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Contraception

Q: At what age can girls go to the doctor alone to get the prescription for the pill?

Sexually Transmitted Infections

1. Are STIs still a problem these days?
2. How common are STIs?
3. Can I get an STI from oral sex?
4. What can I do to avoid getting an STI?
5. Can you get the same STI more than once?
6. What’s the best way to protect against STIs and prevent pregnancy?
7. How do you know if you have an STI?
8. Are any serious problems caused by STIs?
9. Where can I go for help if I think I have an STI?
10. What does an STI check up involve?
11. If I had unprotected sex over a year ago and never had any symptoms, is it likely I have an STI?
12. Last year I was vaccinated with Gardasil – does that mean I’m protected from genital warts?
13. How are STIs treated?
14. What is HIV/AIDS and why is it important?
15. How does circumcision affect transmission of STIs?

1. Are STIs still a problem these days?

The incidence of STIs is currently on the rise in Victoria and Australia. The Victorian Sexually Transmissible Infections Strategy 2006-2009 shows an alarming increase in the notifications of chlamydia, gonorrhoea, syphilis and HIV. Chlamydia – the most commonly notified disease – is increasing in the 15-24 age group. Furthermore, this report shows the age of first sexual intercourse is continuing to decline, ultimately leading to an increased risk of exposure to STIs during one’s lifetime.

The rise in HIV is particularly concerning. Many young people do not see themselves as being at risk of HIV in Australia, but if they are having unprotected sex with anyone, they are at risk. While the rate of HIV in Australia is currently relatively low, it does still exist. Young people may also be exposed when having unprotected sex with people in countries where the rate of HIV is much higher.

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2. How common are STIs?

Sexually transmissible infections (STIs) are common. Anyone who is sexually active is at risk of acquiring one. In Australia, there are more than 20,000 new sexually transmitted disease infections every year1. It can be hard to know if you have an STI as often there are no signs.

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3. Can I get an STI from oral sex?

Yes. Some STIs can be transmitted by oral sex, such as herpes, Chlamydia, genital herpes, gonorrhea, genital warts and HIV. Dental dams, which are thin squares of latex, can be used as a barrier during contact between the mouth and the vagina, or the mouth and the anus.

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4. What can I do to avoid getting an STI?

There are some steps you can take to avoid getting an STI:

• Don’t have sex:
  Abstinence means not having vaginal, oral or anal sex.
• If you are sexually active, be faithful:
  Having a sexual relationship with one partner who has been tested for STIs and is not infected will reduce your chance of getting infected.
• Use condoms:
  A condom is the best way to protect yourself against infections. However, remember that condoms do not provide complete protection against STIs which can occur in places that the condom does not cover such as genital herpes.
• See a doctor if you are concerned:
  Remember that in general, consultations are kept private and confidential. Doctors can order appropriate tests and prescribe treatment if necessary. If you do have an STI, the earlier you are treated, the better the outcome.

5. Can you get the same STI more than once?

STIs can ping-pong between couples if both partners are not treated. Having one STI also increases the chance of you developing another. Beware – STIs travel in packs!

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6. What’s the best way to protect against STIs and prevent pregnancy?

‘Double dutch’ refers to the use of condoms plus the pill. When engaging in heterosex, it is the ideal way to prevent infections and pregnancy.

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7. How do you know if you have an STI?

Although many people may not have any symptoms, they could still be infectious (and can therefore pass it onto others) and may suffer from long-term consequences. STIs may be discovered by doctors when someone experiences genital itching or burning, discharge, a rash, a sore throat, sore joints, a sore bottom, conjunctivitis or pregnancy.

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8. Are any serious problems caused by STIs?

Untreated, STIs (especially chlamydia and gonorrhoea) can result in infertility in women and continual reinfection. These infections also increase the risk of ectopic pregnancies (pregnancies outside the womb). Syphilis can result in dementia and cardiac disease. Herpes and syphilis can lead to foetal abnormalities. HIV and hepatitis cause chronic illnesses which may lead to death, and can be passed to the foetus during pregnancy and labour.

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9. Where can I go for help if I think I have an STI?

You can talk to your local GP.

Or alternatively, the Melbourne Sexual Health Centre (MSHC) is a walk-in clinic in Carlton that specialises in sexual health. They provide counselling, testing and treatment for STIs (including HIV/AIDS). No appointment is necessary. And all services provided by MSHC are free of charge. See www.mshc.org.au for more details regarding services, opening hours and more information on STIs.

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10. What does an STI check up involve?

An STI check up can involve any of: a physical examination, blood test, urine collection or swab from the genital area. The doctor will also take a history about your sexual practices and contraception use.

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11. If I had unprotected sex over a year ago and never had any symptoms, is it likely I have an STI?

Some STIs have no symptoms. Others may not appear for months – so it may be difficult to tell if you have acquired an STI. The best way to check is to see your doctor if you think you may be at risk.

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12. Last year I was vaccinated with Gardasil – does that mean I’m protected from genital warts?

Gardasil is a vaccine which protects against some but not all types of HPV (human papillomavirus). The vaccine protects against certain types of HPV, which are known to cause 7 out of 10 cases of cervical cancer and 9 out of 10 cases of genital warts. 

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13. How are STIs treated?

The treatment will vary depending on the type of STI. Some involve taking an antibiotic to cure the infection. But for other STIs which cannot be cured, treatment is aimed at relieving the symptoms.

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14. What is HIV/AIDS and why is it important?

HIV/AIDS has been affecting and infecting people worldwide for more than 25 years. It is a global health crisis, which has impacted every country in the world. More than 30 million people have already died from HIV/AIDS and more than 40 million people are living with it today. The highest rates of infection are found in sub-Saharan Africa, India and South East Asia.

HIV refers to the Human Immunodeficiency Virus, which is a virus that interferes with a person’s immune system. AIDS (Acquired Immune Deficiency Syndrome) refers to the subsequent stage where the body cannot resist infections it normally stops.

Although recent antiretroviral drugs may delay the progression of HIV, there is no cure. Prevention is the only way to stop it from spreading.

More information about the local and global impacts of HIV/AIDS can be accessed though YEAH (Youth Empowerment Against HIV/AIDS). YEAH is a youth friendly HIV education organisation with a website at www.yeah.org.au

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15. How does circumcision affect transmission of STIs?

There has been debate over recent years about the role of circumcision in preventing STIs. Scientific research has shown that it more than halves the risk of HIV infection. It is believed that this occurs as the main cells by which HIV enters the penis (Langerhans cells) are abundant in the foreskin and are therefore removed during circumcision. Research has also shown that circumcision decreases the risk

of transmitting human papillomavirus2. It is important to remember that as with all surgical procedures there are risks associated with circumcision. These risks are reduced with the more experience a health professional has had. It is also important to remember that the majority of young males in Australia today are not circumcised.

It is their choice whether or not they choose to undergo circumcision. Either way – if they are circumcised or not - they are still at risk of STIs and it is crucial that they continue to practise safe sex and use condoms. It is important to remember that as with all surgical procedures there are risks associated with circumcision and these are reduced with the more experience a health professional has had.

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References

1 The Royal Women’s Hospital. Contraception – Your choices, Revised edition December 2007. Accessed on 26 July 2009, www.thewomens.org.au/ContraceptionYourChoices.

2 Morris BJ. Why circumcision is a biomedical imperative for the 21st century. Bioessays. 2007; 29:1147-1158.

Teaching Methods

Q: What topics are 'acceptable' to teach in Catholic schools?

Teenage Pregnancy

Accessing Youth Friendly Doctors

• Doctors and Young People
• Confidentiality
• Choosing a doctor
• Visiting a doctor
• Cost
• Before the appointment
• The appointment
• How to Find a Youth Friendly Doctor

 

Doctors and Young People

Doctors can assist young people to stay healthy and well by helping with emotional problems, relationship problems, drug and alcohol issues, sexuality issues and family planning, immunisation, physical illness and injury.


Confidentiality

Many young people visit their doctor with their parents, but they can ask the doctor to see them alone or with a trusted companion. Clinical judgement of doctors determines if they will respect a young person’s privacy and confidentiality. The young person should be encouraged to discuss this with their doctor prior to the consult if they are concerned their parents may be involved or informed.

The doctor will not release any information unless they have the young person’s permission; or if the patient is in a dangerous situation; or if the patient is threatening the safety of others.


Choosing a doctor

A doctor who knows the young person’s past medical history and that of their family is best placed to help them. If choosing their own doctor, they should seek someone they feel comfortable with; someone who listens to what they have to say and they feel is interested in them.

Doctor Search on the AMA Victoria website (www.amavic.com.au) enables you to search for General Practitioners by location, language and special interest such as adolescent health.



Visiting a doctor

A telephone call to the clinic is needed to make an appointment. A normal consultation time is 10 – 15 minutes. If they think it will require more time, they should let the receptionist know when they make the appointment. If the young person has not seen the doctor before, the first visit will take longer than a usual appointment as the doctor will need to know about their health, lifestyle, and concerns they have.

If the matter is urgent, they should make sure this is clear when making the appointment.


Cost

When making the appointment, they should ask about the cost. If the doctor bulk bills they can arrange government payment of the cost of the appointment without an account being sent to their home. The young person may call 13 20 11 to get their family Medicare Card number, expiry date of their Medicare Card and their individual patient number to bring to the appointment with them.

If they are aged 15 or over they can obtain their own Medicare Card. Call 13 20 11 for an application form or download from the Medicare Australia website at www.medicareaustralia.gov.au.

If the doctor doesn’t bulk bill this means the cost of the visit is shared by the government and the patient, who will need to pay the doctor either the full cost or the difference between Medicare and the actual cost of the consultation. Young people need to be aware in these instances that a cheque may be received at home from Medicare which may compromise the confidentiality of their visit.


Before the appointment

The young person should write down the questions they want to ask the doctor. The doctor will probably start by asking how they are. This is the opportunity for them to tell the doctor the reason for the visit, what prompted them to make the appointment. The doctor will ask questions to help understand the issue. If the young person finds it hard to talk about it, encourage them to write down their questions, feelings and concerns beforehand and give this to the doctor. If they can’t make the appointment the young person should call the clinic and cancel the appointment. This saves others waiting unnecessarily.


The appointment

There are likely to be other people waiting their turn to see the doctor. Suggest the young person ask the receptionist the likely time the doctor will be able to see them. Urge them to be patient. The doctor may have been delayed by an emergency. They may call the practice to see if their appointment is likely to be delayed if anxious about waiting.


How to Find a Youth Friendly Doctor

While all GPs treat young people and are trained to deal with problems that affect young people, some GPs have a special interest in youth health. Many young people may prefer to see such a doctor. Below are some suggested ways to look for youth friendly doctors in Victoria:

• Use the Doctor Search at www.amavic.com.au – scroll over ‘Community Info’ at the top of the page, then click on ‘Dr Search’, and search GPs by special interest (adolescent medicine).
• Google “youth friendly doctor”.
• Divisions of General Practice Victoria could be a helpful resource to find doctors with special interest in youth health in your local area (although there is no specific reference on the website to youth friendly doctors). See www.gpdv.com.au, or phone (03) 9341 5200
• Headspace is Australia’s National Youth Mental Health Foundation. They provide health services to young people aged 12-25. More details about their locations are at www.headspace.org.au.

Publications

Will contain links to the various publications in list format. At the moment there are only two, but hopefully there will be more with time.