Susan L. Grant MD and Margaret Klugman
Obstetics and Gynecology Board Certified
8 East 83rd Street
New York, New York 10028
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What is the STD?
Aside from colds and the flu, sexually transmitted diseases (STDs) are some of the most widespread diseases both in the United States and the world. STDs affect both men and women, and two-thirds of all STDs occur in people younger than 25 years old. Exposure to an STD can occur any time you have sexual contact with anyone that involves the genitals, the mouth (oral), or the rectum (anal). Exposure is more likely if you have more than one sex partner or do not use condoms. Some STDs can be passed by nonsexual contact, such as by sharing needles or during the delivery of a baby or during breast-feeding. Sexually transmitted diseases (STDs) are also called sexually transmitted infections (STIs).
STDs are a worldwide public health concern because there is more opportunity for STDs to be spread as more people travel and engage in sexual activities. Some STDs have been linked to an increased risk of certain cancers and infection with human immunodeficiency virus (HIV). Pregnant women can spread STDs to their babies. Many people may not have symptoms of an STD but are still able to spread an infection. STD testing can help find problems early on so that treatment can begin if needed. It is important to practice safe sex with all partners, especially if you or they have high-risk sexual behaviors. See the Prevention section of this topic.
Common sexually transmitted diseases
There are at least 20 different STDs. They can be caused by viruses, bacteria and protozoa. Some of the most common STDs in the U.S. are:
Chlamydia is a common sexually transmitted disease (STD) caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs. Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem. Chlamydia also can cause discharge from the penis of an infected man.
Chlamydia is known as a "silent" disease because about three quarters of infected women and about half of infected men have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure.
In women, the bacteria initially infect the cervix and the urethra (urine canal). Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. When the infection spreads from the cervix to the fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. Chlamydial infection of the cervix can spread to the rectum.
Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon.
Men or women who have receptive anal intercourse may acquire chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding. Chlamydia can also be found in the throats of women and men having oral sex with an infected partner.
Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2. Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.
Most people infected with HSV-2 are not aware of their infection. However, if signs and symptoms occur during the first outbreak, they can be quite pronounced. The first outbreak usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. Other signs and symptoms during the primary episode may include a second crop of sores, and flu-like symptoms, including fever and swollen glands. However, most individuals with HSV-2 infection never have sores, or they have very mild signs that they do not even notice or that they mistake for insect bites or another skin condition.
People diagnosed with a first episode of genital herpes can expect to have several (typically four or five) outbreaks (symptomatic recurrences) within a year. Over time these recurrences usually decrease in frequency. It is possible that a person becomes aware of the "first episode" years after the infection is acquired.
Genital HPV Infection
HPV is a virus that is very common. In fact, most men and women are infected with HPV at some time in their lives. There are approximately 100 types of HPV. Some HPV types only infect the genital area and may cause warts, some cause mild changes in cervical cells that do not turn into cancer, and some cause changes that may become cervical cancer if present for many years. The types of HPV that are found in the genital areas are usually passed on during sexual contact (sexually transmitted). HPV types that cause warts on the hands or feet do not cause genital warts or cervical cell changes, nor do genital HPV types generally spread outside the genital area.
Each year, approximately 12,000 women are diagnosed with cervical cancer in the United States. In most cases cervical cancer can be prevented through early detection and treatment of abnormal cell changes that occur in the cervix years before cervical cancer develops. We now know that these cell changes are caused by human papillomavirus, commonly known as HPV. The traditional test for early detection has been the Pap test. Now a test for HPV is being offered that can be used with the Pap test in women starting at 30 years of age and in women of any age when the Pap test alone has found slightly abnormal cell changes.
Most people with HPV do not develop symptoms or health problems. But sometimes, certain types of HPV can cause genital warts in men and women. Other HPV types can cause cervical cancer and other less common cancers, such as cancers of the vulva, vagina, anus, and penis. The types of HPV that can cause genital warts are not the same as the types that can cause cancer.
HPV types are often referred to as "low-risk" (wart-causing) or "high-risk" (cancer-causing), based on whether they put a person at risk for cancer. In 90% of cases, the body's immune system clears the HPV infection naturally within two years. This is true of both high-risk and low-risk types.
Genital warts usually appear as small bumps or groups of bumps, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. Warts may appear within weeks or months after sexual contact with an infected person. Or, they may not appear at all. If left untreated, genital warts may go away, remain unchanged, or increase in size or number. They will not turn into cancer.
Cervical cancer does not have symptoms until it is quite advanced. For this reason, it is important for women to get screened regularly for cervical cancer.
Other less common HPV-related cancers, such as cancers of the vulva, vagina, anus and penis, also may not have signs or symptoms until they are advanced.
Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.
Some men with gonorrhea may have no symptoms at all. However, some men have signs or symptoms that appear two to five days after infection; symptoms can take as long as 30 days to appear. Symptoms and signs include a burning sensation when urinating, or a white, yellow, or green discharge from the penis. Sometimes men with gonorrhea get painful or swollen testicles.
In women, the symptoms of gonorrhea are often mild, but most women who are infected have no symptoms. Even when a woman has symptoms, they can be so non-specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and signs in women include a painful or burning sensation when urinating, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.
Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may cause no symptoms. Infections in the throat may cause a sore throat but usually causes no symptoms.
Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases.
Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated. Although transmission occurs from persons with sores who are in the primary or secondary stage, many of these sores are unrecognized. Thus, transmission may occur from persons who are unaware of their infection.
The primary stage of syphilis is usually marked by the appearance of a single sore (called a chancre), but there may be multiple sores. The time between infection with syphilis and the start of the first symptom can range from 10 to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks, and it heals without treatment. However, if adequate treatment is not administered, the infection progresses to the secondary stage.
Skin rash and mucous membrane lesions characterize the secondary stage. This stage typically starts with the development of a rash on one or more areas of the body. The rash usually does not cause itching. Rashes associated with secondary syphilis can appear as the chancre is healing or several weeks after the chancre has healed. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The signs and symptoms of secondary syphilis will resolve with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.
Late and Latent Stages
The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis even though there are no signs or symptoms; infection remains in the body. This latent stage can last for years. The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10 ? 20 years after infection was first acquired. In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.
Trichomoniasis is a common sexually transmitted disease (STD) that affects both women and men, although symptoms are more common in women.
Most men with trichomoniasis do not have signs or symptoms; however, some men may temporarily have an irritation inside the penis, mild discharge, or slight burning after urination or ejaculation.
Some women have signs or symptoms of infection which include a frothy, yellow-green vaginal discharge with a strong odor. The infection also may cause discomfort during intercourse and urination, as well as irritation and itching of the female genital area. In rare cases, lower abdominal pain can occur. Symptoms usually appear in women within 5 to 28 days of exposure.
- Human immunodeficiency virus (HIV), which causes AIDS. Having other STDs, such as genital herpes, can increase your risk of HIV.
- Other infections that may be sexually transmitted. These include hepatitis A, hepatitis B, cytomegalovirus, molluscum contagiosum, bacterial vaginosis, Mycoplasma genitalium, and possibly hepatitis C.
- Scabies and pubic lice, which can be spread by sexual contact.
Bacterial STDs can be treated and cured, but STDs caused by viruses usually cannot be cured. You can get a bacterial STD over and over again, even if it is one that you were treated for and cured of in the past.
Sexually active teenagers and young adults are at high risk for STDs because they have biological changes during the teen years that increase their risk for getting an STD and they may be more likely to:
- Have unprotected sex.
- Have multiple partners.
- Engage in high-risk sexual behaviors.
Studies show that:
- Sexually active teenagers contract 25% of all new STDs each year.
- Between 12% and 25% of sexually active teen girls test positive for chlamydia.
- As many as 30% to 50% of sexually active teenagers have been infected with the human papillomavirus (HPV).
- Sexually active teenagers between 15 and 19 years old have the highest rates of gonorrhea.
- Genital herpes infection has increased more than 50% in sexually active teenagers.
- About 25% of new HIV infections occur in people under 22 years old.
It is important to seek treatment if you think you may have an STD or have been exposed to an STD. Most health departments, family planning clinics, and STD clinics provide confidential services for the diagnosis and treatment of STDs. Early treatment can cure a bacterial STD and prevent complications.
If you are a parent of a teenager, there are many resources available, such as your health professional or family planning clinics, to help you talk with your teen about safe sex, preventing STDs, and being evaluated and treated for STDs.
Risks specific to women with sexually transmitted diseases
In women, STDs can cause a serious infection of the uterus and fallopian tubes (reproductive organs) called pelvic inflammatory disease (PID). PID may cause scar tissue that blocks the fallopian tubes, leading to infertility, ectopic pregnancy, pelvic abscess, or chronic pelvic pain.
STDs in pregnant women may cause problems such as:
- Low birth weight.
- Premature delivery.
- Infections in their newborn baby, such as pneumonia, eye infections, or nervous system problems.
Risks specific to men with sexually transmitted diseases
- Infection and inflammation of the epididymis, urethra, and prostate.
Any child or vulnerable adult with symptoms of an STD needs to be evaluated by a health professional to determine the cause and to assess for possible sexual abuse.