CHLAMYDIA is the most common sexually transmitted infections (STI) in the United States among men and women. This infection can be transmitted by having vaginal, anal, or oral sex with someone who has chlamydia.

Symptoms

Many with chlamydia do not have symptoms though the infection can still cause serious health problems. Those with symptoms may not notice anything for weeks after they have become infected. Women may notice an abnormal vaginal discharge, abnormal vaginal bleeding or burning with urination. Men may have a discharge from the penis, burning sensation with urination or swelling in one or both testicles.

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, bleeding from the rectum or rectal discharge.

Risks/complications

Chlamydial infections may cause permanent damage to a woman’s reproductive system. This can make it difficult or impossible to get pregnant later, cause chronic pelvic pain or increase the chance of a pregnancy outside of the womb (ectopic) that could be fatal. A pregnant person with chlamydia can give the infection to their baby during childbirth.

How to test/diagnose

Chlamydia is diagnosed with a cotton swab test from the suspected infected area or in some cases a special urine test.

Treatment

Chlamydia is curable with antibiotics, but treatment will not prevent any damage that has already occurred to the reproductive system. It is important for your partner(s) to be treated at the same time as you. You should not have unprotected sex for 7 days after treatment is completed. Repeat infection with chlamydia is common. You should receive testing again about three months after your treatment, even if your sex partner(s) receives treatment.

How to prevent

Ways to decrease risk of chlamydia infections include, maintaining a mutually monogamous relationship with a person who doesn’t have chlamydia and using condoms correctly with each act of intercourse. It is recommended that women under the age of 25 and those older who are high risk, have chlamydia testing every year (screening). Pregnant women with chlamydia can give the infection to their baby during delivery. This can cause an eye infection or pneumonia in your baby and may also make it more likely to deliver your baby early. Untreated chlamydia may increase your chance of getting or transmitting HIV.

GONORRHEA is an STI that can cause infection in the genitals, rectum and throat and is very common between the ages of 15-24 years. Annual testing for gonorrhea is recommended in this age group and for those older than 25 years that are at high risk for infection. You can get gonorrhea by vaginal, anal or oral sex with someone who has gonorrhea.

Symptoms

Most women do not have symptoms with this infection. For those that do, symptoms are often mild and can be mistaken for a bladder or vaginal infection. Symptoms could include:

• Painful or burning sensation with urination

• Increased vaginal discharge

• Vaginal bleeding between periods.

Men who have symptoms may have:

• A burning sensation when urinating

• A white, yellow, or green discharge from the penis

• 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

• Painful bowel movement

Risks/complications

A pregnant person can give the infection to their baby during childbirth. Untreated gonorrhea can cause serious health problems that affect a person’s ability to have children, increase the chance of an ectopic pregnancy (outside of the womb) and chronic pelvic pain. On rare occasions, gonorrhea can spread to your blood or joints and cause a lifethreatening condition. If gonorrhea is not treated, it may increase your chance of getting and transmitting HIV.

How to test/diagnose

Your healthcare provider will use a cotton swab to test possible areas of infection or in some cases a special urine test to determine if you have gonorrhea.

Treatment

Gonorrhea is treated with antibiotics however, it is becoming more difficult to treat due to resistant strains of gonorrhea. It is important that you take all of your medicine, have your partner receive treatment and avoid unprotected intercourse for 7 days after your treatment has ended. If you are having symptoms and they have not improved within several days of starting your treatment notify your healthcare provider immediately. Retesting for gonorrhea is recommended due to the frequent recurrence of the infection and should be done 3 months after treatment

How to prevent

The use of condoms and maintaining a mutually monogamous relationship with a person that has been tested and does not have gonorrhea will help to prevent being infected with gonorrhea.

GENITAL HERPES is a virus that is caused by the herpes simplex type 1 (HSV-1) or type 2 (HSV-2) virus and is a common STI in the United States. Though about 12% of persons 14-49 years of age have the HSV-2 infection, the overall percentage of persons with herpes is higher due to the increasing number of infections cause by HSV-1. HSV-1 is typically acquired in childhood and may cause fever blisters or cold sores. With the practice of oral sex, the HSV-1 infection is now frequently found in the genital areas. The HSV-2 infection is more common in women and may be due to genital infections being more easily transmitted from men to women than from women to men (during penile-vaginal sex).

Symptoms

Most people with herpes don’t have symptoms therefore, transmission commonly occurs from contact with an infected person who doesn’t know that they have the infection. The herpes viruses are spread through contact with herpes lesions on mucosal surfaces, in genital fluids, or oral fluids. It is also possible to spread the virus when it is shed from normal oral or genital mucosa or skin, though this is not a common occurrence.

When symptoms do occur, they typically appear as one or more small blisters on or around the genitals, rectum or mouth occurring 2-12 days after exposure. Once the blisters break open, they leave painful lesions that may take 2-4 weeks to heal after the first infection. This is called the initial or primary herpes “outbreak” or episode. This episode may be accompanied by a fever, body aches, swollen lymph nodes or headache.

Those who experience recurrent outbreaks may notice localized genital pain or tingling in the legs/hips/buttocks a few hours or days before they notice a blister or lesion. Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first one and frequency may decrease over time.

Risks/complications

In individuals with decreased immune systems, herpes can cause rare but serious infections such as meningitis (brain infection) or herpes lesions outside of the area of original infection. Women who are pregnant may transmit the herpes virus to their baby causing severe newborn infections. In cases where it is known that a pregnant woman has herpes, measures are taken to decrease risk to the newborn. Such precautions may include medications and/or a cesarean delivery. HIV is more easily acquired and transmitted when herpes lesions are present during sexual contact.

Treatment

Though herpes is not curable, it is manageable. Antiviral medications (such as Valacyclovir or Acyclovir) can prevent or shorten outbreaks during the period the person takes the medication.

How to prevent

Taking an anti-viral daily (suppressive therapy) for herpes can reduce the likelihood of transmission to partners. The risk of genital herpes transmission can be reduced, but not eliminated, by:

• disclosure of infection to sexual partners

• avoiding sex during an outbreak

• use of suppressive antiviral therapy

• consistent condom use.

There is currently no commercial vaccine for herpes and routine screening is not recommended in asymptomatic patients unless they have a partner who has been diagnosed with herpes

HIV (HUMAN IMMUNODEFICIENCY VIRUS) is a virus that attacks the immune system and if not treated can lead to AIDS (acquired immunodeficiency syndrome). A person who already has any sexually transmitted infection (STI) is at increased risk of becoming infected with HIV compared to those without an STI. Conditions that increase risk of HIV include:

• multiple and anonymous sexual partners

• having anal, oral or vaginal sex without a condom

• having sex while under the influence of alcohol or drugs.

Treatment

There is no cure for HIV/AIDs however they can be controlled with proper medical care and anti-retroviral medications.

How to prevent/reduce risk

In order to reduce risk use condoms correctly with each act of sex from start to finish, avoiding risky behavior, limit your number of sexual partners and discuss with your healthcare provider pre- and post- exposure prophylactic therapies.

HPV (HUMAN PAPILLOMA VIRUS) is the most common sexually transmitted disease in the United States. There is many types of HPV, some of which cause genital warts and others may cause cancer. HPV is a different virus than HIV and HSV 1 & 2 viruses.

HPV can be transmitted by oral, anal or vaginal sex with someone who has the virus or through close skin-to-skin touching during sex. The virus can be transmitted even without any signs or symptoms. A person can develop symptoms years after having sex with someone who has the infection therefore it is difficult to determine when you first got it.

Symptoms

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 cancer.

Genital Warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like cauliflower.

Risks/complications

Cancers caused by HPV include cancer of the cervix, vulva, vagina, penis, or anus. It can also cause cancer in the back of the throat (called oropharyngeal cancer) that involves the base of the tongue and tonsils.

It may take years or decades for cancer from HPV to develop in a person with an intact immune system. Genital warts and cancer from HPV come from different types of HPV viruses. Those with a weak immune system, however, are more likely to develop health problems.

Pregnant people with HPV can get genital warts or develop abnormal cell changes on the cervix. Routine cervical cancer screening can help find abnormal cell changes so routine screening should continue during pregnancy.

How to test/diagnose

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. Women may find out they have HPV when they get an abnormal Pap test result. Most healthcare providers can diagnose genital warts by looking at the genital area.

Treatment There is no treatment for the virus itself. Most of the time (9 out of 10) HPV goes away on its own after 2 years however, if it does not it can cause genital warts or cancer.

There are treatments for the health problems that HPV can cause:

1. Genital warts can go away with treatment from your healthcare provider or with prescription medicine. If left untreated, genital warts may go away on their own, stay the same, or grow in size or number.

2. Cervical precancer treatment is available. Women who get routine Pap tests and follow up as needed can find problems before cancer develops. Prevention is always better than treatment. For more information visit cancer.org.

3. Other HPV-related cancers are also more treatable when found and treated early. Fortunately, there is a vaccine that can prevent some of the health effects caused by HPV.

How to prevent

• Get vaccinated

• Get screened for cervical cancer. Routine screening for women aged 21 to 65 years old can prevent cervical cancer.

• If you are sexually active, use condoms correctly every time you have sex. Note that condoms may not cover all of the area infected by HPV but they do offer some protection.

• Be in a mutually monogamous relationship

CDC recommends HPV vaccination for:

• All preteens ( boys and girls) at age 11 or 12 years (or can start at age 9 years).

• Everyone through age 26 years, if not vaccinated already.

• You may consider and discuss vaccination with your healthcare provider between the age of 27- 45.

SYPHILIS is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum. Syphilis can cause serious health effects without adequate treatment.

Syphilis spreads from person-to-person by direct contact with a syphilitic sore, known as a chancre. Chancres can occur in, on, or around the penis, vagina, anus, rectum, and lips or mouth. Syphilis can spread during vaginal, anal, or oral sex.

Risk of syphilis increase with:

• sex with multiple partners

• sex in conjunction with drug use

• transactional sex

• late entry to prenatal care or no prenatal care

• methamphetamine or heroin use

• incarceration of the pregnant person or their partner

• unstable housing or homelessness

Symptoms

The average time between acquisition of syphilis and the start of the first symptom is 21 days. However, this can range from 10 to 90 days. Many refer to syphilis as “The Great Pretender”, as its symptoms can look like many other diseases. However, syphilis typically follows a progression of stages that can last for weeks, months, or even years.

Stages of Syphilis

Primary Stage

A single chancre marks the onset of the primary (first) stage of syphilis, but there may be multiple sores. The chancre is usually firm, round, and painless. It appears at the location where syphilis enters the body. These painless chancres can occur in locations that make them difficult to notice like in the vagina or anus. The chancre lasts 3 to 6 weeks and heals regardless of whether a person receives treatment. However, the infection will progress to the secondary stage if the person with syphilis does not receive treatment.

Secondary Stage

Skin rashes and/or sores in the mouth, vagina, or anus mark the second stage of symptoms. This stage typically starts with the development of a rash on one or more areas of the body. Rashes during the secondary stage:

• can appear when the primary chancre is healing or several weeks after the chancre heals.

• usually does not cause itching

• may appear as rough, red, or reddish-brown spots on the palm of the hands and bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body Sometimes they resemble rashes caused by other diseases.

• may be so faint they are hard to notice.

Condyloma Lata are large, raised, gray or white lesions. They may develop in warm, moist areas like the mouth, underarm or groin region. In addition to rashes, signs and symptoms of secondary syphilis may include:

• fever

• swollen lymph nodes

• sore throat

• patchy hair loss

• headaches

• weight loss

• muscle aches

• fatigue

The symptoms of secondary syphilis will go away with or without treatment. However, without treatment, the infection will progress to the latent and possibly tertiary stage of disease.

Latent Stage

The latent (hidden) stage of syphilis is a period when there are no visible signs or symptoms of syphilis. Without treatment, syphilis will remain in the body even though there are no signs or symptoms. Latent syphilis can last for years.

Tertiary Syphilis

Tertiary syphilis is rare and develops in a subset of untreated syphilis infections. It can appear 10– 30 years after a person gets the infection, and it can be fatal. Tertiary syphilis can affect multiple organ systems, including the:

• brain

• nerves

• eyes

• heart

• blood vessels

• liver

• bones

• joints

Risks/complications

Pregnant people with syphilis also can transmit the infection to their unborn child.

When a pregnant person has syphilis, the infection can spread to their unborn baby and possibly cause the baby to have brain and nerve problems, like blindness or deafness, be stillborn, have low birthweight, deliver early, seizures or developmental delays. All pregnant people should receive testing for syphilis at the first prenatal visit. Testing is recommended again during the third trimester around 28 weeks’ gestation and at delivery.

How to test/diagnose

Treatment

Syphilis is treated with antibiotics. However, though treatment will prevent disease progression, it might not repair damage already done. People receiving syphilis treatment should not have sex with new partners until syphilis sores completely heal. People with syphilis should notify their sex partners so they also can receive testing and treatment if necessary.

TRICHOMONAS (or “trich”) is a very common STI caused by infection with Trichomonas Vaginalis (a protozoan parasite). 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 vulva, vagina, cervix, or urethra. In men, the infection is primarily 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 one vagina to another vagina. It is not common for the parasite to infect other body parts, like the hands, mouth, or anus.

Symptoms

Although symptoms vary, some will notice itching, burning, redness or soreness of the genitals; discomfort with urination, increase in vaginal discharge that is watery and may have a fishy smell. Men may notice Itching or irritation inside the penis, burning with urination or with ejaculation and discharge from the penis.

30 % of infected people do not have symptoms.

Risks/complications

Trich can increase the risk of getting or spreading other sexually transmitted infections including HIV. Pregnant people with trich are more likely to have low birth weight babies and deliver their babies early.

How to test/diagnose

Treatment

Trichomonas is cured with an antibiotic. If you receive and complete treatment for trich, you can still get it again. Reinfection occurs in 1 in 5 people within 3 months after receiving treatment. To avoid reinfection, both you and your sex partner(s) should receive treatment at the same time. You should wait 7 days after treatment before having unprotected sex and wearing a condom will also prevent infection/reinfection.

PELVIC INFLAMMATORY DISEASE (PID) is a syndrome that is caused by infections (most commonly gonorrhea and chlamydia) traveling from the vagina or cervix into the reproductive organs: uterus, tubes and ovaries.

PID is a serious complication of chlamydia and gonorrhea, two of the most common sexually transmitted infections in the US.

Symptoms

Symptoms may be mild or severe and therefore may go undetected by the person or their healthcare provider. The most common symptoms of PID are:

• Lower abdominal or pelvic pain

• Increased vaginal discharge

• Irregular menstrual bleeding

• Fever (>100.4 F)

• Pain with intercourse

• Painful and frequent urination

Risks/complications

PID can lead to infertility and permanent damage of a woman’s pelvic reproductive system. Complications of PID also include:

• Tubo-ovarian abscess (TOA)

• Ectopic pregnancy

• Chronic pelvic pain and scar tissue

How to test/diagnose

PID is diagnosed by an exam with your healthcare provider, special tests and sometimes imaging.

Treatment

PID is treated with broad-spectrum antibiotics but on occasion may require hospitalization, drainage of a pelvic abscess or surgery. Antibiotic treatment will typically resolve the infection, but it does not reverse any damage that has already been caused by the infection. For this reason, it is critical that a woman receive care immediately if she has pelvic pain or other symptoms of PID. Prompt antibiotic treatment could prevent severe damage to the reproductive organs.

How to prevent

Sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners should be tested yearly for gonorrhea and chlamydia. Wearing condoms and being in a mutually monogamous relationship will help to prevent PID.

Vaginal Infections

Bacterial Vaginosis (BV), is the most common vaginal condition in women ages 15-44. Researchers do not know the cause of BV but it is known to occur most often in women who are sexually active. You cannot get BV from toilet seats, bedding or swimming pools. This infection occurs when there is an imbalance of “good” and “bad” bacteria in the vagina. Activities such as douching, having multiple sex partners and not using condoms during intercourse may contribute to an imbalance in the vaginal bacteria and therefore make one more prone to BV. Having BV will increase your chance of getting sexually transmitted diseases.

Many women with BV don’t have symptoms but those that do 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.

BV is diagnosed by a healthcare provider testing your vaginal fluid to see if BV is present. BV treatment includes antibiotics taken by mouth or placed in the vagina. It is important to take all of your medication, even if your symptoms go away before you complete your treatment. Once BV is cured, however, it can return, even after treatment. Male sex partners of women with BV do not need treatment. However, BV can spread between female sex partners.

It is important for a woman who is pregnant to be treated for BV because it can increase her risk of delivering her baby too early or having a low-birth-weight baby.

Prevention:

• The following practices may lower your risk of getting BV:

• Limiting your number of sexual partners

• Avoid douching

• Sleeping without panties (when not having your menses)

• Using condoms (male or female type)

Yeast infection is a fungal infection that causes irritation, discharge and intense itchiness of the vagina and the vulva — the tissues at the vaginal opening. This condition affects up to 3 out of 4 women at some point in their lifetimes. Many women experience at least two episodes. A vaginal yeast infection isn't considered a sexually transmitted infection. But,there's an increased risk of vaginal yeast infection at the time of first regular sexual activity. There's also some evidence that infections may be linked to mouth to genital contact (oral-genital sex).

Yeast infection symptoms can range from mild to moderate, and include:

• Itching and irritation in the vagina and vulva

• A burning sensation, especially during intercourse or while urinating

• Redness and swelling of the vulva

• Vaginal pain and soreness

• Vaginal rash

• Thick, white, odor-free vaginal discharge with a cottage cheese appearance

• Watery vaginal discharge

The fungus candida albicans is responsible for most vaginal yeast infections though there are other strains. Your vagina naturally contains a balanced mix of yeast, including candida, and bacteria. Certain bacteria (lactobacillus) act to prevent overgrowth of yeast but that balance can be disrupted. An overgrowth of candida or penetration of the fungus into deeper vaginal cell layers causes the signs and symptoms of a yeast infection.

Overgrowth of yeast can result from:

• Antibiotic use, which causes an imbalance in natural vaginal flora

• Pregnancy

• Uncontrolled diabetes

• An impaired immune system

• Taking oral contraceptives or hormone therapy that increase estrogen levels

To reduce your risk of vaginal yeast infections, wear underwear that has a cotton crotch and doesn't fit too tightly. It might also help to avoid:

• Tight-fitting pantyhose

• Douching, which removes some of the normal bacteria in the vagina that protect you from infection

• Scented feminine products, including bubble bath, pads and tampons

• Hot tubs and very hot baths

• Unnecessary antibiotic use, such as for colds or other viral infections

• Staying in wet clothes, such as swimsuits and workout attire, for long periods of time

Yeast is diagnosed by a pelvic exam, collecting and examining your vaginal fluid.

Treatment is achieved with vaginal creams, suppositories or oral tablets. The dosing may vary depending on the severity of your infection. There are those who may have a more complicated yeast infection such as:

• You have severe signs and symptoms, such as extensive redness, swelling and itching that leads to tears, cracks or sores in the genital area

• You have four or more yeast infections in a year

• Your infection is caused by a less typical type of fungus

• You're pregnant

• You have uncontrolled diabetes

• Your immune system is weakened because of certain medications or conditions such as HIV infection

For those who have complicated yeast infections their treatment may require a longer course of treatment and possibly a recommendation to use vaginal Boric Acid Capsules (not to be taken orally) as a part of the treatment plan