Sexually transmitted infections (STIs) are bacteria or viruses that can be acquired through sexual activity. This can include vaginal, anal, and oral sex. Some of these infections can also be spread through other contact with bodily fluids.
*Please note, this guide is designed for folks assigned female at birth. Guidelines vary slightly for Trans Women who have had gender affirming surgery.
In this guide, we’ll go over various sexually transmitted infections including:
CHLAMYDIA
What is it?
Chlamydia trachomatis is the most common bacterial cause of sexually transmitted disease in the United States, with about 4,000,000 cases being diagnosed per year.
How can you get it?
Chlamydia is mainly spread through sexual contact. Infections affect the genital tract, rectum, and anus, and can also cause conjunctivitis if the eyes are exposed to infected body fluid.
What are the symptoms?
Most vagina-owners (up to 90%) do not have any symptoms. However, some may have mild symptoms such as vaginal discharge, abnormal bleeding, abdominal or pelvic pain, pain with sex, and burning with urination.
What are the risks if untreated?
Untreated chlamydia can cause serious complications, including a condition called pelvic inflammatory disease, which can lead to scarring of the fallopian tubes, infertility, and chronic pelvic pain. In addition, untreated chlamydia can cause serious problems with pregnancy, including a higher risk of an ectopic pregnancy, miscarriage and preterm labor, and can even cause eye and lung infections in newborns if exposed at the time of vaginal birth to women with the infection.
How and where do you get tested?
Testing can be done via vaginal or cervical swabs or urine testing with your healthcare provider.
What is the treatment?
Treatment is with antibiotics for the patient and all recent sexual partners. Sex should be avoided until all partners have completed their antibiotic regimen. A test of cure about a month after should also be performed, and it is recommended that a full screen for other STIs also be performed. Finally, it is also recommended that testing for chlamydia be repeated 3 months after treatment as there is a high risk of re-infection.
How do you prevent infection?
Chlamydia infections can be prevented by avoiding sex or using latex condoms.
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GONORRHEA
What is it?
Neisseria gonorrhea is the second most common bacterial cause of sexually transmitted disease in the United States, with more than 600,000 cases being reported per year.
How can you get it?
Gonorrhea is spread through sexual contact. It mainly affects the urethra in males and the cervix in females, but there can also be infections that affect the throat or the rectum.
What are the symptoms?
Up to 70% of cases of gonorrhea are asymptomatic. However, some may experience vaginal itching, abnormal discharge, abnormal bleeding, pelvic pain, or pain with sex.
What are the risks if untreated?
Untreated gonorrhea can cause serious complications, including a condition called pelvic inflammatory disease, which can lead to scarring of the fallopian tubes, infertility, and chronic pelvic pain. In addition, untreated gonorrhea can cause serious problems with pregnancy, including a higher risk of an ectopic pregnancy, miscarriage and preterm labor, and can even cause eye and blood infections in newborns if exposed at the time of vaginal birth to women with the infection.
How and where do you get tested?
Testing can be done via vaginal or cervical swabs or urine testing with your healthcare provider.
What is the treatment?
Treatment is with antibiotics for the patient and all recent sexual partners. Sex should be avoided until all partners have completed their antibiotic regimen. A test occurring 1-2 weeks after should also be performed, and it is recommended that a full screen for other STIs also be performed. Finally, it is also recommended that testing for gonorrhea be repeated 3 months after treatment as there is a high risk of re-infection.
MYCOPLASMA
What is it?
Mycoplasma genitalium is a bacteria that is a common cause of cervicitis and pelvic inflammatory disease in females. In the US, the prevalence is about 1% of the adult population, which puts it between the prevalence of gonorrhea (0.4%) and chlamydia (2.3%).
How can you get it?
Mycoplasma genitalium is spread through unprotected sexual activity. There are other species of mycoplasma that cause other infections in the human body.
What are the symptoms?
Symptoms are non-specific, but can include abnormal vaginal discharge, vaginal itching, burning with urination, pelvic pain, and abnormal bleeding.
What are the risks if untreated?
Untreated mycoplasma can cause serious complications, including a condition called pelvic inflammatory disease, which can lead to chronic pelvic pain. It is unclear if it can also scar the fallopian tubes and cause infertility as can be the case with chlamydia and gonorrhea. In addition, untreated gonorrhea can cause serious problems with pregnancy, including a higher risk of a miscarriage and preterm labor.
How and where do you get tested?
Testing can be done via vaginal or cervical swabs or urine testing with your healthcare provider.
What is the treatment?
Treatment is with antibiotics. Recent sexual partners (within 60 days) should be tested and treated if positive as well. Sex should be avoided until all partners have completed their antibiotic regimen.
TRICHOMONAS
What is it?
Trichomonas vaginalis is a bacteria that causes genitourinary infections that can affect the cervix, vagina, urethra, bladder, and paraurethral and Bartholin’s glands. It is the most common non-viral sexually transmitted disease in the world. In the US, the prevalence is estimated to be 3.1%.
How can you get it?
Trichomonas is spread through unprotected sexual activity between men and women and women and women.
What are the symptoms?
Up to 85% of patients can be asymptomatic, but symptoms such as abnormal foul-smelling discharge, vaginal itching and burning, painful urination, pelvic pain, pain with sex, and abnormal bleeding can occur.
What are the risks if untreated?
Untreated trichomonas has been linked with pelvic inflammatory disease, and also an increased risk of developing abnormal paps and acquiring HIV. Pregnant women may be at risk for preterm labor.
How and where do you get tested?
Testing can be done via vaginal swab with your healthcare provider. At times, trichomonas is also picked up on a pap smear.
What is the treatment?
Treatment is with antibiotics for the patient and all recent sexual partners. Sex should be avoided until at least 7 days after all partners have completed their antibiotic regimen.
SYPHILIS
What is it?
Treponema pallidum is bacteria that causes syphilis, which is a progressive, systemic illness, that starts with the development of a sore called a chancre (primary syphilis), and then can progress within weeks to months to other organs throughout the body (secondary syphilis), and then can also progress years later to cause serious illness affecting the cardiovascular system and brain (tertiary syphilis). According to the World Health Organization, the prevalence of syphilis in the Americas is 34.1 per 100,000 individuals.
How can you get it?
Transmission of syphilis occurs with contact to an infectious lesion anywhere on the body (chancre) with any sexual activity, including touching, kissing, and oral sex. Rarely, it can be spread through a blood transfusion. Syphilis can also cross the placenta and infect the fetus.
What are the symptoms?
Early primary syphilis occurs days to weeks after exposure and causes a painless skin ulcer called a chancre.
If untreated, about 25% can develop secondary syphilis which occurs weeks to months later. Symptoms can include fever, headache, tiredness, sore throat, low appetite, weight loss, swollen glands, rash, hair loss, gastrointestinal symptoms, renal symptoms, musculoskeletal problems, and neurologic problems.
About 25 - 40% of patients can further progress to develop late, tertiary syphilis which can occur 1- 30 years later and cause cardiovascular problems, neurologic problems, and lesions affecting the skin, bones, or internal organs.
What are the risks if untreated?
Late stage, tertiary syphilis is a very serious illness that can cause nerve, brain, and cardiovascular injury resulting in dementia, difficulty walking, pain, and injury to blood vessels and the heart.
How and where do you get tested?
Initial diagnosis is done with blood tests ordered by a healthcare provider.
What is the treatment?
Treatment of syphilis is a regimen of antibiotics depending on the stage of syphilis diagnosed. Blood work needs to be monitored regularly in order to confirm that the treatment is working and curative.
HERPES SIMPLEX VIRUS (HSV)
What is it?
Herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are common causes of oral and genital infections worldwide. Most cases occur due to HSV-1. The prevalence has been found to be up to 16% among 14 to 49 year olds in the US.
How can you get it?
Herpes is transmitted through sexual contact such as kissing and sex at the time of an outbreak, but can also be spread at other times, though less likely.
What are the symptoms?
Patients may be asymptomatic, have only mild symptoms, or have more severe symptoms including painful ulcers, fever, muscle aches, pain with urination, and swollen lymph nodes. New infections, primary herpes, can cause severe systemic symptoms, including an infection of the spinal cord that can cause neurologic problems and the inability to urinate.
What are the risks if untreated?
Severe disease as noted above can occur especially in patients having their initial, primary outbreak.
Even after treatment and resolution, the herpes virus continues to reside in the body and it is common for patients to experience episodic recurrences which are usually milder than the primary outbreak.
How and where do you get tested?
Swab testing of the lesions is done by a healthcare provider.
What is the treatment?
Treatment of herpes is achieved using topical or oral antiviral medication.
GENITAL WARTS - HUMAN PAPILLOMA VIRUS
What is it?
Condylomata acuminata (aka genital warts) are small soft growths that occur in the anogenital area and are caused by the human papilloma virus (HPV). HPV infection is the most common STI in the world. It is estimated that 75% of sexually active adults have been infected with at least one HPV type at some point.
How can you get it?
HPV and genital warts are spread by sexual activity, even just skin to skin contact. Vaccination with the HPV vaccine can prevent most strains of HPV that cause genital warts.
What are the symptoms?
Genital warts are soft, small growths in various shapes and can be white, flesh-toned, pink, or brown and occur in the anogenital area, including the vulva, perineum, anal skin, suprapubic skin, and groin.
What are the risks if untreated?
Extensive genital warts can cause disfiguration of the anogenital area and interfere with defecation or urination. It is rare for genital warts to transform to cancer, however having genital warts, which are caused by low risk HPV subtypes, is associated with an increased risk of having a co-infection with a high risk HPV subtype. High risk HPV infection is associated with a higher risk of anogenital and head and neck cancers, including vulvar, vaginal, cervical, penile, anal, and head and neck cancers.
How and where do you get tested?
Most of the time, a doctor that is familiar with genital warts is able to diagnose the condition simply by a physical exam. When the diagnosis is unclear, a skin biopsy can be performed.
What is the treatment?
Treatment of genital warts can be done in several ways: application of lotions or gels to destroy or clear the warts, which is applied at home over several weeks; acid treatment to destroy the warts; cryotherapy, which uses a chemical to freeze the warts; electrocautery, which uses electrical current to burn the warts; surgery to cut away the warts; laser surgery, which uses light energy to destroy the warts; ultrasound energy, which uses sound waves to destroy the warts.
HEPATITIS
What is it?
Hepatitis A, B, and C are viruses that can infect the liver.
Hepatitis A virus (HAV) is usually a self-limited illness that resolves and does not become a chronic illness. After recovery, there is life-long immunity to the disease. Vaccination can prevent illness as well. Globally, 1.4 million cases occur per year.
Hepatitis B virus (HBV) can cause both an acute and chronic illness. It’s estimated that 2 billion people have or have had HBV infection and 257 million are chronic carriers. HBV can also be prevented with vaccination.
Hepatitis C virus (HCV) can also cause both an acute and chronic illness. It is estimated that 100 million people have or have had HCV infection and 71 million people are chronic carriers.
How can you get it?
HAV is transmitted primarily through a fecal-oral route, so spread by ingesting contaminated water or food, however some cases can occur as a result contact with blood and body fluids, as with illicit drug use, blood transfusions, and as a result of sexual activity.
HBV and HCV are primary transmitted via blood and body fluids, and can be transmitted in pregnancy to a baby from an infected mother, through illicit drug use, blood transfusion or organ transplant, and via sexual activity.
What are the symptoms?
Signs and symptoms of hepatitis virus infections can include: nausea, vomiting, fever, tiredness, low appetite, abdominal pain, dark urine, pale stools, itching, and jaundice. Some people are asymptomatic or have few, mild symptoms.
What are the risks if untreated?
HAV is usually self-limited and does not result in chronic disease, however rarely, in less than 1% of cases, liver failure can occur, which can require a liver transplant.
HBV and HCV can cause both an acute or chronic infection, which can result in permanent liver damage (cirrhosis), cancer of the liver, and liver failure that could require a liver transplant.
Hepatitis infections can also cause disorders in other organ systems, including blood disorders, kidney disease, autoimmune disease, and skin problems.
How and where do you get tested?
Diagnosis is made through bloodwork with a medical provider.
What is the treatment?
Treatment depends on the stage of the disease.
HAV is generally self-limited, so only supportive care is usually needed. Most infections resolve completely within 6 months.
HBV and HCV infections are treated with antiviral medications and other medications that can help to reduce the viral infection.
Advanced diseases, such as cirrhosis, liver cancer, and liver failure, require more extensive treatments that can include surgery, chemotherapy, and liver transplant.
The HAV and HBV vaccines can help prevent those infections.
HUMAN IMMUNODEFICIENCY VIRUS (HIV)
What is it?
The human immunodeficiency virus (HIV) is a viral illness that can weaken the immune system, which can affect the body’s ability to fight off infections. As of 2019, 36.2 million adults and 1.8 million children were living with HIV. That year, 1.5 million adults and 150,000 children were diagnosed with HIV.
How can you get it?
HIV can be acquired through blood and body fluids, through sexual activity, illicit drug use, and from mother to child.
What are the symptoms?
About 10-60% will have no symptoms. When symptoms occur, they can include: fever, swollen lymph nodes, sore throat, rash, muscle aches, joint pain, diarrhea, weight loss, and headache. Other symptoms can include the development of various infections and neurologic problems.
What are the risks if untreated?
If HIV progresses, it can become a chronic disease called the autoimmune deficiency syndrome (AIDS), in which more infections and diseases can develop due to a very weakened immune system. These diseases can include bacterial, yeast, and viral infections, and cancers such as lymphomas and Kaposi sarcoma.
How and where do you get tested?
Testing is done via blood work with a medical provider.
What is the treatment?
AIDS related disease and death can be prevented and transmission rates can be reduced with long-term treatment with anti-viral medications.
ZIKA VIRUS
What is it?
Zika virus is a viral infection that can cause rash, low grade fever, painful joints, and conjunctivitis. Infection in pregnant women can also cause neurologic and developmental problems in babies.
How can you get it?
Zika virus is primarily transmitted to humans via mosquitos, however it can also be transmitted through sexual activity, including vaginal, oral, and anal sex), through the placenta to babies, and from blood transfusion or organ transplants.
The CDC recommends that in areas where Zika is not transmitted by mosquitoes, that men who have been infected or exposed wait at least 3 months from symptom start before having unprotected sex, and women wait at least 8 weeks from symptoms start before having unprotected sex.
What are the symptoms?
About 20-25% of patients experience symptoms, including a low grade fever, rash, muscle aches, headache, nausea, abdominal pain, diarrhea, skin ulcerations, eye problems, hearing problems, and heart problems.
What are the risks if untreated?
In women infected during pregnancy, Zika virus can cause miscarriages and congenital defects in particular, congenital microcephaly (small head size), in newborn babies.
Other complications of Zika virus include Guillan-Barre syndrome, neurologic problems, such as inflammation of the brain and spinal cord, a clot in the brain, and psychiatric and cognitive problems.
How and where do you get tested?
Testing should be performed for patient with symptoms and who give a history of recent travel to a place where Zika virus has been reported, or if they have had unprotected sexual contact with such a person. Testing is done from a blood or urine test ordered by a medical provider.
What is the treatment?
There is no specific treatment for Zika virus, other than rest and symptomatic treatment.
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