STDs: What Are They and How Do You [not] Get Them?
By Everyday Health. Listen to the ► Podcast at How To Sex.
This episode deals with the following STD concerns: Chlamydia, Genital Herpes, Gonorrhea, Hepatitis B, HIV, HPV, Molluscum Contagiosum, Syphilis, Trichomoniasis, Chlamydia, Genital Herpes, Gonorrhea, Hepatitis B, HIV, HPV, Molluscum Contagiosum, Syphilis, Trichomoniasis.
The
number of cases of sexually transmitted diseases (STDs), now more
commonly referred to as sexually transmitted infections (STI), in the
United States hit an all-time high in 2019, according to data released
on April 13, 2021, by the Centers for Disease Control and Prevention
(CDC). The CDC’s surveillance report shows that nearly 2.5 million new cases of gonorrhea, syphilis, and chlamydia were reported that year.
Chlamydia
remained the most common condition reported to the CDC, with close to
1.8 million cases, up 19 percent since 2015. Gonorrhea diagnoses reached
616,392, up 56 percent since 2015. And primary and secondary syphilis
diagnoses reached 129,813, up 74 percent since 2015.
Of high concern is that congenital syphilis cases,
that is, syphilis in newborns, nearly quadrupled between 2015 and 2019,
reaching 1,870 cases. From 2018 to 2019 the number of stillbirths
caused by syphilis increased from 79 to 94, and the number of congenital
syphilis-related infant deaths rose from 15 to 34 deaths.
While the 2019 STD statistics reflect pre-COVID-19 pandemic numbers,
preliminary data from 2020 suggests many of the same trends continued
during the pandemic. Experts attribute some of the growth in STDs in
2020 to disruptions in STD testing and treatment programs caused by the pandemic.
While
2.5 million cases of chlamydia, gonorrhea, and syphilis may sound like a
lot, it’s likely an undercount: Many people with these and other STDs,
formerly known as venereal diseases, go undiagnosed and untreated. The
CDC estimates that nearly 20 million new sexually transmitted infections
occur every year, accounting for almost $16 billion in healthcare costs
annually.
Inequities in STD Burdens
The
numbers of STDs increased in all age groups and among all racial and
ethnic groups in 2019, according to CDC statistics. However, some groups
saw higher rates of STDs than others:
- People ages 15 to 24 accounted for 61 percent of chlamydia cases and 42 percent of gonorrhea cases.
- Gay and bisexual men accounted for nearly half of all primary and secondary syphilis cases.
Here’s what you need to know about how to spot, treat, and prevent STDs.
What Is the Definition of an STD?
“STDs are diseases that are passed from one person to another through sexual contact,” a representative of the CDC says.
According to the CDC, some of the common STDs are chlamydia, gonorrhea, herpes simplex virus type 2 (HSV-2),
human immunodeficiency virus (HIV), human papillomavirus (HPV), and
syphilis. "Many of these STDs do not show symptoms for a long time," per
the CDC, "but they can still be harmful and passed on during sex.”
Virtually
all STDs can be transmitted through anal, vaginal, or oral sex. In
addition, some STDs can also be transmitted through close skin-to-skin
contact, even if no intercourse occurs.
HPV, for example, can be spread through skin-to-skin touching. In addition, “Molluscum contagiosum, a viral skin disease, can be spread through sexual or casual contact, as can scabies,
an itchy skin condition caused by a mite infestation. It is also
possible to get scabies from an infected sleeping bag or bed,” says Edward W. Hook III, MD,
an endowed professor of infectious disease translational research in
the departments of medicine, epidemiology, and microbiology at the
University of Alabama in Birmingham, who works with the CDC.
STDs don’t just affect the genital regions: “Oral herpes can be transmitted through oral and genital sex,” says Dr. Hook.
It
is important to remember that STDs may have no symptoms. However, new
vaginal or urethral discharge or a new rash after sexual contact should
be evaluated by a medical professional.
When symptoms do occur, they can include the following:
Chlamydia Symptoms of chlamydia can include vaginal discharge in women, penile discharge in men, and burning during urination in men and women.
Gonorrhea Gonorrhea
can cause thick, cloudy, or bloody discharge from the vagina or
urethra, and pain or burning when peeing. If you have gonorrhea in your
anus, it may cause itching in and around the anus, discharge from the
anus, and pain when defecating. Gonorrhea in the throat may cause a sore
throat.
Hepatitis B Acute hepatitis B can
cause fever, fatigue, loss of appetite, nausea or vomiting, abdominal
pain, dark urine, clay-colored bowel movements, joint pain,
and jaundice (yellowing of the skin and whites of the eyes). Symptoms
can appear anywhere from six weeks to six months following exposure to
the hepatitis B virus. Chronic hepatitis B sometimes causes symptoms
similar to acute disease.
Genital Herpes Signs of genital herpes typically
include red bumps that develop into blisterlike sores in the genital
area and sometimes on the buttocks or thighs. A new infection with
HSV-2, the virus that causes most cases of genital herpes, may also
cause flulike symptoms, including fever, headache, feeling tired and
achy, and swollen glands.
Oral Herpes Symptoms
of oral herpes can include itching of the mouth or lips, sores or
blisters on the lips or inside the mouth, and flulike symptoms such as
fever, headache, body aches, and swollen glands.
HIV Early symptoms of HIV infection can
resemble those of the flu: fever, headache, muscle aches, and sore
throat. They may also include swollen lymph nodes, diarrhea, nausea and
vomiting, a fungal infection of the mouth, and a rash on the abdomen,
arms, legs, or face. If HIV goes untreated, later symptoms can include
fatigue, weight loss, night sweats, joint pain, short-term memory loss,
and recurrent infections.
HPV Most strains of HPV cause no symptoms and are detected only after abnormal cells are discovered during a Pap smear. However, some types of HPV cause genital warts, which appear as skin-colored or whitish growths on the genitals or anus.
Molluscum Contagiosum Often
the only sign of this skin disease is pink or flesh-colored bumps with a
dimple (indentation) in the center. It is most common in children, who
typically get it from skin-to-skin contact or from shared towels or
similar items. In adults, it can be sexually transmitted.
Pubic Lice Symptoms of pubic lice include itching in the genital area, tiny bugs in your pubic hair, and visible nits (eggs) on hair shafts. Pubic lice can also infest the hair on legs, armpits, eyebrows, eyelashes, and other facial hair such as mustaches and beards.
More on Scabies and Pubic Lice
How to Know If That Rash Is Scabies
Scabies This
skin infestation causes intense itching that is typically worse at
night. It can also cause small red bumps or a rash and raised lines on
the skin where the mites have burrowed.
Syphilis In the primary stage, syphilis causes a painless sore,
or ulcer, at the location the bacteria entered the body, often in the
genital area. In the secondary stage of syphilis, a rash may occur on
the torso and elsewhere on the body.
Trichomoniasis Another
common STD, trichomoniasis is a parasitic infection that can cause
burning and itching in the genital area for men and women as well as
painful intercourse. Trich can also cause a smelly discharge and painful
or frequent peeing.
Can I Have an STD and Not Know It?
Yes.
Many STDs don’t cause any symptoms, especially during the early stages,
so the only way to know for sure if you have one is to get tested. Keep
in mind that you can get an STD from having sex with someone who has no
symptoms and may not know they have an STD.
Are Adolescents Disproportionately Affected?
The CDC reports
that half of newly reported cases of STDs occur in people between the
ages of 15 and 24, noting that young women’s bodies are biologically
more susceptible to STDs.
“Chlamydia and HPV are
common as soon as you become sexually active,” Hook says. “Gonorrhea
and genital herpes peak in the late twenties to thirties.”
All STDs, though, including HIV, can and do occur at any age.
When and How Often Should I Get Tested?
“Women
should be tested for chlamydia on a regular basis. Some gynecologists
test for it automatically, but not all do,” Hook says.
Chlamydia Treatment and Prevention
Testing
for chlamydia, gonorrhea, and trichomoniasis involves collecting either
a urine sample or a swab from the vagina or penis.
For other STDs, including HIV, syphilis, and genital herpes, blood testing is most accurate.
To test for HPV, a sample of cervical or anal cells must be collected.
How often an individual needs to be tested for STDs depends on their level of risk for infection.
The CDC recommends the following for testing for chlamydia:
screening in sexually active women age 25 and younger and in older
women who are at an increased risk for infection because of a new sex
partner or multiple sex partners
Annual screening in men who have sex with men, based on exposure history, with
more frequent screening in people at the highest risk
Screening in all pregnant women at their first prenatal visitAnnual screening in sexually active people living with HIVThe CDC's recommendations for gonorrhea testing include the following:
- Annual screening in sexually active women who are at risk for infection, which includes women ages 25 and younger
- Annual
screening in men who have sex with men, based on exposure history, with
more frequent screening in people at the highest risk
Screening in all pregnant women under age 25 and older women who are at an increased riskAnnual screening in sexually active people living with HIVThe CDC's recommendations regarding screening for syphilis include these guidelines:
- Screening in all pregnant women at their first prenatal visit
- Annual screening in men who have sex with men
- Annual screening in sexually active people living with HIV
The CDC has additional recommendations for other STDs.
In
all cases, more frequent screening or screening for additional STDs may
be appropriate for certain individuals, depending on their risk
factors, including sexual behavior and how common a particular disease
is in their area.
Where Can I Get Tested for STDs?
Your
family doctor or ob-gyn should be able to do STD testing. In some
areas, other options include specialized STD or sexual health clinics.
You can find locations in your area that offer fast, free, and confidential testing using the CDC’s Get Tested tool.
How Can I Protect Myself From Getting an STD?
Abstaining
from all sexual contact is the only way to reduce your risk of STDs to
zero. But the following measures can also help:
- Having only one sexual partner, and ensuring that person is monogamous too, lowers your risk of STDs.
- Proper use of a condom every time you have sex greatly reduces the risk of all STDs.
- Getting
vaccinated against hepatitis B is the best way to avoid this viral
infection. The hepatitis B vaccine can be given to people of any age.
Getting the HPV vaccine protects you against strains of the virus that cause
genital warts and cervical and other cancers. The HPV vaccine is
routinely available to people ages 9 through 26. It is additionally
approved for adults ages 27 through 45 but not routinely recommended.
Adults age 27 or older who believe they would benefit from HPV vaccination should discuss it with their doctors.
What Are the Treatment Options for Common STDs?
Some
STDs are curable with medical treatment, while others can be managed to
control symptoms and reduce the risk of transmission.
These STDs can be cured with antibiotics:
- Chlamydia
- Gonorrhea
- Syphilis
- Trichomoniasis
STDs that can be cured with insecticides include the following:
Minor surgical procedures such as cryosurgery (freezing) or laser surgery can treat certain STDs:
- Genital warts caused by HPV
- Molluscum contagiosum
STDs that can be managed with antiviral medication include these infections:
- Chronic hepatitis B
- Genital herpes
- HIV
When
precancerous cells caused by HPV are found on the cervix, treatment may
include watchful waiting or surgery to remove the abnormal tissue.
Does Having One STD Make You More Likely to Get Another?
“Having one STD does not predispose you to others, aside from the behavioral risks shared by all STDs,” says H. Hunter Handsfield, MD,
a professor emeritus of medicine at the University of Washington Center
for AIDS and STD in Seattle, who also served on the board of the
American Sexual Health Association.
“However,” says Dr. Handsfield, “having genital herpes due to HSV-2, but not HSV-1, roughly doubles the risk of HIV if sexually exposed to the virus.”
What Happens If STDs Are Left Untreated?
“The longer something goes untreated, the more likely it is to cause complications,” Hook says. “Left untreated, infections from gonorrhea and chlamydia can travel from a woman’s cervix to her uterus and fallopian tubes, which may cause infertility.”
Untreated syphilis "can become neurosyphilis, causing neurological disease,” says Suzanne Fenske, MD,
an assistant professor of obstetrics, gynecology, and reproductive
science at the Icahn School of Medicine at Mount Sinai in New York City.
Late-stage complications of syphilis also include aortic aneurysm and other cardiovascular problems.
Untreated
HIV can impair the immune system’s ability to fight off infections and
diseases, leading to so-called opportunistic infections, neurological
complications, and sometimes cancer.
Untreated chronic hepatitis B can lead to liver failure, cirrhosis, liver cancer, and death.
Failing
to treat STDs can have risks for future generations as well. Women who
have herpes, chlamydia, gonorrhea, or syphilis can transmit the
infection to their baby at birth, which is why testing for STDs; and
following safer sex recommendations; during pregnancy is so important.
HIV
can also be passed from mother to child during pregnancy, labor, or
delivery, but the risk of transmission can be reduced if the mother
takes antiretroviral drugs throughout her pregnancy and the baby
receives HIV medicines for several weeks after birth.
Complications of STDs
Does the Number of Sexual Partners Affect My Chances of Getting an STD?
“As
a broad rule, more partners means higher risk,” Handsfield says.
“However, there are innumerable exceptions. Some people have 100 or more
partners per year and remain free of most if not all STDs. Others have
one or two partners and multiple infections over time.”
More on STD Prevention
Best Condoms for Pleasurable Safe Sex
The
bottom line is to use condoms or dental dams (small sheets of latex) to
lower your risk and discuss STD testing with your medical provider if
you are sexually active.
Can STDs Recur?
A
curable STD that has been treated correctly will not recur, but it is
possible to get the same STD again. In fact, it’s fairly common. To
avoid getting the same STD again, your sexual partner, or partners, must
also be treated. And to avoid getting the same or other STDs after
treatment, practice safer sex, including using condoms each time you have sex.
The good news is that getting infected more than once does not appear to cause more long-term complications.
“In
women, a second or third infection with chlamydia may raise the risk of
complications like pelvic inflammatory disease,” says Handsfield. “But
for the most part, people with multiple episodes of STDs do not fare any
worse than after the first infection.”
Chlamydia: Often a Silent Disease
Many
people don't realize they have chlamydia because they don't experience
symptoms. That's why the condition is often called a silent infection.
But untreated chlamydia can
cause serious complications in both men and women, including ectopic
pregnancy in women. To prevent such complications, young women and men
at high risk of chlamydia are advised to get tested for it yearly.
Genital Herpes: A Lifelong Infection
An
easily transmitted disease, genital herpes is caused by a virus that
stays in the body for life. The infection can cause painful sores to
form on the genitals, thighs, or buttocks, but the severity of symptoms
ranges widely from no symptoms at all to recurring sores, painful
urination, and flulike symptoms. Medication can prevent or shorten
outbreaks, as well as lower the chance of passing the virus to a sexual
partner.
Gonorrhea: Still Curable, but Antibiotic Resistance Is a Problem
Gonorrhea
is highly contagious and, like chlamydia, may cause mild or no
symptoms. If left untreated, though, it can cause serious complications,
including pelvic inflammatory disease in women and epididymitis in men.
While gonorrhea is curable, some strains of the bacteria that cause it
have become resistant to most antibiotics.
As of December 2020, the CDC recommends a single 500-milligram (mg) intramuscular dose of the antibiotic Rocephin (ceftriaxone) for uncomplicated gonorrhea. Treatment for coinfection with Chlamydia trachomatis with oral doxycycline (100 mg twice daily for seven days) should be administered when chlamydial infection has not been excluded.
Hepatitis B: Disease of the Liver
Hepatitis
is an inflammation of the liver, and the hepatitis B virus is one of
several viral causes of hepatitis. There are also nonviral causes. In
the United States, infants have been routinely vaccinated against
hepatitis B since 1991, and the rate of acute hepatitis B in the United
States has plummeted since then. Worldwide, however, chronic hepatitis B
infection is common.
HIV: Incurable but Preventable
HIV is
a virus that attacks the body's immune system, impairing its ability to
fight off infections and diseases over time. The final stage of HIV
infection is called acquired immunodeficiency syndrome,
or AIDS. AIDS is a life-threatening disease. You can reduce your risk
of getting sexually transmitted HIV by using condoms correctly and
about everyone who is or has been sexually active has had HPV at some
point. In most cases, the virus clears up on its own, but when it
doesn’t, it can cause genital warts and a variety of types of cancers,
depending on which strain of the virus you have. The Gardasil 9 (HPV 9-valent) vaccine protects against both warts and cancer and is approved for adolescents and young adults.
Molluscum Contagiosum: May Clear on Its Own
This
viral infection can be sexually transmitted or spread through contact
with infected skin or contaminated objects, such as towels and toys. It
can also be spread from one area of the body to another by touching a
lesion then an unaffected area of skin. In many cases it goes away on
its own, but treatments are available if it doesn’t.
Syphilis: Life-Threatening if Not Treated
Syphilis
is a bacterial infection that is growing more common in the United
States, particularly among men who have sex with men. It can be cured
with penicillin or, in the case of a penicillin allergy, other
antibiotics. Left untreated, syphilis can affect the heart and brain and
be life-threatening. Syphilis that is passed from mother to infant
(congenital syphilis) is also a severe, life-threatening condition.
Trichomoniasis: A Parasitic Infection
Trichomoniasis
is more common in women, particularly young women, than men. The
parasite that causes trichomoniasis can infect the penis or vagina but
not the mouth, anus, or other body parts. While symptoms of trichomoniasis may raise a medical provider’s suspicions, a definitive diagnosis requires a laboratory test.
