Sexually Transmitted Diseases (STD’s)

Sexually Transmitted Diseases (STDs), also called “Sexually Transmitted Infections” (STIs) are diseases that spread through person to person contact.


The danger of STDs, is that many do not show symptoms. Left untreated, they can have long-term complications. For example, symptoms from syphilis may disappear, but syphilis remains in the body and can cause damage to the brain, nerves, eyes, heart, blood vessels, liver, bones and more.


Prevention

No one is in doubt that abstinence is the best way to avoid STDs.

After that, there are two schools of thought on how to educate the public about sexually transmitted diseases:

1) People will engage in risky sexual behavior no matter what, so use resources to promote condoms, because condoms will protect them some of the time. This is better than nothing. Providing information on risky sexual behavior methods (i.e. oral sex, anal sex, multiple sex partners, etc.) will increase awareness.

2) People will avoid risky sexual behavior, if they have the right information about condom ineffectiveness and the long-term effects of STDs. Promoting condoms will lead to more risky sexual behavior, with a false sense of protection.

This document on STDs comes from the second perspective – we want to talk people out of engaging in risky sexual behavior. Full disclosure on STDs is the best way to do that.


Types of STDs

STDs come in two forms: Bacterial infections and Viral infections

Bacterial STDs

Bacterial infections can be cured with antibiotics. Left untreated, they can lead to long-term complications.

Examples of Bacterial STDs:

Bacterial Vaginosis

Chlamydia

Gonorrhea

Syphilis

Trichomoniasis

Viral STDs

Viral infections are not curable, but some symptoms may be relieved through treatment.

Examples of Viral STDs:

Human Papillomavirus (HPV)

Genital Herpes

Hepatitis B

HIV / AIDS


STD Details

Below is a summary of the most common STDs, their symptoms and long-term complications. The U.S. Centers for Disease Control is an excellent source for additional information on STDs, including info on treatments:


Bacterial STDs

Bacterial Vaginosis (BV)

Bacterial Vaginosis is a disruption in the balance of “good” and “harmful” bacteria in a woman’s vagina. BV is an increase in the harmful bacteria. Women increase their risk of BV from new sex partners or multiple sex partners. They can also increase their risk by douching or using an intrauterine device (IUD) for birth control. More on Birth Control Methods

BV is not to be confused with a “yeast infection,” which is a fungus.PID may develop following an abortion or hysterectomy, which is why some physicians recommend that all women undergoing a hysterectomy or abortion be treated for BV prior to the procedure, to reduce their risk of developing pelvic inflammatory disease. BV can make a woman more vulnerable to HIV, chlamydia and gonorrhea and increase the chances that she will pass HIV and other diseases onto her sex partner.

Symptoms:

BV symptoms include an abnormal vaginal discharge, usually white or gray, with a strong, unpleasant, fish-like odor, especially after intercourse; burning during urination; itching in the vaginal area.

Complications:

BV can lead to pelvic inflammatory disease (PID) which can also damage the fallopian tubes and the uterus, leading to infertility or an ectopic pregnancy. PID can also cause internal abscesses and chronic pelvic pain.


Chlamydia

Chlamydia, the most commonly reported sexually transmitted disease in the U.S., is caused by the bacterium, Chlamydia trachomatis, and can be transmitted during vaginal, anal, or oral sex. Teenage girls are especially high risk for contracting chlamydia, because their cervix (opening to the uterus) is not fully developed. 46 percent of all reported infections are young women, age 15 to 19. Women age 20 to 24, make up another 33 percent of chlamydia infections. Even after treatment, re-infection is possible.

Symptoms:

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. For women, those symptoms include vaginal discharge and a burning sensation during urination. For men, discharge from the penis, pain or burning during urination, and pain or swelling of the testicles.

Complications:

Chlamydia can lead to infertility and damage a woman’s reproductive organs. Chlamydia can also be passed from an infected mother to her baby during vaginal childbirth and cause other pregnancy complications, such as neonatal conjunctivitis – an irritation to a newborn’s eyes. It can also result in pneumonia.


Gonorrhea

Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the reproductive tract (cervix, uterus, fallopian tubes) in women and urinary tract in women and men. Gonorrhea can be transmitted during vaginal, anal, or oral sex and can develop in the mouth, throat, eyes, and anus. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Even after treatment, re-infection is possible. The highest infection rates are usually found in 15-to-19-year-old women and 20-to-24-year-old men. Gonorrhea also has high infection rates among African Americans. Women may experience an increased vaginal discharge, or vaginal bleeding between periods. Some men and women may have no symptoms at all and some men may not show any symptoms for 30 days after infection.

Symptoms:

Both men and women may experience burning during urination, a painful rash or rectal infection, anal itching, soreness, bleeding, or painful bowel movements. Infections in the throat may cause a sore throat. Men may also have a white, yellow or green discharge or painful, swollen testicles.

Complications:

Gonorrhea can lead to pelvic inflammatory disease (PID) which can also damage the fallopian tubes and the uterus, leading to infertility or an ectopic pregnancy. PID can also cause internal abscesses and chronic pelvic pain. Gonorrhea can also spread to other parts of the body, such as the eyes. Gonorrhea may be fatal if it spreads to the blood or joints. A pregnant woman can also pass gonorrhea to her baby during delivery – which can cause blindness, joint infection, or a life-threatening blood infection. Men may develop epididymitis, a painful condition of the testicles that can lead to infertility. Gonorrhea can make those infected more vulnerable to HIV and increase the chances of passing HIV onto a sex partner.

While medication may stop an infection, it will not repair any permanent damage done by gonorrhea. Treatment of gonorrhea is becoming more difficult, as drug-resistant strains of gonorrhea are increasing in the U.S. and throughout the world.


Syphilis

Syphilis is caused by the bacterium Treponema pallidum and is passed on through direct contact with syphilis sores, which occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Syphilis can be transmitted during vaginal, anal, or oral sex. Syphilis infection is highest in women 20 to 24 years of age and in men 35 to 39 years of age. Syphilis is easy to cure in the first year with penicillin. Even after treatment, re-infection is possible. Untreated, syphilis can be fatal.

Symptoms:

Syphilis has many signs and symptoms indistinguishable from other diseases, earning it the nickname, “the great imitator.” At the Primary Stage, a single sore, called a “chancre” is usually firm, round, small, and painless. It may appear within 10-90 days after an infection, disappear, then reappear several weeks to several months later. Sores or lesions may be hidden on the genital areas, cervix, mouth or throat.

Left untreated, syphilis can progress to a second stage, which starts with a rash on one or more areas of the body, or as rough, reddish brown spots on the palms of the hands and bottoms of the feet. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. These symptoms may also disappear on their own, but the syphilis is still in the body moving towards a third, latent and possibly deadly stage.

Complications:

The third stage of syphilis, the infection may damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This internal damage may show up many years later. Complications from the third stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. Syphilis may even lead to death. Pregnant women can pass syphilis along to their babies. Genital sores associated with syphilis can make those infected more vulnerable to HIV and increase the chances of passing HIV onto a sex partner.


Trichomoniasis

Trichomoniasis, the most common curable STD in young, sexually active women, is caused by the single-celled protozoan parasite, Trichomonas vaginalis. The vagina is the most common site of infection in women, and the urethra is the most common site of infection in men. Women can acquire the disease from infected men or women, but men usually contract it only from infected women.

Symptoms:

Trichomoniasis symptoms for women include a yellow-green vaginal discharge with a strong odor; irritation or itching of the female genital area; or discomfort during intercourse and urination. Women may also experience lower abdominal pain. Symptoms for women may appear in five to 28 days after infection. Men may have an irritation inside the penis, mild discharge, or burning after urination or ejaculation. Most men, however, do not show any symptoms of trichononiasis.

Complications:

The genital inflammation caused by trichomoniasis can make women more vulnerable to HIV and increase the chances of passing HIV onto a sex partner. In pregnant women, it may lead to a premature delivery.


Viral STDs (No cure)

Human Papillomavirus (HPV)

The human papillomavirus (HPV), the most commonly transmitted STD in the U.S., is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted. HPV is not only transmitted by vaginal, anal, or oral sex, but also skin-to-skin contact.

There is no cure for HPV infection, although in most women, the infection goes away on its own. Approximately 10 out of the more than 100 strains of HPV can lead to cervical cancer in women.

Symptoms:

Although most people who have HPV do not show any symptoms, HPV infection may sometimes lead to visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis. The genital warts, which may appear within weeks or months of infection, appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area, on the vulva, in and around the vagina or anus, or the cervix, and on the penis, scrotum, groin, or thigh. The warts can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. HPV may also cause mild Pap test abnormalities.

Complications:

Some HPV strains will lead to cancer of the cervix, vulva, vagina, anus, or penis. Other varieties, considered “low risk” will cause mild Pap test abnormalities or genital warts. HPV can lead to development of cervical cancer in women. A pregnant woman can pass HPV to her baby during a vaginal delivery. In those rare instances, the baby may develop warts in the throat or voice box.


HPV and The Gardasil Controversy

In June of 2006, the Food & Drug Administration approved a vaccine, Gardasil, to vaccinate girls as young as nine years old against future HPV infection. Gardasil targets four HPV strains that most commonly cause cervical cancer and genital warts.

There has been a lot of controversy around Gardasil, as some state governments in the U.S. have tried to make vaccination with the HPV vaccine Gardasil, of girls as young as 11, mandatory.

Parents resisting the idea of having their 11 year-olds vaccinated against a sexually transmitted disease, argue that even though Gardasil has been approved by the FDA, its long-term effects are untested.

At least four women died during the testing of the HPV vaccine – one from a blood clot in the lungs (pulmonary embolism); one from an inflammation of the heart muscle due to influenza; one from a blood clot; and one from multiorgan system failure due to influenza infection unrelated to vaccination. The FDA maintains that the deaths were not related to the vaccine and even pointed out that the two women who died of blood clots were using birth control, making them high risk for blood clots.


Genital Herpes

Genital Herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses Type 1 (HSV-1) and Type 2 (HSV-2). Most genital herpes is caused by HSV-2. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.

Symptoms:

HPV-2 causes blisters on or around the genitals or rectum and can be spread to the mouth. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. HPV-1 causes cold sores and fever blisters but can also spread to the genitals. Most individuals may have no or only minimal signs of infection from HSV-1 or HSV-2. Genital HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five).

The first outbreak, which may be quite severe, usually occurs within two weeks after the virus is transmitted, and the sores typically heal within two to four weeks. It may be accompanied by flu-like symptoms, including fever and swollen glands. Some of the sores may be mistaken for insect bites or another skin condition. An initial outbreak may be followed by several (typically four or five) outbreaks within a year. Over time these recurrences usually decrease in frequency.

Complications:

HSV-2 in a pregnant woman can cause potentially fatal infections in her child. A first episode during pregnancy causes a greater risk of transmission to the baby. If a woman has active genital herpes at delivery, a cesarean delivery is usually performed. Genital herpes can be severe in people with suppressed immune systems. Genital herpes can make those infected more vulnerable to HIV and increase the chances of passing HIV onto a sex partner.

There is no cure for herpes, but taking antiviral medications can shorten and prevent outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy for symptomatic herpes can reduce transmission to partners.

Since a condom may not cover all infected areas, even correct and consistent use of latex condoms cannot guarantee protection from genital herpes. Even if a person does not have any symptoms he or she can still infect sex partners.


Hepatitis B

Hepatitis B (HBV) is caused by a virus that attacks the liver. Hepatitis B infection occurs when blood from an infected person enters the body of a person who is not infected. HBV can spread through sex with an infected person; and also by sharing drugs, needles, when injecting drugs; infected tools from a tattoo or body piercing parlor; sharing of personal care items that might have trace amounts of infected blood, such as a toothbrush or razor; or other contact with the blood from an infected person. The highest rate of Hepatitis B infection is among 20-49 year-olds.

Symptoms:

Hepatitis B symptoms include jaundice, fatigue, abdominal pain, loss of appetite, nausea/vomiting, joint pain. Some of those infected will experience no symptoms.

Complications:

Complications from Hepatitis B include lifelong infection, cirrhosis of the liver, liver cancer, liver failure, and death. Hepatitis B may be passed on from an infected mother to her baby during birth. If you have had Hepatitis B, you should not donate blood, organs, or tissue. Persons at risk for HBV infection might also be at risk for infection with Hepatitis C virus (HCV) or HIV.

There is no cure for Hepatitis B, but there is a vaccine against infection, which is recommended for health care and emergency workers who may be exposed to blood as well as people traveling to countries that have a high rate of Hepatitis B.


HIV / AIDS

Human Immune-deficiency Virus (HIV) attacks the immune system and makes it impossible for the body to fight off disease. Acquired Immune-deficiency Syndrome (AIDS) is the final stage of the HIV infection where the infection has advanced to the point where it has trouble fighting off simple infections.

HIV can be in the body for years, before it causes noticeable symptoms or progresses to AIDS. Although an infected person can still pass on HIV, it could be in the body for 10 years or more before it is diagnosed.

People who have other STDs are at increased risk for HIV. Genital ulcers or other breaks in the skin from Herpes or Syphilis create an opening for HIV to enter the body. Non-ulcer STDs, such as Chlamydia, Gonorrhea or Trichomaniasis, increase the concentrations of cells that HIV attacks. HIV is primarily found in blood, semen, or vaginal fluid. It may also be transmitted from an HIV-infected mother to her child through breast milk.

HIV can be transmitted through the sharing of needles, syringes, cotton swabs or water associated with injected drugs or steroids. It is also possible to contract HIV from of blood transfusions or organ transplants, but this is less common in the United States, because of developments of safety procedures and testing safeguards in the health industry.

It is also possible to be infected with HIV from tattoo artists, whose equipment has not been properly sterilized. People with HIV will sometimes get tattoos to cover dark blotches on the skin from Kaposi Sarcoma, a cancer that may develop in association with HIV.

The majority of new infections (42%) occur among men who have sex with men, 33 percent occur among those who are thought to contract HIV through heterosexual contact, and 25% occur among injection drug use. Most women are infected with HIV through heterosexual contact. (Source: Kaiser Foundation Fact Sheet, “Sexually Transmitted Diseases in the U.S.”, June 2003)

Symptoms:

A person may have HIV for more than 10 years and not show symptoms. Symptoms of advanced HIV and AIDS include rapid weight loss; dry cough; recurring fever or profuse night sweats; profound and unexplained fatigue; swollen lymph glands in the armpits, groin, or neck; diarrhea that lasts for more than a week; white spots or unusual blemishes on the tongue, in the mouth, or in the throat; pneumonia; red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids; memory loss, depression, and other neurological disorders

Complications:

HIV weakens the immune system, leaves you vulnerable infections of all kinds. Many of those infected succumb to pneumonia or gastrointestinal disease. Those who develop AIDS-related Kaposi Sarcoma may exhibit visible skin lesions that look like purple, brown, or red blotches or bumps on the skin.

There is no cure for HIV or AIDS, but medical treatments can slow down the deterioration of the immune system.


Sources: Kaiser Foundation Fact Sheet, “Sexually Transmitted Diseases in the U.S.”, June 2003 and CDC STD Fact Sheets, 2002. For additional information visit: Centers for Disease Control