and fallopian tubes. If untreated, it can cause chronic pelvic pain, damage to the fallopian tubes, difficulties in becoming pregnant or ectopic pregnancy. After one episode of PID, one’s chances of successful pregnancy decrease by 10 per cent. After two or three episodes, this rises to 50 per cent. If left untreated, PID can cause scarring of the fallopian tubes and infertility.6
It’s important to note that with STIs being so common, the quicker the diagnosis occurs and treatment is administered, the less likely it is that complications will arise that can affect fertility. Further, having an STI test before trying for a baby reduces the risk of passing the infection on to a baby or partner. It’s important that pharmacy assistants deliver the message that those who are sexually active should be tested regularly.7
Practising safe sex
Sexual health check-ups are advised for anyone who is sexually active. Practising safe sex is the most effective way to minimise the risk of contracting an STI.
Safe sex refers to minimising the risk of the exchange of body fluids such as semen, vaginal fluid, and blood. Those having unsafe sex risk contracting an STI. This is not limited to genital sex but includes anal, oral and vaginal sex, including some skin-to-skin contact.
According to Better Health, ways to practise safe sex include:
- Talking openly with a partner about sexual health.
- Limiting sexual partners.
- Using protection such as condoms (female and male) and dental dams.
- Being tested for STIs.
- For those concerned that they have an STI, avoid sexual contact until advised by a medical professional that they are no longer infectious.
- Ensuring all sex acts are consensual. Those uncomfortable about any sexual activity should ensure they tell their partner that this is the case.
- Talking to a GP about other forms of contraception.8<superscript>
Pharmacies and STI advice
Community pharmacy plays an important role in promoting safe sex.
As an accessible and safe point of consultation, pharmacies deliver services including:
- Information and advice.
- Contraception counselling.
- Chlamydia screening.
- Private consultation rooms.
- Referring customers to a sexual health clinic.
Let them know
Community pharmacies have long been enablers of sexual and reproductive health, not only through selling sexual protection such as condoms and dental dams, but also through their services and advice. Retail pharmacy assistants can ensure that patients are well informed, and can recommend using protection, while also encouraging sexual health testing.
Should a customer disclose concern that they have an STI, it should be emphasised that they arrange to test and tell their sexual partners that they may be a risk. The ‘Let them know’ campaign includes sample conversations, text messages and emails. If customers are uncomfortable telling their sexual partners about their STI, the ‘Let them know’ website also offers to send a message anonymously via its website, informing sexual partners they may be at risk.
‘Let them know’: letthemknow.org.au/ltk.html
References
- Australian government. ‘Sexual health’. 2023 health.gov.au/topics/sexual-health.
- Australian government. ‘National women’s health strategy 2020-2030’. 2018. health.gov.au/sites/default/files/documents/2021/05/national-women-s-health-strategy-2020-2030.pdf.
- UNSW Kirby Institute. ‘HIV, viral hepatitis, and sexually transmitted infections in Australia annual surveillance report 2021’. kirby.unsw.edu.au/report-type/annual-surveillance-reports
- Australian STI Management Guidelines. ‘Gonorrhoea’. 2021. guidelines.org.au/sexually-transmissible-infections/gonorrhoea/.
- UNSW Kirby Institute. ‘Australia’s annual sexual health check-up: STIs are mostly down, but reductions in testing could be the cause’ scimex.org/newsfeed/australias-annual-sexual-health-check-up-stis-are-mostly-down-but-reductions-in-testing-could-be-the-cause.
- Victoria Sexual Health Network. ‘Pelvic inflammatory disease’. 2023. staystifree.org.au/get-the-facts/pelvic-inflammatory-disease/.
- Your Fertility. ‘Sexually transmitted infections’. 2018. yourfertility.org.au/everyone/health-medical/sexually-transmitted-infections-stis.
- Better Health Channel. ‘Safe sex’. 2022. betterhealth.vic.gov.au/health/healthyliving/safe-sex#types-of-condoms
This feature was originally published in the March issue of Retail Pharmacy Assistants e-magazine.
