• HEPATITIS A

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    Hepatitis A is a virus that causes inflammation of your liver. Symptoms are usually mild and the infection goes away over 1 to 2 weeks (unlike the more serious types of hepatitis, hepatitis B or hepatitis C).

    On this page, you can find the following information:

    Key points

    1. Hepatitis A is usually spread through contact with an infected person’s faeces (poo).
    2. A common cause of infection is poor hand washing with food preparation which can lead to spread via food and water.
    3. Symptoms include flu-like symptoms and yellowing of your skin and the whites of your eyes (jaundice). Some people have no symptoms at all and serious problems are very rare.
    4. In most instances the symptoms go away over 1 to 2 weeks (unlike the more serious types of viral hepatitis caused by hepatitis B or hepatitis C).
    5. There is no specific treatment for hepatitis A infection. For most people, your immune system will fight the virus and heal your liver.
    6. To reduce the risk of other people becoming infected, anyone with hepatitis infection should stay home and not prepare food for other people for 7 days from the onset of jaundice.
    7. Good personal hygiene such as washing your hands after going to the toilet helps to prevent spreading the virus to others.

    How is hepatitis A spread?

    The hepatitis A virus is carried in the faeces (poo) of an infected person. You can come into contact with this when you:

    • drink contaminated water
    • eat food prepared by someone with hepatitis A virus who did not wash their hands well after going to the toilet
    • have sexual contact with someone with the virus
    • do not wash your hands after toileting.

    Hepatitis A is very contagious and people can spread the virus before they feel sick. Only a small amount of virus is needed to spread the infection. The virus can survive on objects and in water for months.

    Who is at risk of hepatitis A?

    Hepatitis A is rare in New Zealand but can affect anyone who is not immune. Those at higher risk of contracting the infection are:

    • people who travel overseas, especially to countries where sanitation is not good
    • children and staff in day-care centres
    • people in jobs that exposes them to faeces (poo), such as healthcare workers and people who work with sewerage
    • sex industry workers
    • men who have sex with men
    • people who inject illegal drugs
    • people who are in close personal contact with an infected person.

    Travelling overseas?

    Hepatitis A is more common in developing countries, so if you are travelling overseas ask your doctor whether you need hepatitis A vaccination before you leave. Also, find out whether it is safe to drink the tap water and take extra care with all you eat and drink.

    When travelling in developing countries, it’s best if you:

    • avoid foods you cannot peel or cook
    • don’t drink unpackaged drinks or ice
    • don’t eat shellfish.

    What are the symptoms of hepatitis A?

    Hepatitis A can cause temporary swelling of your liver, but it rarely causes lasting damage. It usually gets better on its own after several weeks.

    Infants and children usually get no symptoms at all. The older you are, the more severe the symptoms of hepatitis A tend to be, and the illness can be more serious in people with chronic liver disease or with weakened immune systems (also called immuno-compromised). 

    Symptoms of hepatitis A:
    tummy painnausea (feeling sick)vomiting (being sick)diarrhoea (runny poos)fevernot wanting to eatflu-like symptoms (without cough or runny nose)yellowing of your skin and eyespale-coloured faeces (poos)feeling very tired dark, reddish brown urine (pee).

    Symptoms can appear from 2 to 7 weeks after you’ve come into contact with the hepatitis A virus and usually only last 1 to 2 weeks. Sometimes, in more severe cases, it can last weeks to months. In very rare cases, it can be life threatening.

    How long is the infectious period?

    You are infectious (can pass infection on to someone else) for 2 weeks before you show any symptoms and for 1 week after you develop jaundice (yellowing of your skin and eyes).

    To reduce the risk of other people becoming infected, stay home and don’t prepare food for other people for 7 days from the onset of jaundice. After you have recovered from hepatitis A, you are immune and cannot get it again.

    How is hepatitis A diagnosed?

    To diagnose hepatitis A infection, your doctor:

    • will ask you about your symptoms and travel history and check your immunisation status
    • will look for noticeable physical signs such as jaundice (yellowing of your skin and eyes)
    • may also ask for blood tests, such as liver function tests and hepatitis A antibody tests. 

    How is hepatitis A treated?

    Usually, no specific treatment is needed. In most cases, your immune system will fight the virus and your liver will heal completely. To help your recovery, you may be advised to:

    • rest – hepatitis A infection can make you tired, so rest when you feel you need to
    • protect your liver – avoid alcohol and review your medication with your doctor.

    Very rarely, people become very sick and need to be cared for in hospital.

    To reduce the risk of other people becoming infected, anyone with hepatitis A should stay home and not prepare food for other people for 7 days from the onset of jaundice.

    How can hepatitis A be prevented?

    Practising good hygiene

    Good hygiene is the best way to prevent hepatitis A. Avoid the spread of germs by:

    • washing hands before and after preparing food
    • washing hands before eating
    • washing hands after going to the toilet or changing a baby’s nappy.

    Read more about hand hygiene.

    Take care with what you eat and drink

    • Boil your drinking water if it comes from an untreated source, such as a river.
    • High temperatures, such as boiling or cooking food or liquids for at least 1 minute at 85°C, kill the virus, although freezing temperatures do not.

    Protect your body from infection

    • Avoid contact with other people’s blood.
    • Don’t share personal items like razors or injecting gear.
    • Practice safe sex by using condoms.

    Get vaccinated if you are high risk

    There is a vaccine that protects against hepatitis A infection. To get the full benefit of the hepatitis A vaccine, 2 doses of the injection are needed.

    • After 1 dose of hepatitis A vaccine, protection from hepatitis A lasts for at least 1 year.
    • A second boostering dose, given 6 to 12 months after the first dose, gives longer term protection. It is predicted that protection could last for 20 years.

    Hepatitis A is uncommon in New Zealand but the vaccine is funded for people at risk of severe infection, such as:

    • transplant patients
    • children with chronic liver disease
    • people who live in close contact with someone infected with hepatitis A.

    Vaccination is recommended but not funded for the following groups:

    • adults with chronic liver disease, including chronic hepatitis B or chronic hepatitis C
    • men who have sex with men
    • some occupational groups (eg, healthcare workers exposed to faeces/poos, employees of early childhood services, particularly where there are children too young to be toilet trained, sewage workers, those who work with non-human primates (eg, zoos and research laboratories)
    • food handlers during community outbreaks
    • military personnel who are likely to be deployed to high-risk areas.

    If you are planning to travel to a developing country, you may be at risk of hepatitis A infection and should consider getting vaccinated. The vaccine should be given at least 2 weeks before departure so your body has time to respond to the vaccine.

    • High-risk areas include Africa, Asia, Central and South America and the Middle East.
    • Moderate-risk areas include the Mediterranean, Eastern Europe (including Russia) and parts of the Pacific.

    Read more about the hepatitis A vaccine.

    Learn more

    The following links have more information about hepatitis A:

    Hepatitis A Hepatitis Foundation NZ
    Hepatitis A The Immunisation Advisory Centre, NZ
    Hepatitis A Healthy Sex, NZ

    References

    1. Hepatitis A Ministry of Health, NZ, 2018 
    2. Hepatitis A Immunisation Handbook, NZ, 2020
    3. Hepatitis A The Immunisation Advisory Centre, NZ, 2017
    4. Havrix The Immunisation Advisory Centre, NZ, 2019
    5. Hepatitis A vacine NZ Formulary

  • GONORHOEA

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    Gonorrhoea is a sexually transmitted infection (STI) that is very common in people aged less than 30 years. It affects both men and women and is easily treated with antibiotics.

    On this page, you can find the following information:

    Key points

    1. Gonorrhoea is a bacterial infection that you get by having sexual contact with another person who has it. Some people with gonorrhoea don’t notice symptoms.
    2. To test for gonorrhoea, women need a swab from your vagina and men need a urine test. Everyone needs an anal swab if you have had anal sex or anal sex play.
    3. If you have gonorrhoea, you need to tell anyone you have had sex with in the last 3 months to get tested and treated.
    4. You should use condoms or avoid sex for 7 days after you and your partner(s) have been treated so you don’t get infected or pass the infection on to someone else.
    5. If you use a condom every time you have sex you are much less likely to get gonorrhoea.

    How is gonorrhoea spread?

    Gonorrhoea is caused by the bacteria Neisseria gonorrhoeae. In nearly all cases gonorrhoea is transmitted through sexual contact.

    • You can get gonorrhoea by having unprotected vaginal, anal or oral sex with someone who has gonorrhoea.
    • Gonorrhoea can also be spread through other sexual practices such as mutual masturbation or fingering.
    • Gonorrhoea may be transmitted from mother to baby during birth. The baby may develop eye or joint infections as a result.
    • If you use a condom every time you have sex you are much less likely to get gonorrhoea. 

    What are the symptoms of gonorrhoea?

    Some people with gonorrhoea don’t notice symptoms. Around 1 in 10 infected men and almost half of infected women don’t experience any symptoms.

    WomenMen
    Most women do not have any signs or symptoms. If you do, these can include: unusual vaginal dischargeirregular bleedingdiscomfort when passing urine (peeing)pelvic pain (especially during intercourse).Men are more likely to have symptoms and these usually occur within 2 to 10 days after infection. Symptoms may include:urethral discharge from your penis (thick yellow or white discharge)pain or discomfort when passing urine (peeing)redness around the opening of your penispain and swelling in your testicles.

    Both men and women can have infection with gonorrhea in the rectum (bottom) if they have anal sex. This may cause rectal discharge or discomfort, but often there are no symptoms.

    How is gonorrhoea diagnosed?

    The best way to find out if you have gonorrhoea is to have a sexual health check-up.

    • Women will need a swab test from your vagina.
    • Men will need a urine (pee) test and sometimes a swab test from the urethra (the opening in your penis). Throat and anal swabs might be needed if you have sex with males.
    • Anyone who has had anal sex or anal sex play will need a swab from your anus.

    How is gonorrhoea treated?

    Gonorrhoea is treated with antibiotics. In most cases a single dose of an injection called ceftriaxone and a single dose of tablets called azithromycin usually cures gonorrhoea. 

    • If the infection is more serious, you may need to take tablets for up to 2 weeks.
    • Often chlamydia and gonorrhoea occur together, so you may be given treatment for both infections.

    Carefully follow your doctor’s advice about medication. Even if you feel better, finish all the antibiotics. Symptoms may improve in a few days but the bacteria may still be in your body.

    Use of condoms during the treatment period

    • If you receive single-dose treatment, you should avoid sex without a condom for 7 days after treatment and until 7 days after your partner has been treated. This is to prevent getting reinfected or passing the infection on to someone else.
    • If you are using a combined oral contraceptive pill may need to use an additional method of contraception. Ask your doctor, pharmacist or nurse if you are unsure.

    Follow-up appointment

    After completing the treatment, go back to your healthcare professional after 3 months for a final check-up to make sure the infection is completely cleared and that you haven’t been re-infected. If your symptoms don’t go away with treatment go back to your healthcare professional for review. 

    Do sexual partners need treatment?

    If you have had sex without a condom with your sexual partner(s) it is very likely they are infected with gonorrhoea. It is important they have a sexual health check and treatment for gonorrhoea, even if they have no symptoms and even if they have a negative gonorrhoea test.

    If you are diagnosed with gonorrhoea, it is important to tell anyone you have had sex with within the last 3 months to get tested and treated.

    Why is treatment of gonorrhoea important?

    Left untreated, gonorrhea can cause serious and permanent damage.

    • In women, gonorrhoea can spread to your uterus and tubes and cause pelvic inflammatory disease (PID), which can cause infertility or ectopic pregnancies (where the pregnancy develops in your fallopian tubes instead of your uterus). It can also lead to chronic pelvic pain.
    • In men, gonorrhea can cause a painful condition in the tubes attached to your testicles (balls). In rare cases, this may cause you to be sterile and prevent you from being able to father a child.
    • Rarely, gonorrhoea may spread via your bloodstream to cause severe joint pain and infect other internal organs and skin.

    How can I prevent getting gonorrhoea?

    Gonorrhoea and other STIs can be successfully prevented by using appropriate contraception and taking other precautions, such as:

    • using male condoms or female condoms every time you have vaginal sex, or male condoms during anal sex
    • using a condom to cover your penis, or a latex or plastic square (dam) to cover the female genitals, if you have oral sex
    • not sharing sex toys, or washing them and covering them with a new condom before anyone else uses them.

    Learn more

    The following links provide further information on gonorrhoea. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

    Gonorrhoea Sexual Health Society, NZ
    Gonorrhoea Ministry of Health, NZ
    Gonorrhoea Family Planning, NZ
    Gonorrhoea NHS, UK
    Gonorrhoea Healthy Sex, NZ

    References

    1. Gonorrhoea guideline Sexual Health Society, NZ, 2015
    2. Treatment of sexually transmitted and other genital infections BPAC, NZ

    Reviewed by

    Dr Veronica Playle is a clinical microbiologist and infectious diseases physician. She is currently completing her PhD at the University of Auckland and works part-time for Auckland District Health Board.

  • HPV

    By

    The human papillomavirus (HPV) is a family of more than 100 different strains of viruses. Some strains of HPV cause harmless warts, but some can cause cancer. An HPV vaccine can protect against certain strains, including the ones most likely to cause cancer.

    Key points

    1. Many people are infected with HPV but don’t know they are because they don’t have any symptoms.
    2. HPV infection, even if you don’t have any symptoms, can lead to cancer if not treated. 
    3. Having regular cervical smears helps to pick up changes caused by unknown HPV infection.
    4. An HPV vaccine is now available and can protect you against several types of HPV, including some that have been linked to cancer.
    5. In New Zealand, the HPV vaccine is available free for everyone aged 9–26 years. It is recommended to be given to children aged 11–12 years.

    What is HPV?

    The human papillomavirus (HPV) is a family of more than 100 different strains of viruses. Some strains of HPV cause harmless warts, but some can cause cancer. 

    The HPV strains that cause warts on your hands or legs are harmless. They are different to the strains that cause genital warts and the ones that can lead to cancer.

    About 30 types of HPV put you at risk for cancer and can lead to cancers of the cervix, vulva, vagina and anus in women, or cancers of the anus and penis in men, and throat cancers for anyone.

    How is HPV spread?

    Genital HPV infection is usually passed on through sexual contact with an infected partner. Correct usage of latex condoms greatly reduces the risk of catching or spreading HPV but doesn’t take it away completely.

    Most people with HPV virus infection don’t know they have it. This is why women should have regular cervical (Pap) smears to pick up changes in your cervix (caused by unknown HPV infection) that might lead to cancer if not treated.

    HPV vaccine

    An HPV vaccine can protect against certain strains, including the ones most likely to cause cancer. In New Zealand, the HPV vaccine is available free for everyone aged 9 to 26 years. It is recommended to be given to children aged 11–12 years.

    • For children aged 9–14 years, the HPV vaccine is given as 2 doses, at least 5 months apart. This age group develops a stronger immune response than those vaccinated when they are older.
    • Children aged 15 years and older need 3 doses of the vaccine, spaced over 6 months.

    The HPV vaccine currently recommended in New Zealand protects against the 4 most common strains of HPV: 6, 11, 16 and 18. These are responsible for most of the cases of cancer and almost all of the cases of genital warts. The vaccine also protects against 5 other strains that can cause cancer.

    The vaccine works by causing your body’s immune system to produce its own protection (antibodies) against the HPV types most likely to cause cancer or genital warts. If an immunised person comes into contact with HPV, the antibodies in their blood fight the virus and protect them against being infected. It usually takes several weeks after vaccination to develop protection against HPV. Read more about the HPV vaccine.

    The HPV vaccine is only able to prevent HPV infection. It does not treat the infection. For best protection girls need to be vaccinated before they are likely to be exposed to HPV, which means before they start having any sexual contact.

    Learn more

    Key facts about HPV HPV Project, NZ
    HPV vaccination HPV Project, NZ
    HPV vaccine – myth vs fact HPV Project, NZ
    Frequently asked questions about HPV and genital warts HPV Project, NZ
    Cervical smears and HPV HPV Project, NZ
    HPV Healthy Sex, NZ

    Reviewed by

    Dr Jeremy Tuohy is an Obstetrician and Gynaecologist with a special interest in Maternal and Fetal Medicine. Jeremy has been a lecturer at the University of Otago, Clinical leader of Ultrasound and Maternal and Fetal Medicine at Capital and Coast DHB, and has practiced as a private obstetrician. He is currently completing his PhD in Obstetric Medicine at the Liggins Institute, University of Auckland.
    Angela is a pharmacist in the Quality Use of Medicines Team at Waitematā District Health Board. She has experience in hospital pharmacy in New Zealand and in the UK, and was previously a medical writer for Elsevier in The Netherlands. Angela is interested in promoting the safe use of medicines, particularly high-risk medicines.

  • GENITAL HERPES

    By

    Genital herpes is a common viral infection caused by a virus known as the herpes simplex virus (HSV).

    On this page, you can find the following information:

    Key points

    1. Most people have mild symptoms or none at all. Others get a painful rash and blisters on their genitals and surrounding area. 
    2. Genital herpes is usually passed on to others through sex.
    3. It can be passed on when you have no symptoms and symptoms can appear many years after being infected.
    4. There is an effective treatment if symptoms are causing you pain or discomfort.
    5. The emotional impact of being diagnosed with genital herpes can be worse than the symptoms, so there is counselling support available.

    What is genital herpes?

    Genital herpes is a common viral infection caused by a virus known as the herpes simplex virus (HSV).

    There are two types of the virus, types 1 and 2 (HSV-1 and HSV-2). As well as genital herpes, HSV can infect your mouth and cause cold sores. HSV-1 and HSV-2 infections look the same and you can only tell them apart by lab testing.

    Because genital herpes can be passed to others through sexual contact, it is often referred to as a sexually transmitted infection (STI). 

    As many as 1 in 3 adults has the virus that causes genital herpes. Once you have HSV it remains in your body and becomes active again from time to time.

    On average, symptoms of genital herpes are likely to recur 4–5 times in the first 2 years after being infected with HSV. However, over time the virus tends to become active less often and each time you get symptoms they are less severe.

    How is genital herpes spread?

    Genital herpes is usually transmitted by having sexual contact (vaginal, oral or anal) with someone who carries HSV. You can get genital herpes through direct contact with an infected blister or sore, usually through sexual contact. You can also transmit or get the virus when you or your partner have no symptoms present (this is known as ’viral shedding’).

    Most people who infect others don’t realise they are putting their partners at risk.

    • Around 80% of people with genital herpes don’t know they have the virus because they have very mild symptoms or none at all.
    • More than 75% of people who have genital herpes get it from people who are entirely unaware that they have it themselves.

    Using condoms reduces your risk of passing on the virus by about 50%, but does not remove it completely.

    You cannot catch genital herpes by sharing cups, towels or bath water, or from toilet seats. It can only be spread by close skin-to-skin contact.

    HSV that causes genital herpes does not cause cervical cancer.

    What are the symptoms of genital herpes?

    The symptoms of genital herpes vary a lot. Most people (80%) have very mild symptoms or none at all.

    Symptoms can vary from a mild area of irritation to more painful blisters or sores and generally feeling unwell. Common symptoms may include:

    • irritation or sores on the vulva and entrance to the vagina
    • sometimes sores on the cervix
    • sores on your anus (bottom), buttocks and tops of your thighs.

    If you are having a first episode of genital herpes, you are more likely to also feel generally unwell and have fever, headache and general bone and muscle aches. 

    This may last for several days, during or after which reddened areas may appear on your genitals. These may develop into painful blisters. The blisters then burst, generally to leave sores that gradually heal, usually without scarring.

    The severity of this first episode varies between people, but for some it may be severe and last for up to 3 weeks if not treated. These symptoms should quickly resolve with treatment. There is effective treatment available if symptoms are problematic.

    How is genital herpes diagnosed?

    The best way to find out if you have genital herpes is to have a sexual health check-up. This may involve a physical examination and a swab from the affected area to test for HSV. To confirm genital herpes the lab needs to find herpes simplex virus types 1 or 2 (HSV-1 or HSV-2) on a swab.

    Diagnosis is easier if early ulcers or blisters are present.

    Because it is possible to have another STI at the same time, a full sexual health check-up should be done.

    Sexual contacts should be informed of the diagnosis and it may be advisable for them to have a sexual health check-up.

    How has my partner caught genital herpes?

    If your partner has only just been diagnosed with genital herpes, this does not necessarily mean that they have been unfaithful to you or sexually promiscuous in the past.

    • Your partner may have caught genital herpes from you. You can carry the virus without knowing you have it as some people have no symptoms. 
    • It is also possible that your partner caught the virus from a cold sore on your mouth or face during oral sex. You can pass the virus on even if you don’t have a cold sore at the time of contact.
    • Your partner may have contracted the virus from a previous sexual partner, even several years ago. The virus can remain inactive in your body for long periods.

    How is genital herpes treated?

    Genital herpes is best treated with antiviral tablets, which stop the herpes virus from multiplying. You can also use the following simple treatments to ease the symptoms, but they don’t stop the virus from multiplying. You still need antiviral tablets.

    Simple treatments for the relief of discomfort

    • Wear loose underclothes, preferably cotton (not nylon), to help minimise discomfort and allow healing. 
    • Use plain water or saline solution with cotton wool to clean and soothe the area. To make a saline solution, use 1 teaspoon of salt in 600ml of water or a handful of salt in a shallow bath.
    • Don’t use scented soaps, bubble bath, etc in the area, as these may irritate it.
    • Using a hairdryer on its lowest setting to dry the area may be more comfortable than using a towel.
    • Pain relief medication such as paracetamol and ibuprofen may ease the pain. Check with your pharmacist or other health professional whether taking these is suitable for you.
    • Ice wrapped in a face cloth or flannel and placed over the sores for 5–10 minutes may be soothing. Don’t apply ice directly to the sores as this can cause ‘ice burn’.
    • If you find peeing painful, try applying Vaseline® to the area or sitting in a warm bath before urinating (peeing) or using a pump bottle full of water and spraying water on yourself while peeing.  
    • You can also try applying a pain relief cream (a local anaesthetic) such as lignocaine cream to the painful area. This is applied 5 minutes before peeing and should be used for a maximum of 1–2 days.
    • Drink plenty of fluids as this dilutes your pee and may help reduce stinging.

    Antiviral tablets to stop the herpes virus multiplying

    Antiviral medicines taken by mouth, such as valaciclovir or acyclovir, are the most effective in controlling symptoms, although they can’t cure genital herpes. They stop the virus from multiplying in body cells where the virus is present. The medicine only works while you are taking it. The infection can come back when you stop taking it.

    Antiviral tablets are used in the following two ways:

    • To treat outbreaks as they happen (episodic treatment): The aim is to shorten the time each outbreak lasts and to relieve symptoms. This works best when taken as soon as you get symptoms and before the blisters appear.
    • To prevent or reduce recurrences (suppressive therapy): If you get frequent or severe recurrent outbreaks, your doctor may recommend you take antiviral tablets every day to help prevent recurrences. Suppressive therapy is taken continuously, every day, for months or years. Suppressive antiviral therapy may help reduce the risk of transmitting the virus to sexual partners.

    Antiviral creams bought over the counter from the pharmacy are not recommended as a treatment for a first episode or recurrent genital herpes as they are of little benefit. Antiviral tablets are the preferred treatment. 

    Counselling for genital herpes

    If you have just found out that you have genital herpes, it is likely you will have a lot of questions. A diagnosis of genital herpes often comes as a shock. 

    For many people who have genital herpes, the physical symptoms are outweighed by the emotional stress relating to the diagnosis. There are many misconceptions about genital herpes, including the belief that it is associated with promiscuity.

    Seeing a counsellor may be a good idea to discuss any concerns you may have. Counselling offers a way of dealing with your concerns.

    For more information see the NZ Herpes Foundation or talk with one of their trained counsellors on 0508 11 12 13 free call (landline only) 0508 11 12 13 or 09 433 6526 (9am–5pm, Monday to Friday).

    Learn more

    Genital herpes – the facts NZ Herpes Foundation
    Herpes myths vs facts NZ Herpes Foundation
    Recognising genital herpes NZ Herpes Foundation
    Herpes and relationships NZ Herpes Foundation
    Herpes in pregnancy NZ Herpes Foundation
    Images of genital herpes DermNet, NZ
    Genital herpes NHS, UK
    Genital herpes Healthy Sex, NZ

    Reference

    1. The key facts about herpes NZ Herpes Foundation