Sexually Transmitted Infections

Many STIs are asymptomatic, but symptoms that can develop include:

• Pain or discomfort during sexual activity or urination
• Sores, bumps, blisters, or rashes on or around the vulva, anus, buttocks, thighs, or mouth
• Unusual discharge or bleeding from the vagina
• Itchiness in the vagina or vulva
• Unexpected vaginal bleeding or bleeding after sex
• Fever
• Abdominal or pelvic pain

Chlamydia

Chlamydia is caused by the bacterium Chlamydia trachomatis. It is transmitted during vaginal, oral, or anal sex with an infected partner.

Chlamydia can be asymptomatic even when it is relatively advanced, but it can cause unusual vaginal discharge, abdominal or pelvic pain, and fever. If it remains untreated, chlamydia can cause pelvic inflammatory disease, or PID, which can lead to chronic pelvic pain and permanent damage to a woman’s reproductive organs, especially the fallopian tubes.

Chlamydia and gonorrhea often coincide, so women who have one infection are typically treated for both. Treatment is given promptly so as to prevent health complications and further sexual transmission. Sex partners should be treated at the same time and sex should be avoided per the gynecologist’s recommendations to avoid passing the infection back and forth.

Gonorrhea

Gonorrhea is caused by the Neisseria gonorrhea bacterium. It is transmitted by vaginal, oral, or anal sexual contact. Gonorrhea most commonly causes vaginal discharge and painful or difficult urination. Like chlamydia, if left untreated, it can lead to PID, which can cause chronic pelvic pain and chronic reproductive damage. In both men and women, gonorrhea can also infect the mouth, throat, eyes, rectum, and joints.

As mentioned, gonorrhea commonly coincides with chlamydia, so if a woman has gonorrhea, she will be treated for chlamydia as well. Treatment should be given promptly to prevent health complications and further transmission, and recent sex partners should be treated at the same time fo their protection and to avoid reinfection.

Having gonorrhea makes it more easy to contract HIV. HIV-infected people with gonorrhea are also more likely to transmit the HIV virus to someone else.

Genital Herpes

Genital herpes is caused by the herpes simplex virus (HSV). There are two strains: HSV type 1(HSV-1) and HSV type 2 (HSV-2). Both cause genital herpes, although HSV-2 causes most cases.

HSV-1 infection usually presents as fever blisters or cold sores on the lips, but it can also present in the vulvar area after oral-genital or genital-genital contact.

HSV-2 infection typically presents as painful, watery skin blisters on or around the vulva or anus. However, many people who harbor theses viruses have either no or minimal signs or symptoms.

Newly acquired genital HSV-2 infection can cause severe genital ulcerations and neurologic involvement, but symptoms are sometimes mild the first time. Oral anti-viral medication (acyclovir, famciclovir, or valacyclovir) should be given for the first episode of infection. Subsequent to the initial infection, periodic outbreaks with the development of new blisters on the vulvar or perianal skin commonly occur; the virus is more transmissible during these episodes.

In the recurrent infection setting, anti-viral medication can be given either as long-term daily suppressive therapy (which reduces the frequency of recurrences and decreases risk of transmission to sex partners) or episodically at the beginning of outbreaks to shorten the duration of herpetic lesions.

For sexually active people, using condoms consistently and correctly helps prevent genital herpes and other STIs, but genital herpes can still be transmitted through contact with genital or anal areas not covered by the condom.

Trichomoniasis

Trichomoniasis is caused by a single-cell parasite called trichomonas vaginalis. It is easily identified under a microscope. It is also identified on a PAP test.

It is common in sexually active women and less so in men. Trichomonas can be transmitted between men and women but also between women whenever physical contact happens between the genital areas.

It can cause painful, burning urination, a vaginal discharge, and vulvovaginal soreness, redness, and itching.

Like other STIs, it can also not cause any symptoms. This can lead to the reinfection of a sex partner who has recurrent signs of infection.

Trichomoniasis is treated with a single dose of an oral antibiotic, usually metronidazole. Because of the risk of reinfection, it is important to treat the diagnosed woman and all sex partners at the same time. It is also important to retest sexually active women within 3 months of their initial treatment, even if their partner were treated before.

Syphilis

Syphilis is caused by the bacterium Treponema pallidum. It is passed from person to peson dring vaginal, oral, or anal sex through direct contact with syphilis sores in the genitals.

The first sign of a syphilis infection is a chancre: a painless genital sore that most often appears around the vagina. Chancres typically resolve on their own, but that doesn’t mean the body clears the infection on its own. Having a chancre increases the risk of contracting HIV by two to five times.

Syphilis is treated with antibiotics. If syphilis is found in its early stages, usually within the first year of infection, it can be treated with a single injection of antibiotic. If not recognized early, or not treated promptly, syphilis may need longer antibiotic therapy. Without treatment, syphilis usually spreads to other organs, such as the skin, heart, blood vessels, liver, bones, and joints. A syphilis rash can break out. Finally, tertiary syphilis can develop over years and affect nerves, the eyes, and the brain.

Human papilloma virus (HPV)

HPV is the most common sexually transmitted infection. There are some 14 million new cases annually in the United States. There are some 40 subtypes of HPV. They can infect the genitals, mouth, or throat. Most men and women who are sexually active will get at least one type of genital HPV infection at some point in their lifetime.

HPV is transmitted from person to person, even if one’s partner has no symptoms. Genital HPV infections are most often cleared by the immune system within the two years following infection. However, some HPV subtypes can linger and lead to other problems. HPV subtypes 6 and 11 can lead to genital warts and high-risk subtypes 16 and 18 to precancerous and cancerous changes in the cervix.

It is important to be tested for HPV as part of cervical cancer screening, and if positive for the high-risk HPV subtypes, be worked-up and monitored according to established guidelines.

HIV/AIDS

Human immunodeficiency virus (HIV) is the virus that causes AIDS. Transmission of the HIV virus primarily occurs during unprotected sexual activity and by sharing IV drug needles.

HIV infection attacks and compromises the immune system by killing the blood cells responsible for fighting infection (T cells). Once HIV destroys a significant proportion of these cells, the body fails to fight off and recover from infections as before. The individual becomes immune compromised. This is the advanced stage of HIV infections, or Acquired Immune Deficiency (AIDS). This makes an individual susceptible to opportunistic infections and to certain cancers, such as Kaposi’s sarcoma of the skin and cervical cancer.

In individuals who do not have HIV, infection can be prevented by abstaining from sex, limiting the number of sex partners, never sharing needles, and using condoms consistently.

AIDS can be prevented by initiating anti-retroviral therapy early. Individuals can live long lives on this therapy.

If a woman is sexually active, she should talk to her gynecologist about STI testing. Which tests are needed and how often they should be done depends on the woman’s and her partner’s sexual history.

Embarrassment should not get in the way of sharing important information about one’s sex life with the gynecologist. Being open and honest is the only way a doctor can help. An open discussion will lead to ordering the appropriate screening tests.