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Sexually Transmitted Infections (STIs)

Sexually transmitted infections (also known as sexually transmitted diseases/ STDs) are among the most common infectious diseases in the United States today. Affecting nearly 20 million Americans each year, they can have serious and long-lasting consequences. However, when diagnosed and treated early, almost all STIs can be cured or managed effectively. It is important for all sexually active women to be well educated on prevention, symptoms, and risks in order to protect their health. Many STIs do not have symptoms, so regular screening is essential.

Here is information on the most common STIs:

  • HIV/AIDS

    HIV stands for human immunodeficiency virus and is the virus that causes AIDS (acquired immunodeficiency syndrome). It is transmitted from person to person through bodily fluids, like blood, semen, saliva, and vaginal secretions. HIV is transmittable through all forms of sexual intercourse (oral, vaginal, and anal) when one or both sex partners are infected. Mothers can transmit it to their babies during pregnancy, childbirth, or breast-feeding, and the disease can also be spread through contact with blood.        

    AIDS is a fatal viral infection of the immune system. AIDS can result from being HIV-positive; however, testing positive for HIV does not automatically mean you have AIDS. HIV-positive persons are more likely than the general population to develop AIDS, though it can sometimes take several years for AIDS to develop in HIV-positive individuals.

    Symptoms of HIV/AIDS

    For women, the most common symptoms of exposure to HIV are frequent or severe vaginal infections, abnormal Pap smears, or pelvic infections (PID) that are difficult to treat. Within a few weeks of having been infected, many people have flu-like symptoms. However, in some cases, symptoms do not show for many years. As the infection progresses, some symptoms may include:

    • Swollen lymph glands in the neck, underarm, or groin area
    • Recurrent fever including night sweats
    • Rapid weight loss for no apparent reason
    • Constant tiredness
    • Diarrhea and decreased appetite
    • Weight loss
    • Shortness of breath
    • Dry cough
    • White spots or unusual blemishes or sores in the mouth
    • Headache and muscle aches
    • Skin rash
    • Sore throat          
    • Joint pain
    Gynecologic Care for Patients with HIV

    Symptoms that could serve as warning signals of infection may go ignored because many women do not perceive themselves as being at risk for HIV infection. In addition, it is possible for a person infected with HIV to not show signs of infection.

    If you are considered to be at high risk for HIV or AIDS, your provider will discuss testing and regular HIV counseling to ensure that you receive the earliest possible care and treatment. It is also important for HIV-infected women to be alert to the possibility of pelvic inflammatory disease and other STIs. 

    Typical STI symptoms may not appear until the advanced stages of such diseases. Similarly, cervical cancer occurs more frequently in HIV-infected women and progresses more quickly. For this reason, women with HIV should be screened for cervical cancer at more frequent intervals so the cancer is detected and treated early.

    If you experience any of these symptoms or think you may be at risk, request an appointment with a Women’s Health Connecticut provider in your area today.

  • Chlamydia and Gonorrhea
    About Chlamydia and Gonorrhea

    Chlamydia (kluh-MID-ee-uh) is caused by the bacteria chlamydia trachomatis and is the most commonly reported bacterial STI in the U.S. Like other STIs, chlamydia is spread during sexual activity via the exchange of bodily fluids through mucous membranes in the anus, mouth, and genital areas. It may also be spread from mother to child during delivery. Because there are often no symptoms, people who are infected may unknowingly pass the bacteria on to their sexual partners. Chlamydia in women can cause pelvic inflammatory disease (PID), infertility, reactive arthritis, inflammation of the rectum (proctitis), and inflammation of the lining of the eye (conjunctivitis).

    Gonorrhea is another common STI caused by the bacterium Neisseria gonorrhoeae that grows and multiplies quickly in moist, warm areas of the body, such as the cervix, urethra, throat, or rectum. Vaginal, anal, or oral sex are the most common forms of transmission, but babies born to mothers with gonorrhea can also be infected during childbirth. It most often appears in babies’ eyes. Untreated gonorrhea can lead to infertility, complications in babies, increased risk of HIV/AIDS, and related infections, especially of the joints. Gonorrhea increases your susceptibility to other STIs, particularly chlamydia, which often co-occurs with the infection.

    Symptoms of Chlamydia and Gonorrhea

    In women, the cervix and urethra are the most common sites of infection of chlamydia and gonorrhea. Chlamydia can also spread to the uterus (womb) and fallopian tubes, resulting in pelvic inflammatory disease (PID), which can cause infertility and ectopic (tubal) pregnancy. Symptoms of chlamydia, which typically appear within 1 to 3 weeks after exposure, may include genital pain, abnormal vaginal discharge, painful urination, painful intercourse, non-menstrual bleeding and bleeding after sex, and lower abdominal pain. However, many infected women have no symptoms whatsoever. Chlamydia is most common among young women, but can occur in women of all ages.

    Most women who are infected with gonorrhea have no symptoms of the disease. If symptoms do develop, they are often mild and usually appear within 2 to 10 days after sexual contact with an infected partner. A small percentage of patients may be infected for several months without showing symptoms. The genital tract is the most common site of infection, but it may affect multiple areas at once. Symptoms when it affects the genital tract may include painful urination, non-menstrual bleeding and bleeding after sex, abdominal pain, pelvic pain, and increased vaginal discharge. If gonorrhea is not treated, the bacteria can spread to the bloodstream and infect the joints, heart valves, or the brain. The most common consequence of gonorrhea, however, is pelvic inflammatory (PID), a serious infection of the female reproductive organs.

    If you experience any of these symptoms or think you may be at risk, request an appointment with a Women’s Health Connecticut provider in your area today.

    Treatment for Chlamydia and Gonorrhea

    Antibiotic medications are used to treat chlamydia and gonorrhea. It is very important that if you are being treated for an STI you take all of the prescribed medication, even after symptoms disappear. To be sure that the infection is cured, a follow-up visit to your physician or clinician 1 to 2 weeks after finishing the medication is necessary.

  • About STIs

    STIs affect women and men of all backgrounds and economic levels, but are most prevalent among teenagers and young adults. STIs can lead to Pelvic Inflammatory Disease and impact fertility.

    Many STIs initially cause no symptoms in women and when symptoms do develop they may be confused with other diseases not transmitted through sexual contact. For these reasons, doctors recommend periodic testing for people who have more than one sex partner. The absence of symptoms of many STIs causes women to be diagnosed later when more serious problems have developed. For example, STIs can spread to the uterus and fallopian tubes causing pelvic inflammatory disease (PID), a leading cause of infertility, and potentially fatal ectopic (tubal) pregnancy. Some STIs, such as human papillomavirus infection (HPV), are associated with an increased risk of cervical cancer. While some STIs are readily curable, others can be disabling or life threatening during pregnancy and birth since they can be passed from a mother to her baby.

    The most serious STI, for which no cure exists, is acquired immunodeficiency syndrome (AIDS), an advanced disease caused by the human immunodeficiency virus (HIV). Experts believe that having STIs other than HIV increases one’s risk for becoming infected with the HIV virus, marked by a severely compromised immune system. Some of the most common STIs are chlamydia, gonorrhea, and HPV.

    Request an appointment with a Women’s Health Connecticut provider if you experience any of the following symptoms of STIs:
    • unusual discharge or odor from the vagina
    • pain in the pelvic area – the area between the belly button and genitals
    • pain in the groin area – the area around the genitals
    • genital burning or itching
    • bleeding from the vagina that is not a regular period
    • pain deep inside the vagina during sexual intercourse
    • sores, bumps, or blisters near the genitals, rectum, or mouth
    • burning and pain during urination or bowel movement
    • frequent urination
  • Hepatitis B

    A highly contagious virus called the hepatitis B virus (HBV) that infects the liver is the cause of hepatitis B. It affects all age groups and can lead to scarring of the liver (cirrhosis), liver cancer, liver failure, and death in many of those afflicted. The virus is found in the blood and bodily fluids of infected people and can be spread through sexual contact; the sharing of needles, razors, or toothbrushes; from mother to infant during birth; accidental needle sticks; and by living in a household with a chronically infected person. The hepatitis B virus is a hardy virus that can live outside the body for several days. It can be either acute (short-term) or chronic (long-term). The risk of the infection being chronic increases the younger the patient is when it is contracted.

    Prevention of Hepatitis B

    A safe, effective hepatitis B vaccine is available. The vaccine is used to protect everyone from newborn babies to older adults. The 3-shot series, given over a 6-month period, protects those at risk and contributes to the elimination of this often silent, highly infectious killer.

    Symptoms of Hepatitis B

    Hepatitis B is a "silent disease" that often infects people without making them feel sick, or at least not for months or years. If you do get sick from hepatitis B, the symptoms may be flu-like. You may experience appetite loss, extreme tiredness, stomach cramping, dark urine, fever, joint pain, and nausea and vomiting. If you are more seriously ill, your skin and eyes may turn yellow with jaundice and you may need hospitalization.

    If you experience any of these symptoms or think you may be at risk, request an appointment with a Women’s Health Connecticut provider in your area today.

  • Syphilis

    Syphilis is an STI caused by a bacterium (Treponema pallidum) and is usually spread from the sores of an infected person to the skin or mucous membranes of the genital area, the mouth, or the anus of a sexual partner. It can also pass through broken skin on other parts of the body. A mother infected with syphilis can also pass it to her baby during pregnancy or childbirth.

    The disease goes through stages. During the early stages, the symptoms of syphilis can be very minor; later, when it is no longer contagious, untreated syphilis can cause serious heart abnormalities, mental disorders, blindness, other neurological problems, and even death.

    Symptoms of Syphilis

    Syphilis typically develops through a number of stages with their own signs and symptoms, but these can often overlap and may not follow a predictable course in every case. The first symptom of primary syphilis is a sore called a chancre ("shan-ker"), which usually appears about 3 weeks after exposure. Chancres usually develop on the part of the body exposed to the bacteria, such as the vulva or vagina, as well as the cervix, tongue, lips, or other parts of the body. Because the chancre is ordinarily painless and sometimes occurs inside the body, it may go unnoticed. Chancres usually disappear on their own within 6 weeks.

    Secondary syphilis is marked by a skin rash that appears within a few weeks of the original chancre healing, and is sometimes accompanied by symptoms like mild fever, fatigue, headache, sore throat, muscle aches, as well as patchy hair loss and swollen lymph glands throughout the body. The rash typically starts on your trunk, but ultimately spreads to your entire body. The duration of these symptoms can range from a few weeks to intermittently throughout a full year.

    The latent stage of untreated syphilis is characterized by an absence of symptoms, which may not reappear for years or may disappear altogether. The final stage of tertiary (late) syphilis if the disease is untreated is marked by serious complications that can affect a number of organ systems. Small bumps or tumors may develop on the skin, bones, liver, or other organs during this stage. Syphilis is contagious during the first two stages and sometimes in the early part of the latent stage. 

    Early symptoms of syphilis are similar to those of many other diseases. There are three ways to diagnose syphilis: a doctor’s recognition of its signs and symptoms, microscopic identification of syphilis bacteria, and blood tests. A combination of these approaches allows physicians to detect syphilis and determine the stage of infection. It is possible for you to be infected with syphilis for years without knowing it.

    If you experience any of these symptoms or think you may be at risk, request an appointment with a Women’s Health Connecticut provider in your area today.

    Prevention and Treatment of Syphilis

    Syphilis is usually treated with antibiotics, and the primary treatment is typically penicillin at all stages. In the early stages of syphilis, proper treatment will cure the disease, but in later stages, damage already done to body organs may not be reversed.

  • Genital herpes

    Genital herpes is a contagious viral infection that affects approximately 1 out of every 6 people aged 14 to 49, according to the CDC. The herpes simplex virus (HSV) causes the infection. There are two types of HSV, and both can cause the symptoms of genital herpes. HSV type 1 most commonly causes sores on the lips (known as fever blisters or cold sores), but it can be spread to your genitals through oral sex as well. HSV type 2 most often causes genital sores and is spread through sexual and skin-to-skin contact, but it can also infect the mouth. It can be highly contagious even if you have no visible sores. The virus remains in certain nerve cells of the body for life, causing periodic symptoms in some people. Most people who are infected with HSV never develop symptoms or only mild ones.

    Symptoms of Genital Herpes

    The symptoms of genital herpes vary widely from person to person. When symptoms of a first episode of genital herpes occur, they usually appear within 2 to 10 days of exposure to the virus and last an average of 2 to 3 weeks. The early symptoms can include an itching or painful sensation; pain in the legs, buttocks, and genital area; flu-like symptoms during an initial outbreak; or a feeling of pressure in the abdominal region.

    Within a few days, sores (also called lesions) appear at the site of infection. Women can develop sores on the buttocks, anus, mouth, vaginal area, external genitals, and cervix. These small, red bumps may develop into blisters or painful open sores. Over a period of days, the sores become crusted and then heal without scarring. Other symptoms that may accompany a primary episode of genital herpes include fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.

    If you experience any of these symptoms or think you may be at risk, request an appointment with a Women’s Health Connecticut provider in your area today.

    Recurring Genital Herpes

    Even after the skin lesions have disappeared, the virus remains inside the nerve cells in an inactive state. In most people, the virus reactivates from time to time. When this happens, the virus begins to travel along the nerves to the skin, where it multiplies on the surface at or near sites of the original infection, in genital or oral secretions. This shedding is infrequent, however, and usually lasts only a day, but it is sufficient to infect a sex partner.

    The frequency and severity of the recurrent episodes vary greatly. While some people recognize only one or two recurrences in a lifetime, others may experience several outbreaks a year. The number and pattern of recurrence often change over time for an individual. Scientists do not know what causes the virus to reactivate. Although some people with herpes report that other illnesses, stress, or menstruation brings on their recurrences, they are often not predictable. Symptoms of an impending recurrence may include burning, tingling, and itching at the original infection site, as well as discomfort in your lower back, buttocks, and legs.

    Genital herpes has been linked with bladder problems, rectal inflammation, newborn infection, other STIs, and in rare cases, meningitis.

    Treatment for Genital Herpes

    During an active herpes episode, whether primary or recurrent, it is important to follow a few simple steps to speed healing and to avoid spreading the infection to other sites of the body or to other people:

    • keep the infected area clean and dry
    • try to avoid touching the sores
    • wash hands after contact
    • avoid sexual contact from the time the symptoms are first recognized until the sores have healed.

    There is no cure for herpes, but there are prescription antiviral medications that can reduce the severity, frequency, and duration of outbreaks, and help reduce the possibility of transmission. Your physician or clinician will discuss if daily use to prevent transmission to your sexual partners is an option.

  • Trichomoniasis

    Trichomoniasis, sometimes referred to as "trich," is the most common curable STI, currently estimated to affect more than 3 million Americans. Trichomoniasis is primarily an infection of the urogenital tract, with the most common site of infection in women being the vagina. Data now suggest that trichomoniasis may increase the risk of transmission of HIV, the virus that causes AIDS.

    Symptoms of Trichomoniasis

    Symptoms of trichomoniasis usually appear within 4 to 20 days of exposure, although they can appear years after infection. Symptoms typically include heavy, yellow-green vaginal discharge, vaginal irritation and itching, and on rare occasions, lower abdominal pain.

    If you experience any of these symptoms or think you may be at risk, request an appointment with a Women’s Health Connecticut provider in your area today.

    Treatment of Trichomoniasis

    A prescription medication is used to treat this infection. It is preferable to treat both partners to eliminate the infection.

  • Bacterial Vaginosis

    Bacterial vaginosis (BV) is the most common cause of vaginitis symptoms among women of childbearing age. BV (previously called non-specific vaginitis) can be transmitted through sexual activity, although the organisms responsible also have been found in young women who are not sexually active. The role of sexual activity in the development of BV is not understood. BV results from a change in the balance among different types of normal bacteria in the vagina. Additionally, intrauterine devices (IUDs) may increase the risk of acquiring BV.

    Symptoms of Bacterial Vaginosis

    The primary symptom of BV is abnormal vaginal discharge of a grayish-white color with a fishy odor, which is especially noticeable after intercourse. However, nearly half the women with clinical signs of BV report no symptoms. A provider can sample and test vaginal fluid to diagnose BV.

    If you experience any of these symptoms or think you may be at risk, request an appointment with a Women’s Health Connecticut provider in your area today.

    Treatment for Bacterial Vaginosis

    BV can be treated with antibiotics. Generally, male sex partners are not treated. Many women with symptoms of BV do not seek medical treatment; however, all women with symptoms or who have been diagnosed with BV should be treated, as it can cause Pelvic Inflammatory Disease (PID). PID can damage the fallopian tubes and increase risk of ectopic pregnancy and infertility. BV also can increase susceptibility to HIV and other STIs. 

  • Vaginitis

    Vaginal infections, imbalances in vaginal bacteria, and lowered estrogen levels following menopause are often accompanied by vaginitis, an inflammation of the vagina characterized by discharge, irritation, and/or itching. The cause of vaginitis cannot be adequately determined solely on the basis of symptoms or a physical examination. Laboratory tests allowing microscopic evaluation of vaginal fluid are required for a correct diagnosis.

    Bacterial vaginosis (BV), trichomoniasis (trich), and candida (yeast) are common infections that cause vaginitis. While candida is not an STI, many of the symptoms are similar to those of STIs. If you have never been diagnosed with a yeast infection and have vaginal discharge, irritation, or itching, you should first be evaluated by your physician or clinician to be sure you receive proper and timely treatment and ensure that BV and trich are not the source of your symptoms. 

  • Human Papilloma Virus (HPV) & Genital Warts

    Human papillomavirus (HPV) is the most common sexually transmitted infection in the U.S. Approximately 30 types of HPV are spread through sexual contact and infect moist genital tissue, the mouth, and the throat. There are low-risk and high-risk types of HPV; low-risk types cause genital warts, the most recognizable sign of genital HPV infection, while high-risk types cause cervical and other genital cancers. According to the Centers for Disease Control and Prevention (CDC), at least 50% of all sexually active people will contract genital HPV at some point in their lives.

    High-risk HPV is associated with cervical, vulvar, vaginal, and anal cancer, and cancer in the back of the throat. Although most HPV infections do not progress to cancer, it is particularly important for women who have been diagnosed with cervical abnormalities and positive high-risk HPV to have regular screenings and follow-up to prevent these changes from developing into an advanced cancer.

    Low-risk HPV is associated with genital warts (condylomata acuminata or venereal warts). Other common types of HPV infections, such as those causing warts on the hands and soles of the feet, do not cause genital warts.

    In women, genital warts may occur both on the outside and inside of the vagina, on the cervix (the opening to the uterus), on the vulva, and inside or around the anus. They can also develop in the mouth or throat of a person who has had oral sex with an infected person. Genital warts often occur in clusters and can be very tiny or can spread into large masses on genital tissues. Genital warts may also cause complications in pregnancy.

    A person can develop HPV years after sexual contact with an infected person. 

    Symptoms of HPV

    High-risk HPV is a silent infection without visible symptoms. It is important to have annual office visits, regular pelvic exams, Pap tests, and HPV screenings to help detect high-risk HPV. If you have high-risk HPV, you will be watched closely for changes and your provider will work with you on advanced testing and tissue samples or biopsies as needed.

    Small or large, flat or raised, and flesh-colored or gray bumps may indicate the presence of genital warts or low-risk HPV. The warts are often too small to be seen by the naked eye, but may also be larger and cluster together like cauliflower. You may also experience itching or discomfort in your genital area, and bleeding with vaginal sex. Your provider can diagnose them by direct visual exam.

    If you experience any of these symptoms or think you may be at risk, request an appointment with a Women’s Health Connecticut provider in your area today.

    Treatment for HPV

    No treatment currently exists for HPV itself, but the health issues that result can be treated. Depending on the size and location, genital warts are treated in several ways, typically using topical prescription medication and surgical removal. Although treatments can eliminate the warts, no treatment completely gets rid of the virus; warts often reappear after treatment. Regular follow-up with your provider to manage genital warts is required. In addition, regular screening for pre-cancer symptoms can help reduce your chances of suffering from an HPV-related cancer.

    Prevention of HPV
    • There are two vaccines (Cervarix and Gardasil) that can protect women against most cervical cancers. Cervical cancer also can be prevented with routine cervical cancer screening and follow-up of abnormal results. A Pap smear with HPV DNA test will screen for cervical cancer and HPV on a woman's cervix. While Gardasil protects against the strains of HPV causing the majority of genital warts and cervical cancer, Cervarix only protects against cervical cancer.
    • Women who received these vaccines when they were younger still need regular cervical cancer screenings because the vaccine does not protect against all cervical cancers.
    • See the Routine Care section for timing of HPV and cervical cancer screenings as well as who should receive the HPV vaccine.
  • Pelvic Inflammatory Disease (PID)

    A serious and common complication of some STIs among women is pelvic inflammatory disease (PID), an infection of the female reproductive organs that can affect the uterus, ovaries, fallopian tubes, and cervix. Left untreated, PID can lead to infertility, ectopic (tubal) pregnancy, chronic pelvic pain, and other serious consequences. Early intervention is essential.

    PID occurs when bacteria migrate upwards from the vagina and cervix into the pelvic area. Many different kinds of bacteria can cause PID, but most cases are associated with untreated gonorrhea and chlamydia, two very common STIs. PID can also be caused by normal bacteria in the vagina and cervix, even if an STI is not present.

    Symptoms of PID

    The most common symptoms of PID are lower abdominal and pelvic pain. Other symptoms may include fever, abnormal vaginal discharge with an odor, pain in the right upper abdomen, painful intercourse, painful urination, and irregular menstrual bleeding. PID, particularly when caused by chlamydia, may produce only minor or no symptoms at all, even though it can seriously damage the reproductive organs.

    If you experience any of these symptoms or think you may be at risk, request an appointment with a Women’s Health Connecticut provider in your area today.

    Treatment for PID

    A combination of antibiotics is usually the first line of defense against PID, but extreme cases may require surgery. As with all infections, the earlier you get treated, the less likely you are to suffer serious consequences.

  • Prevention of STIs

    The best way to prevent STIs is to avoid sexual contact. If you are sexually active, there are things that you can do to reduce your risk of developing an STI.

    • If entering into a new sexual relationship, ask your partner to get screened for STIs and HIV.
    • Be direct about asking a new sex partner whether they have an STI, have been exposed to one, or have any unexplained physical symptoms.
    • Learn the physical signs of STIs and inspect a sex partner’s body, especially the genital area, for sores, rashes, or discharges. Don’t have sex if your partner has signs or symptoms of STIs.  
    • Always use a condom— correctly — during sexual intercourse.
    • If sexually active, have regular checkups for STIs even in the absence of symptoms, learn the common symptoms of STIs, and seek help immediately if any symptoms develop, however mild.
    • Notify all recent sex partners and urge them to go to their physician to be checked if you are diagnosed with an STI.
    • While being treated for an STI, follow the doctor’s orders and keep follow-up appointments.
    • Complete the full course of medication prescribed, as failure to complete the medication treatment can lead to reemergence of the STI.
    • Have a follow-up test to be sure the infection has been cured; your provider can retest you to determine if the treatment was effective against the STI.
    • Avoid all sexual activity until treatment is complete and the provider has confirmed that it was effective.
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