STDs

    Definition

    STDs (sexually transmitted diseases) are infections that you can get from having sex with someone who has the infection. The causes of STDs are bacteria, parasites and viruses.

    Recent CDC data shows a continued high burden of STDs – particularly among African Americans.

    • More Blacks (45.9%) have genital herpes than white Caucasians (17.6%).

    • Blacks account for about half (49%) of the people who get HIV and AIDS.

    There are more than 20 types of STDs, including:

    •    Chlamydia
    •    Gonorrhea
    •    Genital herpes
    •    HIV/AIDS
    •    HPV
    •    Syphilis
    •    Trichomoniasis

    Sexually transmitted diseases (STDs) are one of the most critical health challenges facing the nation today. CDC estimates there are 19 million new infections every year in the United States at a cost of $17 billion to the U.S health care system each year. CDC’s data is based on the three STDs that physicians are required to report – gonorrhea, Chlamydia, and syphilis, which represent only a fraction of the true burden of STDs. Estimates suggest that even though young people aged 15-24 years represent only 25% of the sexually experienced population, they acquire nearly 50% of all new STDs.

    Correct usage of latex condoms greatly reduces, but does not completely eliminate, the risk of catching or spreading STDs.

    Alternative Names

    Sexually Transmitted Diseases; Sexually Transmitted Infections (STIs)

    Causes

    Sexually transmitted infections can be caused by:

    •    Bacteria (gonorrhea, syphilis, chlamydia)
    •    Parasites (trichomoniasis)
    •    Viruses (human papillomavirus, genital herpes, HIV)

    Sexual activity plays a role in spreading many other infectious agents, although it’s possible to be infected without sexual contact. Examples include the hepatitis A and B viruses, shigella, cryptosporidium and Giardia lamblia.

    Symptoms

    Chlamydia Symptoms

    Chlamydia is a bacterial infection of your genital tract. Chlamydia may be difficult for you to detect because early-stage infections often cause few or no signs and symptoms. When they do occur, they usually start one to three weeks after you’ve been exposed to chlamydia. Even when signs and symptoms do occur, they’re often mild and passing, making them easy to overlook.

    Signs and symptoms may include:

    •    Painful urination
    •    Lower abdominal pain
    •    Vaginal discharge in women
    •    Discharge from the penis in men
    •    Pain during sexual intercourse in women
    •    Testicular pain in men

    Gonorrhea Symptoms

    Gonorrhea is a bacterial infection of your genital tract. The first gonorrhea symptoms generally appear within two to 10 days after exposure. However, some people may be infected for months before signs or symptoms occur. Signs and symptoms of gonorrhea may include:

    •    Thick, cloudy or bloody discharge from the penis or vagina
    •    Pain or burning sensation when urinating
    •    Frequent urination
    •    Pain during sexual intercourse

    Trichomoniasis Symptoms

    Trichomoniasis is a common sexually transmitted disease caused by a microscopic, one-celled parasite called Trichomonas vaginalis. This organism spreads during sexual intercourse with someone who already has the infection. The organism usually infects the urinary tract in men, but often causes no symptoms in men. Trichomoniasis typically infects the vagina in women and may cause these signs and symptoms:

    •    Greenish yellow, possibly frothy vaginal discharge
    •    Strong vaginal odor
    •    Vaginal itching or irritation
    •    Pain during sexual intercourse
    •    Painful urination
    •    Light vaginal bleeding

    HIV Symptoms

    HIV is an infection with the human immunodeficiency virus. HIV interferes with your body’s ability to effectively fight off viruses, bacteria and fungi that cause disease, and it can lead to AIDS, a chronic, life-threatening disease.

    When first infected with HIV, you may have no symptoms at all. Some people develop a flu-like illness, usually two to six weeks after being infected. Early HIV signs and symptoms may include:

    •    Fever
    •    Headache
    •    Sore throat
    •    Swollen lymph glands
    •    Rash
    •    Fatigue

    These early signs and symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, you are very infectious. More persistent or severe symptoms of HIV infection may not appear for 10 years or more after the initial infection.

    As the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic signs and symptoms such as:

    •    Swollen lymph nodes — often one of the first signs of HIV infection
    •    Diarrhea
    •    Weight loss
    •    Fever
    •    Cough and shortness of breath

    Signs and symptoms of later stage HIV infection include:

    •    Persistent, unexplained fatigue
    •    Soaking night sweats
    •    Shaking chills or fever higher than 100.4 F (38 C) for several weeks
    •    Swelling of lymph nodes for more than three months
    •    Chronic diarrhea
    •    Persistent headaches

    Genital Herpes Symptoms

    Genital herpes is highly contagious and caused by a type of the herpes simplex virus (HSV). HSV enters your body through small breaks in your skin or mucous membranes. Most people with HSV never know they have it, because they have no signs or symptoms. The signs and symptoms of HSV can be so mild they go unnoticed. When signs and symptoms are noticeable, the first episode is generally the worst. Some people never experience a second episode. Other people, however, can experience episodes over a period of decades.
    When present, genital herpes signs and symptoms may include:

    •    Small, red bumps, blisters (vesicles) or open sores (ulcers) in the genital, anal and nearby areas
    •    Pain or itching around the genital area, buttocks and inner thighs

    The initial symptom of genital herpes usually is pain or itching, beginning within a few weeks after exposure to an infected sexual partner. After several days, small, red bumps may appear. They then rupture, becoming ulcers that ooze or bleed. Eventually, scabs form and the ulcers heal.

    In women, sores can erupt in the vaginal area, external genitals, buttocks, anus or cervix. In men, sores can appear on the penis, scrotum, buttocks, anus or thighs, or inside the urethra, the tube from the bladder through the penis.

    While you have ulcers, it may be painful to urinate. You may also experience pain and tenderness in your genital area until the infection clears. During an initial episode, you may have flu-like signs and symptoms, such as headache, muscle aches and fever, as well as swollen lymph nodes in your groin.

    In some cases, the infection can be active and contagious even when sores aren’t present.

    Genital Warts (HPV infection) Symptoms

    Genital warts, caused by the human papillomavirus (HPV), are one of the most common types of STDs. The signs and symptoms of genital warts include:

    •    Small, flesh-colored or gray swellings in your genital area
    •    Several warts close together that take on a cauliflower shape
    •    Itching or discomfort in your genital area
    •    Bleeding with intercourse

    Often, however, genital warts cause no symptoms. Genital warts may be as small as 1 millimeter in diameter or may multiply into large clusters.

    In women, genital warts can grow on the vulva, the walls of the vagina, the area between the external genitals and the anus, and the cervix. In men, they may occur on the tip or shaft of the penis, the scrotum, or the anus. Genital warts can also develop in the mouth or throat of a person who has had oral sex with an infected person.

    Hepatitis Symptoms

    Hepatitis A, hepatitis B and hepatitis C are all contagious viral infections that affect your liver. Hepatitis B and C are the most serious of the three, but each can cause your liver to become inflamed.

    Some people never develop signs or symptoms. But for those who do, signs and symptoms may occur after several weeks and may include:

    •    Fatigue
    •    Nausea and vomiting
    •    Abdominal pain or discomfort, especially in the area of your liver on your right side beneath your lower ribs
    •    Loss of appetite
    •    Fever
    •    Dark urine
    •    Muscle or joint pain
    •    Itching
    •    Yellowing of your skin and the whites of your eyes (jaundice)

    Syphilis Symptoms

    Syphilis is a bacterial infection. The disease affects your genitals, skin and mucous membranes, but it may also involve many other parts of your body, including your brain and your heart.

    The signs and symptoms of syphilis may occur in four stages — primary, secondary, latent and tertiary.
    Primary
These signs may occur from 10 days to three months after exposure:

    •    A small, painless sore (chancre) on the part of your body where the infection was transmitted, usually your genitals, rectum, tongue or lips. A single chancre is typical, but there may be multiple sores.

    •    Enlarged lymph nodes.

    Signs and symptoms of primary syphilis typically disappear without treatment, but the underlying disease remains and may reappear in the second (secondary) or third (tertiary) stage.

    Secondary
 signs and symptoms of secondary syphilis may begin two to 10 weeks after the chancre appears, and may include:

    •    Rash marked by red or reddish-brown, penny-sized sores over any area of your body, including your palms and soles
    •    Fever
    •    Fatigue and a vague feeling of discomfort
    •    Soreness and aching

    These signs and symptoms may disappear within a few weeks or repeatedly come and go for as long as a year.

    Latent: 
In some people, a period called latent syphilis — in which no symptoms are present — may follow the secondary stage. Signs and symptoms may never return, or the disease may progress to the tertiary stage.

    Tertiary
: Without treatment, syphilis bacteria may spread, leading to serious internal organ damage and death years after the original infection.

    Some of the signs and symptoms of tertiary syphilis include:

    •    Neurological problems. These may include stroke and infection and inflammation of the membranes and fluid surrounding the brain and spinal cord (meningitis). Other problems may include poor muscle coordination, numbness, paralysis, deafness or visual problems. Personality changes and dementia also are possible.

    •    Cardiovascular problems. These may include bulging (aneurysm) and inflammation of the aorta — your body’s major artery — and of other blood vessels. Syphilis may also cause valvular heart disease, such as aortic valve problems.

    Exams and Tests

    If your sexual history and current signs and symptoms suggest that you have an STI, laboratory tests can identify the cause and detect coinfections you might also have contracted.

    •    Blood tests. Blood tests can confirm the diagnosis of HIV or later stages of syphilis.
    •    Urine samples. Some STIs can be confirmed with a urine sample.
    •    Fluid samples. If you have active genital sores, testing fluid and samples from the sores may be done to diagnose the type of infection. Laboratory tests of material from a genital sore or discharge are used to diagnose the most common bacterial and some viral STIs at an early stage.

    Testing for a disease in someone who doesn’t have symptoms is called screening. Most of the time, STI screening is not a routine part of health care. But there are exceptions:

    •    Everyone. The one STI screening test suggested for everyone ages 13 to 64 is a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Most health care settings in the United States offer a rapid HIV test with same-day results.

    •    Pregnant women. Screening for HIV, hepatitis B, chlamydia and syphilis generally takes place at the first prenatal visit for all pregnant women. Gonorrhea and hepatitis C screening tests are recommended at least once during pregnancy for women at high risk of these infections.

    •    Women age 21 and older. The Pap test screens for cervical abnormalities, including inflammation, precancerous changes and cancer, which is caused by certain strains of human papillomavirus (HPV). Experts recommend that, starting at age 21, women should have a Pap test at least every three years. Some experts also advise that women who start having sex before age 21 should have a Pap test within three years of first intercourse.

    •    Women under age 25 who are sexually active. All sexually active women under age 25 should be tested for chlamydia infection. The chlamydia test uses a sample of urine or vaginal fluid you can collect yourself. Some experts recommend repeating the chlamydia test three months after you’ve had a positive test and been treated. The second test is needed to confirm that the infection is cured, as reinfection by an untreated or undertreated partner is common. A bout of chlamydia doesn’t protect you from future exposures. You can catch the infection again and again, so you should get retested if you have a new partner. Screening for gonorrhea is also recommended in sexually active women under age 25.

    •    Men who have sex with men. Compared with other groups, men who have sex with men run a higher risk of acquiring STIs. Many public health groups recommend annual or more frequent STI screening for these men. Regular tests for HIV, syphilis, chlamydia and gonorrhea are particularly important. Evaluation for herpes and hepatitis B also may be recommended.

    •    People with HIV. If you have HIV, it dramatically raises your risk of catching other STIs. Experts recommend frequent syphilis, gonorrhea, chlamydia and herpes tests for people with HIV. Women with HIV may develop aggressive cervical cancer, so they should have Pap tests twice a year to screen for HPV. Some experts also recommend regular HPV screening of HIV-infected men who risk anal cancer from HPV contracted anally.

    Treatments

    STIs caused by bacteria are generally easy to treat. Viral infections can be managed but not always cured. If you’re pregnant and have an STI, prompt treatment can prevent or reduce the risk of infection of your baby. Treatment usually consists of one of the following, depending on the infection.

    •    Antibiotics. Antibiotics, often in a single dose, can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomoniasis. Typically, you’ll be treated for gonorrhea and chlamydia at the same time because the two infections often appear together.

    Once you start antibiotic treatment, it’s crucial to follow through. If you don’t think you’ll be able to take medication as prescribed, tell your doctor. A shorter, simpler treatment regimen may be available. In addition, it’s important to abstain from sex until you’ve completed treatment and any sores have healed.

    •    Antiviral drugs. You’ll have fewer herpes recurrences if you take daily suppressive therapy with a prescription antiviral drug, but you can still give your partner herpes at any time. 
Antiviral drugs can keep HIV infection in check for many years, although the virus persists and can still be transmitted. The sooner you start treatment, the more effective it is. If you take anti-HIV medication for 28 days, starting as soon as you know you’ve been exposed, you may avoid becoming HIV-positive.

    Possible Complications

    Possible complications include:
    •    Sores or bumps anywhere on the body
    •    Recurrent genital sores
    •    Generalized skin rash
    •    Pain during intercourse
    •    Scrotal pain, redness and swelling
    •    Pelvic pain
    •    Groin abscess
    •    Eye inflammation
    •    Arthritis
    •    Pelvic inflammatory disease
    •    Infertility
    •    Cervical cancer
    •    Other cancers, including HIV-associated lymphoma and HPV-associated rectal and anal cancers
    •    Opportunistic infections occurring in advanced HIV
    •    Maternal-fetal transmission, which causes severe birth defects

    When to Contact a Medical Professional

    If you suspect you have these or other STDs or that you may have been exposed to one, see your doctor for STD testing. Timely diagnosis and treatment are important to avoid or delay more severe, potentially life-threatening health problems and to avoid infecting others.

    Preventions

    There are several ways to avoid or reduce your risk of sexually transmitted infections.

    • Abstain. The most effective way to avoid STIs is to abstain from sex.
    • Stay with one uninfected partner. Another reliable way of avoiding STIs is to stay in a long-term mutually monogamous relationship with a partner who isn’t infected.
    • Get vaccinated. Getting vaccinated early, before sexual exposure, is also effective in preventing certain types of STIs. Vaccines are available to prevent two viral STIs that can cause cancer — human papillomavirus (HPV) and hepatitis B. The Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine for girls and boys ages 11 and 12. If not fully vaccinated at ages 11 and 12, the CDC recommends that girls and women through age 26 and boys and men through age 21 receive the vaccine. However, men may receive the HPV vaccine through age 26 if desired. The hepatitis B vaccine is usually given to newborns.
    • Wait and verify. Avoid vaginal and anal intercourse with new partners until you have both been tested for STIs. Oral sex is less risky, but use a latex condom or dental dam to prevent direct contact between the oral and genital mucosa.
    • Use condoms consistently and correctly. Use a new latex condom for each sex act, whether oral, vaginal or anal. Never use an oil-based lubricant, such as petroleum jelly, with a latex condom. Keep in mind that nonbarrier forms of contraception, such as oral contraceptives or intrauterine devices, don’t protect against STIs.
    • Don’t drink alcohol excessively or use drugs. If you’re under the influence, you’re more likely to take sexual risks.
    • Avoid anonymous, casual sex. Don’t look for sex partners online or in bars or other pickup places. Not knowing your sex partner well increases your risk of possible exposure to an STI.
    • Communicate. Before any serious sexual contact, communicate with your partner about practicing safer sex. Reach an explicit agreement about what activities will and won’t be OK.
    • Teach your child. Becoming sexually active at a young age tends to increase a person’s number of overall partners and, as a result, his or her risk of STIs. Biologically, young girls are more susceptible to infection.  While you can’t control your teen or preteen’s actions, you can help your child understand the risks of sexual activity and that it’s OK to wait to have sex.
    • Consider male circumcision. There’s evidence that male circumcision can help reduce a man’s risk of acquiring HIV from an infected woman (heterosexual transmission) by 50 to 60 percent. Male circumcision may also help prevent transmission of genital HPV and genital herpes.

    Natural Remedies

    A variety of treatments offer relief for most common STDs—find out from a healthcare professional what works best for your symptoms. According to research or other evidence, the following self-care steps may be helpful.

    What You Need To Know:

    • Test topical alternatives
    For symptom relief and faster healing, try ointments containing zinc, lithium succinate, propolis, lemon balm, or aloe

    • Use condoms
    Gain added protection by using latex condoms when having sex

    • Guard your partner
    Avoid sexual contact during active infections to prevent infecting others

    • Protect your unborn child

    Let your obstetrician know about any infections to help prevent passing the infection to your baby.

    These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full genital herpes article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

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