EDITOR’S NOTE: Last month we posted an article specifically about the syphilis epidemic here. The following article discusses other STDs.
Young people – ages 15-24 years – account for half of all new infections from sexually transmitted diseases (STDs), according to the Centers for Disease Control and Prevention (CDC). There are 20 million new STD infections every year in the United States.
There are many types of STDs and no STD is harmless. Even the curable ones can cause serious consequences if left untreated. Untreated chlamydia, gonorrhea, herpes, human papillomavirus and syphilis can cause serious, long-term complications. These include birth defects, blindness, bone deformities, brain damage, cancer, heart disease, infertility, mental retardation, even death. Complications can also cause long-term problems in women and babies, including pelvic inflammatory disease, infertility, tubal or ectopic pregnancy, pre-term births, low birthweight, cervical cancer and infections in infants born to infected mothers.
The direct cost to treat STDs in the United States is about $16 billion annually. Prevention and control efforts are not keeping up with the rapidly increasing number of cases. This problem is likely to worsen because about half of the state or local STD programs are facing budget cuts, according to the CDC. This limits treatment for people who must travel longer distances to receive care, causes delays in getting test results and long wait times for appointments.
STDs are caused by having any type of sex (vaginal, anal or oral) with a person who has a STD infection, even if there are no symptoms.
Many younger people (ages 15-24), who have the highest rate of new STD cases, believe they cannot get or give an STD with oral sex. There is a myth that oral sex is “safer.” This is not true. More than 85 percent or sexually active adults (both heterosexual and same-sex) report having had oral sex. A third of children ages 15 to 17 years report having had oral sex.
If you have symptoms and/or if you have had sex with someone who could be infected with a STD, it is extremely important to be tested. Early testing and treatment limits the chance of passing on the STD to others or to an unborn child if you are pregnant or planning to be. It also reduces the initial pain and illness as well as the long-term damage that most STDs cause.
Infection with any STD increases the chances of getting HIV/AIDS and spreading it to others. People who have an STD are more likely to get HIV. STDs and HIV infection are caused by the same behaviors and circumstances. Also, having a sore or break in the skin from an STD can let HIV enter the body.
Your doctor, or other health care provider or public clinic will determine if you have an STD by examining your body. They may also test your urine, blood or use a cotton swab to get cells from your body. The lab results will determine the type and length of treatment, if needed. You will need to avoid sex of any type until the infection clears your body. You should also notify all your partners about being exposed. It is very important for them to be tested and treated. After treatment, further testing may be needed to determine if you are infection free.
A health department can provide anonymous, free or low-cost testing if you are uncomfortable talking to your doctor. Find a confidential testing center near you here.
Treatment for STDs can include vaccines, antibiotics, antifungals and topical microbicides (a gel, film or suppository applied to the vagina or rectum that kills or disables the microbes that cause STDs). If you are given antibiotics, be sure to take all of them as directed, even if your symptoms go away.
Gardasil is a vaccine that protects against the four most common strains of human papillomavirus (HPV). Currently there are ongoing trials on a vaccine to prevent genital herpes. Vaccine research for other STDs is ongoing.
The CDC says the two strategies that reduce STD cases and save direct treatment costs are:
- Routinely and frequently test for STDs in people at high risk
- Start treatment immediately to reduce the further spread of STDs
The CDC recommends the following STD and HIV screening tests:
- HIV – test everyone between the ages of 13 to 64 at least once.
- HIV – test anyone who has unprotected sex or shares needles or other injection-drug equipment at least once a year.
- HIV – test sexually active gay and bisexual men every three to six months.
- Chlamydia and gonorrhea – test sexually active women younger than age 25 every year; test women over age 25 who have new or multiple sex partners, or a sex partner who has a STD every year.
- Test pregnant women for syphilis, HIV and hepatitis B early in their pregnancy; test for chlamydia and gonorrhea in at-risk pregnant women; repeat testing as needed to protect the health of mother and infant.
- Syphilis, chlamydia and gonorrhea – test sexually active gay, bisexual and other men who have sex with men (MSM) every year. MSM who have multiple or anonymous partners should be screened every three to six months.
The only way to avoid STDs is to:
- Not have vaginal, anal or oral sex.
- If you are a sexually active adult, you can lower your risk of getting an STD by being in and staying in a mutually monogamous (you and your partner agree to only have sex with each other) relationship. Both you and your partner should be tested for STDs and have negative STD test results before you have sex.
- Use male latex condoms the right way every time you have sex. Barrier methods are highly effective and include latex condoms and topical microbicides, according to the National Institute of Health’s National Institute of Allergy and Infectious Diseases (NIHAID).
- Use a condom, dental dam or other barrier every time you have oral sex.
Types of STDs
Although syphilis is perhaps the oldest and best-known STD, there are others, some of which are fairly new. The following outlines basic facts, testing and prevention information about the seven major STDs and four less common ones.
Bacterial vaginosis (BV) is the most common vaginal infection in women ages 15-44 (29% have it). Typically, it occurs in sexually active women when the “good” and “harmful” bacteria that normally occur in the vagina become imbalanced. Douching and new sex partners can upset this bacterial balance.
BV is transmitted during sexual contact, but 20 percent of the cases occur in women who have had no sexual contact. The chances of getting BV increase with the number of sexual partners. Diagnosis is made by testing vaginal fluid.
Most women (84%) with BV do not have symptoms. Symptoms can include a thin white or gray vaginal discharge; pain, itching, or burning in the vagina; a strong odor, especially after sex; burning when peeing; or itching around the vagina.
Treatment is especially important for pregnant women. BV increases the risk of delivering pre-term or having a low birthweight baby (less than 5.5 pounds). The male partners of women who have BV do not need to be treated. However, female sex partners can transfer BV and should be treated.
Sometimes, BV goes away without treatment. However, it should always be checked by a health care provider to determine the best treatment. The risk of getting other STDs increases if BV is not treated. BV can cause pelvic inflammatory disease (PID), making it difficult or impossible to have children.
Chlamydia is the most commonly reported STD by men and women in the United States. It can be easily cured with antibiotics but reinfection is common. If not treated it can be difficult to conceive a baby because of damage to the reproductive system. It can also cause an ectopic pregnancy and is potentially fatal. Chlamydia can be transmitted to a baby during childbirth.
If you are sexually active or have new or many sex partners, you need testing for chlamydia at least every year.
Most people with chlamydia infection have no symptoms. Even without symptoms, the reproductive system can be damaged. If symptoms do occur, they may not appear until several weeks after sex with an infected partner. Symptoms include unusual discharge from the vagina or penis or a burning sensation when peeing. Men may have pain or swelling in one or both testicles. Rectal infection can cause pain, discharge and bleeding.
Two types (type 1 and 2) of herpes simplex virus (HSV) cause genital herpes. It is a common STD and about one out of every six Americans, ages 14 to 49, have HSV.
HSV is a chronic, life-long viral infection and there is no cure. It is spread by contact with the fluids from a herpes sore. It can also be transmitted from an infected person with no visible sores. The virus is released through the skin (called shedding) and spread to others. It can be spread even if wearing a condom because outbreaks can occur in areas not covered by a condom.
HSV in pregnant women can cause miscarriage or a pre-term birth. It can be passed to the baby, causing a potentially deadly infection. A Caesarian section is usually performed if the mother has HSV symptoms at delivery.
Most people do not know they have HSV because they have no symptoms. Symptoms can include an unusual sore, a smelly discharge or burning sensation when peeing. Women can have bleeding between periods. HSV sores are blisters on or around the genitals, rectum or mouth. If the blisters break, they leave painful sores that can take weeks to heal. This is called having an outbreak. With the first outbreak, a person can have flu-like symptoms such as aches, fever and swollen glands.
Repeat HSV outbreaks are common, especially during the first year after infection. After that, repeat outbreaks are usually shorter, less severe and decrease in number over a period of years.
Touching the sores/fluid can spread HSV to other parts of the body. Wash hand immediately to avoid spreading HSV. Daily antiviral medication can prevent or shorten outbreaks. Taking the medicine makes it less likely to pass on the infection to sexual partners.
Gonorrhea is an STD that can infect men or women in the genitals, rectum and throat. It can also be passed to an infant during birth from an infected mother. Gonorrhea can spread to blood or joints and be life threatening. It is an especially common infection among those ages 15-24 years.
Some people do not have symptoms. Men’s symptoms may include a burning sensation when peeing, or a white, yellow or green discharge from the penis. Painful or swollen testicles is less common.
Women’s symptoms include painful or burning when peeing, increased vaginal discharge and bleeding between periods. If gonorrhea infects the rectum, men and women may have discharge, itching, soreness, bleeding and painful bowel movements.
A urine test is used to diagnose most cases. If the infection is in the throat or rectum, a swab is used to collect a sample.
Gonorrhea can be cured with the right medicine but permanent damage cannot be reversed. Gonorrhea is getting harder to cure because it has developed resistance to every antibiotic used, although not in every patient. The CDC reports treatment failure with one of the only two treatment drugs. Go back to the doctor to be retested if you keep having symptoms after taking all your medicine.
Without treatment, women with gonorrhea can develop serious complications from the infection including pelvic inflammatory disease (PID), long-term belly pain and inability to get pregnant. Untreated men can have long-term pain and not be able to father a child.
Human immunodeficiency virus (HIV) weakens the immune system by destroying cells that fight infection and disease. Without treatment, the disease will progress to AIDS, the last stage of HIV infection.
While there is no cure for HIV, it is controllable with antiretroviral therapy (ART). ART can prolong the lives of most HIV-infected people and lower their chance of infecting others.
HIV spreads by sexual contact or by sharing needles or syringes with an infected person. HIV can live in a used needle for up to 42 days. HIV can also be transmitted during pregnancy or birth. Only certain infected body fluids can transmit HIV – blood, semen, vaginal or rectal fluids and breast milk. For transmission to occur, these fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the blood. If you get a tattoo or body piercing, be sure only new needles, ink and other supplies are used.
Many people do not have symptoms when they first contract HIV. Some have flu-like symptoms for a few days to several weeks. If you have symptoms after a potential exposure to HIV or other STD, get tested. Being tested is the only way to know if you have HIV infection. If your test is positive, you will need to start ART medicines immediately.
Human papillomavirus (HPV) is the most common sexually transmitted viral infection in the United States. Nearly all sexually active people get it at some point in their lives. Any type of sexual contact with an infected person spreads HPV, even if the infected person has no symptoms. Symptoms can develop years after you have sex with an infected person.
In most cases, HPV goes away on its own and never causes health problems. However, there are many types of HPV and some do not go away without treatment. They can cause genital warts or cancers.
Genital warts look like a small bump or group of bumps in the genital area. They can be small or large, and raised, flat or cauliflower shaped. Medication can treat genital warts.
Some types of HPV cause cervical cancer and other cancers in the genital area. However, cancer from HPV usually takes years or decades to develop after infection.
While there is no treatment for HPV, there is a safe and effective vaccination. Two doses of vaccine can prevent HPV and the cancers it can cause. The CDC recommends that 11- or 12-year-olds get two doses of HPV vaccine, six to 12 months apart. Vaccinations for young adults, who were not vaccinated at age 11-12, can be given: through age 21 for males, though age 26 for gay or bisexual males, through age 26 for females, or for anyone with a compromised immune system through age 26.
Trichomoniasis is a very common STD in men and women. Caused by a parasite, it is fairly easy to cure with antibiotics. The infection usually has no symptoms. Symptoms can include an unusual discharge from the vagina or penis with a strong smell, painful peeing, or irritation or itching in the genital area.
A pregnant woman with trichomoniasis is more likely to give birth pre-term or have an underweight baby. The disease can cause infections in a man’s urine canal (urethra) or prostate gland and symptoms do not go away without treatment.
Chancroid infection is declining worldwide. It is difficult to diagnose but symptoms include painful genital ulcers and enlargement of lymph nodes in the genital area. Antibiotics can cure it, although scarring can result.
Lymphogranuloma venereum (LGV) is a STD infection that causes tender lymph nodes and sometimes, genital sores. It has symptoms similar to chancroid infection (above). LGV is an invasive infection that can spread throughout the body. If the infection is in the rectum, it can result in symptoms similar to inflammatory bowel disease. It can also cause pain, constipation, fever, and chronic colorectal fistulas and strictures. Antibiotics can cure LGV, which can prevent more tissue damage.
Public lice (“crabs”) are parasitic insects found attached to pubic hair. Lice may also be on eyebrows, eyelashes, beards, and hair on the chest and armpits. Symptoms include itching in the genital area and visible crawling lice or eggs.
Pubic lice are spread by sexual contact. Occasionally, they are spread by contact with clothing, bed linens or towels used by an infested person. Pets do not transmit human lice. Lice found on the head are head lice and generally not pubic lice.
The adult lice feed on blood and are tan to grayish-white in color. Lice eggs are hard to see and firmly attach to a hair shaft. They are oval and usually white or yellow.
Both prescription and over-the-counter medications are available to treat pubic lice infestations. If you find live lice after 10 days, repeat treatment. Wash all clothing, towels and bedding used three days before treatment in hot water and hot dryer cycle.
Infestation of the skin by the human itch mite causes scabies. The mite burrows into the skin and lays eggs there. The most common symptom is intense itching and pimple-like skin rash.
Direct and prolonged skin-to-skin contact with an infested person spreads scabies. Sleeping with or having sex with an infested person can easily transmit scabies. It spreads indirectly through shared clothing, towels or bedding used by an infested person. It can spread easily to household members and spreads rapidly under crowded living conditions. Outbreaks occur often in nursing homes, extended-care facilities and prisons.
Symptoms can take four to six weeks to begin in a person who has never had scabies. If you’ve had it before, symptoms appear in one to four days after exposure. Scabies mites can live on a person for up to two months.
You will need a doctor’s prescription for scabies treatment medicine. To prevent reinfestation, treat all household members and sexual partners at the same time. If itching continues for two to four weeks, repeat treatment.
Animals do not spread human scabies. Pets can become infested with a different kind of scabies mite that causes “mange” in animals. The mite from pets cannot survive or reproduce on humans.
STDs are an increasingly serious public health epidemic. If you notice any unusual sore or change in the genital, anal or oral areas of your body, get it checked out by your doctor or at a confidential testing center. Prevention and treatment are the only ways to slow and stop this epidemic. More information here.