Venereology – sexually transmitted infections

Overview

Venereology deals with infections that are passed on through sex; the abbreviation STI (sexually transmitted infections) and the older term venereal diseases are also in use. It belongs to dermatology because many of these infections show on the skin and the mucous membranes first: as redness, blisters, small nodules, warts or sore areas. Some cause few symptoms or none at all and are only found on examination.

The reason for an appointment can be a change you have noticed on yourself. It can just as well be the wish for clarity after a transmission was possible, without any symptoms at all. Both are sound medical reasons for an appointment.

One point first, because it is time-critical: if a contact carrying a risk was only hours or days ago, please do not wait for an appointment. Preventive treatment after possible HIV transmission (post-exposure prophylaxis) has to start as early as possible and is no longer an option after 72 hours. In that situation, go straight to an emergency department or to a centre specialising in HIV. [PLATZHALTER: Leitet die Praxis eine Postexpositionsprophylaxe selbst ein, oder an welche Stelle verweist sie dafür?]

Medical confidentiality applies to the consultation and to everything that comes up in it. It binds every member of the practice team as well.

Areas of application

• Changes on the skin or mucous membranes in the genital or anal area or at the mouth, such as blisters, small nodules, warts or sore areas
• Discharge, burning when passing water, itching or pain in that area
• A rash or swollen lymph nodes without an obvious cause
• The wish to have things checked after a transmission was possible, even without symptoms
• A partner has told you about an infection that was found
• A check after an infection that has already been treated
• Questions about prevention, for instance about vaccinations against individual pathogens

Procedure

1. The consultation

   A venereological assessment starts with a consultation. You describe what this is about; a few details are needed to make sense of it: how long something has been there, where it shows, and how long ago a possible contact was. The interval is particularly important here, because it determines which test can give a meaningful result at this point.

2. Examination of skin and mucous membranes

   Assessing this involves inspecting the skin and mucous membranes of the area concerned. Individual infections show signs far away from where they entered the body, for instance as a rash on the trunk or on the palms and soles, so including the rest of the skin can be useful. [PLATZHALTER: Wie weit reicht die körperliche Untersuchung beim venerologischen Termin, wird regelhaft die gesamte Haut mit untersucht, und steht dafür eine Vergrößerungsoptik zur Verfügung?]

3. Samples and laboratory

   Depending on the question, a swab, a urine sample or a blood test may be considered. Which method makes sense follows from the pathogen suspected and from the timing. [PLATZHALTER: Welche Untersuchungen und welche Erreger deckt die venerologische Sprechstunde in der Praxis ab, und erfolgt die Labordiagnostik im Haus oder in einem Fremdlabor?]

4. Findings and treatment

   At the end of the assessment the result is discussed with you and put into context: what it means and what it does not mean. The treatment follows the pathogen: bacterial infections are as a rule treated with antibiotics, while for viral infections antiviral medicines or a topical treatment come into question, depending on the pathogen. [PLATZHALTER: Welche Behandlungen erfolgen in der Praxis selbst, wer führt eine Kontrolluntersuchung nach Behandlungsende durch, wann wird an eine andere Fachrichtung oder eine spezialisierte Einrichtung überwiesen, und werden Schutzimpfungen gegen einzelne Erreger angeboten?]

5. Partners and follow-up check

   With some of these infections it makes medical sense for partners to be examined as well, even when they have no symptoms. Otherwise an infection can be passed on again after successful treatment. Until treatment and the follow-up check are complete, sex should be avoided or reliably protected; after a single-dose treatment this still applies for some days, and the exact period depends on the pathogen and on the kind of treatment. For individual pathogens, a follow-up examination after the end of treatment is part of standard practice.

What to expect

• A venereological appointment usually starts with a consultation. You decide what you want to tell us; you are welcome to note down questions beforehand and bring them along.
• How long a result takes depends on the method used. [PLATZHALTER: Welche Ergebniszeiten sind realistisch, gibt es Untersuchungen mit Ergebnis am selben Tag, oder laufen alle Proben über ein Fremdlabor?]
• If a possible contact was only recently, the examination may need to be repeated: after a few weeks for some pathogens, and only after about three months for others.
• Please bring any findings from earlier examinations or treatments as well as a list of the medicines you take.
• Whether statutory health insurance covers the cost of an examination depends on the reason for it and on the method.
• [PLATZHALTER: Gibt es für venerologische Anliegen eine eigene Sprechzeit oder einen gesonderten Terminweg, ist eine Untersuchung ohne Namensnennung oder als Selbstzahlerleistung möglich, und auf welchem Weg werden Patientinnen und Patienten vorab über anfallende Kosten informiert?]

Risks & notes

• A normal result applies to the moment of the examination. Shortly after a possible contact it does not rule out a recent infection, because some pathogens only become detectable after days, and others only after weeks or months (the diagnostic window).
• No single method covers every pathogen. Which examinations make sense follows from the consultation and from the findings.
• If an infection goes unnoticed, it can progress and be passed on, even without symptoms. That is why having things checked early makes sense.
• Some complaints cannot wait for a later appointment. A fever together with pain in the lower abdomen or in a testicle, a rapidly spreading redness or swelling, and feeling markedly unwell all need to be seen promptly, outside surgery hours at an emergency department.
• A swab and a blood sample are briefly uncomfortable; after a blood sample a small bruise is possible.
• Medicines used in treatment can have side effects and can interact with other medicines. Please tell us about existing illnesses, allergies, a pregnancy or breastfeeding, and every medicine you take. A treatment that has been started should be finished as prescribed.
• For individual infections the German Infection Protection Act provides for a notification to the responsible authority; for some of them this is made without naming you. Whether this applies to a finding is explained in the consultation.
• We explain the risks, contraindications and interactions that apply to you in person beforehand.

Prevention

Besides having things checked when something is wrong, there are ways to prevent an infection.

• Condoms lower the risk of transmission. They do not protect equally well against every pathogen: infections that are passed on through skin contact outside the covered area can be transmitted despite a condom.
• For the prevention of HIV infection there is pre-exposure prophylaxis (PrEP): medication taken before a possible contact, under medical supervision. Since 2019 it has been part of the benefits of the German statutory health insurance for people with an increased risk of infection.
• PrEP and the time-critical post-exposure prophylaxis after a contact carrying a risk concern HIV only. They do not protect against other sexually transmitted pathogens.
• [PLATZHALTER: Verordnet und begleitet die Praxis eine Präexpositionsprophylaxe (PrEP), oder wird dafür weiterverwiesen?]

Frequently asked questions

I have no symptoms. Does an examination still make sense?

It can. Some sexually transmitted infections cause few symptoms or none at all and are only found on examination. Whether an examination makes sense in your case, and which one, depends on the reason for it and on how long ago a possible contact was.

How long after a possible contact does an examination say anything?

That differs from pathogen to pathogen and ranges from a few days to about three months. For some pathogens a normal result only counts as reliable around six weeks after the contact, for others only after about three months. If the examination is done too early, the result can be normal even though an infection is present, which is why a second examination at the right interval is often part of the assessment.

Who gets to know my results?

Medical confidentiality applies to everything discussed and found in the practice; it binds the team as well. Without your consent we give no information to relatives, to partners or to employers. One statutory exception is the notification duty under the German Infection Protection Act, which applies to individual infections and, for some of them, is met without naming you.

Do partners have to be treated as well?

With some of these infections that makes medical sense, even when there are no symptoms on their side. Otherwise the infection can be passed on again after successful treatment. Who should be examined, and for which period this applies, follows from the pathogen.

I am not sure whether my concern belongs here.

You are welcome to come with it. Many changes on the skin and mucous membranes in this area have other causes, an eczema or a mechanical irritation for example. Telling them apart is part of the examination.

Will I be treated at the practice or referred?

That follows from the pathogen and from the treatment it calls for. [PLATZHALTER: Welche sexuell übertragbaren Infektionen behandelt die Praxis selbst, und wann wird überwiesen?]