Sexually Transmitted Infections
The first edition of this book was incomplete without a chapter on sexually transmitted infections (STIs), a shortcoming this second edition allows us to amend. But don’t worry—there will be no gruesome pictures—just some basic information.
The Texas Education Code states that “abstinence from sexual activity, if used consistently and correctly, is the only method that is 100 percent effective in preventing . . . sexually transmitted diseases.” This suggests that people may have some misunderstandings about what STIs are and how they can be transmitted. So, let’s start there.
An older term for STI that is still in use today is STD for sexually transmitted disease. However, a significant portion of people with infections do not show signs of disease. In fact, about half of the people with STIs are without symptoms. Thus, the preferred modern term is STI for sexually transmitted infection, although STD is still in common use. An even older term is venereal disease or VD for short.
An STI is any infection that is primarily transmitted by sexual activities. However, STIs can be, and often are, transmitted by ways other than intercourse. To name a few of the many methods of transmitting an STI, we know that STIs can be transmitted by kissing; skin-to-skin contact; intimate contact other than coitus; by shared needles; and by exposure to blood, breast milk, and other bodily fluids. Babies can even be born with an STI. In fact, after a period of decline, there has been a recent sharp increase in the number of babies born with congenital syphilis in the U.S.
STIs are much more common than people realize. In fact, the CDC estimates about 20 million new cases are detected each year, and about 110 million people, including new and persistent cases, are living with STIs overall. That’s one in three Americans with an STI!
STI incidence in the USA.
The chart above shows that the most common STI is HPV (human papilloma virus), with almost 80 million cases in the U.S. The good news is that there is an effective HPV vaccine, which both members of a couple should get well before marriage.
Genital herpes (HSV-2, or herpes simplex virus–2) is the next most common and is the poster child for why one should use condoms: herpes infections never go away, and the painful virus can be activated whenever the host experiences stress. HSV-1 (oral herpes, also called “cold sores”) is also quite common, with about 65% of Americans carrying the virus. Worldwide, about 90% of people have one or both viruses.
There are four main classes of STIs—parasitical, protozoan, bacterial, and viral. We will briefly cover each in turn. Because about half of all STI infections don’t show any signs of disease, we are not going to present a list of symptoms for each. Instead, in addition to covering the four main classes, we refer you to the charts below and suggest that testing is better than assuming you are disease free because of the absence of symptoms or the state of virginity.
COMMON SEXUALLY TRANSMITTED INFECTIONS
|WHAT IS IT||A viral infection of the genital areas and/or mouth.||An infection caused by bacteria that can spread throughout the body.|
|US INFECTIONS||An estimated 1 million new infections each year, with about 45 million people already infected.||About 46,000 new cases reported each year.|
|SYMPTOMS||Most people have no symptoms. Herpes 1 typically causes cold sores and fever blisters on the mouth and Herpes 2 on the genitals, but, they can infect either area. A herpes outbreak can start as red bumps and then turn into painful blisters or sores. During the first outbreak, it can also lead to flu-like symptoms (like a fever, headaches, and swollen glands).||Symptoms vary based on the course (timing) of infection-beginning with a single, painless sore (called a chancre) on the genitals, anus, or mouth. Other symptoms may appear up to 6 months after the first sore has disappeared including a rash. However, there may be no noticeable symptoms until syphilis has progressed to more serious problems (see below).|
|HOW IT SPREADS||Through vaginal, oral, or anal sex. It can also be passed through skin-to-skin sexual contact, kissing, and from mother to child during childbirth.||Through vaginal, oral, or anal sex. It can also be passed through kissing if there is a lesion (sore) on the mouth, and from mother to child during childbirth.|
|TREATMENT||There is no cure for herpes-the virus stays in the body and may cause recurrent outbreaks. Medications can help treat symptoms, reduce the frequency of outbreaks, and reduce the likelihood of spreading it.||Antibiotic treatment can cure syphilis, but can’t undo damage already done. Both partners must be treated and avoid sexual contact until the sores are completely healed.|
|CONSEQUENCES IF UNTREATED||Antibiotic treatment can cure syphilis, but can’t undo damage already done. Both partners must be treated and avoid sexual contact until the sores are completely healed.||Increased risk for other STDs, including HIV. Untreated, the symptoms will disappear, but the infection stays in the body and can cause damage and even death. Syphilis in women can seriously harm a developing fetus during pregnancy.|
|HEPATITUS B VIRUS (HBV)||HIV|
|WHAT IS IT||A viral infection affecting the liver – HBV can be acute (mild illness lasting for a short time) or chronic (a serious life-long illness)||The human immunodeficiency virus (HIV) is the virus that causes AIDS.|
|US INFECTIONS||An estimated 40,000 new cases each year (most acquired through sex). Up to 1.2 million people are already infected with chronic HBV.||About 56,000 new infections each year, with an estimated 1.1 million Americans already living with HIV.|
|SYMPTOMS||Many people don’t have any symptoms, especially adults. Tiredness, aches, nausea & vomiting, loss of appetite, darkening of urine, tenderness in the stomach, or yellowing of the skin and the whites of the eyes (called jaundice). Symptoms of acute HBV may appear 1 to 6 months after exposure. Symptoms of chronic HBV can take up to 30 years to appear, although liver damage can occur silently.||Symptoms usually related to infections and cancers people get due to a weakened immune system. On average it takes about 10 years from initial HIV infection to develop AIDS.|
|HOW IT SPREADS||Through vaginal, oral, or anal sex. Also, through childbirth if the baby does not get vaccinated against HBV; sharing contaminated needles or razors; or exposure to the blood, bodily fluids or saliva of an infected person.||Through vaginal, oral, or anal sex. Also by sharing contaminated needles or drug works; and from mother-to-child during pregnancy or breast-feeding. The chance of getting it through kissing is very low unless there are mouth ulcers.|
|TREATMENT||Most often, acute HBV is treated with rest, eating well, and lots of fluids. Chronic HBV is treated through close monitoring by a doctor and antiviral medications.||There is no cure for HIV or AIDS. Anti-retroviral treatment can slow the progression of HIV disease and delay the onset of AIDS. Early diagnosis and treatment can improve a person’s chances of living a longer, healthy life.|
|CONSEQUENCES IF UNTREATED||Increased risk for other STDs, including HIV. Chronic, persistent inflammation of the liver and later cirrhosis of cancer of the liver. Babies born to infected women are likely to develop chronic HBV infection if not immunized at birth.||Increased risk of other life-threatening infections and certain cancers. Left untreated, HIV infection is fatal.|
|GONORRHEA||GENITAL HUMAN PAPILLOMAVIRUS (HPV)|
|WHAT IS IT||A bacterial infection of the genital areas.||A viral infection with over 40 types that can infect the genital areas, including types that cause warts and cancer.|
|US INFECTIONS||About 820,000 new cases reported each year. The highest rates are among women aged 20 to 24 and men aged 20 to 24.||An estimated 14 million new cases each year, with at least 79 million Americans already infected. There are vaccines to prevent HPV infections and these are given to teens before they become sexually active.|
|SYMPTOMS||Most infected people have no symptoms. For those who do, it can cause a burning sensation while urinating, abnormal white, green, and/or yellowish discharge. Women may also have abnormal vaginal bleeding and/or pelvic pain. Men may also have painful or swollen testicles.||Most infected people have no symptoms. But some HPV types can cause genital warts – small bumps in and around the genitals (vagina, vulva, penis, testicles, and anus, etc.). If they do occur, warts may appear within weeks or months of having sex with an infected partner. Cancer-causing HPV types do not cause symptoms until the cancer is advanced.|
|HOW IT SPREADS||Through vaginal, oral, or anal sex. It can also be passed on from mother to child during childbirth.||Through vaginal, oral, or anal sex. It can also be passed on during skin-to-skin sexual contact, and from mother to child during childbirth.|
|TREATMENT||Oral antibiotics can cure the infection. Both partners must be treated at the same time to prevent passing the infection back and forth. Both partners should avoid sex until the infection is gone.||There is no cure for HPV (a virus), but in most cases, the virus goes away on its own. If the virus does not go away, there are ways to treat HPV-related problems. For example, warts can be removed, frozen off, or treated through topical medicines. Even after treatment, the virus can remain and cause recurrences (warts come back).|
|CONSEQUENCES IF UNTREATED||Increased risk for infection of other STDs, including HIV. In women, gonorrhea can cause pelvic inflammatory disease (PID) which can lead to infertility or tubal (ectopic) pregnancy. Men may develop epididymitis, a painful condition which can lead to infertility. Babies born to infected women can develop eye infections.||Genital warts will not turn into cancer over time, even if they are not treated. Babies born to women with genital warts can develop warts in the throat. Cancer-causing HPV types can cause cervical cancer & other less common cancers (like anal cancer) if the infection lasts for years.|
|WHAT IS IT||A bacterial infection of the genital areas.||A parasitic infection of the genital areas.|
|US INFECTIONS||About 1.4 million new cases reported each year. The highest rates are among adolescent women.||An estimated 1 million new cases each year.|
|SYMPTOMS||Often there are no symptoms. For women who do experience symptoms, they may have abnormal vaginal discharge, bleeding (not their period), and/or burning and pain during urination. Men may have discharge or pain during urination, and/or burning or itching around the opening of the penis.||Often there are no symptoms. Women may notice a frothy, smelly, yellowish-green vaginal discharge, and/or genital area discomfort. Men may temporarily have a discharge from the penis, slight burning after urination or ejaculation, and/or an irritation in the penis.|
|HOW IT SPREADS||Through vaginal, oral, or anal sex. It can also be passed on from mother to child during childbirth.||Through vaginal sex.|
|TREATMENT||Oral antibiotics cure the infection. Both partners must be treated at the same time to prevent passing the infection back and forth. Both partners should avoid sex until the infection is gone.||Antibiotics can cure the infection. Both partners must be treated at the same time to prevent passing the infection back and forth. Both partners should avoid sex until the infection is gone. It is common for this infection to recur.|
|CONSEQUENCES IF UNTREATED||Increased risk for infection of other STDs, including HIV. In women, chlamydia can cause pelvic inflammatory disease (PID) which can lead to infertility or tubal (ectopic) pregnancy. Men may develop pain and swelling in the testicles, although this is rare. Babies born to infected women can develop eye or lung infections.||Increased risk for infection of other STDs, including HIV. Can cause complications during pregnancy.|
Parasitical infections, such as public lice (crabs) and scabies, are easily transmitted, even by sharing towels, brushes and clothing. However, they are treatable and not permanent if treated. Small bites or itchiness in the groin area indicate a possible infection, as do small dots on the hair. Scabies can be difficult to detect, but any clinic can check for you.
There are over-the-counter treatments for parasites—but ordinary soap and water and treatments for head lice will not work. Some prescription and over-the-counter treatments kill both the live lice and their eggs (also called nits). Other products require two applications, approximately seven to nine days apart. Check the label to see if the product kills both lice and eggs, and determine how to use it correctly. Your partner should also be treated.
Typically, all your clothes and bedding must also be washed in very hot soapy water and dried with heat. Items that cannot be washed can be placed in a sealed bag for 2 weeks, until the lice and their eggs die out. You can also vacuum rugs and furniture. You don’t need to call an exterminator or fumigate your home.
Protozoan infections include trichomoniasis, which is another type of parasite. Trichomoniasis is the most common curable STI. In the United States, an estimated 3.7 million people have the infection. However, only about 30% develop any symptoms. It is treated with prescription medication, and your partner must be treated too.
Bacterial infections, such as syphilis, gonorrhea, and chlamydia, are curable with antibiotics. Get tested and treated, and be sure to follow through on all medication. Make sure your partner gets tested and treated as well. Although curable with diligent treatment, some bacterial STIs can be very serious if untreated or if passed from mother to newborn baby.
Less common bacterial infections include chancroid and lymphogranuloma venereum (LGV). Secondary infections include vaginitis and pelvic inflammatory disease, although these can be caused by other factors too.
Viral STIs, such as herpes, hepatitis, HPV, and HIV, are caused by viruses and many are not curable, although they may lie dormant for periods of time. The viral STIs have the worst reputation of all the STIs. HIV will eventually cause AIDS and has killed many people, although it is now treatable, and its progression slowed. HPV can cause cancer. Hepatitis causes liver damage, causes liver cancer and can cause death. Herpes is a lifetime infection, albeit treatable. As with the other STIs, the viral infections are much more serious in the newborn, and it is best to be tested and treated before starting a family.
There are discreet lab services available that will test for a complete panel of STIs and provide quick results. Search “STI testing” or “STD testing.” You should also be aware that many communities offer free or subsidized STI testing. Check www.freeSTDcheck.org to find a clinic near you.
For more information, see your doctor or visit either of the following sites: