Sexually Transmitted Infections (STIs)

Sexually transmitted infections (once called venereal diseases) are among the most common infectious diseases in the United States today. When diagnosed and treated early, almost all STIs can be cured effectively.

Education, proactive steps and regular testing by your physician or clinician are key. It is important for all women who are sexually active to understand the risks and symptoms of STIs. Regular checkups and screening tests by your physician or clinician are important too, since many symptoms may not initially be apparent or felt.

Here is information on the most common STIs, their risks, symptoms and treatments.

Pelvic Inflammatory Disease (PID)
Chlamydia and Gonorrhea
HPV and Genital Warts
Vaginitis, Bacterial Vaginosis and Trichomoniasis
Herpes
Syphilis
Hepatitis B
HIV

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 can 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 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) can be associated with 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 before or during birth.

The most serious STI for which no cure exists, is acquired immunodeficiency syndrome (AIDS), a fatal viral infection of the immune system. Experts believe that having STIs other than AIDS increases one’s risk for becoming infected with the AIDS virus. The most common STIs are Chlamydia, Gonorrhea, and Human Papilloma Virus.

Make an appointment with your health care 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

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Prevention of STIs

The best way to prevent STIs is to avoid sexual contact. If you decide to be sexually active, there are things that you can do to reduce your risk of developing a 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 a 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; and 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.
• Anyone diagnosed with an STI should notify all recent sex partners and urge them to go to their physician to be checked.
• While being treated for an STI, follow the doctor’s orders and keep follow-up appointments.
• Complete the full course of medication prescribed, 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 provider has confirmed that the treatment was effective.

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Pelvic Inflammatory Disease (PID)

The most serious and common complication of STIs among women is pelvic inflammatory disease (PID), an infection of the female reproductive organs that can affect the uterus, ovaries, fallopian tubes, or other related structures. Untreated, PID can lead to infertility, tubal (ectopic) pregnancy, chronic pelvic pain, and other serious consequences.

PID occurs when disease-causing organisms migrate upwards from the vagina and cervix into the upper genital tract. Many different organisms can cause PID, but most cases are associated with gonorrhea and Chlamydia infections, two very common STIs.

Symptoms of PID

The major symptoms of PID are lower abdominal pain and abnormal vaginal discharge. Other symptoms such as fever, pain in the right upper abdomen, painful intercourse, and irregular menstrual bleeding can occur as well. PID, particularly when caused by Chlamydia, may produce only minor or no symptoms at all even though it can seriously damage the reproductive organs. Women can experience "atypical pelvic inflammatory disease" with only mild symptoms that may go unrecognized, or, in a few cases, have no symptoms at all.

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Chlamydia and Gonorrhea

Chlamydia (‘kla-mid-ee-uhl") infection is caused by the bacteria Chlamydia trachomatis. Symptoms of Chlamydia include abnormal genital discharge which typically appears within 1 to 3 weeks after exposure; however, half of infected women have no symptoms whatsoever. Chlamydia in women can cause pelvic inflammatory disease (PID), inflamed rectum (proctitis), and inflammation of the lining of the eye (conjunctivitis).

About Chlamydia and Gonorrhea

Like other sexually transmitted diseases (STIs), Chlamydia is spread during sexual intercourse via the exchange of bodily fluids through mucous membranes in the anus, mouth, and genital areas. Because there are often no symptoms for Chlamydia infection, people who are infected may unknowingly pass the bacteria on to their sexual partners.

Gonorrhea is caused by a gonococcus bacterium that grows and multiplies quickly in moist, warm areas of the body such as the cervix, urethra, mouth, or rectum.

Symptoms of Chlamydia and Gonorrhea

In women, the cervix is the most common site of infection. However, the disease can spread to the uterus (womb) and fallopian tubes, resulting in pelvic inflammatory disease (PID) - which can cause infertility and ectopic (tubal) pregnancy. Most women who are infected with gonorrhea have no symptoms of the disease, and often the early symptoms are mild. If symptoms of gonorrhea develop, they usually appear within 2 to 10 days after sexual contact with an infected partner, although a small percentage of patients may be infected for several months without showing symptoms.

Treatment for Chlamydia and Gonorrhea

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 disease (PID), a serious infection of the female reproductive organs.

Antibiotic medications are used to treat Chlamydia and gonorrhea. It is very important that if you are being treated with a 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.

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Human Papilloma Virus (HPV) & Genital Warts

Human Papilloma Virus (HPV) is the most common sexually transmitted disease. Approximately 40 types of HPV exist and are spread through sexual contact infecting 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.

High-risk HPV is associated with cervical, vulvar cancer and anal cancer. 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. Approximately two-thirds of people who have sexual contact with a partner with genital warts will develop genital warts, usually within three months of contact.

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

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 with regular cervical cancer 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.

Appearances of fleshy small, large raised, or flat cauliflowers are the signs of genital warts or, low-risk HPV. Your provider can diagnose them by direct visual exam. Depending on the size and location, genital warts are treated in several ways, typically using topical prescription medication and 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.

Prevention of HPV

A vaccine (Gardasil) is available to protect against most genital warts.

• 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.
• 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 HPV vaccine.

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Vaginitis

Vaginal infections 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 a STI many of the symptoms are similar to 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 assure that BV and Trich are not the source of your symptoms. 

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Bacterial Vaginosis

Bacterial vaginosis (BV) is the most common cause of vaginitis symptoms among women of childbearing age. BV (previously called nonspecific 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 bacterial vaginosis.

Symptoms of Bacterial Vaginosis

The primary symptom of BV is an abnormal vaginal discharge 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 will can sample and test the vaginal fluid to diagnose BV.

Treatment

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 BV can cause Pelvic Inflammatory Disease, which can damage the fallopian tubes and increase risk of ectopic pregnancy and infertility. BV can also increase susceptibility to HIV, other STIs and Herpes Simplex Virus. 

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Trichomoniasis

Trichomoniasis sometimes referred to as "Trich" is a common STI that affects 2 to 3 million Americans yearly. Trichomoniasis is primarily an infection of the urogenital tract, with the most common site of infection in women being the vagina. Data now suggests that Trichomoniasis may increase the risk of transmission of human immunodeficiency virus (HIV), the virus that causes AIDS.

Symptoms of Trichomoniasis

Trichomoniasis, like many other STIs, often occurs without any symptoms. When symptoms do occur, they usually appear within 4 to 20 days of exposure, although symptoms can appear years after infection. Symptoms typically are the appearance of heavy yellow-green or gray vaginal discharge, irritation, itching, and on rare occasions, lower abdominal pain also can be present.

Treatment for Trichomoniasis

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

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Genital herpes

Genital herpes is a contagious viral infection that affects an estimated 30 million Americans. 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 cause genital infections as well. HSV type 2 most often causes genital sores, but it can also infect the mouth. 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.

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 burning sensation; pain in the legs, buttocks, genital area, vaginal discharge, or a feeling of pressure in the abdominal region.

Within a few days, sores (also called lesions) appear at the site of infection. 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 can include fever, headache, muscle aches, painful or difficult urination, vaginal discharge, and swollen glands in the groin area.

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 illness, stress, or menstruation brings on their recurrences, they are often not predictable.

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, however there are medications that can shorten and prevent outbreaks. Your physician or clinician will discuss if daily use to prevent transmission to your sexual partners is an option.

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Syphilis

Syphilis is a sexually transmitted disease (STI) caused by a bacteria (Treponema pallidum), Syphilis that spread from the sores of an infected person to the 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.

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

The first symptom of primary syphilis is a sore called a chancre ("shan-ker"), which can appear within 10 days to 3 months after exposure. Chancres usually develop on the part of the body exposed to the bacteria, such as the vulva, or the 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. The next stage of syphilis is marked by a skin rash that appears anywhere from 3 to 6 weeks after the chancre appears, sometimes accompanied by symptoms like mild fever, fatigue, headache, sore throat, as well as patchy hair loss, and swollen lymph glands throughout the body.

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.

Prevention and treatment of Syphilis

Syphilis is usually treated with antibiotics. In the early stages of syphilis, proper treatment will cure the disease, but in late stages of syphilis, damage already done to body organs may not be reversed.

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Hepatitis B

A highly contagious virus that infects the liver causes Hepatitis B. It affects all age groups and can lead to liver disease, liver cancer, and death in many of those afflicted. The virus is found in the blood and body fluids of infected people and can be spread through sexual contact, the sharing of needles or razors, from mother to infant during birth and by living in a household with chronically infected person. The hepatitis B virus is a hardy virus that can live outside the body for several days.

Prevention of hepatitis B

Safe, effective hepatitis B vaccines are available. The vaccines are 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 silent, highly infectious killer.

Symptoms of hepatitis B

Hepatitis B is a "silent disease" that often infects many people without making them feel sick. If you do get sick from hepatitis B, the symptoms may be like the "flu." You lose your appetite, feel extremely tired, have stomach cramps, and vomit. If you are more seriously ill, your skin and eyes may turn yellow with jaundice and you may need hospitalization.

Facts about hepatitis B

• Hepatitis B can be prevented with a safe and effective vaccine.
• Even if a person infected with HBV does not feel sick, he or she can still infect others.
• Hepatitis B can be fatal.
• Nearly one-third of those who become infected with HBV does not know how they got the disease.
• Some people who contract HBV carry it for a long time and may continue to infect others without knowing it.
• You cannot get hepatitis B from the hepatitis B vaccine.
• Hepatitis B kills 4,000 - 5,000 Americans every year. Death from cirrhosis or liver cancer often occurs after infection has been present for a long time.
• HBV is found in blood and other body fluids such as semen and vaginal secretions and is very easy to catch. It is 100 times more infectious than the virus that causes AIDS.
• HBV is sexually transmitted. Hepatitis B is the only sexually transmitted disease for that there is a vaccine that offers protection.
• Infants born to women with HBV infection have a very high chance of getting hepatitis B from their mothers.

This information of hepatitis B immunization is provided in the interest of your good health by:
National Coalition for Adult Immunization 4733 Bethesda Avenue, Suite 750 Bethesda, MD 20814-5228.

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HIV/AIDS

HIV stands for human immunodeficiency virus and is the virus that causes AIDS. It is transmitted from person to person through body 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.

AIDS stands for acquired immunodeficiency syndrome and is a fatal viral infection of the immune system. AIDS can result from being HIV positive; however, HIV positive doesn't mean AIDS. HIV positive persons are more likely than the general population to develop AIDS.

Symptoms of HIV/AIDS

For women, the most common symptoms of exposure to the HIV virus 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 can 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
• White spots or unusual blemishes in the mouth.

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 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 assure 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 to be cancer is detected and treated early.

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