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:

• Annual

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 visit

Annual screening in sexually active people living with HIV

The 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 risk

Annual screening in sexually active people living with HIV

The 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:

• Pubic lice
• Scabies

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

consistently.

Just

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.