11.2: Sexually Transmitted Diseases (STD’S)

There are approximately 20 different infections that are known to be transmitted through sexual contact. One in five people in the U.S. has an STD. While sexually transmitted diseases (STDs) affect individuals of all ages, STDs take a particularly heavy toll on young people. CDC estimates that youth ages 15-24 account for almost half of the 26 million new sexually transmitted infections that occurred in the United States in 2018.

Many cases of chlamydia, gonorrhea, and syphilis continue to go undiagnosed and unreported, and data on several additional STDs — such as human papillomavirus, herpes simplex virus, and trichomoniasis — are not routinely reported to CDC. Many STD’s are asymptomatic, meaning they do not show any symptoms, yet can still be spread to sexual partners. As a result, the CDC data on rates of STD’s only captures a fraction of the true burden of STDs in America. However, it provides important insights into the scope, distribution, and trends in STD diagnoses in the country.

Table

Year
Rate of Syphilis	Rate of Chlamydia	Rater of Gonorrhea
1985	28.4	17.4	383
1990	54.3	160.2	276.4
1995	26	187.8	147.5
2000	11.2	251.4	128.7
2005	11.2	329.4	114.6
2010	14.8	423.6	100.2
2015	23.2	475	123
2020	40.8	481.3	206.5

It is important to understand the risk factors and symptoms of STD’s in order to protect yourself and your partners. It is also important to understand the impacts to your health if you do not get treatment.

Women who do not get treatment for STD’s can get Pelvic Inflammatory Disease (PID). PID is a serious condition which left untreated can cause scar tissue and abscesses to develop in the reproductive tract which can lead to permanent damage to the reproductive organs. PID can cause ectopic pregnancy (in which the fetus develops in abnormal places outside of the womb, a condition that can be life-threatening) and infertility.

For more detailed information, review the CDC fact sheet for Pelvic Inflammatory Disease (PID

Partners who do not get treated for an STD can be at an increased risk of contracting or spreading HIV/AIDS. If you get an STD and you have a sore or break in the skin from the STD, this may allow HIV to more easily enter your body and people who have HIV are more likely to spread HIV if they have an STD. The same behaviors and circumstances that may put you at risk for getting an STD also can put you at greater risk for getting HIV. In addition, having a sore or break in the skin from an STD may allow HIV to more easily enter your body. If you are sexually active, get tested for STDs and HIV regularly, even if you don’t have symptoms.

For more detailed information, review the CDC fact sheet for HIV/AIDS & STDs

Bacterial Vaginosis

Bacterial vaginosis (BV) is a condition that happens when there is too much of certain bacteria in the vagina. This changes the normal balance of bacteria in the vagina. BV is the most common vaginal condition in women ages 15-44.

Researchers do not know the cause of BV. However, we do know the condition most often occurs in those who are sexually active. BV is a result of an imbalance of “good” and “harmful” bacteria in a vagina. Douching, not using condoms, and having new or multiple sex partners can upset the normal balance of vaginal bacteria, increasing your risk for getting BV.

We also do not know how sex causes BV. There also is no research to show that treating a sex partner affects whether someone gets BV. Having BV can increase your chances of getting other STDs.

BV rarely affects those who have never had sex.

You cannot get BV from toilet seats, bedding, or swimming pools.

Many people with BV do not have symptoms. If you do have symptoms, you may notice:

• A thin white or gray vaginal discharge;
• Pain, itching, or burning in the vagina;
• A strong fish-like odor, especially after sex;
• Burning when peeing; and
• Itching around the outside of the vagina.

For more detailed information, review the CDC fact sheet for Bacterial Vaginosis (BV)

Chlamydia

Chlamydia is a common bacterial STD that can cause infection among both men and women. It can cause permanent damage to a woman’s reproductive system. This can make it difficult or impossible to get pregnant later. Chlamydia can also cause a potentially fatal ectopic pregnancy (pregnancy that occurs outside the womb).

You can get chlamydia by having vaginal, anal, or oral sex with someone who has chlamydia. Also, you can still get chlamydia even if your sex partner does not ejaculate (cum). A pregnant person with chlamydia can give the infection to their baby during childbirth.

Chlamydia often has no symptoms, but it can cause serious health problems, even without symptoms. If symptoms occur, they may not appear until several weeks after having sex with a partner who has chlamydia.

Even when chlamydia has no symptoms, it can damage a woman’s reproductive system.

Women with symptoms may notice:

• An abnormal vaginal discharge; and
• A burning sensation when peeing.

Symptoms in men can include:

• A discharge from their penis;
• A burning sensation when peeing; and
• Pain and swelling in one or both testicles (although this is less common).

Men and women can also get chlamydia in their rectum. This happens either by having receptive anal sex, or by spread from another infected site (such as the vagina). While these infections often cause no symptoms, they can cause

• Rectal pain;
• Discharge; and
• Bleeding.

See a healthcare provider if you notice any of these symptoms. You should also see a provider if your partner has an STD or symptoms of one. Symptoms can include

• An unusual sore;
• A smelly discharge;
• Burning when peeing; or
• Bleeding between periods.

For more detailed information, review the CDC fact sheet for Chlamydia

Gonorrhea

Gonorrhea is is a common bacterial STD that can cause infection in the genitals, rectum, and throat. It is very common, especially among young people ages 15-24 years.

You can get gonorrhea by having vaginal, anal, or oral sex with someone who has gonorrhea. A pregnant person with gonorrhea can give the infection to their baby during childbirth.

Gonorrhea often has no symptoms, but it can cause serious health problems, even without symptoms.

Most women with gonorrhea do not have any symptoms. Even when a woman has symptoms, they are often mild and can be mistaken for a bladder or vaginal infection.

Symptoms in women can include:

• Painful or burning sensation when peeing;
• Increased vaginal discharge; and
• Vaginal bleeding between periods.

Men who do have symptoms may have:

• A burning sensation when peeing;
• A white, yellow, or green discharge from the penis; and
• Painful or swollen testicles (although this is less common).

Rectal infections may either cause no symptoms or cause symptoms in both men and women that may include:

• Discharge;
• Anal itching;
• Soreness;
• Bleeding; and
• Painful bowel movements.

See your healthcare provider if you notice any of these symptoms. You should also see a provider if your partner has an STD or symptoms of one. Symptoms can include an unusual sore, a smelly discharge, burning when peeing, or bleeding between periods.

For more detailed information, review the CDC fact sheet for Gonorrhea

Genital Herpes

Genital herpes is common viral STD in the United States. In 2018, CDC estimates show there were 572,000 new genital herpes infections in the United States among people aged 14 to 49.

HSV-1 often causes oral herpes, which can result in cold sores or fever blisters on or around the mouth. HSV-1 is typically acquired during childhood, is very common, and often has no symptoms. HSV-2 is a sexually transmitted disease that causes genital herpes. Oral herpes caused by HSV-1 can spread from the mouth to the genitals through oral sex, thus Genital herpes is an STD that can be caused by two types of viruses – herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2).

You can get genital herpes by having vaginal, anal, or oral sex with someone who has the infection. You can get herpes if you have contact with:

• A herpes sore;
• Saliva from a partner with an oral herpes infection;
• Genital fluids from a partner with a genital herpes infection;
• Skin in the oral area of a partner with oral herpes; or
• Skin in the genital area of a partner with genital herpes.

You also can get genital herpes from a sex partner who does not have a visible sore or is unaware of their infection. It is also possible to get genital herpes if you receive oral sex from a partner with oral herpes.

You will not get herpes from toilet seats, bedding, or swimming pools. You also will not get it from touching objects, such as silverware, soap, or towels.

Most people with genital herpes have no symptoms or have very mild symptoms. Mild symptoms may go unnoticed or be mistaken for other skin conditions like a pimple or ingrown hair. Because of this, most people do not know they have a herpes infection.

Herpes sores usually appear as one or more blisters on or around the genitals, rectum or mouth. This is known as having an “outbreak”. The blisters break and leave painful sores that may take a week or more to heal. Flu-like symptoms (e.g., fever, body aches, or swollen glands) also may occur during the first outbreak.

For more detailed information, review the CDC fact sheet for Genital Herpes

Hepatitis

Hepatitis means inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C (there is also Hepatitis D and E).

Hepatitis A and B can be transmitted through sexual activity, it is less common to be infected with Hepatitis C through sexual intercourse.

For more detailed information, review the CDC fact sheet for Hepatitis

Human Papillomavirus Virus (HPV)- Genital Warts

HPV is a viral STD and the most common STD/STI. There were about 43 million HPV infections in 2018, many among people in their late teens and early 20s. There are many different types of HPV. Some types can cause health problems, including genital warts and cancers. But there are vaccines that can stop these health problems from happening. HPV is a different virus than HIV and HSV (herpes).

You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. It also spreads through close skin-to-skin touching during sex. A person with HPV can pass the infection to someone even when they have no signs or symptoms. If you are sexually active, you can get HPV, even if you have had sex with only one person. You also can develop symptoms years after having sex with someone who has the infection. This makes it hard to know when you first got it.

HPV can cause cervical and other cancers, including cancer of the vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat (called oropharyngeal cancer). This can include the base of the tongue and tonsils. Cancer often takes years, even decades, to develop after a person gets HPV. Genital warts and cancers result from different types of HPV.

There is no test to find out a person’s “HPV status.” Also, there is no approved HPV test to find HPV in the mouth or throat. However, there are HPV tests that can screen for cervical cancer. Most people with HPV do not know they have the infection. They never develop symptoms or health problems from it. Some people find out they have HPV when they get genital warts. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems from HPV, such as cancers.

There is a vaccine available to prevent new HPV infections. The HPV vaccine is recommended for routine vaccination starting at age 11 or 12 years (can be started at age 9). Vaccination is not recommended for everyone older than age 26 years, however adults ages 27 through 45 years might decide to get the HPV vaccine based on discussion with their clinician, if they did not get adequately vaccinated when they were younger.

For more detailed information, review the CDC fact sheet for Human Papillomavirus (HPV

Syphilis

Syphilis is a bacterial sexually transmitted infection (STI) that can cause serious health problems without treatment. Infection develops in stages (primary, secondary, latent, and tertiary). Each stage can have different signs and symptoms.

You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. You cannot get syphilis through casual contact with objects, such as toilet seats or doorknobs.

Syphilis can spread from a mother with syphilis to her unborn baby.

There are four stages of syphilis (primary, secondary, latent, and tertiary). Each stage has different signs and symptoms. Without treatment, syphilis can spread to the brain and nervous system (neurosyphilis), the eye (ocular syphilis), or the ear (otosyphilis) during any of the four stages.

• Primary Stage
  • During the first (primary) stage of syphilis, you may notice a single sore or multiple sores. The sore is the location where syphilis entered your body. These sores usually occur in, on, or around the penis, vagina, anus, rectum, or mouth.
  • Sores are usually (but not always) firm, round, and painless. Because the sore is painless, you may not notice it. The sore usually lasts 3 to 6 weeks and heals regardless of whether you receive treatment.
  • Even after the sore goes away, you must still receive treatment. This will stop your infection from moving to the secondary stage.
• Secondary Stage
  • During the secondary stage, you may have skin rashes and/or sores in your mouth, vagina, or anus.
  • This stage usually starts with a rash on one or more areas of your body. The rash can show up when your primary sore is healing or several weeks after the sore has healed. The rash usually won’t itch and can be on the palms of your hands and/or the bottoms of your feet and look rough, red, or reddish-brown.
  • Other symptoms may include fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.
  • The symptoms from this stage will go not away unless you receive treatment. Without the right treatment, your infection will move to the latent and possibly tertiary stages of syphilis.
• Latent Stage
  • The latent stage of syphilis is a period when there are no visible signs or symptoms. Without treatment, you can continue to have syphilis in your body for years.
• Tertiary Stage
  • Most people with untreated syphilis do not develop tertiary syphilis. However, when it does happen, it can affect many different organ systems. These include the heart and blood vessels, and the brain and nervous system. Tertiary syphilis is very serious and would occur 10–30 years after your infection began. In tertiary syphilis, the disease damages your internal organs and can result in death. A healthcare provider can usually diagnose tertiary syphilis with the help of multiple tests.

For more detailed information, review the CDC fact sheet for Syphilis

Trichomoniasis

Trichomoniasis (or “trich”) is a very common STD caused by infection with Trichomonas vaginalis (a protozoan parasite). Although symptoms vary, most people who have trich cannot tell they have it.

Sexually active people can get trich by having sex without a condom with a partner who has trich.

In women, the infection is most commonly found in the lower genital tract (vulva, vagina, cervix, or urethra). In men, the infection is most commonly found inside the penis (urethra). During sex, the parasite usually spreads from a penis to a vagina, or from a vagina to a penis. It can also spread from a vagina to another vagina.

It is not common for the parasite to infect other body parts, like the hands, mouth, or anus. It is unclear why some people with the infection get symptoms while others do not. It probably depends on factors like a person’s age and overall health. People with trich can pass the infection to others, even if they do not have symptoms.

About 70% of people with the infection do not have any signs or symptoms. When trich does cause symptoms, they can range from mild irritation to severe inflammation. Some people get symptoms within 5 to 28 days after getting the infection. Others do not develop symptoms until much later. Symptoms can come and go.

Men with trich may notice:

• Itching or irritation inside the penis;
• Burning after peeing or ejaculating; and
• Discharge from the penis.

Women with trich may notice:

• Itching, burning, redness or soreness of the genitals;
• Discomfort when peeing; and
• A clear, white, yellowish, or greenish vaginal discharge (i.e., thin discharge or increased volume) with a fishy smell.

Having trich can make sex feel unpleasant. Without treatment, the infection can last for months or even years.

For more detailed information, review the CDC fact sheet for Trichomoniasis