Sexually transmitted diseases

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Chlamydia is a sexually transmitted disease (STI) caused by Chlamydia trachomatis. The bacteria colonise mucous membranes of the genitals, urinary tract, or rectum and can cause inflammation in these locations. The bacteria can also enter the mucous membranes of the eyes and throat, causing infection. About 2000 Icelanders are diagnosed with chlamydia every year.

Transmission

Transmission occurs during sexual intercourse when infected mucous membranes of one individual come into contact with the mucous membranes of the other. Transmission may also occur through anal and oral contact.

There is a risk that Chlamydia could be transmitted to the eyes if an infected person touches the genitals and then rubs the eyes. Therefore, hand hygiene is essential, e.g., after the toilet. Newborns can get an eye infection during birth if the mother is infected with Chlamydia.

Prevention of infection

The condom is the ONLY protection against infection. It provides maximum protection, but it must be used correctly.

Is chlamydia dangerous?

The chlamydia bacterium is dangerous because it can cause infertility in women due to inflammation of the fallopian tubes, which may then close. Chlamydia is one of the most common causes of infertility in young women. Because of this risk, it is essential to treat the disease promptly. Chlamydia is easy to treat, but it can be hard to know whether you are infected or not because the disease is often asymptomatic.

Symptoms

As with many sexually transmitted diseases, many people are infected with Chlamydia without having any symptoms.

When symptoms appear, they are as follows:

Women

• Changes in discharge or bleeding between menstrual periods.

• Burning sensation when passing urine and frequent urination.

• Pain in the pelvis. You should seek medical attention on the same day if you also develop a fever.

Men

• Clear fluid, yellow or white discharge from the urethra (there should never be discharge from the male urethra).

• Burning sensation when passing urine and frequent urination.

• Soreness and pain in your scrotum.

• Chlamydia infection can occasionally cause joint pain and arthritis in both men and women.

When do Chlamydia symptoms start after infection?

If you have symptoms on one side, they often appear 1-3 weeks after the sex that resulted in the infection. In some cases, symptoms may develop within a few days after infection.

Chlamydia diagnosis

Men who sleep with women submit a urine sample. Examination in women is a vaginal smear. Depending on the circumstances, it is sometimes necessary to take more samples.

Treatment of chlamydia

Chlamydia can be treated with antibiotics. You must take all the given tablets and follow your doctor's instructions. It is essential that your partner is treated simultaneously, or you could pass the infection on to each other again. The other person could also pass on the disease to others with whom they have sex if they are not treated. Do not have sex until the treatment is completed (up to one week to 10 days after starting treatment, depending on the treatment). If one of the patients continues to have any symptoms, a new test must be performed, but not until 3–4 weeks after the end of treatment. It is recommended that sexually transmitted infections be monitored routinely by a full-time specialist.

What about those I have had sex with?

If you have been told you have chlamydia, there is a high probability that some of your intimate partners in the last 6-12 months have the disease. It is, therefore, important that everyone you have had sex with over the previous 12 months is informed so they can receive treatment if needed. This is called infection tracking.

You can personally tell them or ask their doctor to contact them without mentioning your name. In all cases, however, information on sexual partners must be given. By encouraging those you have had sex with to get checked up, you can prevent them from infecting others in the future. This way, you can prevent the spread of this severe disease.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by chlamydia with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

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What is gonorrhoea?

Gonorrhoea is a sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae, but the bacterium takes up residence in the genitals, urethra, rectum, or throat.

How is gonorrhoea transmitted?

Transmission occurs during sexual intercourse when an infected mucous membrane comes into contact with the mucous membrane of an infected partner. Transmission can also happen during anal and oral sex. Infection can also occur during birth and cause an eye infection in newborns.

How can I prevent infection?

The condom is the ONLY protection against infection. For it to provide maximum protection, it must be used correctly.

Is gonorrhoea dangerous?

Gonorrhea is a severe disease because it can cause infertility, like chlamydia. This applies to both women and men. Gonorrhea can also cause infection and inflammation in the joints, eye infections, and, in the worst cases, the fallopian tubes in women and the abdominal cavity.

What are the symptoms of gonorrhoea?

The bacterium causes inflammation in the cervix and urethra in women and men. Still, it can also infect the uterus and fallopian tubes in women and the testicles and testicles in men. There are also examples of the bacterium entering the blood and causing infection in the skin and joints. Gonorrhea is a known cause of infertility among women and men.

The symptoms of gonorrhoea are similar to those of chlamydia, but the symptoms and inflammation are often more severe than in chlamydia. Gonorrhea can also be asymptomatic. Common symptoms include changes in the colour and odour of vaginal or urethral discharge, increased urethral discharge, pain when urinating (like peeing razor blades), or pelvic pain, in both women and men. Infection can also occur in the throat and anus.

When do the symptoms appear after infection?

If you develop symptoms, they usually appear 1-7 days after infection but can arise later.

How can gonorrhoea be diagnosed?

Gonorrhea can be confirmed with a urine sample in men who sleep with women. Women return a vaginal swab. Depending on the circumstances, a swab from the urethra, vagina, throat, or rectum is sometimes required. Samples can be taken at all health clinics and Landspítali's dermatology and venereal disease outpatient department.

Treatment of gonorrhea

Antibiotics are used for gonorrhoea. Many strains of gonorrhoea bacteria are resistant to various antibiotics. Therefore, cultures are taken samples to check the sensitivity of the bacteria to antibiotics so that it is possible to ensure that the correct antibiotic has been chosen. You must always have a check-up after treatment to ensure its success.

What about those I have had sex with?

If you have had sex with someone in the last year since infection, there is a high probability that some of them have contracted gonorrhoea. Therefore, you must notify everyone you have had sex with recently so they can receive treatment if needed. This is called infection tracking.
You can let them know yourself or ask the doctor to contact you anonymously. In all cases, however, it is possible to provide information about roommates.
By encouraging those you have had sex with to get tested, you can prevent them from infecting others. This way, you can prevent the spread of this severe disease.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by gonorrhoea with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

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Hepatitis B is common in many places, but short-term travellers rarely need vaccination. The virus is transmitted between people during close contact (intercourse, from mother to child during childbirth, or even if an infected person bites another person) or, during injection accidents, blood transfusions if the virus is not screened, etc. Two doses at least four weeks apart are required before travel, and a third 6–12 months after the first dose if long-term protection is required. Booster doses are not needed after the appropriate 3-dose series is completed.

What is hepatitis B?

Hepatitis B means liver inflammation caused by the hepatitis B virus, one of many viruses that can cause hepatitis. The first symptoms of the infection are due to acute hepatitis B, which resolves, but not everyone develops symptoms. Some infected people develop persistent hepatitis, mainly if the infection occurs during childhood.

How is hepatitis B transmitted?

The virus is found in body fluids such as blood, semen, and vaginal fluid/mucus. During intercourse, the virus is transmitted with these body fluids on the genitals, mouth, and anus. The virus can also be transmitted through blood transfusions and needle sticks. A child can be infected during birth if the mother is contagious.

How can I prevent infection?

Correct use of condoms can prevent infection. Injecting people with an addiction should be careful never to share syringes or needles with others.

Is hepatitis B dangerous?

Acute hepatitis can, in rare cases, lead to death. When hepatitis B persists, it can be severe and life-threatening. It can then progress to cirrhosis and liver cancer.

What are the symptoms of hepatitis B?

Acute hepatitis often causes abdominal pain and yellow skin (jaundice). Nausea, fever, and weakness are also characteristic, along with reddish-brown urine and pale stools. Some also experience joint pain. Hepatitis can also be completely asymptomatic.

When do the symptoms appear after infection?

Symptoms of acute hepatitis usually appear two to three months after infection.

How can hepatitis B be diagnosed?

The disease is diagnosed with a blood test that any doctor can take, and the results are available within a few days.

Can hepatitis B be treated?

Treatment is available for acute hepatitis B but is only used in more severe cases. Adults who become infected often recover, but children often have a persistent infection. If hepatitis develops into persistent hepatitis, treatment can be given against it in some instances. Prevention can be obtained through vaccination, and people who may be at risk but are not infected can get vaccinated. Vaccination of newborns immediately after birth is recommended if the mother has a chronic infection.

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Genital herpes is an infection caused by the virus Herpes simplex, type 2, which causes small blisters and sores on the genitals. The virus spreads from the skin infection and settles in a ganglion near the spinal cord. It can lie dormant there for years, usually harmless to the infected person. However, the virus can travel back along the nerve to the skin or mucous membrane, usually to the same place it started. It can often take a long time for the infection to reappear. The symptoms diminish and typically disappear entirely over time. Genital herpes is a common disease.

How is genital herpes transmitted?

Genital herpes is found in infected wounds and wound fluids. The virus is mainly transmitted when a wound or wound fluid touches the mucous membrane of the partner's genitals, anus, eyes, lips, or mouth.

Infection can also occur if a person gets infected with wound fluid on their hands and then touches their mucous membranes or the mucous membranes of others.

Prevent infection

The condom can only protect the parts of the genitals it covers. A virus in a wound that is not covered by a condom can, therefore, be transmitted during intercourse. The transmission rate is highest when the disease has visible blisters and sores and just before the blisters appear. You should, therefore, not have intercourse when your condition is like that. The risk of infection is lower when there are no blisters or sores on the skin or mucous membranes.

Good hand washing when sores and blisters appear can prevent you from infecting others with your hands.

Is genital herpes dangerous?

Genital herpes can be painful, especially at the beginning of the infection, and can cause considerable discomfort. It is still harmless to the woman, but the virus can cause severe infections in newborn babies whom the mother can infect during childbirth. Therefore, pregnant women need to inform their doctor about a genital tract infection.

Symptoms

The first symptoms are burning, or pain in the skin or mucous membrane, but then cysts of different sizes appear. The cysts often burst quickly and become painful sores. At the same time, there is often soreness in the groin due to enlarged lymph nodes if the infection is in the genitals. In addition, the infection can cause fever, headache, weakness, and, in exceptional cases, meningitis.

The first time blisters and sores form, they usually heal within three weeks. When re-infection occurs, the sores usually appear in the same place as before but are milder, less painful, and usually heal faster.

When do the symptoms appear after infection?

Symptoms usually appear one to three weeks after infection. Some people get the symptoms later, and it can take a long time to appear. Most people who get infected never actually get sores and cysts, and many people never know that they are infected with genital warts.

Analysis

Genital herpes is easy to diagnose if the symptoms are present, with a doctor's examination and taking a sample for research.

Treatment

There is still no cure for genital herpes. On the other hand, some treatments can reduce symptoms and shorten the time you have blisters and sores. For the treatment to work, it must be started as soon as possible. You do not need treatment if the sores are not bothering you.

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Is HIV transmitted in daily contact?

HIV is not transmitted through daily contact. It is, therefore, completely safe to live in the same household or be in daily contact with a person who is infected with HIV/AIDS.

How can I prevent infection?

The condom is the ONLY protection against infection. For it to provide maximum protection, it must be used correctly. People with an addiction should be careful never to share needles with others.

Is HIV a dangerous disease?

HIV is a severe and life-threatening disease; the disease progresses without treatment. There is no cure for it, and there is none in sight.

What are the symptoms of HIV?

Some newly infected people develop symptoms a few days or weeks after infection. The main symptoms are general weakness, sore throat, enlarged lymph nodes, rash, headache and muscle and joint pain, which usually resolve within 1–2 weeks. After that, most people are asymptomatic for many years, but the virus gradually works on the body's defences and damages the immune system.

What is AIDS?

AIDS is the final stage of the disease, and the word refers to the diseases and symptoms that HIV-positive people get when the immune system begins to fail. This usually happens many years after infection. When people have AIDS, they get diseases that uninfected people rarely get, as their immune systems have lost the ability to fight disease. A person who has AIDS usually dies within a few years without medication, but it improves the prognosis significantly.

How can HIV/AIDS be diagnosed?

HIV infection is diagnosed with a blood test that any doctor can take. The blood test is free and confidential. When HIV enters the blood, the body develops antibodies that can be detected with an HIV antibody test up to three months after infection. A positive HIV test means that antibodies against HIV have been found in your blood and that you are therefore HIV infected. A negative HIV test, on the other hand, means that you are not infected with HIV. HIV test results are available a few days after the blood test.

Can HIV/AIDS be treated?

Daily intake of HIV drugs for the rest of your life can reduce the multiplication of the virus in the body and thereby improve the well-being and prolong the life of HIV-positive people. Side effects may accompany the medication.

What about the ones I've slept with?

If you have slept with someone since you were infected, one of them may have been infected with HIV. It is, therefore, important that previous roommates are informed. You can inform them yourself or ask the doctor to write anonymously. In all cases, however, it is mandatory to provide information about roommates. By encouraging those you have slept with to get tested, you can prevent them from infecting those they sleep with in the future. This way, you can prevent the spread of this severe disease.

HIV is a disease subject to registration by the Chief Epidemiologist, as it is a threat to public health.

When HIV infection is suspected or confirmed, doctors, directors of laboratories, hospital wards, and other healthcare facilities must send the Chief Epidemiologist information without delay and by further instructions.

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HPV virus and vaccination against HPV infections and cervical cancer

The Human Papilloma Virus (HPV) is the primary cause of premalignant cervical lesions and cancers. The virus is widespread, and it is estimated that around 80% of women become infected at some point in their lives. The virus is sexually transmitted and is mainly common in sexually active young people.

The HPV virus has more than 100 subtypes. Approximately 40 of these can cause genital infections in both men and women, of which 15–17 are strains associated with cancer (high-risk strains). Infection with high-risk strains of HPV can lead to premalignant cervical disease and cervical cancer. These same species can also cause infections in other organs that can progress to cancer, such as the rectum, vagina, and external genitals of both women and men. Still, the virus can also cause cancer of the oral cavity, throat, and bronchi and can be transmitted through oral sex. HPV viruses of other types (low-risk strains) may cause, for example, genital mutilation.

Epidemiology

Cervical cancer is the second most common cancer in women worldwide. About 1700 women with premalignant cervical lesions are diagnosed each year in Iceland, and 15-20 women with cervical cancer. The average age of women with pre-cancerous lesions is around 30 years, and women with cervical cancer are about 45 years, with 80% of the latter surviving for five years or more from diagnosis.

The incidence of HPV viruses in other cancers in Iceland is not as well known but has been increasing in Iceland and many parts of the world in recent decades. It has been confirmed that HPV 16 is the most common type of virus in pharyngeal cancers. HPV is estimated to contribute to the development of 5% of all cancers worldwide.

Symptoms

Infections caused by the virus can be persistent, but in most cases, the body's immune system destroys them within a few months without any consequences. If an infection becomes established and persists, the risk of pre-cancerous changes and subsequent cancer increases if nothing is done.

Premature cervical lesions do not cause noticeable symptoms of infection, but if the lesions progress to cancer, symptoms are:

• Vaginal bleeding after sex

• Abnormal vaginal discharge

• Genital pain

These symptoms are not just limited to cervical cancer. Infections from other causes can cause the same kind of symptoms. If you notice these symptoms, you must seek medical attention, even though the last cervical smear may have been as expected.

HPV-related cancers, such as those of the rectum, oropharynx, or external genitals, may present as rounds or thicknesses and may cause pain and bleeding.

Treatment

There is no treatment for HPV infections,  but precancerous changes can be detected with a smear from the cervix. If the precursor changes are mild, their development is monitored, and the body's immune system works on the infection. This is done by regular medical check-ups, which take a cell roar from the cervix, which is sent to the Cancer Society's cell laboratory for further examination of cell changes under a microscope and for a specific search for HPV viruses.

Severe and persistent premalignant changes are treated with cone cutting, but if cancer has already developed, three primary methods are used, i.e. surgery, radiation, and chemotherapy.

The vaccine

In Iceland, two vaccines have been used against the types of HPV that mainly cause cervical cancer. The vaccines are Cervarix and Gardasil 9. The latter vaccine contains antigens against the types of virus (HPV-6/11) that cause genital warts.

The vaccine Cervarix contains antigens HPV-16 and HPV-18, which are by far the most common high-risk strains of the HPV virus. In addition, the vaccine has shown significant cross-immunity against type 31/33/45, which can also cause cancer. Cervarix was used in general vaccinations for girls in 2011–2023. Gardasil 9 also contains antigen HPV-16/18 and antigen high-risk strains 31/33/45/52/58. It is now used regardless of gender for all 12-year-olds. The HPV vaccines do not protect against all strains of the virus that can cause cervical cancer, but vaccination can prevent the majority of cancer cases. The duration of the vaccine's effects cannot be certain, but all indications are that this period is many years, possibly lifelong.

Vaccination

With parliament's approval at the end of 2010, health authorities began vaccinations against the HPV virus in the autumn of 2011. Girls born in 1998 and 1999 were the first to be vaccinated, but in the beginning, the vaccination only applied to 12-year-old girls to prevent the development of cervical cancer. From 2023, the vaccination covers all 12-year-olds, regardless of gender, making the HPV vaccination part of the general vaccination scheme for all children.

Vaccination is primarily preventive but does not cure diseases caused by HPV infection. The vaccine is given in two injections at least six months apart. A single dose provides considerable protection, and vaccinations in some countries are now targeted at one dose. In Iceland, information on the benefits of vaccination to reduce the spread of HPV infections is still emerging, and it has not been considered timely to reduce the dose from two to one.

Older individuals have the option to receive the vaccine by prescription and by paying for it.

Since vaccination does not provide complete protection against oncogenic HPV viruses, women need to have regular cervical cancer screening with cervical smears for diagnosis of premalignant lesions or early cancer. Broader spectrum vaccines and more widespread vaccinations globally will potentially reduce the usefulness of screening in the future. However, screening is still essential in preventing cancer development, while HPV viruses are still widespread in the community.

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What are pubic lice?

Pubic lice (Phthirus pubis) is an insect mainly found in the hairs around the genitals. It can also be in the armpit, sternum, eyebrow, and eyelashes. Pubic lice are rare on the scalp.

How do pubic lice spread?

Pubic lice are transmitted through close contact and by towels, bedding, and clothes.

What are the symptoms of pubic lice?

In most cases, pubic lice cause severe local itching.

Is it possible to get treatment for pubic lice?

Lice creme may be purchased without a prescription in pharmacies. It is applied to all hairy locations except the scalp. Follow the instructions in the packet strictly. The sexual partner and family members must also be treated so that infection does not occur again. Bed linen and clothes should be washed in the usual way.

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What are Scabies?

Scabies is a parasite that lives in human skin. This is a common skin disease that can be transmitted through sexual contact.

How does the mite infect?

Scabies are transmitted by close contact but also in other ways, such as sleeping in the bed of an infected person where the sheets have not been changed or the same towels are used. It is doubtful that infection can occur even if an infected person greets you with a handshake, but if you hold hands for a long time and the skin is hot and clammy, the mite will come to the surface and can become infected. Infection on toilet seats is extremely unlikely. The ant can live for two to three days outside the body. It takes four to six weeks from infection until symptoms appear if the person has never had scabies, but if they have had scabies before, symptoms may appear after a few days.

What are the symptoms?

Scabies causes rashes and itching. The rash tends to appear in those parts of the body where the mite is most at home: between the fingers, on the wrists, in the waist, on the back, and around the genitals. It is highly unusual for scabies to come to the face. The itching is often worse at night under a warm blanket.

Can scabies be treated?

The treatment involves smearing the whole body (except the face and scalp) with a fertiliser that kills the scabies. The fertiliser can be bought without a prescription in drugstores, and instructions are included in the package.

An infected partner and family members must be treated simultaneously to prevent re-infection. Bedding and clothes are washed in the usual way. The itching may continue for several weeks after the treatment ends, even if the mite is gone.

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The bacterium (Treponema pallidum) that causes syphilis is transmitted during unprotected sex and from mother to fetus. Infected individuals are mainly contagious when they have sores. In the past, people feared syphilis, most of all sexually transmitted diseases. In this country, syphilis has been a rare disease, but there has been an increase in recent years. Sometimes, it is an old infection, and the individuals are not contagious.

How can I prevent infection?
The use of condoms during sexual intercourse can prevent the transmission of syphilis. The condom only protects the part of the genitals that it covers.
Mucous membranes and skin that are not covered can, therefore, become infected.

Is syphilis dangerous?
If adequate treatment is not given in the early stages of the disease, the bacterium can cause various diseases later in life, such as heart, brain, and neurological diseases. Untreated syphilis during pregnancy can cause fetal damage and miscarriage.

What are the symptoms of syphilis?
The first symptoms of syphilis are sores where the bacteria came into contact, usually on the genitals, in the rectum, or the mouth, along with enlarged lymph nodes. Sometime later, a rash may develop on the skin. In advanced untreated syphilis, symptoms arise from the central nervous system and the cardiovascular system.

When do symptoms appear after infection?
The first symptoms of syphilis appear ten days to 10 weeks (usually three weeks) after infection.

How can syphilis be diagnosed?
Syphilis is diagnosed with a blood test that can be taken at any doctor's office and Landspítali's dermatology and venereal disease outpatient department.

Can syphilis be treated?
An antibiotic (usually penicillin) is given for syphilis and cures the disease.

What about those I have had sex with?
If you have slept with someone in the last year since infection, there is a high probability that some of them have been infected with syphilis. It is, therefore, important that previous roommates are informed so that they can receive treatment if needed. You can tell them yourself or ask the doctor to write anonymously. In all cases, however, it is mandatory to provide information about roommates.
By encouraging those you have slept with to get tested, you can prevent them from infecting those they sleep with in the future. This way, you can prevent the spread of this severe disease.
Syphilis is a disease subject to registration.

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What is trichomoniasis?
Trichomonas infection is caused by the parasite Trichomonas vaginalis.

How is the trichomonas parasite transmitted?
The parasite is transmitted through unprotected intercourse.

Is the infection dangerous?
Trichomonas infection is harmless.

What are the symptoms of trichomoniasis?
It can cause soreness in the vagina and cervix of women, increased discharge that smells bad is yellow-green, and "bubbles". At the same time, the swollen mucosa in the vagina and cervix can cause soreness during intercourse and burning during urination.
Men can also experience burning during urination but usually have little or no symptoms.

Can trichomoniasis be treated?
The infection can be treated effectively with a short course of antibiotics. The bed partner should also be treated.