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He who immerses himself in sexual intercourse will be assailed by premature ageing, his strength will wane, his eyes will weaken, and a bad odour will emit from his mouth and his armpits, his teeth will fall out and many other maladies will afflict him.


Sexually transmitted infections (STIs) are a group of communicable infections, usually transmitted by sexual contact. STIs that have developed a high profile include chlamydia, the most common notifiable disease in Australia and a major cause of pelvic inflammatory disease (PID), HIV infection, syphilis and multi-drug resistant gonorrhoea. Presentations of STIs are summarised in TABLE 117.1, however most STIs are asymptomatic.

Table 117.1Presentations of STIs and causative organisms1

Key facts and guidelines

  • In Western society most patients with STIs are in the 15–30 years age group.

  • Chlamydia is detected in approximately 1 in 20 young Australians who have screening tests in general practice.2

  • Not all STIs manifest on the genitals.

  • Not all genital lesions are STIs.

  • Chlamydia trachomatis is the commonest cause of urethritis.

  • Up to 50% of men and 75% of women with Chlamydia may be asymptomatic.1

  • Gonorrhoea may cause no symptoms, especially in women.

  • STIs such as donovanosis, lymphogranuloma venereum and chancroid occur mainly in tropical countries.

  • The presentation of STIs in children, especially vaginitis, should alert practitioners to consider sexual abuse.

  • HIV infection, which is predominantly sexually transmitted, should be considered in any person at risk of STIs as well as IV drug users. It must be appreciated that it can present as an acute febrile illness (similar to Epstein–Barr mononucleosis) before going into a long asymptomatic ‘carrier’ phase.

  • All sexually active young people aged 15–29 years should be tested annually for chlamydia with a first-pass urine or genital swab.2


  • Young people aged 15–29 years

  • Men who have sex with men (MSM), especially:

    • – unprotected anal sex

    • – >10 ...

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