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We Need to Talk About Your Sexual Health
Although this can be an uncomfortable topic, talking about sexual and reproductive health is just as important as talking about any other health problems. In fact, in many places the subject of sex is such a taboo, that young people receive little to no education in sexual health or contraception. As a result, this highly increases the chances of many people catching a sexually transmitted infection (STI) or women accidentally becoming pregnant.
Photo by Reproductive Health Supplies Coalition on Unsplash
Why do you need to know about this?
In a recent survey we sent out, 54% of 479 people we surveyed in Iraq said that they use no form of contraception at all. Of course, there are many reasons why people may choose not to use contraception, but it is important that the decision not to use contraception is made only after understanding all of the risks and benefits of not using it. The use of condoms in particular is often advised, as it is protective against both pregnancy and sexually transmitted diseases when used properly.
Contraception is a personal choice with no right or wrong answer. However, the use of condoms to protect against STIs is something that is important for both you and any of your partners’ health, but unfortunately it is often overlooked. Condoms are an important barrier to sexually transmitted infections in all types of sexual intercourse, including oral and anal sex.
Many people choose not to use condoms when engaging in oral or anal sex, as there is no chance of getting pregnant. However, STIs can still be transmitted through these sexual activities. Therefore you should always use contraception unless you and your partner have both had a recent negative sexual health screen, and are certain that you do not have any active infections.
What are the most common sexually transmitted infections in Iraq?
If you choose to engage in sexual activities without using condoms, you should be aware that you will be at risk of contracting the following STIs, which are the most common in Iraq:
For a number of different reasons, there is limited research on sexually transmitted diseases in Iraq. However, one large study found that discharge, in both men and women, was one of the commonest symptoms of sexually transmitted infections (1).
The most likely cause of this symptom is a bacterial infection called chlamydia, often reported to be the most common sexually transmitted infection in the world (2).
One of the most important things to understand about chlamydia is that over 50% of people with an active chlamydia infection don’t have any symptoms (3). This is called a “silent infection” and it means that if you have been sexually active and have not been tested for STIs, you may have the infection, even if you don’t have any symptoms.
For people who do experience chlamydia symptoms, these may include:
- Pain when urinating
- Pain when having sex
- Pain in the stomach
- Unusual vaginal
- bleeding in women
- Vaginal discharge
- Urethral discharge
Thankfully though, chlamydia is easily treatable with antibiotics. However, it can cause long term pain and fertility problems, especially in women who have left the infection untreated. This can also happen to women who have chlamydia, but have no symptoms.
Gonorrhoea is another bacterial infection that can be treated with antibiotics. It has symptoms that are generally similar to chlamydia, but it sometimes causes patients to have discharge that can look green or yellow.
Just like chlamydia, patients with gonorrhoea can also have no signs or symptoms at all. This means that the infection can be spread very easily by people who do not know that they have it. This can be particularly dangerous if a pregnant woman with gonorrhoea, because the infection can cause eye infections and even permanent blindness in newborn babies (4). This is however, completely avoidable if the woman has treatment before her baby is born.
Gonorrhoea and chlamydia both have the potential to cause long term fertility and pain problems in women if it is left untreated. This is known as pelvic inflammatory disease (PID). PID can also be treated by antibiotics.
The third most important sexually transmitted bacterial infection that you should be aware of is syphilis. It is a sexually transmitted infection that can remain in the body for decades if it is left untreated, and it can go on to cause serious health problems. It is described according to the following stages:
- Primary Syphilis – The initial sign of syphilis infection is a painless sore, usually on the genitalia or in the mouth. This heals by itself and some people may not even notice it.
- Secondary Syphilis – The first stage is followed by a rash that develops over most of the body and flu like symptoms. These symptoms often then disappear on their own and the infection lies dormant in the body for many years if it is left untreated.
- Tertiary Syphilis – Between 15 and 30% of people who progress to this phase of syphilis develop serious and potentially fatal problems. These include: meningitis, damage to eyes including blindness, strokes, heart problems and neurological problems similar to dementia (5).
In Iraq, there were 166 reported deaths due to syphilis in 2017 (6), and it was found that around 3% of pregnant women have undiagnosed syphilis that can be passed on to their baby or cause a miscarriage (7). Syphilis can be treated at any stage, but any damage that has occurred as a result of the infection is permanent, and cannot be resolved with antibiotic treatment after the damage has occurred. This is why it is particularly important to use condoms and to have regular sexual health check ups.
It isn’t just bacteria that can cause STIs, but viruses too. There are two main sexually transmitted viruses that everyone should be aware of, the first being the herpes simplex virus, commonly known as herpes. This is the same type of virus that causes cold sores on the face. When the virus comes into contact with the genitals, it causes painful blister type sores on the genitals and surrounding areas. The sores can appear quickly after the infection, or up to years afterwards. In most cases, they usually go away on their own, but may need to be treated with antiviral medication.
Whilst you can treat the symptoms of herpes, once you get the infection, it unfortunately cannot be cured and removed completely (8). This means that some people may experience repeated outbreaks of these painful blisters throughout their life, often during times of stress or illness. Antiviral tablets are usually only needed during a flare up when you have active blisters, and you may also be given a cream to apply to the area to reduce pain. In many cases however, people do not experience regular outbreaks, and the virus does not end up affecting their daily lives.
It is important however, for pregnant women who have been diagnosed with the herpes simplex virus to notify their doctors, as the virus can potentially be passed on to their baby during labour, if the virus is active at the time of childbirth.
The second sexually transmitted virus that it is incredibly vital to be aware of is HIV, or Human Immunodeficiency Virus. You may already have heard of it as it frequently features in worldwide health initiatives and global news. It is not only transmitted sexually however, it can also be passed on through contaminated needles, blood transfusions, and even breast milk.
Compared to the rest of the world, Iraq has a low rate of HIV infections, with around 0.1% of the population affected (9), but this doesn’t mean that it is not a risk, and the virus can be contracted by anybody.
The initial symptoms of HIV can be vague, including rashes, headaches and flu like symptoms. It is somewhat similar to syphilis in that it can lay dormant and exist in the body for years without causing any symptoms, even while the virus is attacking your immune system internally (10).
If HIV is left untreated, the virus continues to weaken the immune system, leaving the body vulnerable to unusual and severe infections, known as AIDS (Acquired Immune Deficiency Syndrome). These infections can be difficult to treat and potentially life-threatening.
However, HIV itself is actually a controllable condition. Patients with HIV have to take anti-retroviral medication daily, as this will help to reduce the number of copies of the virus that are inside the body, which decreases the risk of the patient developing AIDS, as well as reducing the risk of transmitting the virus to other people. In fact, when the virus is well controlled with medication, it is undetectable in the blood and is therefore untransmissible, meaning that it cannot be passed on (11).
Mothers with HIV can pass the virus on to their babies if they are not on the correct treatment. This is why it is important to get tested early if you think there is a possibility that you have been exposed to HIV.
Photo by Toa Heftiba on Unsplash
How can you reduce the risk of getting an STI?
All five of the sexually transmitted infections described in this article can be protected against by using condoms during any form of sexual activity. Of course, condoms cannot guarantee that you will not get an infection, but they have been shown to be around 98% effective in preventing the spread of the STIs we have discussed (12). Condoms also have the added benefit of protecting against pregnancy, and do not require a prescription to obtain.
What should you do if you’re worried you may have an STI?
It can be really difficult to overcome social and cultural expectations in talking about sexual health and using protection, but it is incredibly important to be aware of the consequences of unsafe sex in all its forms.
Although it may be a very difficult, embarrassing, or scary thing to do, you should try your absolute best to find a trusted doctor to speak to if you are worried about your sexual health. It’s important that these infections are dealt with correctly and quickly, to stop them from causing you more significant health problems.
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- Al Jumaily, H. (2011). Prevalence of sexually transmitted Diseases (STDs) in Iraq for the years (1999–2001) based on syndromic approach. Iraqi Journal of Community Medicine, 2, pp.105 -108.
- Who.int. (2019). Sexually transmitted infections (STIs). [online] Available at: https://www.who.int/news-room/fact-sheets/detail/sexually-transmitted-infections-(stis) [Accessed 31 Jan. 2020].
- nhs.uk. (2018). Chlamydia – Symptoms. [online] Available at: https://www.nhs.uk/conditions/chlamydia/symptoms/ [Accessed 31 Jan. 2020].
- nhs.uk. (2018). Gonorrhoea. [online] Available at: https://www.nhs.uk/conditions/gonorrhoea/ [Accessed 31 Jan. 2020].
- Mayo Clinic. (2019). Syphilis – Symptoms and causes. [online] Available at: https://www.mayoclinic.org/diseases-conditions/syphilis/symptoms-causes/syc-20351756 [Accessed 31 Jan. 2020].
- World Life Expectancy. (2017). Syphilis in Iraq. [online] Available at: https://www.worldlifeexpectancy.com/iraq-syphilis [Accessed 31 Jan. 2020].
- Salman, J. (2015). AN EVALUATION OF SYPHILIS DISEASE IN PREGNANT WOMEN OF ABU-GRAB PROVENCE, IRAQ. Canadian Journal of Pure and Applied Sciences, [online] 9(2), pp.3379-3381. Available at: https://www.researchgate.net/publication/313852393_AN_EVALUATION_OF_SYPHILIS_DISEASE_IN_PREGNANT_WOMEN_OF_ABU-GRAB_PROVENCE_IRAQ [Accessed 31 Jan. 2020].
- nhs.uk. (2017). Genital herpes. [online] Available at: https://www.nhs.uk/conditions/genital-herpes/ [Accessed 31 Jan. 2020].
- Emro.who.int. (2020). WHO EMRO | HIV/AIDS | Programmes | Iraq. [online] Available at: http://www.emro.who.int/irq/programmes/hiv-aids.html [Accessed 31 Jan. 2020].
- nhs.uk. (2017). HIV and AIDS. [online] Available at: https://www.nhs.uk/conditions/hiv-and-aids/ [Accessed 31 Jan. 2020].
- I-base.info. (2019). U=U: Undetectable = Untransmittable | HIV i-Base. [online] Available at: http://i-base.info/u-equals-u/ [Accessed 31 Jan. 2020].
- Getthefacts.health.wa.gov.au. (2020). Do condoms protect against all STIs? | Get the Facts. [online] Available at: https://www.getthefacts.health.wa.gov.au/faqs/do-condoms-protect-against-all-stis [Accessed 31 Jan. 2020].
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