Sexually Transmitted Diseases

Since we first began hearing about the acquired immunodeficiency syndrome (AIDS) epidemic in the mid 1980s, many people seem to have forgotten that other sexually transmitted diseases (STDs) are still common. Diseases such as syphilis, gonorrhea, genital herpes, hepatitis B and chlamydia also pose serious health risks.

When it comes to STDs, having sex with many different partners, especially if you don’t use condoms, puts you at much greater risk. It puts you at the same risk as if you had sex with all of your partners' partners. Not having sex or having sex only with a single partner who is uninfected and who has no other sexual partners are the two best ways to prevent STDs. You can get some STDs even if you don’t have penetrating intercourse; some are transmitted by intimate contact such as foreplay.

Once acquired, however, STDs need to be treated by your doctor. If your condition is especially difficult to handle, your doctor may bring in doctors who specialize in infectious disease.

Common Sexually Transmitted Diseases

STDs are some of the most common infectious diseases in the United States, affecting millions of people each year -- mostly teenagers and young adults. Nearly two-thirds of all STDs occur in people younger than 25.

Women are twice as likely as men to be infected by STDs and are less likely to have symptoms. Health problems caused by untreated STDs tend to be more frequent and severe for women than for men, partly because the lack of symptoms may prevent women from seeing a doctor until serious problems have developed.

STDs are passed from person to person through sexual intercourse, genital contact or contact with body fluids such as semen, vaginal secretions and blood. Some STDs can also be spread by sharing intravenous drug needles or other items contaminated with the body fluids of an infected person.

Symptoms

Often, STDs have no symptoms. This is especially true for women. Symptoms that do develop vary depending on the disease and can sometimes be confused with those of other diseases.

Even when there are no symptoms, some STDs may still be passed from person to person. That is why many doctors recommend periodic testing or screening for people who have more than one trusted sex partner.

Treatment

Your doctor may make a diagnosis based on your history and a physical examination. There are also a number of laboratory tests available. Your doctor may scrape a sample of cells from the affected area to be analyzed. For some STDs, blood tests can be used to confirm a diagnosis.

When diagnosed and treated early, many STDs can be cured by antibiotics or other medications. Some people are too embarrassed to ask for help or information about STDs, but the earlier you seek treatment and warn sex partners about the disease, the less likely the disease will cause permanent physical damage or be spread to others. Tell everyone with whom you have had sex in the past few months about your infection. Even if they have no symptoms, they could be infected and should be examined and treated if infected. Both you and your partner should be treated. Abstain from sex until you have completed treatment and your provider says you are cured.

Pregnant women, adolescents and children may not be able to take some of the standard treatments for STDs. Your health care provider can modify treatments so they are safe and effective for people in these groups.

Chlamydia

Chlamydia is an infection with the organism Chlamydia trachomatis. It is spread during vaginal, anal or oral sex. In women, chlamydia infection can cause inflammation of the cervix and pelvic inflammatory disease (PID) and infertility. In men, it can cause inflammation of the urethra, the organ through which urine passes; the epididymis, where sperm are stored; or the prostate gland. It can increase the chance of getting HIV. Pregnant women who get chlamydia can pass the infection on to their child during birth; chlamydia infection in an infant may cause an eye infection or pneumonia.

Symptoms

You may have genital chlamydia infection without any symptoms. Experts estimate that up to 75 percent of women and 50 percent of men who have chlamydia infection have no symptoms or symptoms so mild they don't seek treatment.

If you do have symptoms, they usually appear one to three weeks after exposure.

For women, symptoms may include:

• Burning or pain during urination

• Pain in the lower abdomen

• Anal discomfort

• Abnormal vaginal bleeding or discharge

For men, symptoms may include:

• Burning or pain during urination

• Watery or thin white discharge from penis

• Pain or swelling in the testicles

• Anal discomfort

Treatment

Fortunately, chlamydia infection can be treated with antibiotics such as azithromycin, doxycycline and erythromycin. Because many people with chlamydia also have gonorrhea, antibiotics for both infections are usually given together.

Genital Herpes

Genital herpes is caused by the herpes simplex virus (HSV), which also causes cold sores around the mouth. Most genital herpes is caused by HSV type 2, while cold sores are most often cause by HSV type 1.  However, either can cause oral or genital infection. Genital herpes infection is spread through sexual contact with someone who has the infection. Usually the virus is transmitted through the sores. It can be spread to others when sores are not present, but this is uncommon.

Symptoms

Some people, even when first infected with genital herpes, do not have any symptoms. For most people, symptoms occur within 10 days of having sex with an infected person. They include:

• Itching, burning, or pain in the genital or anal area

• Visible blisters

• Swollen glands in the genital area

• Lower back, buttock or leg pain

• Fever

• Vaginal discharge

Symptoms can last up to three weeks. Even after the initial outbreak of sores heals, infected people carry the virus for the rest of their lives, with new sores erupting from time to time. It's typical to have a few outbreaks a year, although the number of outbreaks tends to decrease over time.

Treatment

There is no permanent cure for herpes. Once you become infected with the virus, it stays in your body. Your doctor can prescribe antiviral drugs, such as acyclovir, valacycolvir or famciclovir, which can reduce the length and pain of herpes outbreaks.  Antiviral medication may also be prescribed on a daily basis to prevent recurrences.

Genital Warts

Genital warts (condyloma acuminate) are caused by the human papillomavirus (HPV), the virus that also causes common skin warts. There are many strains of HPV. Infection with HPV-6 or HPV-11 causes genital warts. Infection with HPV-16, HPV-18, HPV-31 or HPV-45 increases a woman’s risk for cervical cancer. About one-third of HPV types are spread through sexual contact and cause warts in the genital area. In 2006, the FDA approved a vaccine to prevent the virus. All females age 9 to 26 and women with Pap smear abnormalities should be vaccinated.

Symptoms

You may have genital warts and not be aware you are infected, because there are often no symptoms. If warts are visible, they appear as small, raised bumps that may grow larger or disappear. You may experience itching and burning on or near your sex organs or anus and may have pain with intercourse.

In women, genital warts may occur:

• On the inside or outside of the vagina

• On the cervix

• Around the anus

In men, genital warts are less common, generally occurring:

• Around the tip of the penis

• On the shaft of the penis

• On the scrotum

• Around the anus

Prevention

In June 2006, the Food and Drug Administration (FDA) approved the first vaccine to prevent infection with HPV. The vaccine, Gardasil, protects against HPV-16 and HPV-18, which cause about 70 percent of cervical cancers, and against HPV-6 and HPV-11, which cause about 90 percent of genital warts. The vaccine does not protect against HPV-31 or HPV-45, which can also cause cervical cancer.

The Advisory Committee on Immunization Practices recommends the vaccine for three age groups: all girls between 11 and 12; girls and women 13 to 26 years old who have not received the vaccine; and women who have had abnormal Pap smears, genital warts or some other conditions. Girls as young as 9 can receive the vaccine.

The vaccine is given in three doses over six months.  If a woman is already infected with HPV-16, HPV-18, HPV-6 or HPV-11, the vaccine cannot protect her from the effects of the strain she already has. It also will not protect against infection with other HPV strains, so regular Pap tests are still important, the FDA says.

Treatment

In many cases the body’s immune system will rid the body of the virus over time. There is no cure for HPV infection, but the visible warts it causes can be treated with medications that are applied to the wart every few weeks. Treatment must be prescribed by your health care provider; do not use over-the-counter treatments intended for other kinds of warts. Because warts may reoccur, see your doctor regularly for checkups. Women with HPV infections should get regular Pap smears.

Gonorrhea

Gonorrhea is an infection caused by the bacterium Neisseria gonorrhoeae, which grows and multiplies in warm, moist areas of the body, including the reproductive tract, rectum and throat. It is most commonly spread through vaginal, oral and anal sex. Mothers may infect their infants during delivery, causing serious eye infections in their newborn.

Symptoms

The symptoms of gonorrhea are frequently so mild that you could have the disease and not know it. Even if you don't have symptoms, you are still contagious. If symptoms do develop, they usually appear within five days after exposure.

For women, symptoms may include:

• A painful or burning sensation during urination or bowel movements

• Abnormal vaginal discharge that is yellow or bloody

• Cramps and pain in the lower abdomen

• More pain than usual during menstrual periods

For men, symptoms may include:

• White or yellow discharge (pus) from the penis

• A burning sensation, often severe, during urination

Symptoms of rectal infection include discharge, anal itching and, sometimes, painful bowel movements.

Treatment

Neisseria gonorrhoeae has become resistant to many of the antibiotics that were used  in the past. The current effective antibiotics are ceftriaxone injection, cefixime, ciprofloxacin and ofloxacin. It is important that partners be treated at the same time to avoid re-infecting one another or others. Because many people with gonorrhea also have chlamydia, antibiotics for both infections are usually given together. Left untreated, gonorrhea can cause pelvic inflammatory disease and infertility in women or urethra blockage (stricture) in men.

Hepatitis B Virus

Hepatitis B virus (HBV) can be transmitted through blood and through sexual intercourse. It can cause inflammation of the liver and can lead to cirrhosis, cancer of the liver and liver failure. It is spread through contact with body fluids, so people at risk for getting HBV include anyone exposed to blood and blood products, people who share drug needles, health care workers and anyone who has a sexual partner whose sexual and drug history are unknown. One-third of new cases of HBV in the United States, however, occur in sexually active young adults with no other risk factors.

Symptoms

Some people who have HBV don't have any symptoms. If you do have symptoms, they'll begin 45 to 180 days after exposure and may include:

• Yellow eyes or skin (jaundice)

• Loss of appetite

• Nausea and vomiting

• Fever

• Diarrhea, light-colored stools

• Stomach or joint pain

• Extreme fatigue

Treatment

There is no cure for hepatitis B. About 90 percent of adults recover from HBV in a few months, clearing the virus from their system and developing an immunity. A small percentage of adults are unable to clear the infection from their bodies, and the infection becomes chronic. Over time, chronic HBV infection may cause your liver to stop working and you may need a liver transplant. If you think you have been exposed to HBV, your doctor may be able to give you hepatitis B immune globulin to prevent hepatitis from developing. People who have chronic active disease can be treated with drugs that fight viral infections, such as interferon, lamivudine, adefovir and entecavir.

Prevention

A very effective vaccine is available to prevent HBV infection. People who should be vaccinated include:

• All babies at birth

• All children 7 to 18 years of age who have not been previously vaccinated

• People of any age who fall into a high-risk group: people who have more than one sex partner in six months, men who have sex with men, and people who inject illegal drugs

• Anyone who is exposed to human blood

Human Immunodeficiency Virus

Human immunodeficiency virus (HIV) is the virus that causes AIDS. HIV destroys CD4 cells, immune cells that help the body fight off infection and disease. A low CD4 cell count is an indication that your immune system is weakening and not able to protect you adequately. A CD4 cell count of less than 200 is one of the criteria for diagnosing AIDS.  AIDS causes you to become susceptible to certain types of infection, parasites and some cancers. Following infection with HIV, it may take up to 10 years to develop AIDS. The National Institutes of Health reported in February 2005, however, that a new strain of HIV appeared to progress from infection to full-blown AIDS in less than 20 months, and possibly in only two to three months. 

Causes

HIV is spread through sexual contact, shared drug needles or other situations in which people are exposed to infected blood, semen or vaginal secretions. For you to become infected with HIV, the blood, semen or vaginal secretions must enter your body.

HIV is not spread through:

• Using public restrooms

• Coughing or sneezing

• Hugging or touching

• Food or water

• Shared work or school space

Even if an HIV-infected person is otherwise healthy and has not yet developed AIDS, he or she can spread it to other people. If you already have another STD and are sexually active with a person with HIV, you're at greater risk for becoming infected with HIV.

Symptoms

Early symptoms of HIV, occurring weeks to months after exposure, include swollen lymph glands and flu-like illness. Later symptoms, occurring years after exposure, include:

• Persistent fevers and night sweats

• Persistent fatigue

• Unexplained weight loss or loss of appetite

• Prolonged diarrhea

• Swollen lymph nodes

• Skin infections such as ringworm, candida, thrush or molluscum contagiosum not normally seen in healthy adults

• Purple bumps on skin or inside mouth and nose

• Recurrent respiratory infections, shortness of breath or dry cough

HIV is diagnosed by testing blood for the presence of antibodies to the virus. HIV tests may not be positive immediately after infection because it may take three or more months for your body to develop these antibodies. In some cases it can take up to six months for an HIV antibody test to become positive.  During that period, however, even though your test is negative, you remain infectious to other people.

There is no cure for HIV/AIDS, but many medications can dramatically prolong the lives of people infected with HIV by slowing replication of the virus and subsequently slowing damage to the immune system. In July 2006, the FDA approved a single-pill, once-a-day medication for the treatment of most cases of AIDS. The new medication simplifies the daily regimen of medicines.

Syphilis

Syphilis is a complex disease caused by the bacterium Treponema pallidum.  It is usually spread through vaginal, anal or oral sex; it can also be spread through contact with infected blood. It can cross the placenta and infect an unborn child. In its first stage (primary syphilis), this bacterial infection can cause sores called chancres on the genitals and rectum or in the throat, generally at the site of entry of the bacterium. Sores usually appear within 10 days to three months after exposure. Because they are painless, sores often go unnoticed.

Symptoms

If left untreated, the next stage (secondary syphilis) can produce these symptoms:

• Rash (usually round, red to reddish brown color and does not itch) over any area of the body, especially on the palms of the hands or soles of the feet

• Fever

• Fatigue

• Muscle aches

• Sore throat

When the secondary symptoms disappear, the latent (hidden) stage of syphilis begins. In this stage there are no symptoms, but without treatment, the disease can begin to damage the internal organs. This damage may show up years later in the late stage (tertiary syphilis). In this stage, serious problems can occur, including paralysis, heart abnormalities and mental illness. The damage at this point is irreversible and may be serious enough to cause death.

Treatment

Syphilis can be cured with penicillin or other antibiotics. Although treatment will kill the syphilis bacterium and prevent further damage, it will not repair any damage already done. Some people need more antibiotics to cure the disease, followed by periodic blood tests to check that the infection is gone.

Trichomoniasis

Trichomoniasis is a parasitic infection caused by Trichomonas vaginalis, a single-cell parasite with a whip-like tail.  It is spread through sexual activity. In women, the vagina is the most common site of infection. It can cause pelvic inflammatory disease and infertility. In men, infection most often occurs in the urethra.

Symptoms

Trichomoniasis often occurs without any symptoms. When symptoms do develop, it's usually within 20 days of exposure.

For women, symptoms may include:

• Heavy yellow-green vaginal discharge

• Pain during intercourse

• Abnormal vaginal odor

• Vaginal irritation and itching

• Lower abdominal pain

For men, symptoms are rare, but may include:

• Discharge from the penis

• Painful or difficult urination

Treatment

Trichomoniasis can be treated with the antimicrobial drugs metronidazole and tinidazole. To prevent reinfection, all sexual partners should be treated at the same time, even if not all have symptoms. Avoid sexual intercourse or use a condom until treatment is completed.

Special Risks During Pregnancy

STDs pose special risks during pregnancy. Many STDs can be passed from mother to child during pregnancy (hepatitis B, syphilis), at birth (chlamydia, gonorrhea, herpes simplex virus, HIV, hepatitis B), or shortly after (HIV and hepatitis B). Often, STDs can lead to health problems for newborns. For example:

• Low birth weight and premature birth appear to be associated with STDs, including chlamydial infection and trichomoniasis.

• Chlamydia infection can cause pneumonia and eye infections.

• Gonorrhea can cause blindness or life-threatening infections.

• Syphilis can cause a baby to be stillborn or to die shortly after birth.

• Herpes simplex can cause encephalitis and death.

• Babies born with HIV may not grow and develop normally and may also develop cerebral palsy. They are vulnerable to the same problems as adults with HIV, and eventually the disease is fatal.

• Children who get hepatitis at or before birth may become chronic carriers of the virus.

Women who have syphilis, gonorrhea or chlamydia must be treated with antibiotics during pregnancy to prevent complications for themselves and their babies. Women with active genital herpes sores may need to deliver by cesarean section to keep their babies from getting the virus. Women who are HIV positive should take anti-HIV medications during pregnancy to reduce the risk of passing the virus to the baby.

Prevention

The two best ways to prevent STDs are to abstain from sex and to have a mutually monogamous sexual relationship, in which you and your uninfected partner only have sex with each other. If neither option works for you, here are some other things you can do:

• Limit the number of sexual partners you have, and don't go back and forth between partners. The more sexual partners you have, the greater your risk for STDs.

• Always use a condom, even during foreplay. Choose latex condoms with receptacle tips rather than natural-membrane (lambskin) condoms, which may be more likely to break or to allow viruses and bacteria to pass through. If you're sensitive to latex, choose polyurethane condoms. Never use oil-based lubricants such as petroleum jelly or baby oil, which can cause condoms to break. Keep in mind that condoms fail at a rate of 10 to 15 percent as a result of flaws or improper use.

• If a male condom cannot be used appropriately, use a female condom.

• During oral sex, use a condom, a dental dam or plastic wrap.

• Remember that condoms don't offer complete protection against all STDs, because they don't cover the entire genital area.

• Don't share drug needles.

• If you are sexually active with multiple partners, have screening tests regularly to check for STDs.

• Avoid douching, which removes some of the normal protective bacteria in the vagina and increases the risk for some STDs.

Decision Guide for Sexually Transmitted Diseases
Symptoms/Signs	Action
Sore in the genital area, rectum, or throat	See provider
Burning or pain during urination, pain in lower abdomen, or anal discomfort	See provider
Pain or bleeding during intercourse	See provider
For women, abnormal vaginal bleeding or discharge	See provider
For men, discharge from the penis or pain or swelling in testicles	See provider
Unprotected sex with someone who uses injected drugs, has multiple other partners, has a partner who has been diagnosed with an STD, or a partner who uses injected drugs.	See provider
Pregnant and think you have been exposed to an STD	See provider