Types of birth control

• Continuous abstinence
• Natural family planning/rhythm method
• Barrier methods

• Contraceptive sponge
• Diaphragm, cervical cap, and cervical shield
• Female condom
• Male condom

• Hormonal methods

• Oral contraceptives — combined pill ("The pill")
• Oral contraceptives — progestin-only pill ("Mini-pill")
• The patch
• Shot/injection
• Vaginal ring

• Implantable devices

• Implantable rods
• Intrauterine devices

• Permanent birth control methods

• Sterilization implant
• Surgical sterilization

• Emergency contraception

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The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Source: Office of Women's Health, HHS

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Emergency contraception (morning after pill, IUD)

Page last reviewed: 13/01/2015

Next review due: 13/01/2017

Source: NHS Choices, UK

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 Sexually transmitted infections (STI) fact sheet

• What is a sexually transmitted infection (STI)?
• How many people have STIs and who is infected?
• How do you get an STI?
• Can STIs cause health problems?
• What are the symptoms of STIs?
• How do you get tested for STIs?
• Who needs to get tested for STIs?
• How are STIs treated?
• What can I do to keep from getting an STI?
• How do STIs affect pregnant women and their babies?
• What can pregnant women do to prevent problems from STIs?
• Do STIs affect breastfeeding?
• Is there any research being done on STIs?
• For more information
• More information on sexually transmitted infections (STI)

What is a sexually transmitted infection (STI)?

It is an infection passed from person to person through intimate sexual contact. STIs are also called sexually transmitted diseases, or STDs.

How many people have STIs and who is infected?

In the United States about 19 million new infections are thought to occur each year. These infections affect men and women of all backgrounds and economic levels. But almost half of new infections are among young people ages 15 to 24. Women are also severely affected by STIs. They have more frequent and more serious health problems from STIs than men. African-American women have especially high rates of infection.

How do you get an STI?

You can get an STI by having intimate sexual contact with someone who already has the infection. You can’t tell if a person is infected because many STIs have no symptoms. But STIs can still be passed from person to person even if there are no symptoms. STIs are spread during vaginal, anal, or oral sex or during genital touching. So it’s possible to get some STIs without having intercourse. Not all STIs are spread the same way.

Can STIs cause health problems?

Yes. Each STI causes different health problems. But overall, untreated STIs can cause cancer, pelvic inflammatory disease, infertility, pregnancy problems, widespread infection to other parts of the body, organ damage, and even death.

Having an STI also can put you at greater risk of getting HIV. For one, not stopping risky sexual behavior can lead to infection with other STIs, including HIV. Also, infection with some STIs makes it easier for you to get HIV if you are exposed.

What are the symptoms of STIs?

Many STIs have only mild or no symptoms at all. When symptoms do develop, they often are mistaken for something else, such as urinary tract infection or yeast infection. This is why screening for STIs is so important. The STIs listed here are among the most common or harmful to women.

Symptoms of sexually transmitted infections

STI	Symptoms
Bacterial vaginosis (BV)	Most women have no symptoms. Women with symptoms may have: Vaginal itching Pain when urinating Discharge with a fishy odor
Chlamydia	Most women have no symptoms. Women with symptoms may have: Abnormal vaginal discharge Burning when urinating Bleeding between periods Infections that are not treated, even if there are no symptoms, can lead to: Lower abdominal pain Low back pain Nausea Fever Pain during sex
Genital herpes	Some people may have no symptoms. During an “outbreak,” the symptoms are clear: Small red bumps, blisters, or open sores where the virus entered the body, such as on the penis, vagina, or mouth Vaginal discharge Fever Headache Muscle aches Pain when urinating Itching, burning, or swollen glands in genital area Pain in legs, buttocks, or genital area Symptoms may go away and then come back. Sores heal after 2 to 4 weeks.
Gonorrhea	Symptoms are often mild, but most women have no symptoms. If symptoms are present, they most often appear within 10 days of becoming infected. Symptoms are: Pain or burning when urinating Yellowish and sometimes bloody vaginal discharge Bleeding between periods Pain during sex Heavy bleeding during periods Infection that occurs in the throat, eye, or anus also might have symptoms in these parts of the body.
Hepatitis B	Some women have no symptoms. Women with symptoms may have: Low-grade fever Headache and muscle aches Tiredness Loss of appetite Upset stomach or vomiting Diarrhea Dark-colored urine and pale bowel movements Stomach pain Skin and whites of eyes turning yellow
HIV/AIDS	Some women may have no symptoms for 10 years or more. About half of people with HIV get flu-like symptoms about 3 to 6 weeks after becoming infected. Symptoms people can have for months or even years before the onset of AIDS include: Fevers and night sweats Feeling very tired Quick weight loss Headache Enlarged lymph nodes Diarrhea, vomiting, and upset stomach Mouth, genital, or anal sores Dry cough Rash or flaky skin Short-term memory loss Women also might have these signs of HIV: Vaginal yeast infections and other vaginal infections, including STIs Pelvic inflammatory disease (PID) that does not get better with treatment Menstrual cycle changes
Human papillomavirus (HPV)	Some women have no symptoms. Women with symptoms may have: Visible warts in the genital area, including the thighs. Warts can be raised or flat, alone or in groups, small or large, and sometimes they are cauliflower-shaped. Growths on the cervix and vagina that are often invisible.
Pubic lice (sometimes called "crabs")	Symptoms include: Itching in the genital area Finding lice or lice eggs
Syphilis	Syphilis progresses in stages. Symptoms of the primary stage are: A single, painless sore appearing 10 to 90 days after infection. It can appear in the genital area, mouth, or other parts of the body. The sore goes away on its own. If the infection is not treated, it moves to the secondary stage. This stage starts 3 to 6 weeks after the sore appears. Symptoms of the secondary stage are: Skin rash with rough, red or reddish-brown spots on the hands and feet that usually does not itch and clears on its own Fever Sore throat and swollen glands Patchy hair loss Headaches and muscle aches Weight loss Tiredness In the latent stage, symptoms go away, but can come back. Without treatment, the infection may or may not move to the late stage. In the late stage, symptoms are related to damage to internal organs, such as the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Some people may die.
Trichomoniasis (sometimes called "trich")	Many women do not have symptoms. Symptoms usually appear 5 to 28 days after exposure and can include: Yellow, green, or gray vaginal discharge (often foamy) with a strong odor Discomfort during sex and when urinating Itching or discomfort in the genital area Lower abdominal pain (rarely)

 How do you get tested for STIs?

There is no one test for all STIs. Ask your doctor about getting tested for STIs. She or he can tell you what test(s) you might need and how it is done. Testing for STIs is also called STI screening. Testing (or screening) for STIs can involve:

• Pelvic and physical exam — Your doctor can look for signs of infection, such as warts, rashes, discharge.
• Blood sample
• Urine sample
• Fluid or tissue sample —  A swab is used to collect a sample that can be looked at under a microscope or sent to a lab for testing.

These methods are used for many kinds of tests. So if you have a pelvic exam and Pap test, for example, don’t assume that you have been tested for STIs. Pap testing is mainly used to look for cell changes that could be cancer or precancer. Although a Pap test sample also can be used to perform tests for HPV, doing so isn’t routine. And a Pap test does not test for other STIs. If you want to be tested for STIs, including HPV, you must ask.

You can get tested for STIs at your doctor’s office or a clinic. But not all doctors offer the same tests. So it’s important to discuss your sexual health history to find out what tests you need and where you can go to get tested.

 Who needs to get tested for STIs?

If you are sexually active, talk to your doctor about STI screening. Which tests you might need and how often depend mainly on your sexual history and your partner’s. Talking to your doctor about your sex life might seem too personal to share. But being open and honest is the only way your doctor can help take care of you. Also, don’t assume you don’t need to be tested for STIs if you have sex only with women. Talk to your doctor to find out what tests make sense for you.

How are STIs treated?

The treatment depends on the type of STI. For some STIs, treatment may involve taking medicine or getting a shot. For other STIs that can’t be cured, like herpes, treatment can help to relieve the symptoms.

Only use medicines prescribed or suggested by your doctor. There are products sold over the Internet that falsely claim to prevent or treat STIs, such as herpes, chlamydia, human papillomavirus, and HIV. Some of these drugs claim to work better than the drugs your doctor will give you. But this is not true, and the safety of these products is not known.

What can I do to keep from getting an STI?

You can lower your risk of getting an STI with the following steps. The steps work best when used together. No single strategy can protect you from every single type of STI.

• Don’t have sex. The surest way to keep from getting any STI is to practice abstinence. This means not having vaginal, oral, or anal sex. Keep in mind that some STIs, like genital herpes, can be spread without having intercourse.
• Be faithful. Having a sexual relationship with one partner who has been tested for STIs and is not infected is another way to lower your risk of getting infected. Be faithful to each other. This means you only have sex with each other and no one else.
• Use condoms correctly and every time you have sex. Use condoms for all types of sexual contact, even if intercourse does not take place. Use condoms from the very start to the very end of each sex act, and with every sex partner. A male latex condom offers the best protection. You can use a male polyurethane condom if you or your partner has a latex allergy. For vaginal sex, use a male latex condom or a female condom if your partner won’t wear a condom. For anal sex, use a male latex condom. For oral sex, use a male latex condom. A dental dam might also offer some protection from some STIs.
• Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs. If you use one of these methods, be sure to also use a condom correctly every time you have sex.
• Talk with your sex partner(s) about STIs and using condoms before having sex. It’s up to you to set the ground rules and to make sure you are protected.
• Don’t assume you’re at low risk for STIs if you have sex only with women. Some common STIs are spread easily by skin-to-skin contact. Also, most women who have sex with women have had sex with men, too. So a woman can get an STI from a male partner and then pass it to a female partner.
• Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had. Talk about symptoms, such as sores or discharge. Try not to be embarrassed. Your doctor is there to help you with any and all health problems. Also, being open with your doctor and partner will help you protect your health and the health of others.
• Have a yearly pelvic exam. Ask your doctor if you should be tested for STIs and how often you should be retested. Testing for many STIs is simple and often can be done during your checkup. The sooner an STI is found, the easier it is to treat.
• Avoid using drugs or drinking too much alcohol. These activities may lead to risky sexual behavior, such as not wearing a condom.

How do STIs affect pregnant women and their babies?

STIs can cause many of the same health problems in pregnant women as women who are not pregnant. But having an STI also can threaten the pregnancy and unborn baby's health. Having an STI during pregnancy can cause early labor, a woman's water to break early, and infection in the uterus after the birth.

Some STIs can be passed from a pregnant woman to the baby before and during the baby’s birth. Some STIs, like syphilis, cross the placenta and infect the baby while it is in the uterus. Other STIs, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can be passed from the mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the placenta during pregnancy and infect the baby during the birth process.

The harmful effects to babies may include:

• Low birth weight
• Eye infection
• Pneumonia
• Infection in the baby’s blood
• Brain damage
• Lack of coordination in body movements
• Blindness
• Deafness
• Acute hepatitis
• Meningitis
• Chronic liver disease
• Cirrhosis
• Stillbirth

Some of these problems can be prevented if the mother receives routine prenatal care, which includes screening tests for STIs starting early in pregnancy and repeated close to delivery, if needed. Other problems can be treated if the infection is found at birth.

What can pregnant women do to prevent problems from STIs?

Pregnant women should be screened at their first prenatal visit for STIs, including:

• Chlamydia
• Gonorrhea
• Hepatitis B
• HIV
• Syphilis

In addition, some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis (BV) at the first prenatal visit. Even if a woman has been tested for STIs in the past, she should be tested again when she becomes pregnant.

Chlamydia, gonorrhea, syphilis, trichomoniasis, and BV can be treated and cured with antibiotics during pregnancy. Viral STIs, such as genital herpes and HIV, have no cure. But antiviral medication may be appropriate for some pregnant woman with herpes to reduce symptoms. For women who have active genital herpes lesions at the onset of labor, a cesarean delivery (C-section) can lower the risk of passing the infection to the newborn. For women who are HIV positive, taking antiviral medicines during pregnancy can lower the risk of giving HIV to the newborn to less than 2 percent. C-section is also an option for some women with HIV. Women who test negative for hepatitis B may receive the hepatitis B vaccine during pregnancy.

Pregnant women also can take steps to lower their risk of getting an STI during pregnancy.

Do STIs affect breastfeeding?

Talk with your doctor, nurse, or a lactation consultant about the risk of passing the STI to your baby while breastfeeding. If you have chlamydia or gonorrhea, you can keep breastfeeding. If you have syphilis or herpes, you can keep breastfeeding as long as the sores are covered. Syphilis and herpes are spread through contact with sores and can be dangerous to your newborn. If you have sores on your nipple or areola, stop breastfeeding on that breast. Pump or hand express your milk from that breast until the sore clears. Pumping will help keep up your milk supply and prevent your breast from getting engorged or overly full. You can store your milk to give to your baby in a bottle for another feeding. But if parts of your breast pump that contact the milk also touch the sore(s) while pumping, you should throw the milk away.

If you are being treated for an STI, ask your doctor about the possible effects of the drug on your breastfeeding baby. Most treatments for STIs are safe to use while breastfeeding.

Is there any research being done on STIs?

Yes. Research on STIs is a public health priority. Research is focused on prevention, diagnosis, and treatment.

With prevention, researchers are looking at strategies such as vaccines and topical microbicides (meye-KROH-buh-syds). One large study is testing a herpes vaccine for women. Topical microbicides could play a big role in protecting women from getting STIs. But so far, they have been difficult to design. They are gels or creams that would be put into the vagina to kill or stop the STI before it could infect someone. Researchers are also looking at the reasons some people are at higher risk of STIs, and ways to lower these risks.

Early and fast diagnosis of STIs means treatment can start right away. Early treatment helps to limit the effects of an STI and keep it from spreading to others. Researchers are looking at quick, easy, and better ways to test for STIs, including vaginal swabs women can use to collect a sample for testing. They also are studying the reasons why many STIs have no symptoms, which can delay diagnosis.

Research also is underway to develop new ways to treat STIs. For instance, more and more people are becoming infected with types of gonorrhea that do not respond well to drugs. So scientists are working to develop new antibiotics to treat these drug-resistant types. An example of treatment research success is the life-prolonging effects of new drugs used to treat HIV.

More information on sexually transmitted infections (STI)

For more information about sexually transmitted infections (STI), call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, HHS
  Phone: 800-232-4636 (TDD: 888-232-6348)
• National HIV and STD Testing Resources, CDC, HHS
  Phone: 800-458-5231 or 404-679-3860
• National Institute of Allergy and Infectious Diseases, NIH, HHS
  Phone: 866- 284-4107 or 301-496-5717 (TDD: 800-877-8339)

Source: Office on Women's Health, HHS

STD/STS Summaries

What are STDs and sexually transmitted infections(STIs)?

STDs are a group of illnesses that are passed from person to person during sexual intercourse, oral sex, or sex play. These diseases can be caused by bacteria, viruses, yeasts, or parasites and are spread through intimate sexual contact involving the penis, vagina, mouth, or anus. STDs are also called venereal diseases or STIs. Health care professionals prefer the term "infection" rather than "disease," because it is possible for a person to have no symptoms but still carry the bacterium or virus and require treatment. Scientists have identified more than 20 different STDs/STIs.

How many people are affected by or at risk for a sexually transmitted disease or sexually transmitted infection (STD/STI)?

Anyone who has had or is having sexual intercourse or oral sex, or who has participated or is participating in sex play, is at risk for acquiring an STD/STI. Fortunately, it is possible for a person to decrease his or her risk by having protected sex and knowing his or her STD/STI status and that of his or her partner. Still, the Centers for Disease Control and Prevention (CDC) estimates nearly 20 million new cases of these reportable STDs/STIs (gonorrhea, chlamydia, syphilis) occur each year in the United States—almost half of them among young people 15 to 24 years of age.

While not the most common STD/STI, HIV/AIDS is one of the most devastating and most well known. Recent data from the CDC indicate that 1.1 million Americans have HIV:

• One in five is unaware that they have the virus.
• Approximately 50,000 Americans become infected with HIV each year.
• 15,529 people with AIDS died in 2010.

More information about the number of people who test positive for HIV/AIDS in the United States and the differences in these numbers for individuals from different cultures and backgrounds is available at the CDC website.

What are the symptoms of a sexually transmitted disease or sexually transmitted infection (STD/STI)?

People with STDs/STIs may feel ill and notice some of the following signs and symptoms:

• Unusual discharge from the penis or vagina
• Sores or warts on the genital area
• Painful or frequent urination
• Itching and redness in the genital area
• Blisters or sores in or around the mouth
• Abnormal vaginal odor
• Anal itching, soreness, or bleeding
• Abdominal pain
• Fever

In some cases, people with STDs/STIs have no symptoms, and over time the symptoms, if present, can improve on their own. However, it is common for individuals to have an STD/STI and pass it on to others without knowing it.

If you are concerned that you or your sexual partner may have an STD/STI, talk to your health care provider. Even if you do not have symptoms, it is possible you may have an STD/STI that needs to be treated to ensure your and your partner's sexual health.

What causes a sexually transmitted disease or sexually transmitted infection (STD/STI)?

There are two major causes of STDs/STIs:

• Bacteria, including chlamydia, gonorrhea, and syphilis
• Viruses, including HIV/AIDS, herpes simplex virus, human papillomavirus (HPV), hepatitis B virus, and cytomegalovirus (CMV; pronounced sahy-toh-MEG-uh-loh-vahy-ruhs), yeasts and protozoan parasites, such as Trichomonas vaginalis (pronounced TRIK-uh-MOH-nuss vaj-uh-NAHY-lis), or insects such as crab lice or scabies mites, cause STDs/STIs.

Any STD/STI can be spread through sexual intercourse, and some STDs/STIs also are spread through oral sex and sex play. Ejaculation does not have to occur for an STD/STI to be passed from person to person. Sharing contaminated needles used to inject drugs or using contaminated body piercing and tattooing equipment also can transmit some infections, such as HIV or hepatitis B and C.

A few diseases (such as CMV and molluscum contagiosum) can be sexually transmitted but are also spread through nonsexual, close contact. Regardless of how a person is exposed, once a person is infected by an STD/STI, he or she can spread the infection to other people through oral, vaginal, or anal sex, even if he or she has no symptoms.

STDs/STIs are of particular concern in pregnant women, because some infections can be passed on to the infant before birth or during delivery. However, the risk of transmission from mother to infant can be lowered, and it is important for every expectant mother to be screened.

For example, HIV can be passed from mother to infant during pregnancy before birth, at the time of delivery, or after birth during breastfeeding. This transmission can be prevented through treatment with certain medications during pregnancy and near delivery. After birth, women who have HIV should refrain from breastfeeding their infants if safe alternatives, such as infant formula, are available, further reducing the infant's risk.

In other cases, if the mother has an infection such as gonorrhea or herpes, in which risks of transmission are high during delivery, other steps can be taken to reduce the likelihood that the infant will be infected. In these instances, health care providers can treat the pregnant woman for the STD/STI before birth, or the infant can be delivered by cesarean section (also referred to as C section).

CMV affects about 1% of all births. A pregnant woman infected with CMV can transmit the infection to the fetus in the womb, or it can be passed to the infant during delivery or by breastfeeding. She could also pass it to her newborn after birth if the child comes into contact with her body fluids (for example, saliva or urine) carrying the virus. If a health care provider suspects that a woman has a CMV infection during pregnancy, an ultrasound examination, blood tests, and other tests are done to assess the health of the fetus. Most infants who were infected with the virus during pregnancy do not have any detectable problems after birth. But, 10% or 20% will have serious problems, including deafness and intellectual disabilities. If fetal testing shows increased risk of serious problems, some women opt to end the pregnancy. Researchers are studying antiviral drugs, immune treatments, and other medical approaches to control the infection during pregnancy. Some research is focusing on vaccines to prevent CMV infection.

What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?

Approximately 20 different infections are known to be transmitted through sexual contact. Here are descriptions of some of the most common and well known:

• Chlamydia
• Gonorrhea
• Genital Herpes
• HIV/AIDS
• Human Papillomavirus (HPV)
• Syphilis
• Bacterial Vaginosis
• Trichomoniasis
• Viral Hepatitis

Chlamydia

Chlamydia1 (pronounced kla-MID-ee-uh) is a common STD/STI caused by the bacterium Chlamydia trachomatis. Chlamydia can be transmitted during vaginal, oral, or anal sexual contact with an infected partner. While many individuals will not experience symptoms, chlamydia can cause fever, abdominal pain, and unusual discharge of the penis or vagina.

In women, whether or not they are having symptoms and know about their infection, chlamydia can cause pelvic inflammatory disease (PID). In PID, the untreated STD/STI progresses and involves other parts of the woman's reproductive system, including the uterus and fallopian tubes. This progression can lead to permanent damage to the woman's reproductive organs. This damage may lead to ectopic pregnancy (in which the fetus develops in abnormal places outside of the womb, a condition that can be life-threatening) and infertility.

Additionally, if the woman is pregnant, her developing fetus is at risk, because chlamydia can be passed on during her pregnancy or delivery and could lead to eye infections or pneumonia in the infant. If chlamydia is detected early, it can be treated easily with an antibiotic taken by mouth.

Gonorrhea

Gonorrhea (pronounced gon-uh-REE-uh) is caused by the bacterium Neisseria gonorrhoeae, which can grow rapidly and multiply easily in the warm, moist areas of the reproductive tract. The most common symptoms of gonorrheal infection are a discharge from the vagina or penis and painful or difficult urination.

As with chlamydial infection, the most common and serious complications of gonorrhea occur in women and include pelvic inflammatory disease ((PID), ectopic pregnancy, infertility, and the potential spread to the developing fetus if acquired during pregnancy. Gonorrhea also can infect the mouth, throat, eyes, and rectum and can spread to the blood and joints, where it can become a life-threatening illness.

In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are also more likely to transmit the virus to someone else.

Genital Herpes

Genital herpes is a contagious infection caused by the herpes simplex virus (HSV). There are two different strains, or types, of HSV: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Both can cause genital herpes, although most cases of genital herpes are caused by HSV-2.⁵ When symptomatic, HSV-1 usually appears as fever blisters or cold sores on the lips, but it can also infect the genital region through oral-genital or genital-genital contact. Symptomatic HSV-2 typically causes painful, watery skin blisters on or around the genitals or anus. However, substantial numbers of people who carry these viruses have no or only minimal signs or symptoms.

Neither HSV-1 nor HSV-2 can be cured, and even during times when an infected person has no symptoms, the virus can be found in the body's nerve cells. Periodically, some people will experience outbreaks in which new blisters form on the skin in the genital area; at those times, the virus is more likely to be passed on to other people.

Pregnant women, especially those who acquire genital herpes for the first time during pregnancy, may pass the infection to their newborns, causing life-threatening neonatal HSV, an infection affecting the infant's skin, brain, and other organs.

HIV/AIDS

HIV, or the human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV destroys the body's immune system by killing the blood cells that fight infection. Once HIV destroys a substantial proportion of these cells, the body's ability to fight off and recover from infections is compromised. This advanced stage of HIV infection is known as AIDS.

 People whose HIV has progressed to AIDS are very susceptible to opportunistic infections that do not normally make people sick and to certain forms of cancer.

AIDS can be prevented by early initiation of antiretroviral therapy in those with HIV infection. Transmission of the virus primarily occurs during unprotected sexual activity and by sharing needles used to inject intravenous drugs, although the virus also can spread from mother to infant during pregnancy, delivery, and breastfeeding.

In 2013, NIH-supported researchers reported that a 2-year-old child who was born with HIV and was treated starting in the first few days of life has had her HIV infection go into remission. This appears to be the first case of functional cure of HIV.

Human Papillomavirus (HPV)

HPV is the most common STD/STI. More than 40 HPV types exist, and all of them can infect both men and women. The types of HPVs vary in their ability to cause genital warts; infect other regions of the body, including the mouth and throat; and cause cancers of the cervix, vulva, penis, and mouth.

Although no cure exists for HPV infection once it occurs, regular screening with a Pap smear test can prevent or detect at an early stage most cases of HPV-caused cervical cancer. (A Pap smear test involves a health care provider taking samples of cells from the cervix during a standard gynecologic exam; these cells are examined under a microscope for signs of developing cancer).

A newly available vaccine protects against most (but not all) HPV types that cause cervical cancer. The American Academy of Pediatrics recommends this vaccine for school-aged boys and girls.

Syphilis

Syphilis infections, caused by the bacterium Treponema pallidum, are passed from person to person during vaginal, anal, or oral sex through direct contact with sores, called chancres. Between 2001 and 2009, the Centers for Disease Control and Prevention (CDC) data show that the syphilis rate increased each year. Those people at highest risk for syphilis include men having sex with both men and women and people residing in the south. The first sign of syphilis is a chancre, a painless genital sore that most often appears on the penis or in and around the vagina. Beyond being the first sign of a syphilis infection, chancres make a person two to five times more likely to contract an HIV infection. If the person is already infected with HIV, chancres also increase the likelihood that the virus will be passed on to a sexual partner. These sores typically resolve on their own, even without treatment. However, the body does not clear the infection on its own, and, over time, syphilis may involve other organs, including the skin, heart, blood vessels, liver, bones, and joints in secondary syphilis. If the illness is still not treated, tertiary syphilis can develop over a period of years and involve the nerves, eyes, and brain and can potentially cause death.

Expectant mothers harboring the bacterium are at an increased risk of miscarriage and stillbirth, and they can pass the infection on to their fetuses during pregnancy and delivery. Infants that acquire congenital syphilis during pregnancy may suffer from skeletal deformity, difficulty with speech and motor development, seizure, anemia, liver disease, and neurologic problems.

Bacterial Vaginosis

Bacterial vaginosis is a common, possibly sexually transmitted, vaginal infection in women of reproductive age. While it is healthy and normal for a vagina to have bacteria, just like the skin, mouth, or gastrointestinal (GI) tract, sometimes changes in the balance of different types of bacteria can cause problems.

Bacterial vaginosis occurs when problematic bacteria that are normally present only in small amounts increase in number, replace normal vaginal lactobacilli bacteria, and upset the usual balance. This situation becomes more likely if a woman douches frequently or has new or multiple sexual partners. The most common sign of a bacterial vaginosis infection is a thin, milky discharge that is often described as having a "fishy" odor. However, some women will have no symptoms at all.

Regardless of symptoms, having bacterial vaginosis increases the risk of getting other STDs/STIs and is also associated with pelvic inflammatory disease (PID), an infection of the female reproductive organs, including the uterus and the fallopian tubes (which carry eggs to the uterus), and postoperative infections. Preterm labor and birth are also possibly more common in women with bacterial vaginosis.

Trichomoniasis

Trichomoniasis12 (pronounced trik-uh-muh-NAHY-uh-sis) infection is caused by the single-celled protozoan parasite Trichomonas vaginalis and is common in young, sexually active women. The parasite also infects men, though less frequently. The parasite can be transmitted between men and women as well as between women whenever physical contact occurs between the genital areas. Although Trichomonas infections do not always cause symptoms, they can cause frequent, painful, or burning urination in men and women as well as vaginal discharge, genital soreness, redness, or itching in women. Because the infection can occur without symptoms, a person may be unaware that he or she is infected and continue to re-infect a sexual partner who is having recurrent signs of infection. As with bacterial STDs/STIs, all sexual partners should be treated at the same time to avoid re-infection.

NICHD-sponsored research has shown that during pregnancy, Trichomonas infection is associated with an increased risk of premature birth and infants with low birth weight. Moreover, infants born to mothers with Trichomonas infection are more than twice as likely as infants born to uninfected women to be stillborn or to die as newborns.

Viral Hepatitis

Viral hepatitis is a serious liver disease that can be caused by several different viruses, which can be transmitted through sexual contact.

• Hepatitis A virus (HAV) causes a short-term or self-limited liver infection that can be quite serious, although it does not result in chronic infection. While there are other ways the virus can be transmitted, HAV can be spread from person to person during sexual activity through oral-rectal contact. Vaccination can prevent HAV infection.
• Hepatitis B virus (HBV) causes a serious liver disease that can result in both immediate illness and lifelong infection leading to permanent liver scarring (cirrhosis), cancer, liver failure, and death. HBV spreads through both heterosexual and homosexual contact as well as through contact with other bodily fluids, such as blood, through shared contaminated needles used for injecting intravenous (IV) drugs, tattooing, and piercing. Pregnant women with HBV can transmit the virus to their infants during delivery. HBV infection is preventable through vaccination.
• Hepatitis C virus (HCV) can cause an immediate illness affecting the liver, but it more commonly becomes a silent, chronic infection that leads to liver scarring (cirrhosis), cancer, liver failure, and death. HCV is most commonly transmitted through sharing needles or exposure to infected blood. However, it can spread through sexual contact or from mother to fetus during pregnancy and delivery. There is no vaccine for HCV, and treatments are not always effective.

How do health care providers diagnose a sexually transmitted disease or sexually transmitted infection (STD/STI)?

Any person who is sexually active should discuss his or her risk factors for STDs/STIs with a health care provider and ask about getting tested. If you are sexually active, it is important to remember that you may have an STD/STI and not know it because many STDs/STIs do not cause symptoms. You should get tested and have regular checkups with a health care provider who can help assess and manage your risk, answer your questions, and diagnose and treat an STD/STI if needed.

Starting treatment quickly is important to prevent transmission of infections to other people and to minimize the long-term complications of STDs/STIs. Recent sexual partners should also be treated to prevent re-infection and further transmission.

Some STDs/STIs may be diagnosed during a physical exam or through microscopic examination of a sore or fluid swabbed from the vagina, penis, or anus. This fluid can also be cultured over a few days to see whether infectious bacteria or yeast can be detected. The effects of human papilloma virus (HPV), which causes genital warts and cervical cancer, can be detected in a woman when her health care provider performs a pap smear test and takes samples of cells from the cervix to be checked microscopically for abnormal changes.¹ Blood tests are used to detect infections such as hepatitis A, B, and C or HIV/AIDS.

Because sexually transmitted diseases are passed from person to person and can have serious health consequences, the health department notifies people if they have been exposed to certain STDs/STIs. Not all STDs/STIs are reported, though. If you receive a notice, it is important to see a health care provider, be tested, and start treatment right away.

Screening is especially important for pregnant women, because many STDs/STIs can be passed on to the fetus during pregnancy or delivery. During an early prenatal visit, with the help of her health care provider, an expectant mother should be screened for these infections, including HIV  and syphilis. Some of these STDs/STIs can be cured with drug treatment, but not all of them. However, even if the infection is not curable, a pregnant woman can usually take measures to protect her infant from infection.

Is there a cure for sexually transmitted diseases and sexually transmitted infections (STDs/STIs)?

Viruses such as HIV, genital herpes, human papillomavirus, hepatitis, and cytomegalovirus cause STDs/STIs that cannot be cured. People with an STD/STI caused by a virus will be infected for life and will always be at risk of infecting their sexual partners, although for many viruses treatment significantly reduces this risk. Treatments are available to cure STDs/STIs caused by bacteria, yeast, or parasites.

What are the treatments for sexually transmitted diseases and sexually transmitted infections (STDs/STIs)?

STDs/STIs caused by bacteria, yeast, or parasites can be treated with antibiotics. These antibiotics are most often given by mouth (orally). However, sometimes they are injected or applied directly to the affected area. Whatever the infection, and regardless of how quickly the symptoms resolve after beginning treatment, the infected person must take all of the medicine prescribed by the health care provider to ensure that the STD/STI is completely treated.

Although treatments, complications, and outcomes vary among viral STDs/STIs depending on the particular virus (HIV, genital herpes, human papillomavirus, hepatitis, or cytomegalovirus), health care providers can provide treatments to reduce the symptoms and the progression of most of these illnesses. For example, medications are available to limit the frequency and severity of genital herpes outbreaks while reducing the risk that the virus will be passed on to other people.

Individuals with HIV need to take special antiretroviral drugs that control the amount of virus they carry. These drugs, called highly active antiretroviral therapy, or HAART,¹ can help people live longer, healthier lives. If a woman with HIV becomes pregnant, these medicines also can reduce the chance that her fetus or infant will get the infection.

Being tested and treated for STDs/STIs is especially important for pregnant women because some STDs/STIs may be passed on to their infants during pregnancy or delivery. Testing women for these STDs/STIs early in their pregnancy is important, so that steps can be taken to help ensure delivery of a healthy infant. The necessary treatment will depend on the type of STD/STI involved.

Treatments for Specific Types of Sexually Transmitted Diseases and Sexually Transmitted Infections (STDs/STIs)

• Gonorrhea and Chlamydia
• Genital Herpes
• Human Papillomavirus (HPV)
• Syphilis
• Bacterial Vaginosis
• Trichomoniasis
• Viral Hepatitis
• HIV/AIDS
• During Pregnancy

Gonorrhea and Chlamydia

Gonorrhea and chlamydia are bacterial STDs/STIs that can be treated with antibiotics given either orally or by injection. Because the infections often occur together, people who have one infection are typically treated for both by their health care provider. Recent sexual partners should be treated at the same time.

Genital Herpes

Genital herpes outbreaks can be treated with antiviral drugs. Although this medication can limit the length and severity of outbreaks, it does not cure the infection. In addition, daily suppressive therapy (daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners. A pregnant woman known to have the infection must take additional care because she can pass the infection to her infant during delivery. Women who first acquire genital HSV during pregnancy are at highest risk of transmission to their infants. If a pregnant woman has an outbreak when she goes into labor, she may need to have a cesarean section (C-section) to prevent the infant from getting the virus during birth.

Human Papillomavirus (HPV)

A person who has an HPV infection cannot be cured. However, many HPV infections can be prevented with vaccination. Furthermore, a health care provider can treat genital warts caused by the virus as well as monitor and control a woman's risk of cervical cancer through frequent screening with Pap smear tests.

Syphilis

If recognized during the early stages, usually within the first year of infection, syphilis can be treated with a singular intramuscular injection of antibiotic. A person being treated for syphilis must avoid sexual contact until the chancre sores caused by the bacteria are completely healed to avoid infecting other people.

If a person does not recognize the infection early, or does not seek treatment immediately, longer treatment with antibiotics may be required. If left untreated, the infection can progress even further and potentially cause death. Although antibiotics can prevent the infection from getting worse, they cannot reverse damage that has already occurred.

Bacterial Vaginosis

Bacterial vaginosis can be treated with antibiotics, typically metronidazole or clindamycin. Generally, male sexual partners of women with bacterial vaginosis do not need to be treated because treatment of partners has not been shown to reduce the risk of recurrence.

Treatment during pregnancy is recommended primarily for women at risk for preterm labor or having a low birthweight infant.

Trichomoniasis

Trichomoniasis can be treated with a single dose of an antibiotic, usually either metronidazole or tinidazole, taken by mouth. Often, Trichomonas infection recurs, so it is important to make sure that both you and your sexual partners are treated if you are diagnosed with this infection.

Viral Hepatitis

• Hepatitis A virus (HAV) infects the liver and may cause abdominal pain, nausea, and vomiting. Usually the infection gets better on its own without requiring treatment. In some cases, however, individuals may have lasting damage to their livers or may have such severe nausea and vomiting that they must be admitted to the hospital.
• Hepatitis B virus (HBV) can cause a lifelong infection but can be treated with antiviral medications. People with HBV infection will need to see a liver specialist with experience treating individuals with chronic liver disease. These individuals need to take special care not to pass on the virus to their sexual partners, and sexual partners should receive hepatitis B vaccine if not already immune.
• Hepatitis C virus can cause immediate illness affecting the liver or, more commonly, it can be a silent, chronic infection. As with hepatitis B, individuals with HCV may have a lifelong infection and will always be at risk of passing the virus on to their sexual partners. New treatments are available that can clear the infection in some individuals.

HIV/AIDS

There is no cure for HIV/AIDS. However, research into new treatments has improved outcomes for people living with the disease. A combination of antiretroviral drugs can be given in highly active antiretroviral therapy to control the virus, promote a healthy immune system, help people with the virus live longer lives, and reduce the risk of transmission.

During Pregnancy

Pregnant women who have certain types of STDs/STIs may pass them on to their infants during pregnancy or delivery. Therefore, it is important for women to be tested for such STDs/STIs as part of their early prenatal care to help ensure delivery of a healthy infant.

 

The specific treatment will depend on which STD/STI is involved.

Sexually Transmitted Diseases (STDs): Other FAQs

Basic information for topics, such as “What is it?” and “How many people are affected?” is available in the Condition Information section. In addition, Frequently Asked Questions (FAQs) that are specific to a certain topic are answered in this section.

Am I at risk for STDs/STIs?

STDs/STIs affect men and women of all races, backgrounds, sexual orientations, and economic levels. Anyone who is having or has had vaginal, anal, or oral sex has some degree of risk for an STD/STI. In fact, some STDs/STIs can be passed through sexual play that does not involve intercourse.

You can analyze your risk for STDs/STIs with the STD Wizard—a free interactive online tool based on the Centers for Disease Control and Prevention's (CDC's) STD Treatment Guidelines. The STD Wizard recommends tests and vaccines based on your responses concerning some of your personal characteristics and behaviors. You can use these recommendations to start a discussion with your health care provider about your STD/STI risk and the tests you may need. The STD Wizard is available in both English and Spanish.

How can I avoid getting a sexually transmitted disease or sexually transmitted infection (STD/STI)?

The most reliable ways to avoid STDs/STIs are to abstain from sexual contact or to be in a long-term monogamous relationship with a partner who has been tested and is uninfected. In addition, the following measures can also help you avoid STDs/STIs:

• Know your sexual partner's STD/STI and health history.
• Talk to your health care provider about your risk, and get tested for STDs/STIs.
• Get vaccinated against hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomavirus (HPV).
• Use latex condoms correctly and consistently.

Remember, however, that while condoms greatly reduce the chance of getting certain STDs/STIs, such as gonorrhea, condoms cannot fully protect against infection because viruses and some bacteria can be passed from person to person by skin-to-skin contact in the genital area not covered by a condom

What should I do if I have been diagnosed with an STD/STI?

You should see your health care provider for treatment as soon as possible after receiving a diagnosis of an STD/STI. You also should notify, either yourself or with the help of the local health department, all recent sex partners and advise them to see their health care providers and be treated. These steps will reduce your risk of becoming re-infected, help avoid spreading the STD/STI to other people, and decrease the risk that your previous sexual partners will develop serious complications from the STD/STI. You and all of your sex partners must avoid sex until treatment is complete and all symptoms have disappeared.

In the case of STDs/STIs caused by viruses with no cure (for example, HIV, genital herpes, or hepatitis), special care and preventive measures can help control the infection, limit symptoms, and help maximize health.

Are there disorders or conditions associated with sexually transmitted diseases and sexually transmitted infections (STDs/STIs)?

STDs/STIs in women can cause pelvic inflammatory disease (PID), which may result in infertility (difficulty getting pregnant).

Men with STDs/STIs also can have problems with infertility.

Additionally, a person with an STD/STI other than HIV is two to five times more likely to contract the HIV virus than a person without an STD/STI. If a person is already HIV positive, having another STD/STI increases the chances that he or she will pass the virus on to his or her sexual partner.

Some STDs/STIs, such as human papillomavirus, viral hepatitis, and HIV, increase the risk of some forms of cancer.

Certain STDs/STIs can pass from a pregnant woman to the fetus in her womb. The effects can be life threatening, as is the case with HIV. Other STDs/STIs can cause a range of disorders in the infant, including deafness, blindness, and intellectual disability.

Can a sexually transmitted disease or sexually transmitted infection (STD/STI) lead to cancer?

Having an STD/STI increases a person's risk for several types of cancer.

Certain high-risk types of human papillomavirus (HPV) can cause cervical cancer in women. In men, HPV infection can lead to the development of penile cancers. HPV also can cause cancers of the mouth, throat, and anus in both sexes. 

Acquiring viral hepatitis B or C puts a person at risk for liver cancer, and untreated HIV/AIDS increases risk for several types of rare cancers, including lymphomas, sarcomas, and cervical cancer

If I have a sexually transmitted disease or sexually transmitted infection (STD/STI), will I be able to get pregnant?

Having an STD/STI will not prevent a woman from getting pregnant.

However, in some instances, women who have had STDs/STIs may have difficulty getting pregnant because of scarring and damage to their reproductive organs leading to infertility. This situation is particularly common in women who have had pelvic inflammatory disease. Additionally, early during pregnancy, STDs/STIs may increase the risk of miscarriage

What is the link between sexually transmitted diseases or sexually transmitted infections (STDs/STIs) and infertility?

In most cases, STDs/STIs are linked to infertility primarily when they are left untreated.

For instance, chlamydia and gonorrhea are sexually transmitted bacterial infections that can be cured easily with antibiotics. Left untreated, 10% to 20% of chlamydial and gonorrheal infections in women can result in pelvic inflammatory disease (PID)—a condition that can cause long-term complications, such as chronic pelvic pain, ectopic pregnancy (pregnancy outside of the uterus), and infertility.

Additionally, infections with gonorrhea and chlamydia may not cause symptoms and may go unnoticed. These undiagnosed and untreated infections can lead to severe health consequences, especially in women, causing permanent damage to reproductive organs.

The Ccenters for Disease Control and Prevention estimates that these infections cause infertility in at least 24,000 women each year. Although infertility is less common among men, it does occur. More commonly, untreated chlamydia and gonorrhea infections in men may cause epididymitis, a painful infection in the tissue surrounding the testicles, or urethritis, an infection of the urinary canal in the penis, which causes painful urination and fever.

Additional information on PID is available from the National Institute of Allergy and Infectious Diseases.

How do sexually transmitted diseases and sexually transmitted infections (STDs/STIs) affect pregnancy?

STDs/STIs pose special risks for pregnant women and their infants.

If a mother has an STD/STI, it is possible for the fetus or newborn to become infected. Some STDs/STIs, including chlamydia, gonorrhea, genital herpes, and cytomegalovirus can be passed from mother to infant during delivery when the infant passes through an infected birth canal. A few STDs/STIs, including syphilis, HIV, and CMV, can infect a fetus before birth during the pregnancy. It is important for a pregnant woman to be tested for STDs/STIs, including HIV/AIDS and syphilis, as a part of her prenatal care.

STD/STI testing as a part of prenatal care can determine if an expectant mother or her sexual partner has an infection that can be cured with drug treatment. Early treatment decreases the chances that the infant will contract the disease. While not all STDs/STIs can be cured, the mother and her health care provider can take steps to protect her and her infant.

To reduce the chance of certain STDs/STIs spreading to the infant during delivery, the health care provider might recommend a cesarean delivery.

In most hospitals, infants’ eyes are routinely treated with an antibiotic ointment shortly after birth. This is to prevent blindness due to exposure to gonorrhea or chlamydia bacteria during delivery if the pregnant woman had an undetected infection.

STDs/STIs during pregnancy can also cause:

• Miscarriage
• Ectopic pregnancy (when the embryo implants outside of the uterus, usually in a fallopian tube)
• Preterm labor and delivery (before 37 completed weeks of pregnancy)
• Low birth weight
• Birth defects, including blindness, deafness, bone deformities, and intellectual disability
• Stillbirth
• Illness in the newborn period (first month of life)
• Newborn death

STDs/STIs are of special concern during pregnancy and pose significant health risks to unborn infants:

• HIV/AIDS. HIV can be passed from mother to infant during pregnancy before birth, at the time of delivery, or after birth during breastfeeding.
• Gonorrhea. If a pregnant woman has a gonorrheal infection, she may give the infection to her infant as the infant passes through the birth canal during delivery. This infection in an infant can cause eye infections, pneumonia, or infections of the joints or blood. Treating gonorrhea as soon as it is detected in pregnant women will reduce the risk of transmission.
• Chlamydia. Similar to a gonorrheal infection, a chlamydial infection at the time of delivery can lead to eye infections or pneumonia in the infant. However, chlamydial infection during pregnancy also has been associated with an increased risk of preterm birth and its complications.
• Genital herpes. Pregnant women newly infected with genital herpes late in pregnancy have a 30% to 60% chance of infecting the infant they carry. The risk of infection is particularly high during delivery. Herpes infections in newborns are serious and potentially life-threatening. Infection with the herpes virus during pregnancy or at the time of delivery can lead to brain damage, blindness, and damage to other organs.
  • If a pregnant woman has had genital herpes in the past, there are medications that she can take to reduce the chance that she will have an outbreak and thus reduce the risk to her infant.
  • If a woman has active herpes sores when she goes into labor, the infant can be delivered by cesarean section to reduce the chance that the infant will come in contact with the virus.
• Hepatitis B virus. If a woman is infected with the hepatitis B virus during pregnancy, the virus also could infect her fetus. The likelihood of this occurrence depends on when the mother was infected. If the mother acquires the infection early in her pregnancy, the chance that the virus will infect her fetus is less than 10%. However, if the infection occurs later in her pregnancy, the risk goes up to 90%. Hepatitis B can be severe in infants and can threaten their lives. It also can lead to liver scarring, failure, and cancer, which can be fatal in up to 25% of cases. In addition, infected newborns have a very high risk of becoming carriers of the hepatitis B virus and can spread the infection to others.
  • In some cases, if a woman is exposed to hepatitis B during pregnancy, she may be treated with a special antibody to reduce the likelihood that she will get the infection. All healthy infants should be vaccinated against hepatitis B to give them lifelong protection against the virus. Infants born to women with evidence of ongoing hepatitis B infection (hepatitis B surface antigen positive) should also receive hepatitis B hyperimmune globulin as soon as possible after birth.
• Cytomegalovirus (CMV). CMV is a common virus present in many body fluids that can be spread through close personal contact, such as kissing or sharing eating utensils, as well as sexual contact. The virus is common in the general population and usually does not cause health problems. However, if an expectant mother acquires the virus for the first time during pregnancy, the risk is high that she will pass it on to her infant. Unfortunately, a pregnant woman may not even know she has the infection, and she may still pass the virus on to her infant.⁷ CMV in an infant can lead to serious illness, lasting disabilities, or death. Each year in the United States, an estimated 40,000 infants are born with CMV infection, causing an estimated 400 deaths and leaving about 8,000 infants with permanent disabilities, such as hearing or vision loss, or intellectual disability. Currently routine screening for CMV in pregnancy is not recommended. Researchers are working on treatments for CMV and also vaccines to try to prevent new infections during pregnancy and to reduce the risk of transmission to the infant.

Sexually Transmitted Diseases (STDs): NICHD Research Information

STDs/STIs have enormous effects on the health of individuals and society. Consequently, STDs/STIs are an active focus of the NICHD’s research. While many effective, commonly available interventions can reduce the incidence of STDs/STIs, these interventions are not always implemented, in part because of complicating social factors. As a result, STDs/STIs are often difficult to prevent, diagnose, and treat, and this situation has a serious impact on public health. The NICHD’s portfolio covers a variety of topics in STDs/STI research with a focus on understanding epidemiology and improving screening, education, and preventative health interventions.

Sexually Transmitted Diseases (STDs): NICHD Research Goals

The NICHD focuses a great deal of its research on factors and behaviors that affect the risk of contracting or spreading STDs/STIs and works to develop new interventions to prevent the spread of STDs/STIs in vulnerable populations. Also, since 1987, the NICHD has supported research and training activities that have helped to establish and define the field of contraceptive microbicides, products that both prevent pregnancy and reduce the transmission of STDs, including HIV.

NICHD-supported researchers are also trying to understand the best ways to communicate with people about STDs/STIs and effective preventive measures. Some of this research includes studying attitudes, perception, and knowledge of STDs/STIs and their prevention; understanding the use and misuse of contraception to prevent STDs/STIs; and understanding the misinformation surrounding the topic while aiming to identify the best settings for providing education about sexual health.

Because preventing and treating STDs/STIs is a major goal for the NIH and its Institutes, the NICHD conducts and supports a variety of clinical trials on STDs/STIs, including HIV

NIAID: National Institute of Allergy and Infectious Diseases, NIH

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 Pelvic Inflammatory Disease (PID) - CDC Fact Sheet

 Untreated sexually transmitted diseases (STDs) can cause pelvic inflammatory disease (PID), a serious condition, in women. 1 in 8 women with a history of PID experience difficulties getting pregnant. You can prevent PID if you know how to protect yourself.

What is PID?

Pelvic inflammatory disease is an infection of a woman’s reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID.

How do I get PID?

You are more likely to get PID if you

• Have an STD and do not get treated;
• Have more than one sex partner;
• Have a sex partner who has sex partners other than you;
• Have had PID before;
• Are sexually active and are age 25 or younger;
• Douche;
• Use an intrauterine device (IUD) for birth control.

How can I reduce my risk of getting PID?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting PID:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

How do I know if I have PID?

There are no tests for PID. A diagnosis is usually based on a combination of your medical history, physical exam, and other test results. You may not realize you have PID because your symptoms may be mild, or you may not experience any symptoms. However, if you do have symptoms, you may notice

• Pain in your lower abdomen;
• Fever;
• An unusual discharge with a bad odor from your vagina;
• Pain and/or bleeding when you have sex;
• Burning sensation when you urinate; or
• Bleeding between periods.

You should

• Be examined by your doctor if you notice any of these symptoms;
• Promptly see a doctor if you think you or your sex partner(s) have or were exposed to an STD;
• Promptly see a doctor if you have any genital symptoms such as an unusual sore, a smelly discharge, burning when peeing, or bleeding between periods;
• Get a test for chlamydia every year if you are sexually active and 25 years of age or younger;
• Have an honest and open talk with your health care provider if you are sexually active and ask whether you should be tested for other STDs.

Can PID be cured?

Yes, if PID is diagnosed early, it can be treated. However, treatment won’t undo any damage that has already happened to your reproductive system. The longer you wait to get treated, the more likely it is that you will have complications from PID. While taking antibiotics, your symptoms may go away before the infection is cured. Even if symptoms go away, you should finish taking all of your medicine. Be sure to tell your recent sex partner(s), so they can get tested and treated for STDs, too. It is also very important that you and your partner both finish your treatment before having any kind of sex so that you don’t re-infect each other.

You can get PID again if you get infected with an STD again. Also, if you have had PID before, you have a higher chance of getting it again.

What happens if I don't get treated?

If diagnosed and treated early, the complications of PID can be prevented. Some of the complications of PID are

• Formation of scar tissue both outside and inside the fallopian tubes that can lead to tubal blockage;
• Ectopic pregnancy (pregnancy outside the womb);
• Infertility (inability to get pregnant);
• Long-term pelvic/abdominal pain.

What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is a clinical syndrome that results from the ascension of microorganisms from the cervix and vagina to the upper genital tract. PID can lead to infertility and permanent damage of a woman’s reproductive organs.

How do women get pelvic inflammatory disease?

Women develop PID when certain bacteria, such as chlamydia or gonorrhea, move upward from a woman's vagina or cervix into her reproductive organs. PID is a serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea.

What causes pelvic inflammatory disease?

Many different types of microorganisms can cause PID; therefore, it is a considered a polymicrobial infection. Most cases of PID are caused by gonorrhea and chlamydia. Sexually transmitted disease pathogens Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) have frequently been identified among women with PID infection and these microbes have accounted for a third to a half of the cases  While the focus has been on the role played by STDs, especially CT in the etiology of PID, endogenous microorganisms, including gram positive and negative anaerobic organisms and aerobic/facultative gram positive and negative rods and cocci, found at high levels in women with bacterial vaginosis, also have been implicated in the pathogenesis of PID^. Newer data suggest that Mycoplasm genitalium may also play a role in PID and may be associated with milder symptoms Because of this polymicrobial nature, broad-spectrum regimens that provide adequate coverage of likely pathogens are recommended.

What are the signs and symptoms of pelvic inflammatory disease?

Since some women with PID have subtle or mild symptoms, many episodes of PID can go unrecognized by women and their health care providers. Women with PID present with a variety of clinical signs and symptoms that range from subtle and mild to severe. Some of the signs and symptoms associated with acute PID are nonspecific, so it is important to consider other reproductive tract illnesses and diseases of both the urinary and the gastrointestinal tracts during an evaluation of a sexually active female with lower abdominal pain. Pregnancy must also be excluded. A pregnancy test should always be performed to exclude ectopic pregnancy and because PID can occur concurrently with pregnancy. In the case of subclinical PID, women have mild or no pelvic pain, despite evidence of endometritis or salpingitis.

When symptoms are present, the most common symptoms of PID are

• Lower abdominal pain
• Mild pelvic pain
• Increased vaginal discharge
• Irregular menstrual bleeding
• Fever (>38° C)
• Pain with intercourse
• Painful and frequent urination
• Abdominal tenderness
• Pelvic organ tenderness
• Uterine tenderness (along with endometriosis)
• Adnexal tenderness (along with salpingitis)
• Cervical motion tenderness
• Inflammation

What are the complications of pelvic inflammatory disease?

The risk of developing short and long-term complications from PID depends upon the severity and number of episodes of PID, thereby emphasizing the importance of prompt and appropriate treatment.

Complications of PID include

• Scarred fallopian tube
• Tubo-ovarian abscess (TOA)
• Tubal factor infertility
• Ectopic pregnancy
• Pelvic adhesions
• Chronic pelvic pain

Complications of PID such as chronic pelvic pain and scarring are difficult to treat but sometimes improve with surgery.

Tubo-ovarian abscess (TOA) is a serious short-term complication of PID that is characterized by an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs. The microbiology of TOAs is similar to PID and the diagnosis necessitates initial hospital admission. Treatment includes broad-spectrum antibiotics with or without a drainage procedure, with surgery often reserved for patients with suspected rupture or who fail to respond to antibiotics. Women infected with HIV may be at higher risk for TOA. Mortality from PID is less than 1% and is usually secondary to rupture of a TOA or to ectopic pregnancy.

How is pelvic inflammatory disease diagnosed?

There are no tests specifically for diagnosing PID. Because the diagnosis of PID can be imprecise, clinicians should have a high index of suspicion for the diagnosis. Physical examination findings to detect PID can also vary, and there is no single finding that is sensitive and specific for the diagnosis. When the diagnosis of PID is questionable, or when the illness is severe or not responding to therapy, further investigation may be warranted using other invasive procedures (endometrial biopsy, transvaginal ultrasonography or magnetic resonance imaging, and/or laparoscopy).

What medical examinations and assessments can be performed to diagnose pelvic inflammatory disease?

Clinical providers should perform a physical examination assessing the abdomen for tenderness. Other assessments may include evaluation of the vaginal pH, a whiff test (performed by adding a small amount of potassium hydroxide to a microscopic slide containing the vaginal discharge), and microscopy of the vaginal secretions for the presence of leukocytes, clue cells, and trichomonads.

The cervix should be examined for abnormal cervical and vaginal discharge, and friability. An internal exam should be performed to assess for pelvic organ tenderness and/or a mass. A clinician should also check for fever and for laboratory documentation of cervical infection with NG and CT. However, laboratory confirmation is not necessary to justify initiation of therapy for PID.

A serologic test for human immunodeficiency virus (HIV) is also recommended. A pregnancy test should always be performed to exclude ectopic pregnancy and because PID can occur concurrently with pregnancy. When the diagnosis of PID is questionable, or when the illness is severe or not responding to therapy, further investigation may be warranted using other invasive procedures (endometrial biopsy, transvaginal ultrasonography, magnetic resonance imaging, or laparoscopy).

A bimanual pelvic examination can be performed and may reveal pelvic organ tenderness, uterine tenderness in the case of endometritis, and adnexal tenderness in the case of salpingitis.

Cervical motion tenderness is another common finding in women with PID. Assessment of the lower genital tract (mucopurulent cervical discharge or evidence of WBCs on a microscopic evaluation of a saline preparation of vaginal fluid) can also yield signs of inflammation, which are consistent with the diagnosis of PID.

How is pelvic inflammatory disease treated?

Several types of antibiotics can cure PID. Antibiotic treatment does not, however, reverse any scarring 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 can prevent severe damage to the reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

PID is usually treated with antibiotics to provide empiric, broad spectrum coverage of likely pathogens. Recommended regimens can be found in the 2010 STD Treatment Guidelines. Health care providers should emphasize to their patients that although their symptoms may go away before the infection is cured, they should finish taking all of the prescribed medicine. Additionally, a woman’s sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.

In certain cases, clinicians may recommend hospitalization to treat PID. This decision should be based on the judgment of the health care provider and the use of suggested criteria found in the 2010 STD Treatment Guidelines. If a woman’s symptoms continue, or if an abscess does not resolve, surgery may be needed.

What should a patient do after being diagnosed with pelvic inflammatory disease?

A patient should abstain from sexual intercourse until she and her partner(s) have completed treatment. Female latex condoms are also an option if a woman prefers them or if her male partner chooses not to use male condoms. Women who are told they have an STD and are treated for it should notify all of their recent sex partners so they can see a health care provider and be evaluated for STDs.

The diagnosis of PID provides an opportunity to educate adolescent and young women about prevention of STDs, including abstinence, consistent use of barrier methods of protection, immunization, and the importance of receiving periodic screening for STDs and HIV.

How can pelvic inflammatory disease be prevented?

Latex condoms may reduce the risk of PID. Treating STDs early can prevent PID. Since STDs play a major role in PID, screening and early treatment of infected women and their sex partners can help to minimize the risk of acquisition and continued transmission of STDs and subsequent adverse sequelae. Identifying, testing, and treating women at increased risk of cervical chlamydial infection can reduce the incidence of PID.

Consistent and correct use of latex male condoms can reduce the risk of transmission of chlamydia and gonorrhea and the risk of PID.

CDC recommends that providers screen the following populations for chlamydia and gonorrhea: all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.

What are the risk factors for developing pelvic inflammatory disease?

Risk factors are important considerations in both the clinical management and prevention of upper genital tract infections. As STDs are the most common etiological agents for PID, risk factors for developing PID can be related to those associated with the acquisition of STDs, including early coitarche, young age, alcohol use, inconsistent use of barrier contraceptives, and multiple sexual partners or having one partner with multiple sexual partners. Other factors that have been associated with PID include a prior history of PID, intrauterine device use (IUD) (risk seems to be primarily restricted to the first several weeks following insertion), and douching.

Is the number of women in the United States being diagnosed with pelvic inflammatory disease increasing?

No. Over the last decade, there have been several studies published suggesting overall declines in PID diagnosis in both hospital and ambulatory settings. While no single explanation exists for this declining trend, some have suggested that changes in sexually transmitted disease (STD) rates, increases in chlamydia screening coverage, availability of antimicrobial therapies that increase adherence to treatment, and more sensitive diagnostic technologies, could be impacting PID rates.

Despite declining trends, PID is a frequent and important infection that occurs among women of reproductive age. Based on a nationally representative sample from 2006-2010, 5.0% of U.S. women have reported being treated for PID in their lifetime.

The significant burden of disease attributed to PID comes predominantly from the long-term reproductive sequelae of tubal infection: tubal factor infertility, ectopic pregnancy, and pelvic adhesions, which can lead to chronic pelvic pain. Our knowledge of the longitudinal outcomes for affected women who experience PID is primarily derived from data published using a Scandinavian cohort of inpatients diagnosed with PID. Data from this study indicated that those women with PID were more likely to have ectopic pregnancy (6 times increased rate), tubal factor infertility (ranging 8% after first episode to as high as 40% after three episodes) and chronic pelvic pain (18% following 1 episode).

What is the economic burden of pelvic inflammatory disease in the United States?

A decline in incidence of PID is also reflected in the most recent cost estimates of PID and its sequelae. Direct medical expenditures for PID and its sequelae were estimated at $1.88 billion in 1998, compared to approximately $2.7 billion estimated in 1990. Based on a nationally representative sample from 2006-2010, approximately 4.2% of U.S. women have reported being treated for PID in their lifetime.

How can clinicians manage PID?

A critical component to the outpatient management is short-term follow-up, especially in the adolescent population. Since many adolescent women rely on outpatient services for the evaluation and treatment of STD symptoms, the need for a low diagnostic and management threshold for PID is even more critical, as the likelihood for additional follow-up care is low.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

Sources

American College of Obstetricians and Gynecologists (ACOG). Pelvic Inflammatory Disease. ACOG Patient Education Pamphlet, 1999.

Westrom L and Eschenbach D. In: K. Holmes, P. Sparling, P. Mardh et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, 783-809.

Source: CDC, HHS

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 Bacterial Vaginosis – CDC Fact Sheet

Any woman can get bacterial vaginosis. Having bacterial vaginosis can increase your chance of getting an STD.

What is bacterial vaginosis?

Bacterial vaginosis (BV) is an infection caused when too much of certain bacteria change the normal balance of bacteria in the vagina.

How common is bacterial vaginosis?

Bacterial vaginosis is the most common vaginal infection in women ages 15-44.

How is bacterial vaginosis spread?

We do not know about the cause of BV or how some women get it. BV is linked to an imbalance of “good” and “harmful” bacteria that are normally found in a woman's vagina.

We do know that having a new sex partner or multiple sex partners and douching can upset the balance of bacteria in the vagina and put women at increased risk for getting BV.

However, we do not know how sex contributes to BV. BV is not considered an STD, but having BV can increase your chances of getting an STD. BV may also affect women who have never had sex.

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

How can I avoid getting bacterial vaginosis?

Doctors and scientists do not completely understand how BV is spread, and there are no known best ways to prevent it.

The following basic prevention steps may help lower your risk of developing BV:

• Not having sex;
• Limiting your number of sex partners; and
• Not douching.

I’m pregnant. How does bacterial vaginosis affect my baby?

Pregnant women can get BV. Pregnant women with BV are more likely to have babies who are born premature (early) or with low birth weight than women who do not have BV while pregnant. Low birth weight means having a baby that weighs less than 5.5 pounds at birth.

Treatment is especially important for pregnant women.

How do I know if I have bacterial vaginosis?

Many women with BV do not have symptoms. If you do have symptoms, you may notice a thin white or gray vaginal discharge, odor, pain, itching, or burning in the vagina. Some women have a strong fish-like odor, especially after sex. You may also have burning when urinating; itching around the outside of the vagina, or both.

How will my doctor know if I have bacterial vaginosis?

A health care provider will look at your vagina for signs of BV and perform laboratory tests on a sample of vaginal fluid to determine if BV is present.

Can bacterial vaginosis be cured?

BV will sometimes go away without treatment. But if you have symptoms of BV you should be checked and treated. It is important that you take all of the medicine prescribed to you, even if your symptoms go away. A health care provider can treat BV with antibiotics, but BV can recur even after treatment. Treatment may also reduce the risk for STDs.

Male sex partners of women diagnosed with BV generally do not need to be treated. However, BV may be transferred between female sex partners.

What happens if I don't get treated?

BV can cause some serious health risks, including

• Increasing your chance of getting HIV if you have sex with someone who is infected with HIV;
• If you are HIV positive, increasing your chance of passing HIV to your sex partner;
• Making it more likely that you will deliver your baby too early if you have BV while pregnant;
• Increasing your chance of getting other STDs, such as chlamydia and gonorrhea. These bacteria can sometimes cause pelvic inflammatory disease (PID), which can make it difficult or impossible for you to have children.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

Order Publication Online at www.cdc.gov/std/pub

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

American Sexual Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-9877

Sources

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59(No. RR-12)

Hillier S and Holmes K. Bacterial vaginosis. In: K. Holmes, P. Sparling, P. Mardh et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, 563-586.

CDC: Centers for Disease Control and Prevention

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 Chlamydia - CDC Fact Sheet

Chlamydia is a common sexually transmitted disease (STD) that can be easily cured. If left untreated, chlamydia can make it difficult for a woman to get pregnant.

What is chlamydia?

Chlamydia is a common STD that can infect both men and women. It can cause serious, permanent damage to a woman's reproductive system, making it difficult or impossible for her to get pregnant later on. Chlamydia can also cause a potentially fatal ectopic pregnancy (pregnancy that occurs outside the womb).

How is chlamydia spread?

You can get chlamydia by having vaginal, anal, or oral sex with someone who has chlamydia.

If your sex partner is male you can still get chlamydia even if he does not ejaculate (cum).

If you’ve had chlamydia and were treated in the past, you can still get infected again if you have unprotected sex with someone who has chlamydia.

If you are pregnant, you can give chlamydia to your baby during childbirth.

How can I reduce my risk of getting chlamydia?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting chlamydia:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

Am I at risk for chlamydia?

Anyone who has sex can get chlamydia through unprotected vaginal, anal, or oral sex. However, sexually active young people are at a higher risk of getting chlamydia. This is due to behaviors and biological factors common among young people. Gay, bisexual, and other men who have sex with men are also at risk since chlamydia can be spread through oral and anal sex.

Have an honest and open talk with your health care provider and ask whether you should be tested for chlamydia or other STDs. If you are a sexually active woman younger than 25 years, or an older woman with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection, you should get a test for chlamydia every year. Gay, bisexual, and men who have sex with men; as well as pregnant women should also be tested for chlamydia.

I'm pregnant. How does chlamydia affect my baby?

If you are pregnant and have chlamydia, you can pass the infection to your baby during delivery. This could cause an eye infection or pneumonia in your newborn. Having chlamydia may also make it more likely to deliver your baby too early.

If you are pregnant, you should be tested for chlamydia at your first prenatal visit. Testing and treatment are the best ways to prevent health problems.

How do I know if I have chlamydia?

Most people who have chlamydia have no symptoms. If you do have symptoms, they may not appear until several weeks after you have sex with an infected partner. Even when chlamydia causes no symptoms, it can damage your reproductive system.

Women with symptoms may notice

• An abnormal vaginal discharge;
• A burning sensation when urinating.

Symptoms in men can include

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

Men and women can also get infected with chlamydia in their rectum, 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;
• Bleeding.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or bleeding between periods.

How will my doctor know if I have chlamydia?

There are laboratory tests to diagnose chlamydia. Your health care provider may ask you to provide a urine sample or may use (or ask you to use) a cotton swab to get a sample from your vagina to test for chlamydia.

Can chlamydia be cured?

Yes, chlamydia can be cured with the right treatment. It is important that you take all of the medication your doctor prescribes to cure your infection. When taken properly it will stop the infection and could decrease your chances of having complications later on. Medication for chlamydia should not be shared with anyone.

Repeat infection with chlamydia is common. You should be tested again about three months after you are treated, even if your sex partner(s) was treated.

I was treated for chlamydia. When can I have sex again?

You should not have sex again until you and your sex partner(s) have completed treatment. If your doctor prescribes a single dose of medication, you should wait seven days after taking the medicine before having sex. If your doctor prescribes a medicine for you to take for seven days, you should wait until you have taken all of the doses before having sex.

What happens if I don't get treated?

The initial damage that chlamydia causes often goes unnoticed. However, chlamydia can lead to serious health problems.

If you are a woman, untreated chlamydia can spread to your uterus and fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease (PID). PID often has no symptoms, however some women may have abdominal and pelvic pain. Even if it doesn’t cause symptoms initially, PID can cause permanent damage to your reproductive system and lead to long-term pelvic pain, inability to get pregnant, and potentially deadly ectopic pregnancy (pregnancy outside the uterus).

Men rarely have health problems linked to chlamydia. Infection sometimes spreads to the tube that carries sperm from the testicles, causing pain and fever. Rarely, chlamydia can prevent a man from being able to have children.

Untreated chlamydia may also increase your chances of getting or giving HIV – the virus that causes AIDS.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

American Sexual Health Association (ASHA)
P.O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-9877

CDC:Centers for Disease Control and Prevention

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Anyone who is sexually active can get gonorrhea. Gonorrhea can cause very serious complications when not treated, but can be cured with the right medication.

What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) that can infect both men and women. It can cause infections in the genitals, rectum, and throat. It is a very common infection, especially among young people ages 15-24 years.

How is gonorrhea spread?

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

How can I reduce my risk of getting gonorrhea?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting gonorrhea:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

Am I at risk for gonorrhea?

Any sexually active person can get gonorrhea through unprotected vaginal, anal, or oral sex.

If you are sexually active, have an honest and open talk with your health care provider and ask whether you should be tested for gonorrhea or other STDs. If you are a sexually active man who is gay, bisexual, or who has sex with men, you should be tested for gonorrhea every year. If you are a sexually active women younger than 25 years or an older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection, you should be tested for gonorrhea every year.

I'm pregnant. How does gonorrhea affect my baby?

If you are pregnant and have gonorrhea, you can give the infection to your baby during delivery. This can cause serious health problems for your baby. If you are pregnant, it is important that you talk to your health care provider so that you get the correct examination, testing, and treatment, as necessary. Treating gonorrhea as soon as possible will make health complications for your baby less likely.

How do I know if I have gonorrhea?

Some men with gonorrhea may have no symptoms at all. However, men who do 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).

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. Women with gonorrhea are at risk of developing serious complications from the infection, even if they don’t have any symptoms.
Symptoms in women can include:

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

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 movements.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or bleeding between periods.

How will my doctor know if I have gonorrhea?

Most of the time, urine can be used to test for gonorrhea. However, if you have had oral and/or anal sex, swabs may be used to collect samples from your throat and/or rectum. In some cases, a swab may be used to collect a sample from a man’s urethra (urine canal) or a woman’s cervix (opening to the womb).

Can gonorrhea be cured?

Yes, gonorrhea can be cured with the right treatment. It is important that you take all of the medication your doctor prescribes to cure your infection. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not undo any permanent damage caused by the disease.

It is becoming harder to treat some gonorrhea, as drug-resistant strains of gonorrhea are increasing. If your symptoms continue for more than a few days after receiving treatment, you should return to a health care provider to be checked again.

I was treated for gonorrhea. When can I have sex again?

You should wait seven days after finishing all medications before having sex. To avoid getting infected with gonorrhea again or spreading gonorrhea to your partner(s), you and your sex partner(s) should avoid having sex until you have each completed treatment. If you’ve had gonorrhea and took medicine in the past, you can still get infected again if you have unprotected sex with a person who has gonorrhea.

What happens if I don’t get treated?

Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, untreated gonorrhea can cause pelvic inflammatory disease (PID). Some of the complications of PID are

• Formation of scar tissue that blocks fallopian tubes;
• Ectopic pregnancy (pregnancy outside the womb);
• Infertility (inability to get pregnant);
• Long-term pelvic/abdominal pain.

In men, gonorrhea can cause a painful condition in the tubes attached to the testicles. In rare cases, this may cause a man to be sterile, or prevent him from being able to father a child.
Rarely, untreated gonorrhea can also spread to your blood or joints. This condition can be life-threatening.

Untreated gonorrhea may also increase your chances of getting or giving HIV – the virus that causes AIDS.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

CDC: Centers for Disease Control and Prevention

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Herpes is a common sexually transmitted disease (STD) that any sexually active person can get. Most people with the virus don’t have symptoms. It is important to know that even without signs of the disease, it can still spread to sexual partners.

What is genital herpes?

Genital herpes is an STD caused by two types of viruses. The viruses are called herpes simplex type 1 and herpes simplex type 2.

How common is genital herpes?

Genital herpes is common in the United States. In the United States, about one out of every six people aged 14 to 49 years have genital herpes.

How is genital herpes spread?

You can get herpes by having vaginal, anal, or oral sex with someone who has the disease.

Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. You can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected because the virus can be released through your skin and spread the infection to your sex partner(s).

How can I reduce my risk of getting herpes?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting herpes:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

Herpes symptoms can occur in both male and female genital areas that are covered by a latex condom. However, outbreaks can also occur in areas that are not covered by a condom so condoms may not fully protect you from getting herpes.

I'm pregnant. How could genital herpes affect my baby?

If you are pregnant and have genital herpes, it is even more important for you to go to prenatal care visits. You need to tell your doctor if you have ever had symptoms of, been exposed to, or been diagnosed with genital herpes. Sometimes genital herpes infection can lead to miscarriage. It can also make it more likely for you to deliver your baby too early. Herpes infection can be passed from you to your unborn child and cause a potentially deadly infection (neonatal herpes). It is important that you avoid getting herpes during pregnancy.

If you are pregnant and have genital herpes, you may be offered herpes medicine towards the end of your pregnancy to reduce the risk of having any symptoms and passing the disease to your baby. At the time of delivery your doctor should carefully examine you for symptoms. If you have herpes symptoms at delivery, a ‘C-section’ is usually performed.

How do I know if I have genital herpes?

Most people who have herpes have no, or very mild symptoms. You may not notice mild symptoms or you may mistake them for another skin condition, such as a pimple or ingrown hair. Because of this, most people who have herpes do not know it.

Genital herpes sores usually appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take weeks to heal. These symptoms are sometimes called “having an outbreak.” The first time someone has an outbreak they may also have flu-like symptoms such as fever, body aches, or swollen glands.

Repeat outbreaks of genital herpes are common, especially during the first year after infection. Repeat outbreaks are usually shorter and less severe than the first outbreak. Although the infection can stay in the body for the rest of your life, the number of outbreaks tends to decrease over a period of years.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or, for women specifically, bleeding between periods.

How will my doctor know if I have herpes?

Often times, your healthcare provider can diagnose genital herpes by simply looking at your symptoms. Providers can also take a sample from the sore(s) and test it. Have an honest and open talk with your health care provider and ask whether you should be tested for herpes or other STDs.

Can herpes be cured?

There is no cure for herpes. However, there are medicines that can prevent or shorten outbreaks. One of these herpes medicines can be taken daily, and makes it less likely that you will pass the infection on to your sex partner(s).

What happens if I don't get treated?

Genital herpes can cause painful genital sores and can be severe in people with suppressed immune systems. If you touch your sores or the fluids from the sores, you may transfer herpes to another part of your body, such as your eyes. Do not touch the sores or fluids to avoid spreading herpes to another part of your body. If you touch the sores or fluids, immediately wash your hands thoroughly to help avoid spreading your infection.

Some people who get genital herpes have concerns about how it will impact their overall health, sex life, and relationships. It is best for you to talk to a health care provider about those concerns, but it also is important to recognize that while herpes is not curable, it can be managed. Since a genital herpes diagnosis may affect how you will feel about current or future sexual relationships, it is important to understand how to talk to sexual partners about STDs. You can find one resource here: GYT Campaign.

If you are pregnant, there can be problems for you and your unborn child. See “I’m pregnant. How could genital herpes affect my baby?” above for information about this.

Can I still have sex if I have herpes?

If you have herpes, you should tell your sex partner(s) and let him or her know that you do and the risk involved. Using condoms may help lower this risk but it will not get rid of the risk completely. Having sores or other symptoms of herpes can increase your risk of spreading the disease. Even if you do not have any symptoms, you can still infect your sex partners.

What is the link between genital herpes and HIV?

Genital herpes can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum. The genital sores caused by herpes can bleed easily. When the sores come into contact with the mouth, vagina, or rectum during sex, they increase the risk of giving or getting HIV if you or your partner has HIV.

 

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention

Personal health inquiries and information about STDs:

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

Resources:

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

Source: Centers for Disease Control and Prevention. HHS

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People who have STDs are more likely to get HIV, when compared to people who do not have STDs.

Are some STDs associated with HIV?

Yes. In the United States, people who get syphilis, gonorrhea, and herpes often also have HIV, or are more likely to get HIV in the future.

Why does having an STD put me more at risk for getting HIV?

If you get an STD you are more likely to get HIV than someone who is STD-free. This is because the same behaviors and circumstances that may put you at risk for getting an STD can also 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.

What activities can put me at risk for both STDs and HIV?

• Having anal, vaginal, or oral sex without a condom;
• Having multiple sex partners;
• Having anonymous sex partners;
• Having sex while under the influence of drugs or alcohol can lower inhibitions and result in greater sexual risk-taking.

What can I do to prevent getting STDs and HIV?

The only way to avoid STDs is to not have vaginal, anal, or oral sex. If you are sexually active, you can do the following things to lower your chances of getting STDs and HIV:

• Choose less risky sexual behaviors
• Use condoms consistently and correctly;
• Reduce the number of people with whom you have sex;
• Limit or eliminate drug and alcohol use before and during sex;
• Have an honest and open talk with your healthcare provider and ask whether you should be tested for STDs and HIV;
• Talk to your healthcare provider and find out if pre-exposure prophylaxis, or PrEP, is a good option for you to prevent HIV infection.

If I already have HIV, and then I get an STD, does that put my sex partner(s) at an increased risk for getting HIV?

It can. If you already have HIV, and then get another STD, it can put your HIV-negative partners at greater risk of getting HIV from you.

Your sex partners are less likely to get HIV from you if you

• Use antiretroviral therapy (ART).  ART reduces the amount of virus (viral load) in your blood and body fluids. ART can keep you healthy for many years, and greatly reduce your chance of transmitting HIV to sex partners, if taken consistently.
• Choose less risky sexual behaviors.
• Use condoms consistently and correctly.

The risk of getting HIV may also be reduced if your partner takes pre-exposure prophylaxis, or PrEP, after discussing this option with his or her healthcare provider and determining whether it is appropriate.

Will treating STDs prevent me from getting HIV?  

No. It’s not enough.  

If you get treated for an STD, this will help to prevent its complications, and prevent spreading STDs to your sex partners. Treatment for an STD other than HIV does not prevent the spread of HIV.

If you are diagnosed with an STD, talk to your doctor about ways to protect yourself and your partner(s) from getting reinfected with the same STD, or getting HIV.

 

People who have STDs are more likely to get HIV, when compared to people who do not have STDs.

Are STDs related to HIV?

Yes. In the United States, people who get syphilis, gonorrhea, and herpes often also have HIV or are more likely to get HIV in the future.  One reason is the behaviors that put someone at risk for one infection (not using condoms, multiple partners, anonymous partners) often put them at risk for other infections.  Also, because STD and HIV tend to be linked, when someone gets an STD it suggests they got it from someone who may be at risk for other STD and HIV.  Finally, a sore or inflammation from an STD may allow infection with HIV that would have been stopped by intact skin.

STDs can increase the risk of spreading HIV.

HIV-infected persons are more likely to shed HIV when they have urethritis or a genital ulcer. When HIV-infected persons get another STD such as gonorrhea or syphilis, it suggests that they were having sex without using condoms. If so, they may have spread HIV to their partners.

Some STDs are more closely linked to HIV than others.  

In the US, both syphilis and HIV are highly concentrated epidemics among men who have sex with men. In 2012, approximately 75% of persons reported with syphilis in the U.S. were MSM.  In Florida, in 2010, among all persons diagnosed with infectious syphilis 42% were also HIV infected. Men who get syphilis are at very high risk of being diagnosed with HIV in the future; among HIV-uninfected men who got syphilis in Florida in 2003, 22% were newly diagnosed with HIV by 2011.  HIV is more closely linked to gonorrhea than chlamydia (which is particularly common among young women).  Herpes is also commonly associated with HIV; a meta-analysis found persons infected with HSV-2 are at 3-fold increased risk for acquiring HIV infection.

Some activities can put people at increased risk for both STDs and HIV.

• Having anal, vaginal, or oral sex without a condom;
• Having multiple sex partners;
• Having anonymous sex partners;
• Having sex while under the influence of drugs or alcohol can lower inhibitions and result in greater sexual risk taking.

Does treating STDs prevent HIV?  

Not by itself. Given the close link between STD and HIV in many studies, it seems obvious that treating STDs should reduce the risk of HIV.  However, studies that have lowered the risk of STD in communities have not necessarily lowered the risk of HIV.  Risk of HIV was lowered in one community trial, but not in 3 others.  

• In Mwanza (Tanzania), improved STD treatment lowered 2-year HIV incidence by 40% in the intervention towns (1.2%) compared to other towns (1.9%).
• In Rakai (Uganda), a more intensive intervention (mass treatment and improved STD control) was done, leading to lower rates of syphilis and trichomoniasis, but the incidence of HIV was the same in intervention and comparison towns (1.5% per year).
• A third community trial found no difference in HIV incidence when behavioral plus STD control interventions were compared to usual services (Incidence rate ratio = 1.00), despite lower rates of syphilis (rate ratio 0.52) and gonorrhea (rate ratio 0.25).
• A fourth community trial found HIV incidence was slightly higher in communities that received a combination of interventions including improved STD treatment when compared to control communities (incidence rate ratio 1.27, not statistically significant).

Treating individuals for STDs has also not necessarily lowered their risk of acquiring HIV.

• One study found there was slightly lower risk of HIV seroconversion among female sex workers who had monthly exams for STD (5.3%) compared to sex workers who were examined when they had symptoms (7.6%, P=0.5); their rates of infection were lower for trichomonas (14% vs 7% P=0.07) but not for gonorrhea, chlamydia, or genital ulcers.
• A second trial in female sex workers found a slightly higher incidence of HIV among women who received monthly treatment with azithromycin (4%) compared to women who did not (3.2%, P=0.5) despite major differences in the incidence of infection with gonorrhea (relative risk RR 0.46), chlamydia (RR 0.38), and trichomoniasis (RR 0.56).

Three placebo-controlled trials have assessed the benefit to individuals from treatment with acyclovir to suppress genital herpes ulcers:

• One enrolled female sex workers who were infected with HSV but not HIV; it found no impact on HIV incidence in the acyclovir group (4.29%) compared to the placebo group (4.25%), though it also found no difference in reported episodes of genital ulceration or in measured HSV shedding.
• A second study of HIV acquisition among persons infected with HSV-2 included women and men who have sex with men; HIV incidence was similar in the acyclovir group (3.9%) and the placebo group (3.3%) despite a 47% reduction in observed genital ulcers in the acyclovir group.
• The third study looked at the effect of acyclovir on HIV transmission from heterosexuals infected with both HIV and HSV-2 to their HIV-uninfected partners; after removing 29% of new infections that were apparently acquired from an outside partner, the incidence was similar in the acyclovir group (1.8%) and the placebo group (1.9%, P=0.69) despite major reductions in genital ulcer disease (risk ratio 0.39).

Screening for STDs can help assess a person’s risk for getting HIV. Treatment of STDs is important to prevent the complications of those infections, and to prevent transmission to partners, but it should not be expected to prevent spread of HIV.  

What can people do to reduce their risk of getting STDs and HIV?

The only way to avoid STDs is to not have vaginal, anal, or oral sex. If people are sexually active, they can do the following things to lower their chances of getting STDs and HIV:

• Choose less risky sexual behaviors;
• Use condoms consistently and correctly;
• Reduce the number of people with whom they have sex;
• Limit or eliminate drug and alcohol use before and during sex;
• Have an honest and open talk with their healthcare provider and ask whether they should be tested for STDs and HIV.
• Talk with their healthcare provider and find out if pre-exposure prophylaxis, or PrEP, is a good option for them to prevent HIV infection.

If someone already has HIV, and subsequently gets an STD, does that put their sex partner(s) at an increased risk for getting HIV?

It can. HIV-negative sex partners are at greater risk of getting HIV from someone who is HIV-positive and acquires another STD. The HIV-negative sex partners of persons who are HIV-positive are less likely to get HIV if:

• HIV-positive persons use antiretroviral therapy (ART).  ART reduces the amount of virus (viral load) in blood and body fluids. ART can keep HIV-positive persons healthy for many years, and greatly reduce the chance of transmitting HIV to sex partners if taken consistently.
• Sex partners take pre-exposure prophylaxis (PrEP) after discussing this option with his/her healthcare provider and determining whether it is appropriate.
• Choose less risky sexual behaviors.
• Use condoms consistently and correctly.

Will treating someone for STDs prevent them from getting HIV?  

No. It’s not enough. Screening for STDs can help assess a person’s risk for getting HIV.  Treatment of STDs is important to prevent the complications of those infections, and to prevent transmission to partners, but it should not be expected to prevent spread of HIV.  

If someone HIV-positive is diagnosed with an STD, they should receive counseling about risk reduction and how to protect their sex partner(s) from getting re-infected with the same STD or getting HIV.

Where can I get more information?

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

CDC: Centers for Disease Control and Prevention. HHS

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Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Some health effects caused by HPV can be prevented with vaccines.

What is HPV?

HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). HPV is so common that nearly all sexually active men and women get it at some point in their lives. 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.

How is HPV spread?

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. HPV can be passed even when an infected person has no signs or symptoms.

Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected making it hard to know when you first became infected.

Does HPV cause health problems?

In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and 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 a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.

Does HPV cause cancer?

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, including the base of the tongue and tonsils (called oropharyngeal cancer).

Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.

There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including individuals with HIV/AIDS) may be less able to fight off HPV and more likely to develop health problems from it.

How can I avoid HPV and the health problems it can cause?

You can do several things to lower your chances of getting HPV.

Get vaccinated. HPV vaccines are safe and effective. They can protect males and females against diseases (including cancers) caused by HPV when given in the recommended age groups (see “Who should get vaccinated?” below). HPV vaccines are given in three shots over six months; it is important to get all three doses.

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 latex condoms the right way every time you have sex. This can lower your chances of getting HPV. But HPV can infect areas that are not covered by a condom - so condoms may not give full protection against getting HPV;
• Be in a mutually monogamous relationship – or have sex only with someone who only has sex with you.

Who should get vaccinated?

All boys and girls ages 11 or 12 years should get vaccinated.

Catch-up vaccines are recommended for males through age 21 and for females through age 26, if they did not get vaccinated when they were younger.

The vaccine is also recommended for gay and bisexual men (or any man who has sex with a man) through age 26. It is also recommended for men and women with compromised immune systems (including people living with HIV/AIDS) through age 26, if they did not get fully vaccinated when they were younger.

How do I know if I have 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.

There are HPV tests that can be used to screen for cervical cancer. These tests are recommended for screening only in women aged 30 years and older. They are not recommended to screen men, adolescents, or women under the age of 30 years.

Most people with HPV do not know they are infected and 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.

How common is HPV and the health problems caused by HPV?

HPV (the virus): About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that most sexually-active men and women will get at least one type of HPV at some point in their lives.

Health problems related to HPV include genital warts and cervical cancer.

Genital warts: About 360,000 people in the United States get genital warts each year.

Cervical cancer: More than 11,000 women in the United States get cervical cancer each year.

There are other conditions and cancers caused by HPV that occur in persons living in the United States.

I'm pregnant. Will having HPV affect my pregnancy?

If you are pregnant and have HPV, you can get genital warts or develop abnormal cell changes on your cervix. Abnormal cell changes can be found with routine cervical cancer screening. You should get routine cervical cancer screening even when you are pregnant.

Can I be treated for HPV or health problems caused by HPV?

There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause:

1. Genital warts can be treated by you or your physician. If left untreated, genital warts may go away, stay the same, or grow in size or number.
2. Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. For more information visit www.cancer.org.
3. Other HPV-related cancer are also more treatable when diagnosed and treated early. For more information visit www.cancer.org. All STD Fact Sheets

Where can I get more information?

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

National HPV and Cervical Cancer Prevention Resource Center American Sexual Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC
27709-3827
1-800-783-9877

CDC: Centers for Disease Control and Prevention, HHS

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Syphilis is a sexually transmitted disease (STD) that can have very serious complications when left untreated, but it is simple to cure with the right treatment.

What is syphilis?

Syphilis is an STD that can cause long-term complications if not treated correctly. Symptoms in adults are divided into stages. These stages are primary, secondary, latent, and late syphilis.

How is syphilis spread?

You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores can be found on the penis, vagina, anus, in the rectum, or on the lips and in the mouth. Syphilis can also be spread from an infected mother to her unborn baby.

What does syphilis look like?

Syphilis has been called ‘the great imitator’ because it has so many possible symptoms, many of which look like symptoms from other diseases. The painless syphilis sore that you would get after you are first infected can be confused for an ingrown hair, zipper cut, or other seemingly harmless bump. The non-itchy body rash that develops during the second stage of syphilis can show up on the palms of your hands and soles of your feet, all over your body, or in just a few places. You could also be infected with syphilis and have very mild symptoms or none at all.

How can I reduce my risk of getting syphilis?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting syphilis:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex. Condoms prevent transmission of syphilis by preventing contact with a sore. Sometimes sores occur in areas not covered by a condom. Contact with these sores can still transmit syphilis.

Am I at risk for syphilis?

Any sexually active person can get syphilis through unprotected vaginal, anal, or oral sex. Have an honest and open talk with your health care provider and ask whether you should be tested for syphilis or other STDs. You should get tested regularly for syphilis if you are pregnant, are a man who has sex with men, have HIV infection, and/or have partner(s) who have tested positive for syphilis.

I’m pregnant. How does syphilis affect my baby?

If you are pregnant and have syphilis, you can give the infection to your unborn baby. Having syphilis can lead to a low birth weight baby. It can also make it more likely you will deliver your baby too early or stillborn (a baby born dead). To protect your baby, you should be tested for syphilis during your pregnancy and at delivery and receive immediate treatment if you test positive.

An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies can have health problems such as cataracts, deafness, or seizures, and can die.

How do I know if I have syphilis?

Symptoms of syphilis in adults can be divided into stages:

Primary Stage

During the first (primary) stage of syphilis, you may notice a single sore, but there may be multiple sores. The sore is the location where syphilis entered your body. The sore is usually firm, round, and painless. Because the sore is painless, it can easily go unnoticed. The sore lasts 3 to 6 weeks and heals regardless of whether or not you receive treatment. Even though the sore goes away, you must still receive treatment so your infection does not move to the secondary stage.

Secondary Stage

During the secondary stage, you may have skin rashes and/or sores in your mouth, vagina, or anus (also called mucous membrane lesions). 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 can look like rough, red, or reddish brown spots on the palms of your hands and/or the bottoms of your feet. The rash usually won’t itch and it is sometimes so faint that you won’t notice it. Other symptoms you may have can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue (feeling very tired). The symptoms from this stage will go away whether or not you receive treatment. Without the right treatment, your infection will move to the latent and possibly late stages of syphilis.

Latent and Late Stages

The latent stage of syphilis begins when all of the symptoms you had earlier disappear. If you do not receive treatment, you can continue to have syphilis in your body for years without any signs or symptoms. Most people with untreated syphilis do not develop late stage syphilis. However, when it does happen it is very serious and would occur 10–30 years after your infection began. Symptoms of the late stage of syphilis include difficulty coordinating your muscle movements, paralysis (not able to move certain parts of your body), numbness, blindness, and dementia (mental disorder). In the late stages of syphilis, the disease damages your internal organs and can result in death.

A syphilis infection is called an ‘early’ case if a patient has been infected for a year or less, such as during the primary or secondary stages of syphilis. People who have ‘early’ syphilis infections can more easily spread the infection to their sex partners. The majority of early syphilis cases are currently found among men who have sex with men, but women and unborn children are also at risk of infection.

How will my doctor know if I have syphilis?

Most of the time, a blood test can be used to test for syphilis. Some health care providers will diagnose syphilis by testing fluid from a syphilis sore.

Can syphilis be cured?

Yes, syphilis can be cured with the right antibiotics from your health care provider. However, treatment will not undo any damage that the infection has already done.

I’ve been treated. Can I get syphilis again?

Having syphilis once does not protect you from getting it again. Even after you’ve been successfully treated, you can still be re-infected. Only laboratory tests can confirm whether you have syphilis. Follow-up testing by your health care provider is recommended to make sure that your treatment was successful.

Because syphilis sores can be hidden in the vagina, anus, under the foreskin of the penis, or in the mouth, it may not be obvious that a sex partner has syphilis. Unless you know that your sex partner(s) has been tested and treated, you may be at risk of getting syphilis again from an untreated sex partner.

CDC

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Most people who have trichomoniasis do not have any symptoms.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

 Source: Centers for Disease Control and Prevention, HHS

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Did I get scabies from my pet?

No. Animals do not spread human scabies. Pets can become infested with a different kind of scabies mite that does not survive or reproduce on humans but causes "mange" in animals. If an animal with "mange" has close contact with a person, the animal mite can get under the person’s skin and cause temporary itching and skin irritation. However, the animal mite cannot reproduce on a person and will die on its own in a couple of days. Although the person does not need to be treated, the animal should be treated because its mites can continue to burrow into the person’s skin and cause symptoms until the animal has been treated successfully.

Can scabies be spread by swimming in a public pool?

Scabies is spread by prolonged skin-to-skin contact with a person who has scabies. Scabies sometimes also can be spread by contact with items such as clothing, bedding, or towels that have been used by a person with scabies, but such spread is very uncommon unless the infested person has crusted scabies.

Scabies is very unlikely to be spread by water in a swimming pool. Except for a person with crusted scabies, only about 10-15 scabies mites are present on an infested person; it is extremely unlikely that any would emerge from under wet skin.

Although uncommon, scabies can be spread by sharing a towel or item of clothing that has been used by a person with scabies.

How can I remove scabies mites from my house or carpet?

Scabies mites do not survive more than 2-3 days away from human skin. Items such as bedding, clothing, and towels used by a person with scabies can be decontaminated by machine-washing in hot water and drying using the hot cycle or by dry-cleaning. Items that cannot be washed or dry-cleaned can be decontaminated by removing from any body contact for at least 72 hours.

Because persons with crusted scabies are considered very infectious, careful vacuuming of furniture and carpets in rooms used by these persons is recommended.

Fumigation of living areas is unnecessary.

How can I remove scabies mites from my clothes?

Scabies mites do not survive more than 2-3 days away from human skin. Items such as bedding, clothing, and towels used by a person with scabies can be decontaminated by machine-washing in hot water and drying using the hot cycle or by dry-cleaning. Items that cannot be washed or dry-cleaned can be decontaminated by removing from any body contact for at least 72 hours.

My spouse and I were diagnosed with scabies. After several treatments, he/she still has symptoms while I am cured. Why?

The rash and itching of scabies can persist for several weeks to a month after treatment, even if the treatment was successful and all the mites and eggs have been killed. Your health care provider may prescribe additional medication to relieve itching if it is severe. Symptoms that persist for longer than 2 weeks after treatment can be due to a number of reasons, including:

• Incorrect diagnosis of scabies. Many drug reactions can mimic the symptoms of scabies and cause a skin rash and itching; the diagnosis of scabies should be confirmed by a skin scraping that includes observing the mite, eggs, or mite feces (scybala) under a microscope. If you are sleeping in the same bed with your spouse and have not become reinfested, and you have not retreated yourself for at least 30 days, then it is unlikely that your spouse has scabies.
• Reinfestation with scabies from a family member or other infested person if all patients and their contacts are not treated at the same time; infested persons and their contacts must be treated at the same time to prevent reinfestation.
• Treatment failure caused by resistance to medication, by faulty application of topical scabicides, or by failure to do a second application when necessary; no new burrows should appear 24-48 hours after effective treatment.
• Treatment failure of crusted scabies because of poor penetration of scabicide into thick scaly skin containing large numbers of scabies mites; repeated treatment with a combination of both topical and oral medication may be necessary to treat crusted scabies successfully.
• Reinfestation from items (fomites) such as clothing, bedding, or towels that were not appropriately washed or dry-cleaned (this is mainly of concern for items used by persons with crusted scabies); potentially contaminated items (fomites) should be machine washed in hot water and dried using the hot temperature cycle, dry-cleaned, or removed from skin contact for at least 72 hours.
• An allergic skin rash (dermatitis); or
• Exposure to household mites that cause symptoms to persist because of cross-reactivity between mite antigens.

If itching continues more than 2-4 weeks or if new burrows or rash continue to appear, seek the advice of a physician; retreatment with the same or a different scabicide may be necessary.

If I come in contact with a person who has scabies, should I treat myself?

No. If a person thinks he or she might have scabies, he/she should contact a doctor. The doctor can examine the person, confirm the diagnosis of scabies, and prescribe an appropriate treatment. Products used to treat scabies in humans are available only with a doctor’s prescription.

Sleeping with or having sex with any scabies infested person presents a high risk for transmission. The longer a person has skin-to-skin exposure, the greater is the likelihood for transmission to occur. Although briefly shaking hands with a person who has non-crusted scabies could be considered as presenting a relatively low risk, holding the hand of a person with scabies for 5-10 minutes could be considered to present a relatively high risk of transmission. However, transmission can occur even after brief skin-to-skin contact, such as a handshake, with a person who has crusted scabies. In general, a person who has skin-to-skin contact with a person who has crusted scabies would be considered a good candidate for treatment.

To determine when prophylactic treatment should be given to reduce the risk of transmission, early consultation should be sought with a health care provider who understands:

1. the type of scabies (i.e. non-crusted vs crusted) to which a person has been exposed;
2. the degree and duration of skin exposure that a person has had to the infested patient;
3. whether the exposure occurred before or after the patient was treated for scabies; and,
4. whether the exposed person works in an environment where he/she would be likely to expose other people during the asymptomatic incubation period. For example, a nurse or caretaker who works in a nursing home or hospital often would be treated prophylactically to reduce the risk of further scabies transmission in the facility.

 Source: Centers for Disease Control and Prevention, HHS

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Hepatitis A FAQs for Health Professionals

Index of Questions

Overview and Statistics

What is the case definition for acute Hepatitis A?

The clinical case definition for acute viral hepatitis is 1) discrete onset of symptoms (e.g., nausea, anorexia, fever, malaise, or abdominal pain) and 2) jaundice or elevated serum aminotransferase levels. Because the clinical characteristics are the same for all types of acute viral hepatitis, Hepatitis A diagnosis must be confirmed by a positive serologic test for immunoglobulin M (IgM) antibody to Hepatitis A virus, or the case must meet the clinical case definition and occur in a person who has an epidemiologic link with a person who has laboratory-confirmed Hepatitis A (i.e., household or sexual contact with an infected person during the 15–50 days before the onset of symptoms).

The case definition for acute Hepatitis A is available at the following link: Acute Hepatitis A

Additional guidance on viral hepatitis surveillance and case management is available at http://www.cdc.gov/hepatitis/SurveillanceGuidelines.htm.

How common is Hepatitis A virus (HAV) infection in the United States?

Hepatitis A rates in the United States have declined by 95% since Hepatitis A vaccine first became available in 1995.

In 2012, 1,562 acute symptomatic cases of Hepatitis A were reported; The overall incidence rate for 2012 was 0.5 cases per 100,000. After adjusting for asymptomatic infection and underreporting, the estimated number of new infections was 3,000.

How is HAV transmitted?

• Person-to-person transmission through the fecal-oral route (i.e., ingestion of something that has been contaminated with the feces of an infected person) is the primary means of HAV transmission in the United States. Most infections result from close personal contact with an infected household member or sex partner.
• Common-source outbreaks and sporadic cases also can occur from exposure to fecally contaminated food or water. Uncooked HAV-contaminated foods have been recognized as a source of outbreaks. Cooked foods also can transmit HAV if the temperature during food preparation is inadequate to kill the virus or if food is contaminated after cooking, as occurs in outbreaks associated with infected food handlers. Waterborne outbreaks are infrequent in developed countries with well-maintained sanitation and water supplies.

Who is at increased risk for acquiring HAV infection?

• Travelers to countries with high or intermediate endemicity of HAV infection
• Men who have sex with men
• Users of injection and non-injection illegal drugs
• Persons with clotting factor disorders
• Persons working with nonhuman primates

What are the signs and symptoms of HAV infection?

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice

In children aged 70% of patients.

When symptoms occur, how long do they usually last?

Symptoms usually last less than 2 months, although 10%–15% of symptomatic persons have prolonged or relapsing disease for up to 6 months.

What is the incubation period for Hepatitis A?

The average incubation period for Hepatitis A is 28 days (range: 15–50 days).

How long does HAV survive outside the body? How can the virus be killed?

HAV can live outside the body for months, depending on the environmental conditions. The virus is killed by heating to >185 degrees F (>85 degrees C) for one minute. However, the virus can still be spread from cooked food if it is contaminated after cooking. Adequate chlorination of water, as recommended in the United States, kills HAV that enters the water supply.

Can Hepatitis A become chronic?

No. Hepatitis A does not become chronic.

Can persons become reinfected with HAV after recovering from Hepatitis A?

No. IgG antibodies to HAV, which appear early in the course of infection, provide lifelong protection against the disease.

How is HAV infection prevented?

Vaccination with the full, two-dose series of Hepatitis A vaccine is the best way to prevent HAV infection. Hepatitis A vaccine has been licensed in the United States for use in persons 12 months of age and older. The vaccine is recommended for persons who are more likely to get HAV infection or are more likely to get seriously ill if they get Hepatitis A, and for any person wishing to obtain immunity (see Who should be vaccinated against Hepatitis A?).

Immune globulin is available for short-term protection (approximately 3 months) against Hepatitis A, both pre- and post-exposure. Immune globulin must be administered within 2 weeks after exposure for maximum protection.

Good hygiene — including handwashing after using the bathroom, changing diapers, and before preparing or eating food — is also integral to Hepatitis A prevention, given that the virus is transmitted through the fecal–oral route. Environmental surfaces can be cleaned with a freshly prepared solution of 1:100 dilution of household bleach.

 Hepatitis A Vaccination

Who should be vaccinated against Hepatitis A?

Hepatitis A vaccination is recommended for all children at age 1 year, for persons who are at increased risk for infection, for persons who are at increased risk for complications from Hepatitis A, and for any person wishing to obtain immunity. The following groups are recommended to receive Hepatitis A vaccination:

Which Hepatitis A vaccines are licensed for use in the United States?

Two single-antigen Hepatitis A vaccines, HAVRIX® (manufactured by GlaxoSmithKline) and VAQTA® (manufactured by Merck & Co., Inc), are currently licensed in the United States. A combination vaccine, TWINRIX® (manufactured by GlaxoSmithKline), contains both HAV (in a lower dosage; see table) and Hepatitis B virus antigens. All are inactivated vaccines.

What are the dosages and schedules for Hepatitis A vaccines?

 Licensed dosages and schedules for HAVRIX ^{® 1}

Age	Dose (ELISA units)2	Volume (mL)	No. of doses	Schedule (mos)3
12 mos–18 yrs	720	0.5	2	0,6-12
≥19 years	1,440	1.0	2	0,6-12

¹Hepatitis A vaccine, inactivated, GlaxoSmithKline.
²Enzyme-linked immunosorbent assay units.
³0 months represents timing of the initial dose; subsequent numbers represent months after the initial dose.

Licensed dosages and schedules for VAQTA ® 1
Age	Dose (U.)2	Volume (mL)	No. of doses	Schedule (mos)3
12 mos–18 yrs	25	0.5	2	0,6-18
≥19 years	50	1.0	2	0,6-18

¹Hepatitis A vaccine, inactivated, Merck & Co., Inc.
²Units.
³0 months represents timing of the initial dose; subsequent numbers represent months after the initial dose.

TWINRIX ^{® 1} (HepAHepB) Vaccine Schedule (Not recommended for post exposure prophylaxis)

 Licensed dosages and schedules for TWINRIX ^{® 1}

Age	Dose (ELISA units)2	Volume (mL)	No. of doses	Schedule
≥ 18 yrs	720	1.0	3	0, 1, 6 mos
≥ 18 yrs	720	1.0	4	0, 7, 21–30 days + 12 mos3

¹Combined Hepatitis A and Hepatitis B vaccine, inactivated, GlaxoSmithKline.
²Enzyme-linked immunosorbent assay units.
³This 4-dose schedule enables patients to receive 3 doses in 21 days; this schedule is used prior to planned exposure with short notice and requires a fourth dose at 12 months.

How long does protection from Hepatitis A vaccine last?

A recent review by an expert panel, which evaluated the projected duration of immunity from vaccination, concluded that protective levels of antibody to HAV could be present for at least 25 years in adults and at least 14–20 years in children.

Can Hepatitis A vaccine be administered concurrently with other vaccines?

Yes. Hepatitis B, diphtheria, poliovirus (oral and inactivated), tetanus, oral and intramuscular typhoid, cholera, Japanese encephalitis, rabies, and yellow fever vaccines and immune globulin can be given at the same time that Hepatitis A vaccine is given, but at a different injection site.

Can a patient receive the first dose of Hepatitis A vaccine from one manufacturer and the second (last) dose from another manufacturer?

Yes. Although studies have not been done to examine this issue, there is no reason to believe that using single-antigen vaccine from different manufacturers would be a problem.

What should be done if the second (last) dose of Hepatitis A vaccine is delayed?

The second dose should be administered as soon as possible. The first dose does not need to be readministered.

Can Hepatitis A vaccine be given during pregnancy?

The safety of Hepatitis A vaccination during pregnancy has not been determined; however, because the vaccine is produced from inactivated HAV, the theoretical risk to the developing fetus is expected to be low. The risk associated with vaccination, however, should be weighed against the risk for Hepatitis A in women who might be at high risk for exposure to HAV.

Can Hepatitis A vaccine be given to immunocompromised persons (e.g., persons on hemodialysis or persons with AIDS)?

Yes. Because Hepatitis A vaccine is inactivated, no special precautions need to be taken when vaccinating immunocompromised persons.

Is it harmful to administer an extra dose(s) of Hepatitis A or Hepatitis B vaccine or to repeat the entire vaccine series if documentation of vaccination history is unavailable?

No. If necessary, administering extra doses of Hepatitis A or Hepatitis B vaccine is not harmful.

Should prevaccination testing be performed before administering Hepatitis A vaccine?

• Persons who were born in geographic areas with high or intermediate prevalence of HAV infection
• Older adolescents and adults in certain population groups (i.e., American Indians, Alaska Natives, and Hispanics)
• Adults in groups that have a high prevalence of infection (e.g., injection drug users)

Prevaccination testing might also be warranted for all older adults. The decision to test should be based on 1) the expected prevalence of immunity, 2) the cost of vaccination compared with the cost of serologic testing, and 3) the likelihood that testing will not interfere with initiation of vaccination.

Should postvaccination testing be performed?

No. Postvaccination testing is not indicated because of the high rate of vaccine response among adults and children. In addition, not all testing methods approved for routine diagnostic use in the United States have the sensitivity to detect low, but protective, anti-HAV concentrations after vaccination.

Which groups do NOT need routine vaccination against Hepatitis A?

Hepatitis A and International Travel

Who should receive protection against Hepatitis A before travel?

All susceptible persons traveling to or working in countries that have high or intermediate rates of Hepatitis A should be vaccinated or receive immune globulin (IG) before traveling. Persons from developed countries who travel to developing countries are at high risk for Hepatitis A. The risk for Hepatitis A exists even for travelers to urban areas, those who stay in luxury hotels, and those who report that they have good hygiene and that they are careful about what they drink and eat. For more information on international travel and HAV, see CDC's travel page at http://wwwn.cdc.gov/travel/yellowBookCh4-HepA.aspx .

How soon before travel should the first dose of Hepatitis A vaccine be given?

The first dose of Hepatitis A vaccine should be administered as soon as travel is considered.

Previously, Hepatitis A vaccination was recommended to be administered at least 2–4 weeks before departure to an area with intermediate or high rates of Hepatitis A. Travelers who were departing in less than 2 weeks were recommended to receive receive immune globulin (IG) for short-term protection.

However, on the basis of data indicating that immune globulin and vaccine have equivalent postexposure efficacy among healthy persons aged ≤40 years, the Advisory Committee on Immunization Practices (ACIP) has amended its guidelines for Hepatitis A vaccination for travelers. ACIP now recommends that one dose of single-antigen Hepatitis A vaccine administered at any time before departure may provide adequate protection for most healthy persons.

For optimal protection, older adults, immunocompromised persons, and persons with chronic liver disease or other chronic medical conditions who are planning to depart in ≤2 weeks should receive the initial dose of vaccine and also can simultaneously be administered IG (0.02 mL/kg) at a separate anatomic injection site.

What should be done if a traveler cannot receive Hepatitis A vaccine?

Travelers who are allergic to a vaccine component, who elect not to receive vaccine, or who are aged

What should be done for travelers less than 12 months of age?

Immune globulin is recommended because Hepatitis A vaccine is currently not approved for use in this age group.

Postexposure Prophylaxis for Hepatitis A

What are the current CDC guidelines for postexposure protection against Hepatitis A?

Until recently, an injection of immune globulin (IG) was the only recommended way to protect people after they have been exposed to Hepatitis A virus. In June 2007, U.S. guidelines were revised to allow for Hepatitis A vaccine to be used after exposure to prevent infection in healthy persons aged 1–40 years.

• For healthy persons aged 12 months–40 years, single-antigen Hepatitis A vaccine at the age-appropriate dose is preferred to IG because of the vaccine’s advantages, including long-term protection and ease of administration, as well as the equivalent efficacy of vaccine to IG.
• For persons aged 40 years and older, IG is preferred because of the absence of information regarding vaccine performance in this age group and because of the more severe manifestations of Hepatitis A in older adults. The magnitude of the risk of HAV transmission from the exposure should be considered in decisions to use vaccine or IG in this age group. 
• Vaccine can be used if IG cannot be obtained.
• IG should be used for children aged less than12 months, immunocompromised persons, persons with chronic liver disease, and persons who are allergic to the vaccine or a vaccine component (see Footnote).

Footnote:

• CDC does not have official guidance to define all subgroups of persons recommended to receive IG.
• IG is indicated for persons at increased risk of severe or fatal hepatitis A infection. These persons include adults older than 40 years of age, particularly adults 75 years and older, persons with chronic liver disease (e.g., cirrhosis), and those who are immunocompromised. 
• IG is indicated for persons with decreased response to hepatitis A vaccine. Based on available data such persons include those with HIV/AIDs, persons undergoing hemodialysis, recipients of solid organ, bone marrow or stem cell transplants, persons with chronic liver disease (e.g., cirrhosis), and other patients unlikely to develop an adequate immune response.  Also, antibody response after a single dose of hepatitis A vaccine in persons older than 40 years may be reduced, but data are limited.
• Immunocompromised persons generally are incapable of developing a normal immune response, usually as a result of disease, malnutrition, or immunosuppressive therapy.  IG is indicated for patients who might include those receiving high dose steroids, chemotherapy, immunomodulators, and those who have primary immunodeficiency conditions.  Clinical guidance should be obtained if the immune status is unclear.

Who requires protection (i.e., IG or Hepatitis A vaccine) after exposure to HAV?

• Household and sex contacts
• Persons who have shared illicit drugs with someone with Hepatitis A

Consideration should also be given to providing IG or Hepatitis A vaccine to persons with other types of ongoing, close personal contact with a person with Hepatitis A (e.g., a regular babysitter or caretaker).

• Postexposure prophylaxis (PEP) should be administered to all previously unvaccinated staff and attendees of child care centers or homes if 1) one or more cases of Hepatitis A are recognized in children or employees or 2) cases are recognized in two or more households of center attendees.
• In centers that provide care only to older children who no longer wear diapers, PEP need be administered only to classroom contacts of the index patient (i.e., not to children or staff in other classrooms).
• When an outbreak occurs (i.e., Hepatitis A cases in three or more families), PEP should also be considered for members of households that have diaper-wearing children attending the center.

Persons exposed to a common source, such as an infected food handler. If a food handler receives a diagnosis of Hepatitis A, post-exposure prophylaxis (PEP) should be administered to other food handlers at the same establishment. Because transmission to patrons is unlikely, PEP administration to patrons typically is not indicated but may be considered if 1) during the time when the food handler was likely to be infectious, the food handler both directly handled uncooked foods or foods after cooking and had diarrhea or poor hygienic practices, and 2) patrons can be identified and treated within 2 weeks of exposure.

In settings in which repeated exposures to HAV might have occurred, such as institutional cafeterias, stronger consideration of PEP use might be warranted.

If a case of Hepatitis A is found in a school, hospital, or office setting, what should be done?

If a single case of Hepatitis A is identified in a school (other than a child care setting in which children wear diapers), office, or other work setting, and if the source of infection is outside the school or work setting, PEP (i.e., injection of IG or Hepatitis A vaccine) is not routinely recommended. Similarly, when a person who has Hepatitis A is admitted to a hospital, staff should not routinely be administered PEP; instead, careful hygienic practices should be emphasized.

However, if it is determined that Hepatitis A has been spread among students in a school or among patients and staff in a hospital, PEP should be administered to unvaccinated persons who have had close contact with an infected person.

 Source: Centers for Disease Control and Prevention, HHS

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Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

Resources:

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

Source: Centers for Disease Control and Prevention, HHS

 

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Types of birth control

• Continuous abstinence
• Natural family planning/rhythm method
• Barrier methods

• Contraceptive sponge
• Diaphragm, cervical cap, and cervical shield
• Female condom
• Male condom

• Hormonal methods

• Oral contraceptives — combined pill ("The pill")
• Oral contraceptives — progestin-only pill ("Mini-pill")
• The patch
• Shot/injection
• Vaginal ring

• Implantable devices

• Implantable rods
• Intrauterine devices

• Permanent birth control methods

• Sterilization implant
• Surgical sterilization

• Emergency contraception

Share this information!

The information on our website is provided by the U.S. federal government and is in the public domain. This public information is not copyrighted and may be reproduced without permission, though citation of each source is appreciated.

Source: Office of Women's Health, HHS

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Emergency contraception (morning after pill, IUD)

Page last reviewed: 13/01/2015

Next review due: 13/01/2017

Source: NHS Choices, UK

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 Sexually transmitted infections (STI) fact sheet

• What is a sexually transmitted infection (STI)?
• How many people have STIs and who is infected?
• How do you get an STI?
• Can STIs cause health problems?
• What are the symptoms of STIs?
• How do you get tested for STIs?
• Who needs to get tested for STIs?
• How are STIs treated?
• What can I do to keep from getting an STI?
• How do STIs affect pregnant women and their babies?
• What can pregnant women do to prevent problems from STIs?
• Do STIs affect breastfeeding?
• Is there any research being done on STIs?
• For more information
• More information on sexually transmitted infections (STI)

What is a sexually transmitted infection (STI)?

It is an infection passed from person to person through intimate sexual contact. STIs are also called sexually transmitted diseases, or STDs.

How many people have STIs and who is infected?

In the United States about 19 million new infections are thought to occur each year. These infections affect men and women of all backgrounds and economic levels. But almost half of new infections are among young people ages 15 to 24. Women are also severely affected by STIs. They have more frequent and more serious health problems from STIs than men. African-American women have especially high rates of infection.

How do you get an STI?

You can get an STI by having intimate sexual contact with someone who already has the infection. You can’t tell if a person is infected because many STIs have no symptoms. But STIs can still be passed from person to person even if there are no symptoms. STIs are spread during vaginal, anal, or oral sex or during genital touching. So it’s possible to get some STIs without having intercourse. Not all STIs are spread the same way.

Can STIs cause health problems?

Yes. Each STI causes different health problems. But overall, untreated STIs can cause cancer, pelvic inflammatory disease, infertility, pregnancy problems, widespread infection to other parts of the body, organ damage, and even death.

Having an STI also can put you at greater risk of getting HIV. For one, not stopping risky sexual behavior can lead to infection with other STIs, including HIV. Also, infection with some STIs makes it easier for you to get HIV if you are exposed.

What are the symptoms of STIs?

Many STIs have only mild or no symptoms at all. When symptoms do develop, they often are mistaken for something else, such as urinary tract infection or yeast infection. This is why screening for STIs is so important. The STIs listed here are among the most common or harmful to women.

Symptoms of sexually transmitted infections

STI	Symptoms
Bacterial vaginosis (BV)	Most women have no symptoms. Women with symptoms may have: Vaginal itching Pain when urinating Discharge with a fishy odor
Chlamydia	Most women have no symptoms. Women with symptoms may have: Abnormal vaginal discharge Burning when urinating Bleeding between periods Infections that are not treated, even if there are no symptoms, can lead to: Lower abdominal pain Low back pain Nausea Fever Pain during sex
Genital herpes	Some people may have no symptoms. During an “outbreak,” the symptoms are clear: Small red bumps, blisters, or open sores where the virus entered the body, such as on the penis, vagina, or mouth Vaginal discharge Fever Headache Muscle aches Pain when urinating Itching, burning, or swollen glands in genital area Pain in legs, buttocks, or genital area Symptoms may go away and then come back. Sores heal after 2 to 4 weeks.
Gonorrhea	Symptoms are often mild, but most women have no symptoms. If symptoms are present, they most often appear within 10 days of becoming infected. Symptoms are: Pain or burning when urinating Yellowish and sometimes bloody vaginal discharge Bleeding between periods Pain during sex Heavy bleeding during periods Infection that occurs in the throat, eye, or anus also might have symptoms in these parts of the body.
Hepatitis B	Some women have no symptoms. Women with symptoms may have: Low-grade fever Headache and muscle aches Tiredness Loss of appetite Upset stomach or vomiting Diarrhea Dark-colored urine and pale bowel movements Stomach pain Skin and whites of eyes turning yellow
HIV/AIDS	Some women may have no symptoms for 10 years or more. About half of people with HIV get flu-like symptoms about 3 to 6 weeks after becoming infected. Symptoms people can have for months or even years before the onset of AIDS include: Fevers and night sweats Feeling very tired Quick weight loss Headache Enlarged lymph nodes Diarrhea, vomiting, and upset stomach Mouth, genital, or anal sores Dry cough Rash or flaky skin Short-term memory loss Women also might have these signs of HIV: Vaginal yeast infections and other vaginal infections, including STIs Pelvic inflammatory disease (PID) that does not get better with treatment Menstrual cycle changes
Human papillomavirus (HPV)	Some women have no symptoms. Women with symptoms may have: Visible warts in the genital area, including the thighs. Warts can be raised or flat, alone or in groups, small or large, and sometimes they are cauliflower-shaped. Growths on the cervix and vagina that are often invisible.
Pubic lice (sometimes called "crabs")	Symptoms include: Itching in the genital area Finding lice or lice eggs
Syphilis	Syphilis progresses in stages. Symptoms of the primary stage are: A single, painless sore appearing 10 to 90 days after infection. It can appear in the genital area, mouth, or other parts of the body. The sore goes away on its own. If the infection is not treated, it moves to the secondary stage. This stage starts 3 to 6 weeks after the sore appears. Symptoms of the secondary stage are: Skin rash with rough, red or reddish-brown spots on the hands and feet that usually does not itch and clears on its own Fever Sore throat and swollen glands Patchy hair loss Headaches and muscle aches Weight loss Tiredness In the latent stage, symptoms go away, but can come back. Without treatment, the infection may or may not move to the late stage. In the late stage, symptoms are related to damage to internal organs, such as the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Some people may die.
Trichomoniasis (sometimes called "trich")	Many women do not have symptoms. Symptoms usually appear 5 to 28 days after exposure and can include: Yellow, green, or gray vaginal discharge (often foamy) with a strong odor Discomfort during sex and when urinating Itching or discomfort in the genital area Lower abdominal pain (rarely)

 How do you get tested for STIs?

There is no one test for all STIs. Ask your doctor about getting tested for STIs. She or he can tell you what test(s) you might need and how it is done. Testing for STIs is also called STI screening. Testing (or screening) for STIs can involve:

• Pelvic and physical exam — Your doctor can look for signs of infection, such as warts, rashes, discharge.
• Blood sample
• Urine sample
• Fluid or tissue sample —  A swab is used to collect a sample that can be looked at under a microscope or sent to a lab for testing.

These methods are used for many kinds of tests. So if you have a pelvic exam and Pap test, for example, don’t assume that you have been tested for STIs. Pap testing is mainly used to look for cell changes that could be cancer or precancer. Although a Pap test sample also can be used to perform tests for HPV, doing so isn’t routine. And a Pap test does not test for other STIs. If you want to be tested for STIs, including HPV, you must ask.

You can get tested for STIs at your doctor’s office or a clinic. But not all doctors offer the same tests. So it’s important to discuss your sexual health history to find out what tests you need and where you can go to get tested.

 Who needs to get tested for STIs?

If you are sexually active, talk to your doctor about STI screening. Which tests you might need and how often depend mainly on your sexual history and your partner’s. Talking to your doctor about your sex life might seem too personal to share. But being open and honest is the only way your doctor can help take care of you. Also, don’t assume you don’t need to be tested for STIs if you have sex only with women. Talk to your doctor to find out what tests make sense for you.

How are STIs treated?

The treatment depends on the type of STI. For some STIs, treatment may involve taking medicine or getting a shot. For other STIs that can’t be cured, like herpes, treatment can help to relieve the symptoms.

Only use medicines prescribed or suggested by your doctor. There are products sold over the Internet that falsely claim to prevent or treat STIs, such as herpes, chlamydia, human papillomavirus, and HIV. Some of these drugs claim to work better than the drugs your doctor will give you. But this is not true, and the safety of these products is not known.

What can I do to keep from getting an STI?

You can lower your risk of getting an STI with the following steps. The steps work best when used together. No single strategy can protect you from every single type of STI.

• Don’t have sex. The surest way to keep from getting any STI is to practice abstinence. This means not having vaginal, oral, or anal sex. Keep in mind that some STIs, like genital herpes, can be spread without having intercourse.
• Be faithful. Having a sexual relationship with one partner who has been tested for STIs and is not infected is another way to lower your risk of getting infected. Be faithful to each other. This means you only have sex with each other and no one else.
• Use condoms correctly and every time you have sex. Use condoms for all types of sexual contact, even if intercourse does not take place. Use condoms from the very start to the very end of each sex act, and with every sex partner. A male latex condom offers the best protection. You can use a male polyurethane condom if you or your partner has a latex allergy. For vaginal sex, use a male latex condom or a female condom if your partner won’t wear a condom. For anal sex, use a male latex condom. For oral sex, use a male latex condom. A dental dam might also offer some protection from some STIs.
• Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs. If you use one of these methods, be sure to also use a condom correctly every time you have sex.
• Talk with your sex partner(s) about STIs and using condoms before having sex. It’s up to you to set the ground rules and to make sure you are protected.
• Don’t assume you’re at low risk for STIs if you have sex only with women. Some common STIs are spread easily by skin-to-skin contact. Also, most women who have sex with women have had sex with men, too. So a woman can get an STI from a male partner and then pass it to a female partner.
• Talk frankly with your doctor and your sex partner(s) about any STIs you or your partner has or has had. Talk about symptoms, such as sores or discharge. Try not to be embarrassed. Your doctor is there to help you with any and all health problems. Also, being open with your doctor and partner will help you protect your health and the health of others.
• Have a yearly pelvic exam. Ask your doctor if you should be tested for STIs and how often you should be retested. Testing for many STIs is simple and often can be done during your checkup. The sooner an STI is found, the easier it is to treat.
• Avoid using drugs or drinking too much alcohol. These activities may lead to risky sexual behavior, such as not wearing a condom.

How do STIs affect pregnant women and their babies?

STIs can cause many of the same health problems in pregnant women as women who are not pregnant. But having an STI also can threaten the pregnancy and unborn baby's health. Having an STI during pregnancy can cause early labor, a woman's water to break early, and infection in the uterus after the birth.

Some STIs can be passed from a pregnant woman to the baby before and during the baby’s birth. Some STIs, like syphilis, cross the placenta and infect the baby while it is in the uterus. Other STIs, like gonorrhea, chlamydia, hepatitis B, and genital herpes, can be passed from the mother to the baby during delivery as the baby passes through the birth canal. HIV can cross the placenta during pregnancy and infect the baby during the birth process.

The harmful effects to babies may include:

• Low birth weight
• Eye infection
• Pneumonia
• Infection in the baby’s blood
• Brain damage
• Lack of coordination in body movements
• Blindness
• Deafness
• Acute hepatitis
• Meningitis
• Chronic liver disease
• Cirrhosis
• Stillbirth

Some of these problems can be prevented if the mother receives routine prenatal care, which includes screening tests for STIs starting early in pregnancy and repeated close to delivery, if needed. Other problems can be treated if the infection is found at birth.

What can pregnant women do to prevent problems from STIs?

Pregnant women should be screened at their first prenatal visit for STIs, including:

• Chlamydia
• Gonorrhea
• Hepatitis B
• HIV
• Syphilis

In addition, some experts recommend that women who have had a premature delivery in the past be screened and treated for bacterial vaginosis (BV) at the first prenatal visit. Even if a woman has been tested for STIs in the past, she should be tested again when she becomes pregnant.

Chlamydia, gonorrhea, syphilis, trichomoniasis, and BV can be treated and cured with antibiotics during pregnancy. Viral STIs, such as genital herpes and HIV, have no cure. But antiviral medication may be appropriate for some pregnant woman with herpes to reduce symptoms. For women who have active genital herpes lesions at the onset of labor, a cesarean delivery (C-section) can lower the risk of passing the infection to the newborn. For women who are HIV positive, taking antiviral medicines during pregnancy can lower the risk of giving HIV to the newborn to less than 2 percent. C-section is also an option for some women with HIV. Women who test negative for hepatitis B may receive the hepatitis B vaccine during pregnancy.

Pregnant women also can take steps to lower their risk of getting an STI during pregnancy.

Do STIs affect breastfeeding?

Talk with your doctor, nurse, or a lactation consultant about the risk of passing the STI to your baby while breastfeeding. If you have chlamydia or gonorrhea, you can keep breastfeeding. If you have syphilis or herpes, you can keep breastfeeding as long as the sores are covered. Syphilis and herpes are spread through contact with sores and can be dangerous to your newborn. If you have sores on your nipple or areola, stop breastfeeding on that breast. Pump or hand express your milk from that breast until the sore clears. Pumping will help keep up your milk supply and prevent your breast from getting engorged or overly full. You can store your milk to give to your baby in a bottle for another feeding. But if parts of your breast pump that contact the milk also touch the sore(s) while pumping, you should throw the milk away.

If you are being treated for an STI, ask your doctor about the possible effects of the drug on your breastfeeding baby. Most treatments for STIs are safe to use while breastfeeding.

Is there any research being done on STIs?

Yes. Research on STIs is a public health priority. Research is focused on prevention, diagnosis, and treatment.

With prevention, researchers are looking at strategies such as vaccines and topical microbicides (meye-KROH-buh-syds). One large study is testing a herpes vaccine for women. Topical microbicides could play a big role in protecting women from getting STIs. But so far, they have been difficult to design. They are gels or creams that would be put into the vagina to kill or stop the STI before it could infect someone. Researchers are also looking at the reasons some people are at higher risk of STIs, and ways to lower these risks.

Early and fast diagnosis of STIs means treatment can start right away. Early treatment helps to limit the effects of an STI and keep it from spreading to others. Researchers are looking at quick, easy, and better ways to test for STIs, including vaginal swabs women can use to collect a sample for testing. They also are studying the reasons why many STIs have no symptoms, which can delay diagnosis.

Research also is underway to develop new ways to treat STIs. For instance, more and more people are becoming infected with types of gonorrhea that do not respond well to drugs. So scientists are working to develop new antibiotics to treat these drug-resistant types. An example of treatment research success is the life-prolonging effects of new drugs used to treat HIV.

More information on sexually transmitted infections (STI)

For more information about sexually transmitted infections (STI), call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, HHS
  Phone: 800-232-4636 (TDD: 888-232-6348)
• National HIV and STD Testing Resources, CDC, HHS
  Phone: 800-458-5231 or 404-679-3860
• National Institute of Allergy and Infectious Diseases, NIH, HHS
  Phone: 866- 284-4107 or 301-496-5717 (TDD: 800-877-8339)

Source: Office on Women's Health, HHS

STD/STS Summaries

What are STDs and sexually transmitted infections(STIs)?

STDs are a group of illnesses that are passed from person to person during sexual intercourse, oral sex, or sex play. These diseases can be caused by bacteria, viruses, yeasts, or parasites and are spread through intimate sexual contact involving the penis, vagina, mouth, or anus. STDs are also called venereal diseases or STIs. Health care professionals prefer the term "infection" rather than "disease," because it is possible for a person to have no symptoms but still carry the bacterium or virus and require treatment. Scientists have identified more than 20 different STDs/STIs.

How many people are affected by or at risk for a sexually transmitted disease or sexually transmitted infection (STD/STI)?

Anyone who has had or is having sexual intercourse or oral sex, or who has participated or is participating in sex play, is at risk for acquiring an STD/STI. Fortunately, it is possible for a person to decrease his or her risk by having protected sex and knowing his or her STD/STI status and that of his or her partner. Still, the Centers for Disease Control and Prevention (CDC) estimates nearly 20 million new cases of these reportable STDs/STIs (gonorrhea, chlamydia, syphilis) occur each year in the United States—almost half of them among young people 15 to 24 years of age.

While not the most common STD/STI, HIV/AIDS is one of the most devastating and most well known. Recent data from the CDC indicate that 1.1 million Americans have HIV:

• One in five is unaware that they have the virus.
• Approximately 50,000 Americans become infected with HIV each year.
• 15,529 people with AIDS died in 2010.

More information about the number of people who test positive for HIV/AIDS in the United States and the differences in these numbers for individuals from different cultures and backgrounds is available at the CDC website.

What are the symptoms of a sexually transmitted disease or sexually transmitted infection (STD/STI)?

People with STDs/STIs may feel ill and notice some of the following signs and symptoms:

• Unusual discharge from the penis or vagina
• Sores or warts on the genital area
• Painful or frequent urination
• Itching and redness in the genital area
• Blisters or sores in or around the mouth
• Abnormal vaginal odor
• Anal itching, soreness, or bleeding
• Abdominal pain
• Fever

In some cases, people with STDs/STIs have no symptoms, and over time the symptoms, if present, can improve on their own. However, it is common for individuals to have an STD/STI and pass it on to others without knowing it.

If you are concerned that you or your sexual partner may have an STD/STI, talk to your health care provider. Even if you do not have symptoms, it is possible you may have an STD/STI that needs to be treated to ensure your and your partner's sexual health.

What causes a sexually transmitted disease or sexually transmitted infection (STD/STI)?

There are two major causes of STDs/STIs:

• Bacteria, including chlamydia, gonorrhea, and syphilis
• Viruses, including HIV/AIDS, herpes simplex virus, human papillomavirus (HPV), hepatitis B virus, and cytomegalovirus (CMV; pronounced sahy-toh-MEG-uh-loh-vahy-ruhs), yeasts and protozoan parasites, such as Trichomonas vaginalis (pronounced TRIK-uh-MOH-nuss vaj-uh-NAHY-lis), or insects such as crab lice or scabies mites, cause STDs/STIs.

Any STD/STI can be spread through sexual intercourse, and some STDs/STIs also are spread through oral sex and sex play. Ejaculation does not have to occur for an STD/STI to be passed from person to person. Sharing contaminated needles used to inject drugs or using contaminated body piercing and tattooing equipment also can transmit some infections, such as HIV or hepatitis B and C.

A few diseases (such as CMV and molluscum contagiosum) can be sexually transmitted but are also spread through nonsexual, close contact. Regardless of how a person is exposed, once a person is infected by an STD/STI, he or she can spread the infection to other people through oral, vaginal, or anal sex, even if he or she has no symptoms.

STDs/STIs are of particular concern in pregnant women, because some infections can be passed on to the infant before birth or during delivery. However, the risk of transmission from mother to infant can be lowered, and it is important for every expectant mother to be screened.

For example, HIV can be passed from mother to infant during pregnancy before birth, at the time of delivery, or after birth during breastfeeding. This transmission can be prevented through treatment with certain medications during pregnancy and near delivery. After birth, women who have HIV should refrain from breastfeeding their infants if safe alternatives, such as infant formula, are available, further reducing the infant's risk.

In other cases, if the mother has an infection such as gonorrhea or herpes, in which risks of transmission are high during delivery, other steps can be taken to reduce the likelihood that the infant will be infected. In these instances, health care providers can treat the pregnant woman for the STD/STI before birth, or the infant can be delivered by cesarean section (also referred to as C section).

CMV affects about 1% of all births. A pregnant woman infected with CMV can transmit the infection to the fetus in the womb, or it can be passed to the infant during delivery or by breastfeeding. She could also pass it to her newborn after birth if the child comes into contact with her body fluids (for example, saliva or urine) carrying the virus. If a health care provider suspects that a woman has a CMV infection during pregnancy, an ultrasound examination, blood tests, and other tests are done to assess the health of the fetus. Most infants who were infected with the virus during pregnancy do not have any detectable problems after birth. But, 10% or 20% will have serious problems, including deafness and intellectual disabilities. If fetal testing shows increased risk of serious problems, some women opt to end the pregnancy. Researchers are studying antiviral drugs, immune treatments, and other medical approaches to control the infection during pregnancy. Some research is focusing on vaccines to prevent CMV infection.

What are some types of sexually transmitted diseases or sexually transmitted infections (STDs/STIs)?

Approximately 20 different infections are known to be transmitted through sexual contact. Here are descriptions of some of the most common and well known:

• Chlamydia
• Gonorrhea
• Genital Herpes
• HIV/AIDS
• Human Papillomavirus (HPV)
• Syphilis
• Bacterial Vaginosis
• Trichomoniasis
• Viral Hepatitis

Chlamydia

Chlamydia1 (pronounced kla-MID-ee-uh) is a common STD/STI caused by the bacterium Chlamydia trachomatis. Chlamydia can be transmitted during vaginal, oral, or anal sexual contact with an infected partner. While many individuals will not experience symptoms, chlamydia can cause fever, abdominal pain, and unusual discharge of the penis or vagina.

In women, whether or not they are having symptoms and know about their infection, chlamydia can cause pelvic inflammatory disease (PID). In PID, the untreated STD/STI progresses and involves other parts of the woman's reproductive system, including the uterus and fallopian tubes. This progression can lead to permanent damage to the woman's reproductive organs. This damage may lead to ectopic pregnancy (in which the fetus develops in abnormal places outside of the womb, a condition that can be life-threatening) and infertility.

Additionally, if the woman is pregnant, her developing fetus is at risk, because chlamydia can be passed on during her pregnancy or delivery and could lead to eye infections or pneumonia in the infant. If chlamydia is detected early, it can be treated easily with an antibiotic taken by mouth.

Gonorrhea

Gonorrhea (pronounced gon-uh-REE-uh) is caused by the bacterium Neisseria gonorrhoeae, which can grow rapidly and multiply easily in the warm, moist areas of the reproductive tract. The most common symptoms of gonorrheal infection are a discharge from the vagina or penis and painful or difficult urination.

As with chlamydial infection, the most common and serious complications of gonorrhea occur in women and include pelvic inflammatory disease ((PID), ectopic pregnancy, infertility, and the potential spread to the developing fetus if acquired during pregnancy. Gonorrhea also can infect the mouth, throat, eyes, and rectum and can spread to the blood and joints, where it can become a life-threatening illness.

In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. HIV-infected people with gonorrhea are also more likely to transmit the virus to someone else.

Genital Herpes

Genital herpes is a contagious infection caused by the herpes simplex virus (HSV). There are two different strains, or types, of HSV: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Both can cause genital herpes, although most cases of genital herpes are caused by HSV-2.⁵ When symptomatic, HSV-1 usually appears as fever blisters or cold sores on the lips, but it can also infect the genital region through oral-genital or genital-genital contact. Symptomatic HSV-2 typically causes painful, watery skin blisters on or around the genitals or anus. However, substantial numbers of people who carry these viruses have no or only minimal signs or symptoms.

Neither HSV-1 nor HSV-2 can be cured, and even during times when an infected person has no symptoms, the virus can be found in the body's nerve cells. Periodically, some people will experience outbreaks in which new blisters form on the skin in the genital area; at those times, the virus is more likely to be passed on to other people.

Pregnant women, especially those who acquire genital herpes for the first time during pregnancy, may pass the infection to their newborns, causing life-threatening neonatal HSV, an infection affecting the infant's skin, brain, and other organs.

HIV/AIDS

HIV, or the human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV destroys the body's immune system by killing the blood cells that fight infection. Once HIV destroys a substantial proportion of these cells, the body's ability to fight off and recover from infections is compromised. This advanced stage of HIV infection is known as AIDS.

 People whose HIV has progressed to AIDS are very susceptible to opportunistic infections that do not normally make people sick and to certain forms of cancer.

AIDS can be prevented by early initiation of antiretroviral therapy in those with HIV infection. Transmission of the virus primarily occurs during unprotected sexual activity and by sharing needles used to inject intravenous drugs, although the virus also can spread from mother to infant during pregnancy, delivery, and breastfeeding.

In 2013, NIH-supported researchers reported that a 2-year-old child who was born with HIV and was treated starting in the first few days of life has had her HIV infection go into remission. This appears to be the first case of functional cure of HIV.

Human Papillomavirus (HPV)

HPV is the most common STD/STI. More than 40 HPV types exist, and all of them can infect both men and women. The types of HPVs vary in their ability to cause genital warts; infect other regions of the body, including the mouth and throat; and cause cancers of the cervix, vulva, penis, and mouth.

Although no cure exists for HPV infection once it occurs, regular screening with a Pap smear test can prevent or detect at an early stage most cases of HPV-caused cervical cancer. (A Pap smear test involves a health care provider taking samples of cells from the cervix during a standard gynecologic exam; these cells are examined under a microscope for signs of developing cancer).

A newly available vaccine protects against most (but not all) HPV types that cause cervical cancer. The American Academy of Pediatrics recommends this vaccine for school-aged boys and girls.

Syphilis

Syphilis infections, caused by the bacterium Treponema pallidum, are passed from person to person during vaginal, anal, or oral sex through direct contact with sores, called chancres. Between 2001 and 2009, the Centers for Disease Control and Prevention (CDC) data show that the syphilis rate increased each year. Those people at highest risk for syphilis include men having sex with both men and women and people residing in the south. The first sign of syphilis is a chancre, a painless genital sore that most often appears on the penis or in and around the vagina. Beyond being the first sign of a syphilis infection, chancres make a person two to five times more likely to contract an HIV infection. If the person is already infected with HIV, chancres also increase the likelihood that the virus will be passed on to a sexual partner. These sores typically resolve on their own, even without treatment. However, the body does not clear the infection on its own, and, over time, syphilis may involve other organs, including the skin, heart, blood vessels, liver, bones, and joints in secondary syphilis. If the illness is still not treated, tertiary syphilis can develop over a period of years and involve the nerves, eyes, and brain and can potentially cause death.

Expectant mothers harboring the bacterium are at an increased risk of miscarriage and stillbirth, and they can pass the infection on to their fetuses during pregnancy and delivery. Infants that acquire congenital syphilis during pregnancy may suffer from skeletal deformity, difficulty with speech and motor development, seizure, anemia, liver disease, and neurologic problems.

Bacterial Vaginosis

Bacterial vaginosis is a common, possibly sexually transmitted, vaginal infection in women of reproductive age. While it is healthy and normal for a vagina to have bacteria, just like the skin, mouth, or gastrointestinal (GI) tract, sometimes changes in the balance of different types of bacteria can cause problems.

Bacterial vaginosis occurs when problematic bacteria that are normally present only in small amounts increase in number, replace normal vaginal lactobacilli bacteria, and upset the usual balance. This situation becomes more likely if a woman douches frequently or has new or multiple sexual partners. The most common sign of a bacterial vaginosis infection is a thin, milky discharge that is often described as having a "fishy" odor. However, some women will have no symptoms at all.

Regardless of symptoms, having bacterial vaginosis increases the risk of getting other STDs/STIs and is also associated with pelvic inflammatory disease (PID), an infection of the female reproductive organs, including the uterus and the fallopian tubes (which carry eggs to the uterus), and postoperative infections. Preterm labor and birth are also possibly more common in women with bacterial vaginosis.

Trichomoniasis

Trichomoniasis12 (pronounced trik-uh-muh-NAHY-uh-sis) infection is caused by the single-celled protozoan parasite Trichomonas vaginalis and is common in young, sexually active women. The parasite also infects men, though less frequently. The parasite can be transmitted between men and women as well as between women whenever physical contact occurs between the genital areas. Although Trichomonas infections do not always cause symptoms, they can cause frequent, painful, or burning urination in men and women as well as vaginal discharge, genital soreness, redness, or itching in women. Because the infection can occur without symptoms, a person may be unaware that he or she is infected and continue to re-infect a sexual partner who is having recurrent signs of infection. As with bacterial STDs/STIs, all sexual partners should be treated at the same time to avoid re-infection.

NICHD-sponsored research has shown that during pregnancy, Trichomonas infection is associated with an increased risk of premature birth and infants with low birth weight. Moreover, infants born to mothers with Trichomonas infection are more than twice as likely as infants born to uninfected women to be stillborn or to die as newborns.

Viral Hepatitis

Viral hepatitis is a serious liver disease that can be caused by several different viruses, which can be transmitted through sexual contact.

• Hepatitis A virus (HAV) causes a short-term or self-limited liver infection that can be quite serious, although it does not result in chronic infection. While there are other ways the virus can be transmitted, HAV can be spread from person to person during sexual activity through oral-rectal contact. Vaccination can prevent HAV infection.
• Hepatitis B virus (HBV) causes a serious liver disease that can result in both immediate illness and lifelong infection leading to permanent liver scarring (cirrhosis), cancer, liver failure, and death. HBV spreads through both heterosexual and homosexual contact as well as through contact with other bodily fluids, such as blood, through shared contaminated needles used for injecting intravenous (IV) drugs, tattooing, and piercing. Pregnant women with HBV can transmit the virus to their infants during delivery. HBV infection is preventable through vaccination.
• Hepatitis C virus (HCV) can cause an immediate illness affecting the liver, but it more commonly becomes a silent, chronic infection that leads to liver scarring (cirrhosis), cancer, liver failure, and death. HCV is most commonly transmitted through sharing needles or exposure to infected blood. However, it can spread through sexual contact or from mother to fetus during pregnancy and delivery. There is no vaccine for HCV, and treatments are not always effective.

How do health care providers diagnose a sexually transmitted disease or sexually transmitted infection (STD/STI)?

Any person who is sexually active should discuss his or her risk factors for STDs/STIs with a health care provider and ask about getting tested. If you are sexually active, it is important to remember that you may have an STD/STI and not know it because many STDs/STIs do not cause symptoms. You should get tested and have regular checkups with a health care provider who can help assess and manage your risk, answer your questions, and diagnose and treat an STD/STI if needed.

Starting treatment quickly is important to prevent transmission of infections to other people and to minimize the long-term complications of STDs/STIs. Recent sexual partners should also be treated to prevent re-infection and further transmission.

Some STDs/STIs may be diagnosed during a physical exam or through microscopic examination of a sore or fluid swabbed from the vagina, penis, or anus. This fluid can also be cultured over a few days to see whether infectious bacteria or yeast can be detected. The effects of human papilloma virus (HPV), which causes genital warts and cervical cancer, can be detected in a woman when her health care provider performs a pap smear test and takes samples of cells from the cervix to be checked microscopically for abnormal changes.¹ Blood tests are used to detect infections such as hepatitis A, B, and C or HIV/AIDS.

Because sexually transmitted diseases are passed from person to person and can have serious health consequences, the health department notifies people if they have been exposed to certain STDs/STIs. Not all STDs/STIs are reported, though. If you receive a notice, it is important to see a health care provider, be tested, and start treatment right away.

Screening is especially important for pregnant women, because many STDs/STIs can be passed on to the fetus during pregnancy or delivery. During an early prenatal visit, with the help of her health care provider, an expectant mother should be screened for these infections, including HIV  and syphilis. Some of these STDs/STIs can be cured with drug treatment, but not all of them. However, even if the infection is not curable, a pregnant woman can usually take measures to protect her infant from infection.

Is there a cure for sexually transmitted diseases and sexually transmitted infections (STDs/STIs)?

Viruses such as HIV, genital herpes, human papillomavirus, hepatitis, and cytomegalovirus cause STDs/STIs that cannot be cured. People with an STD/STI caused by a virus will be infected for life and will always be at risk of infecting their sexual partners, although for many viruses treatment significantly reduces this risk. Treatments are available to cure STDs/STIs caused by bacteria, yeast, or parasites.

What are the treatments for sexually transmitted diseases and sexually transmitted infections (STDs/STIs)?

STDs/STIs caused by bacteria, yeast, or parasites can be treated with antibiotics. These antibiotics are most often given by mouth (orally). However, sometimes they are injected or applied directly to the affected area. Whatever the infection, and regardless of how quickly the symptoms resolve after beginning treatment, the infected person must take all of the medicine prescribed by the health care provider to ensure that the STD/STI is completely treated.

Although treatments, complications, and outcomes vary among viral STDs/STIs depending on the particular virus (HIV, genital herpes, human papillomavirus, hepatitis, or cytomegalovirus), health care providers can provide treatments to reduce the symptoms and the progression of most of these illnesses. For example, medications are available to limit the frequency and severity of genital herpes outbreaks while reducing the risk that the virus will be passed on to other people.

Individuals with HIV need to take special antiretroviral drugs that control the amount of virus they carry. These drugs, called highly active antiretroviral therapy, or HAART,¹ can help people live longer, healthier lives. If a woman with HIV becomes pregnant, these medicines also can reduce the chance that her fetus or infant will get the infection.

Being tested and treated for STDs/STIs is especially important for pregnant women because some STDs/STIs may be passed on to their infants during pregnancy or delivery. Testing women for these STDs/STIs early in their pregnancy is important, so that steps can be taken to help ensure delivery of a healthy infant. The necessary treatment will depend on the type of STD/STI involved.

Treatments for Specific Types of Sexually Transmitted Diseases and Sexually Transmitted Infections (STDs/STIs)

• Gonorrhea and Chlamydia
• Genital Herpes
• Human Papillomavirus (HPV)
• Syphilis
• Bacterial Vaginosis
• Trichomoniasis
• Viral Hepatitis
• HIV/AIDS
• During Pregnancy

Gonorrhea and Chlamydia

Gonorrhea and chlamydia are bacterial STDs/STIs that can be treated with antibiotics given either orally or by injection. Because the infections often occur together, people who have one infection are typically treated for both by their health care provider. Recent sexual partners should be treated at the same time.

Genital Herpes

Genital herpes outbreaks can be treated with antiviral drugs. Although this medication can limit the length and severity of outbreaks, it does not cure the infection. In addition, daily suppressive therapy (daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners. A pregnant woman known to have the infection must take additional care because she can pass the infection to her infant during delivery. Women who first acquire genital HSV during pregnancy are at highest risk of transmission to their infants. If a pregnant woman has an outbreak when she goes into labor, she may need to have a cesarean section (C-section) to prevent the infant from getting the virus during birth.

Human Papillomavirus (HPV)

A person who has an HPV infection cannot be cured. However, many HPV infections can be prevented with vaccination. Furthermore, a health care provider can treat genital warts caused by the virus as well as monitor and control a woman's risk of cervical cancer through frequent screening with Pap smear tests.

Syphilis

If recognized during the early stages, usually within the first year of infection, syphilis can be treated with a singular intramuscular injection of antibiotic. A person being treated for syphilis must avoid sexual contact until the chancre sores caused by the bacteria are completely healed to avoid infecting other people.

If a person does not recognize the infection early, or does not seek treatment immediately, longer treatment with antibiotics may be required. If left untreated, the infection can progress even further and potentially cause death. Although antibiotics can prevent the infection from getting worse, they cannot reverse damage that has already occurred.

Bacterial Vaginosis

Bacterial vaginosis can be treated with antibiotics, typically metronidazole or clindamycin. Generally, male sexual partners of women with bacterial vaginosis do not need to be treated because treatment of partners has not been shown to reduce the risk of recurrence.

Treatment during pregnancy is recommended primarily for women at risk for preterm labor or having a low birthweight infant.

Trichomoniasis

Trichomoniasis can be treated with a single dose of an antibiotic, usually either metronidazole or tinidazole, taken by mouth. Often, Trichomonas infection recurs, so it is important to make sure that both you and your sexual partners are treated if you are diagnosed with this infection.

Viral Hepatitis

• Hepatitis A virus (HAV) infects the liver and may cause abdominal pain, nausea, and vomiting. Usually the infection gets better on its own without requiring treatment. In some cases, however, individuals may have lasting damage to their livers or may have such severe nausea and vomiting that they must be admitted to the hospital.
• Hepatitis B virus (HBV) can cause a lifelong infection but can be treated with antiviral medications. People with HBV infection will need to see a liver specialist with experience treating individuals with chronic liver disease. These individuals need to take special care not to pass on the virus to their sexual partners, and sexual partners should receive hepatitis B vaccine if not already immune.
• Hepatitis C virus can cause immediate illness affecting the liver or, more commonly, it can be a silent, chronic infection. As with hepatitis B, individuals with HCV may have a lifelong infection and will always be at risk of passing the virus on to their sexual partners. New treatments are available that can clear the infection in some individuals.

HIV/AIDS

There is no cure for HIV/AIDS. However, research into new treatments has improved outcomes for people living with the disease. A combination of antiretroviral drugs can be given in highly active antiretroviral therapy to control the virus, promote a healthy immune system, help people with the virus live longer lives, and reduce the risk of transmission.

During Pregnancy

Pregnant women who have certain types of STDs/STIs may pass them on to their infants during pregnancy or delivery. Therefore, it is important for women to be tested for such STDs/STIs as part of their early prenatal care to help ensure delivery of a healthy infant.

 

The specific treatment will depend on which STD/STI is involved.

Sexually Transmitted Diseases (STDs): Other FAQs

Basic information for topics, such as “What is it?” and “How many people are affected?” is available in the Condition Information section. In addition, Frequently Asked Questions (FAQs) that are specific to a certain topic are answered in this section.

Am I at risk for STDs/STIs?

STDs/STIs affect men and women of all races, backgrounds, sexual orientations, and economic levels. Anyone who is having or has had vaginal, anal, or oral sex has some degree of risk for an STD/STI. In fact, some STDs/STIs can be passed through sexual play that does not involve intercourse.

You can analyze your risk for STDs/STIs with the STD Wizard—a free interactive online tool based on the Centers for Disease Control and Prevention's (CDC's) STD Treatment Guidelines. The STD Wizard recommends tests and vaccines based on your responses concerning some of your personal characteristics and behaviors. You can use these recommendations to start a discussion with your health care provider about your STD/STI risk and the tests you may need. The STD Wizard is available in both English and Spanish.

How can I avoid getting a sexually transmitted disease or sexually transmitted infection (STD/STI)?

The most reliable ways to avoid STDs/STIs are to abstain from sexual contact or to be in a long-term monogamous relationship with a partner who has been tested and is uninfected. In addition, the following measures can also help you avoid STDs/STIs:

• Know your sexual partner's STD/STI and health history.
• Talk to your health care provider about your risk, and get tested for STDs/STIs.
• Get vaccinated against hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomavirus (HPV).
• Use latex condoms correctly and consistently.

Remember, however, that while condoms greatly reduce the chance of getting certain STDs/STIs, such as gonorrhea, condoms cannot fully protect against infection because viruses and some bacteria can be passed from person to person by skin-to-skin contact in the genital area not covered by a condom

What should I do if I have been diagnosed with an STD/STI?

You should see your health care provider for treatment as soon as possible after receiving a diagnosis of an STD/STI. You also should notify, either yourself or with the help of the local health department, all recent sex partners and advise them to see their health care providers and be treated. These steps will reduce your risk of becoming re-infected, help avoid spreading the STD/STI to other people, and decrease the risk that your previous sexual partners will develop serious complications from the STD/STI. You and all of your sex partners must avoid sex until treatment is complete and all symptoms have disappeared.

In the case of STDs/STIs caused by viruses with no cure (for example, HIV, genital herpes, or hepatitis), special care and preventive measures can help control the infection, limit symptoms, and help maximize health.

Are there disorders or conditions associated with sexually transmitted diseases and sexually transmitted infections (STDs/STIs)?

STDs/STIs in women can cause pelvic inflammatory disease (PID), which may result in infertility (difficulty getting pregnant).

Men with STDs/STIs also can have problems with infertility.

Additionally, a person with an STD/STI other than HIV is two to five times more likely to contract the HIV virus than a person without an STD/STI. If a person is already HIV positive, having another STD/STI increases the chances that he or she will pass the virus on to his or her sexual partner.

Some STDs/STIs, such as human papillomavirus, viral hepatitis, and HIV, increase the risk of some forms of cancer.

Certain STDs/STIs can pass from a pregnant woman to the fetus in her womb. The effects can be life threatening, as is the case with HIV. Other STDs/STIs can cause a range of disorders in the infant, including deafness, blindness, and intellectual disability.

Can a sexually transmitted disease or sexually transmitted infection (STD/STI) lead to cancer?

Having an STD/STI increases a person's risk for several types of cancer.

Certain high-risk types of human papillomavirus (HPV) can cause cervical cancer in women. In men, HPV infection can lead to the development of penile cancers. HPV also can cause cancers of the mouth, throat, and anus in both sexes. 

Acquiring viral hepatitis B or C puts a person at risk for liver cancer, and untreated HIV/AIDS increases risk for several types of rare cancers, including lymphomas, sarcomas, and cervical cancer

If I have a sexually transmitted disease or sexually transmitted infection (STD/STI), will I be able to get pregnant?

Having an STD/STI will not prevent a woman from getting pregnant.

However, in some instances, women who have had STDs/STIs may have difficulty getting pregnant because of scarring and damage to their reproductive organs leading to infertility. This situation is particularly common in women who have had pelvic inflammatory disease. Additionally, early during pregnancy, STDs/STIs may increase the risk of miscarriage

What is the link between sexually transmitted diseases or sexually transmitted infections (STDs/STIs) and infertility?

In most cases, STDs/STIs are linked to infertility primarily when they are left untreated.

For instance, chlamydia and gonorrhea are sexually transmitted bacterial infections that can be cured easily with antibiotics. Left untreated, 10% to 20% of chlamydial and gonorrheal infections in women can result in pelvic inflammatory disease (PID)—a condition that can cause long-term complications, such as chronic pelvic pain, ectopic pregnancy (pregnancy outside of the uterus), and infertility.

Additionally, infections with gonorrhea and chlamydia may not cause symptoms and may go unnoticed. These undiagnosed and untreated infections can lead to severe health consequences, especially in women, causing permanent damage to reproductive organs.

The Ccenters for Disease Control and Prevention estimates that these infections cause infertility in at least 24,000 women each year. Although infertility is less common among men, it does occur. More commonly, untreated chlamydia and gonorrhea infections in men may cause epididymitis, a painful infection in the tissue surrounding the testicles, or urethritis, an infection of the urinary canal in the penis, which causes painful urination and fever.

Additional information on PID is available from the National Institute of Allergy and Infectious Diseases.

How do sexually transmitted diseases and sexually transmitted infections (STDs/STIs) affect pregnancy?

STDs/STIs pose special risks for pregnant women and their infants.

If a mother has an STD/STI, it is possible for the fetus or newborn to become infected. Some STDs/STIs, including chlamydia, gonorrhea, genital herpes, and cytomegalovirus can be passed from mother to infant during delivery when the infant passes through an infected birth canal. A few STDs/STIs, including syphilis, HIV, and CMV, can infect a fetus before birth during the pregnancy. It is important for a pregnant woman to be tested for STDs/STIs, including HIV/AIDS and syphilis, as a part of her prenatal care.

STD/STI testing as a part of prenatal care can determine if an expectant mother or her sexual partner has an infection that can be cured with drug treatment. Early treatment decreases the chances that the infant will contract the disease. While not all STDs/STIs can be cured, the mother and her health care provider can take steps to protect her and her infant.

To reduce the chance of certain STDs/STIs spreading to the infant during delivery, the health care provider might recommend a cesarean delivery.

In most hospitals, infants’ eyes are routinely treated with an antibiotic ointment shortly after birth. This is to prevent blindness due to exposure to gonorrhea or chlamydia bacteria during delivery if the pregnant woman had an undetected infection.

STDs/STIs during pregnancy can also cause:

• Miscarriage
• Ectopic pregnancy (when the embryo implants outside of the uterus, usually in a fallopian tube)
• Preterm labor and delivery (before 37 completed weeks of pregnancy)
• Low birth weight
• Birth defects, including blindness, deafness, bone deformities, and intellectual disability
• Stillbirth
• Illness in the newborn period (first month of life)
• Newborn death

STDs/STIs are of special concern during pregnancy and pose significant health risks to unborn infants:

• HIV/AIDS. HIV can be passed from mother to infant during pregnancy before birth, at the time of delivery, or after birth during breastfeeding.
• Gonorrhea. If a pregnant woman has a gonorrheal infection, she may give the infection to her infant as the infant passes through the birth canal during delivery. This infection in an infant can cause eye infections, pneumonia, or infections of the joints or blood. Treating gonorrhea as soon as it is detected in pregnant women will reduce the risk of transmission.
• Chlamydia. Similar to a gonorrheal infection, a chlamydial infection at the time of delivery can lead to eye infections or pneumonia in the infant. However, chlamydial infection during pregnancy also has been associated with an increased risk of preterm birth and its complications.
• Genital herpes. Pregnant women newly infected with genital herpes late in pregnancy have a 30% to 60% chance of infecting the infant they carry. The risk of infection is particularly high during delivery. Herpes infections in newborns are serious and potentially life-threatening. Infection with the herpes virus during pregnancy or at the time of delivery can lead to brain damage, blindness, and damage to other organs.
  • If a pregnant woman has had genital herpes in the past, there are medications that she can take to reduce the chance that she will have an outbreak and thus reduce the risk to her infant.
  • If a woman has active herpes sores when she goes into labor, the infant can be delivered by cesarean section to reduce the chance that the infant will come in contact with the virus.
• Hepatitis B virus. If a woman is infected with the hepatitis B virus during pregnancy, the virus also could infect her fetus. The likelihood of this occurrence depends on when the mother was infected. If the mother acquires the infection early in her pregnancy, the chance that the virus will infect her fetus is less than 10%. However, if the infection occurs later in her pregnancy, the risk goes up to 90%. Hepatitis B can be severe in infants and can threaten their lives. It also can lead to liver scarring, failure, and cancer, which can be fatal in up to 25% of cases. In addition, infected newborns have a very high risk of becoming carriers of the hepatitis B virus and can spread the infection to others.
  • In some cases, if a woman is exposed to hepatitis B during pregnancy, she may be treated with a special antibody to reduce the likelihood that she will get the infection. All healthy infants should be vaccinated against hepatitis B to give them lifelong protection against the virus. Infants born to women with evidence of ongoing hepatitis B infection (hepatitis B surface antigen positive) should also receive hepatitis B hyperimmune globulin as soon as possible after birth.
• Cytomegalovirus (CMV). CMV is a common virus present in many body fluids that can be spread through close personal contact, such as kissing or sharing eating utensils, as well as sexual contact. The virus is common in the general population and usually does not cause health problems. However, if an expectant mother acquires the virus for the first time during pregnancy, the risk is high that she will pass it on to her infant. Unfortunately, a pregnant woman may not even know she has the infection, and she may still pass the virus on to her infant.⁷ CMV in an infant can lead to serious illness, lasting disabilities, or death. Each year in the United States, an estimated 40,000 infants are born with CMV infection, causing an estimated 400 deaths and leaving about 8,000 infants with permanent disabilities, such as hearing or vision loss, or intellectual disability. Currently routine screening for CMV in pregnancy is not recommended. Researchers are working on treatments for CMV and also vaccines to try to prevent new infections during pregnancy and to reduce the risk of transmission to the infant.

Sexually Transmitted Diseases (STDs): NICHD Research Information

STDs/STIs have enormous effects on the health of individuals and society. Consequently, STDs/STIs are an active focus of the NICHD’s research. While many effective, commonly available interventions can reduce the incidence of STDs/STIs, these interventions are not always implemented, in part because of complicating social factors. As a result, STDs/STIs are often difficult to prevent, diagnose, and treat, and this situation has a serious impact on public health. The NICHD’s portfolio covers a variety of topics in STDs/STI research with a focus on understanding epidemiology and improving screening, education, and preventative health interventions.

Sexually Transmitted Diseases (STDs): NICHD Research Goals

The NICHD focuses a great deal of its research on factors and behaviors that affect the risk of contracting or spreading STDs/STIs and works to develop new interventions to prevent the spread of STDs/STIs in vulnerable populations. Also, since 1987, the NICHD has supported research and training activities that have helped to establish and define the field of contraceptive microbicides, products that both prevent pregnancy and reduce the transmission of STDs, including HIV.

NICHD-supported researchers are also trying to understand the best ways to communicate with people about STDs/STIs and effective preventive measures. Some of this research includes studying attitudes, perception, and knowledge of STDs/STIs and their prevention; understanding the use and misuse of contraception to prevent STDs/STIs; and understanding the misinformation surrounding the topic while aiming to identify the best settings for providing education about sexual health.

Because preventing and treating STDs/STIs is a major goal for the NIH and its Institutes, the NICHD conducts and supports a variety of clinical trials on STDs/STIs, including HIV

NIAID: National Institute of Allergy and Infectious Diseases, NIH

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 Pelvic Inflammatory Disease (PID) - CDC Fact Sheet

 Untreated sexually transmitted diseases (STDs) can cause pelvic inflammatory disease (PID), a serious condition, in women. 1 in 8 women with a history of PID experience difficulties getting pregnant. You can prevent PID if you know how to protect yourself.

What is PID?

Pelvic inflammatory disease is an infection of a woman’s reproductive organs. It is a complication often caused by some STDs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID.

How do I get PID?

You are more likely to get PID if you

• Have an STD and do not get treated;
• Have more than one sex partner;
• Have a sex partner who has sex partners other than you;
• Have had PID before;
• Are sexually active and are age 25 or younger;
• Douche;
• Use an intrauterine device (IUD) for birth control.

How can I reduce my risk of getting PID?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting PID:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

How do I know if I have PID?

There are no tests for PID. A diagnosis is usually based on a combination of your medical history, physical exam, and other test results. You may not realize you have PID because your symptoms may be mild, or you may not experience any symptoms. However, if you do have symptoms, you may notice

• Pain in your lower abdomen;
• Fever;
• An unusual discharge with a bad odor from your vagina;
• Pain and/or bleeding when you have sex;
• Burning sensation when you urinate; or
• Bleeding between periods.

You should

• Be examined by your doctor if you notice any of these symptoms;
• Promptly see a doctor if you think you or your sex partner(s) have or were exposed to an STD;
• Promptly see a doctor if you have any genital symptoms such as an unusual sore, a smelly discharge, burning when peeing, or bleeding between periods;
• Get a test for chlamydia every year if you are sexually active and 25 years of age or younger;
• Have an honest and open talk with your health care provider if you are sexually active and ask whether you should be tested for other STDs.

Can PID be cured?

Yes, if PID is diagnosed early, it can be treated. However, treatment won’t undo any damage that has already happened to your reproductive system. The longer you wait to get treated, the more likely it is that you will have complications from PID. While taking antibiotics, your symptoms may go away before the infection is cured. Even if symptoms go away, you should finish taking all of your medicine. Be sure to tell your recent sex partner(s), so they can get tested and treated for STDs, too. It is also very important that you and your partner both finish your treatment before having any kind of sex so that you don’t re-infect each other.

You can get PID again if you get infected with an STD again. Also, if you have had PID before, you have a higher chance of getting it again.

What happens if I don't get treated?

If diagnosed and treated early, the complications of PID can be prevented. Some of the complications of PID are

• Formation of scar tissue both outside and inside the fallopian tubes that can lead to tubal blockage;
• Ectopic pregnancy (pregnancy outside the womb);
• Infertility (inability to get pregnant);
• Long-term pelvic/abdominal pain.

What is pelvic inflammatory disease?

Pelvic inflammatory disease (PID) is a clinical syndrome that results from the ascension of microorganisms from the cervix and vagina to the upper genital tract. PID can lead to infertility and permanent damage of a woman’s reproductive organs.

How do women get pelvic inflammatory disease?

Women develop PID when certain bacteria, such as chlamydia or gonorrhea, move upward from a woman's vagina or cervix into her reproductive organs. PID is a serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea.

What causes pelvic inflammatory disease?

Many different types of microorganisms can cause PID; therefore, it is a considered a polymicrobial infection. Most cases of PID are caused by gonorrhea and chlamydia. Sexually transmitted disease pathogens Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) have frequently been identified among women with PID infection and these microbes have accounted for a third to a half of the cases  While the focus has been on the role played by STDs, especially CT in the etiology of PID, endogenous microorganisms, including gram positive and negative anaerobic organisms and aerobic/facultative gram positive and negative rods and cocci, found at high levels in women with bacterial vaginosis, also have been implicated in the pathogenesis of PID^. Newer data suggest that Mycoplasm genitalium may also play a role in PID and may be associated with milder symptoms Because of this polymicrobial nature, broad-spectrum regimens that provide adequate coverage of likely pathogens are recommended.

What are the signs and symptoms of pelvic inflammatory disease?

Since some women with PID have subtle or mild symptoms, many episodes of PID can go unrecognized by women and their health care providers. Women with PID present with a variety of clinical signs and symptoms that range from subtle and mild to severe. Some of the signs and symptoms associated with acute PID are nonspecific, so it is important to consider other reproductive tract illnesses and diseases of both the urinary and the gastrointestinal tracts during an evaluation of a sexually active female with lower abdominal pain. Pregnancy must also be excluded. A pregnancy test should always be performed to exclude ectopic pregnancy and because PID can occur concurrently with pregnancy. In the case of subclinical PID, women have mild or no pelvic pain, despite evidence of endometritis or salpingitis.

When symptoms are present, the most common symptoms of PID are

• Lower abdominal pain
• Mild pelvic pain
• Increased vaginal discharge
• Irregular menstrual bleeding
• Fever (>38° C)
• Pain with intercourse
• Painful and frequent urination
• Abdominal tenderness
• Pelvic organ tenderness
• Uterine tenderness (along with endometriosis)
• Adnexal tenderness (along with salpingitis)
• Cervical motion tenderness
• Inflammation

What are the complications of pelvic inflammatory disease?

The risk of developing short and long-term complications from PID depends upon the severity and number of episodes of PID, thereby emphasizing the importance of prompt and appropriate treatment.

Complications of PID include

• Scarred fallopian tube
• Tubo-ovarian abscess (TOA)
• Tubal factor infertility
• Ectopic pregnancy
• Pelvic adhesions
• Chronic pelvic pain

Complications of PID such as chronic pelvic pain and scarring are difficult to treat but sometimes improve with surgery.

Tubo-ovarian abscess (TOA) is a serious short-term complication of PID that is characterized by an inflammatory mass involving the fallopian tube, ovary, and, occasionally, other adjacent pelvic organs. The microbiology of TOAs is similar to PID and the diagnosis necessitates initial hospital admission. Treatment includes broad-spectrum antibiotics with or without a drainage procedure, with surgery often reserved for patients with suspected rupture or who fail to respond to antibiotics. Women infected with HIV may be at higher risk for TOA. Mortality from PID is less than 1% and is usually secondary to rupture of a TOA or to ectopic pregnancy.

How is pelvic inflammatory disease diagnosed?

There are no tests specifically for diagnosing PID. Because the diagnosis of PID can be imprecise, clinicians should have a high index of suspicion for the diagnosis. Physical examination findings to detect PID can also vary, and there is no single finding that is sensitive and specific for the diagnosis. When the diagnosis of PID is questionable, or when the illness is severe or not responding to therapy, further investigation may be warranted using other invasive procedures (endometrial biopsy, transvaginal ultrasonography or magnetic resonance imaging, and/or laparoscopy).

What medical examinations and assessments can be performed to diagnose pelvic inflammatory disease?

Clinical providers should perform a physical examination assessing the abdomen for tenderness. Other assessments may include evaluation of the vaginal pH, a whiff test (performed by adding a small amount of potassium hydroxide to a microscopic slide containing the vaginal discharge), and microscopy of the vaginal secretions for the presence of leukocytes, clue cells, and trichomonads.

The cervix should be examined for abnormal cervical and vaginal discharge, and friability. An internal exam should be performed to assess for pelvic organ tenderness and/or a mass. A clinician should also check for fever and for laboratory documentation of cervical infection with NG and CT. However, laboratory confirmation is not necessary to justify initiation of therapy for PID.

A serologic test for human immunodeficiency virus (HIV) is also recommended. A pregnancy test should always be performed to exclude ectopic pregnancy and because PID can occur concurrently with pregnancy. When the diagnosis of PID is questionable, or when the illness is severe or not responding to therapy, further investigation may be warranted using other invasive procedures (endometrial biopsy, transvaginal ultrasonography, magnetic resonance imaging, or laparoscopy).

A bimanual pelvic examination can be performed and may reveal pelvic organ tenderness, uterine tenderness in the case of endometritis, and adnexal tenderness in the case of salpingitis.

Cervical motion tenderness is another common finding in women with PID. Assessment of the lower genital tract (mucopurulent cervical discharge or evidence of WBCs on a microscopic evaluation of a saline preparation of vaginal fluid) can also yield signs of inflammation, which are consistent with the diagnosis of PID.

How is pelvic inflammatory disease treated?

Several types of antibiotics can cure PID. Antibiotic treatment does not, however, reverse any scarring 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 can prevent severe damage to the reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

PID is usually treated with antibiotics to provide empiric, broad spectrum coverage of likely pathogens. Recommended regimens can be found in the 2010 STD Treatment Guidelines. Health care providers should emphasize to their patients that although their symptoms may go away before the infection is cured, they should finish taking all of the prescribed medicine. Additionally, a woman’s sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.

In certain cases, clinicians may recommend hospitalization to treat PID. This decision should be based on the judgment of the health care provider and the use of suggested criteria found in the 2010 STD Treatment Guidelines. If a woman’s symptoms continue, or if an abscess does not resolve, surgery may be needed.

What should a patient do after being diagnosed with pelvic inflammatory disease?

A patient should abstain from sexual intercourse until she and her partner(s) have completed treatment. Female latex condoms are also an option if a woman prefers them or if her male partner chooses not to use male condoms. Women who are told they have an STD and are treated for it should notify all of their recent sex partners so they can see a health care provider and be evaluated for STDs.

The diagnosis of PID provides an opportunity to educate adolescent and young women about prevention of STDs, including abstinence, consistent use of barrier methods of protection, immunization, and the importance of receiving periodic screening for STDs and HIV.

How can pelvic inflammatory disease be prevented?

Latex condoms may reduce the risk of PID. Treating STDs early can prevent PID. Since STDs play a major role in PID, screening and early treatment of infected women and their sex partners can help to minimize the risk of acquisition and continued transmission of STDs and subsequent adverse sequelae. Identifying, testing, and treating women at increased risk of cervical chlamydial infection can reduce the incidence of PID.

Consistent and correct use of latex male condoms can reduce the risk of transmission of chlamydia and gonorrhea and the risk of PID.

CDC recommends that providers screen the following populations for chlamydia and gonorrhea: all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.

What are the risk factors for developing pelvic inflammatory disease?

Risk factors are important considerations in both the clinical management and prevention of upper genital tract infections. As STDs are the most common etiological agents for PID, risk factors for developing PID can be related to those associated with the acquisition of STDs, including early coitarche, young age, alcohol use, inconsistent use of barrier contraceptives, and multiple sexual partners or having one partner with multiple sexual partners. Other factors that have been associated with PID include a prior history of PID, intrauterine device use (IUD) (risk seems to be primarily restricted to the first several weeks following insertion), and douching.

Is the number of women in the United States being diagnosed with pelvic inflammatory disease increasing?

No. Over the last decade, there have been several studies published suggesting overall declines in PID diagnosis in both hospital and ambulatory settings. While no single explanation exists for this declining trend, some have suggested that changes in sexually transmitted disease (STD) rates, increases in chlamydia screening coverage, availability of antimicrobial therapies that increase adherence to treatment, and more sensitive diagnostic technologies, could be impacting PID rates.

Despite declining trends, PID is a frequent and important infection that occurs among women of reproductive age. Based on a nationally representative sample from 2006-2010, 5.0% of U.S. women have reported being treated for PID in their lifetime.

The significant burden of disease attributed to PID comes predominantly from the long-term reproductive sequelae of tubal infection: tubal factor infertility, ectopic pregnancy, and pelvic adhesions, which can lead to chronic pelvic pain. Our knowledge of the longitudinal outcomes for affected women who experience PID is primarily derived from data published using a Scandinavian cohort of inpatients diagnosed with PID. Data from this study indicated that those women with PID were more likely to have ectopic pregnancy (6 times increased rate), tubal factor infertility (ranging 8% after first episode to as high as 40% after three episodes) and chronic pelvic pain (18% following 1 episode).

What is the economic burden of pelvic inflammatory disease in the United States?

A decline in incidence of PID is also reflected in the most recent cost estimates of PID and its sequelae. Direct medical expenditures for PID and its sequelae were estimated at $1.88 billion in 1998, compared to approximately $2.7 billion estimated in 1990. Based on a nationally representative sample from 2006-2010, approximately 4.2% of U.S. women have reported being treated for PID in their lifetime.

How can clinicians manage PID?

A critical component to the outpatient management is short-term follow-up, especially in the adolescent population. Since many adolescent women rely on outpatient services for the evaluation and treatment of STD symptoms, the need for a low diagnostic and management threshold for PID is even more critical, as the likelihood for additional follow-up care is low.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

Sources

American College of Obstetricians and Gynecologists (ACOG). Pelvic Inflammatory Disease. ACOG Patient Education Pamphlet, 1999.

Westrom L and Eschenbach D. In: K. Holmes, P. Sparling, P. Mardh et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, 783-809.

Source: CDC, HHS

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 Bacterial Vaginosis – CDC Fact Sheet

Any woman can get bacterial vaginosis. Having bacterial vaginosis can increase your chance of getting an STD.

What is bacterial vaginosis?

Bacterial vaginosis (BV) is an infection caused when too much of certain bacteria change the normal balance of bacteria in the vagina.

How common is bacterial vaginosis?

Bacterial vaginosis is the most common vaginal infection in women ages 15-44.

How is bacterial vaginosis spread?

We do not know about the cause of BV or how some women get it. BV is linked to an imbalance of “good” and “harmful” bacteria that are normally found in a woman's vagina.

We do know that having a new sex partner or multiple sex partners and douching can upset the balance of bacteria in the vagina and put women at increased risk for getting BV.

However, we do not know how sex contributes to BV. BV is not considered an STD, but having BV can increase your chances of getting an STD. BV may also affect women who have never had sex.

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

How can I avoid getting bacterial vaginosis?

Doctors and scientists do not completely understand how BV is spread, and there are no known best ways to prevent it.

The following basic prevention steps may help lower your risk of developing BV:

• Not having sex;
• Limiting your number of sex partners; and
• Not douching.

I’m pregnant. How does bacterial vaginosis affect my baby?

Pregnant women can get BV. Pregnant women with BV are more likely to have babies who are born premature (early) or with low birth weight than women who do not have BV while pregnant. Low birth weight means having a baby that weighs less than 5.5 pounds at birth.

Treatment is especially important for pregnant women.

How do I know if I have bacterial vaginosis?

Many women with BV do not have symptoms. If you do have symptoms, you may notice a thin white or gray vaginal discharge, odor, pain, itching, or burning in the vagina. Some women have a strong fish-like odor, especially after sex. You may also have burning when urinating; itching around the outside of the vagina, or both.

How will my doctor know if I have bacterial vaginosis?

A health care provider will look at your vagina for signs of BV and perform laboratory tests on a sample of vaginal fluid to determine if BV is present.

Can bacterial vaginosis be cured?

BV will sometimes go away without treatment. But if you have symptoms of BV you should be checked and treated. It is important that you take all of the medicine prescribed to you, even if your symptoms go away. A health care provider can treat BV with antibiotics, but BV can recur even after treatment. Treatment may also reduce the risk for STDs.

Male sex partners of women diagnosed with BV generally do not need to be treated. However, BV may be transferred between female sex partners.

What happens if I don't get treated?

BV can cause some serious health risks, including

• Increasing your chance of getting HIV if you have sex with someone who is infected with HIV;
• If you are HIV positive, increasing your chance of passing HIV to your sex partner;
• Making it more likely that you will deliver your baby too early if you have BV while pregnant;
• Increasing your chance of getting other STDs, such as chlamydia and gonorrhea. These bacteria can sometimes cause pelvic inflammatory disease (PID), which can make it difficult or impossible for you to have children.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

Order Publication Online at www.cdc.gov/std/pub

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

American Sexual Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-9877

Sources

Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR 2010;59(No. RR-12)

Hillier S and Holmes K. Bacterial vaginosis. In: K. Holmes, P. Sparling, P. Mardh et al (eds). Sexually Transmitted Diseases, 3rd Edition. New York: McGraw-Hill, 1999, 563-586.

CDC: Centers for Disease Control and Prevention

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 Chlamydia - CDC Fact Sheet

Chlamydia is a common sexually transmitted disease (STD) that can be easily cured. If left untreated, chlamydia can make it difficult for a woman to get pregnant.

What is chlamydia?

Chlamydia is a common STD that can infect both men and women. It can cause serious, permanent damage to a woman's reproductive system, making it difficult or impossible for her to get pregnant later on. Chlamydia can also cause a potentially fatal ectopic pregnancy (pregnancy that occurs outside the womb).

How is chlamydia spread?

You can get chlamydia by having vaginal, anal, or oral sex with someone who has chlamydia.

If your sex partner is male you can still get chlamydia even if he does not ejaculate (cum).

If you’ve had chlamydia and were treated in the past, you can still get infected again if you have unprotected sex with someone who has chlamydia.

If you are pregnant, you can give chlamydia to your baby during childbirth.

How can I reduce my risk of getting chlamydia?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting chlamydia:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

Am I at risk for chlamydia?

Anyone who has sex can get chlamydia through unprotected vaginal, anal, or oral sex. However, sexually active young people are at a higher risk of getting chlamydia. This is due to behaviors and biological factors common among young people. Gay, bisexual, and other men who have sex with men are also at risk since chlamydia can be spread through oral and anal sex.

Have an honest and open talk with your health care provider and ask whether you should be tested for chlamydia or other STDs. If you are a sexually active woman younger than 25 years, or an older woman with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection, you should get a test for chlamydia every year. Gay, bisexual, and men who have sex with men; as well as pregnant women should also be tested for chlamydia.

I'm pregnant. How does chlamydia affect my baby?

If you are pregnant and have chlamydia, you can pass the infection to your baby during delivery. This could cause an eye infection or pneumonia in your newborn. Having chlamydia may also make it more likely to deliver your baby too early.

If you are pregnant, you should be tested for chlamydia at your first prenatal visit. Testing and treatment are the best ways to prevent health problems.

How do I know if I have chlamydia?

Most people who have chlamydia have no symptoms. If you do have symptoms, they may not appear until several weeks after you have sex with an infected partner. Even when chlamydia causes no symptoms, it can damage your reproductive system.

Women with symptoms may notice

• An abnormal vaginal discharge;
• A burning sensation when urinating.

Symptoms in men can include

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

Men and women can also get infected with chlamydia in their rectum, 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;
• Bleeding.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or bleeding between periods.

How will my doctor know if I have chlamydia?

There are laboratory tests to diagnose chlamydia. Your health care provider may ask you to provide a urine sample or may use (or ask you to use) a cotton swab to get a sample from your vagina to test for chlamydia.

Can chlamydia be cured?

Yes, chlamydia can be cured with the right treatment. It is important that you take all of the medication your doctor prescribes to cure your infection. When taken properly it will stop the infection and could decrease your chances of having complications later on. Medication for chlamydia should not be shared with anyone.

Repeat infection with chlamydia is common. You should be tested again about three months after you are treated, even if your sex partner(s) was treated.

I was treated for chlamydia. When can I have sex again?

You should not have sex again until you and your sex partner(s) have completed treatment. If your doctor prescribes a single dose of medication, you should wait seven days after taking the medicine before having sex. If your doctor prescribes a medicine for you to take for seven days, you should wait until you have taken all of the doses before having sex.

What happens if I don't get treated?

The initial damage that chlamydia causes often goes unnoticed. However, chlamydia can lead to serious health problems.

If you are a woman, untreated chlamydia can spread to your uterus and fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), causing pelvic inflammatory disease (PID). PID often has no symptoms, however some women may have abdominal and pelvic pain. Even if it doesn’t cause symptoms initially, PID can cause permanent damage to your reproductive system and lead to long-term pelvic pain, inability to get pregnant, and potentially deadly ectopic pregnancy (pregnancy outside the uterus).

Men rarely have health problems linked to chlamydia. Infection sometimes spreads to the tube that carries sperm from the testicles, causing pain and fever. Rarely, chlamydia can prevent a man from being able to have children.

Untreated chlamydia may also increase your chances of getting or giving HIV – the virus that causes AIDS.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

American Sexual Health Association (ASHA)
P.O. Box 13827
Research Triangle Park, NC 27709-3827
1-800-783-9877

CDC:Centers for Disease Control and Prevention

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Anyone who is sexually active can get gonorrhea. Gonorrhea can cause very serious complications when not treated, but can be cured with the right medication.

What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) that can infect both men and women. It can cause infections in the genitals, rectum, and throat. It is a very common infection, especially among young people ages 15-24 years.

How is gonorrhea spread?

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

How can I reduce my risk of getting gonorrhea?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting gonorrhea:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

Am I at risk for gonorrhea?

Any sexually active person can get gonorrhea through unprotected vaginal, anal, or oral sex.

If you are sexually active, have an honest and open talk with your health care provider and ask whether you should be tested for gonorrhea or other STDs. If you are a sexually active man who is gay, bisexual, or who has sex with men, you should be tested for gonorrhea every year. If you are a sexually active women younger than 25 years or an older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection, you should be tested for gonorrhea every year.

I'm pregnant. How does gonorrhea affect my baby?

If you are pregnant and have gonorrhea, you can give the infection to your baby during delivery. This can cause serious health problems for your baby. If you are pregnant, it is important that you talk to your health care provider so that you get the correct examination, testing, and treatment, as necessary. Treating gonorrhea as soon as possible will make health complications for your baby less likely.

How do I know if I have gonorrhea?

Some men with gonorrhea may have no symptoms at all. However, men who do 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).

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. Women with gonorrhea are at risk of developing serious complications from the infection, even if they don’t have any symptoms.
Symptoms in women can include:

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

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 movements.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or bleeding between periods.

How will my doctor know if I have gonorrhea?

Most of the time, urine can be used to test for gonorrhea. However, if you have had oral and/or anal sex, swabs may be used to collect samples from your throat and/or rectum. In some cases, a swab may be used to collect a sample from a man’s urethra (urine canal) or a woman’s cervix (opening to the womb).

Can gonorrhea be cured?

Yes, gonorrhea can be cured with the right treatment. It is important that you take all of the medication your doctor prescribes to cure your infection. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not undo any permanent damage caused by the disease.

It is becoming harder to treat some gonorrhea, as drug-resistant strains of gonorrhea are increasing. If your symptoms continue for more than a few days after receiving treatment, you should return to a health care provider to be checked again.

I was treated for gonorrhea. When can I have sex again?

You should wait seven days after finishing all medications before having sex. To avoid getting infected with gonorrhea again or spreading gonorrhea to your partner(s), you and your sex partner(s) should avoid having sex until you have each completed treatment. If you’ve had gonorrhea and took medicine in the past, you can still get infected again if you have unprotected sex with a person who has gonorrhea.

What happens if I don’t get treated?

Untreated gonorrhea can cause serious and permanent health problems in both women and men.
In women, untreated gonorrhea can cause pelvic inflammatory disease (PID). Some of the complications of PID are

• Formation of scar tissue that blocks fallopian tubes;
• Ectopic pregnancy (pregnancy outside the womb);
• Infertility (inability to get pregnant);
• Long-term pelvic/abdominal pain.

In men, gonorrhea can cause a painful condition in the tubes attached to the testicles. In rare cases, this may cause a man to be sterile, or prevent him from being able to father a child.
Rarely, untreated gonorrhea can also spread to your blood or joints. This condition can be life-threatening.

Untreated gonorrhea may also increase your chances of getting or giving HIV – the virus that causes AIDS.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

CDC: Centers for Disease Control and Prevention

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Herpes is a common sexually transmitted disease (STD) that any sexually active person can get. Most people with the virus don’t have symptoms. It is important to know that even without signs of the disease, it can still spread to sexual partners.

What is genital herpes?

Genital herpes is an STD caused by two types of viruses. The viruses are called herpes simplex type 1 and herpes simplex type 2.

How common is genital herpes?

Genital herpes is common in the United States. In the United States, about one out of every six people aged 14 to 49 years have genital herpes.

How is genital herpes spread?

You can get herpes by having vaginal, anal, or oral sex with someone who has the disease.

Fluids found in a herpes sore carry the virus, and contact with those fluids can cause infection. You can also get herpes from an infected sex partner who does not have a visible sore or who may not know he or she is infected because the virus can be released through your skin and spread the infection to your sex partner(s).

How can I reduce my risk of getting herpes?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting herpes:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex.

Herpes symptoms can occur in both male and female genital areas that are covered by a latex condom. However, outbreaks can also occur in areas that are not covered by a condom so condoms may not fully protect you from getting herpes.

I'm pregnant. How could genital herpes affect my baby?

If you are pregnant and have genital herpes, it is even more important for you to go to prenatal care visits. You need to tell your doctor if you have ever had symptoms of, been exposed to, or been diagnosed with genital herpes. Sometimes genital herpes infection can lead to miscarriage. It can also make it more likely for you to deliver your baby too early. Herpes infection can be passed from you to your unborn child and cause a potentially deadly infection (neonatal herpes). It is important that you avoid getting herpes during pregnancy.

If you are pregnant and have genital herpes, you may be offered herpes medicine towards the end of your pregnancy to reduce the risk of having any symptoms and passing the disease to your baby. At the time of delivery your doctor should carefully examine you for symptoms. If you have herpes symptoms at delivery, a ‘C-section’ is usually performed.

How do I know if I have genital herpes?

Most people who have herpes have no, or very mild symptoms. You may not notice mild symptoms or you may mistake them for another skin condition, such as a pimple or ingrown hair. Because of this, most people who have herpes do not know it.

Genital herpes sores usually appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take weeks to heal. These symptoms are sometimes called “having an outbreak.” The first time someone has an outbreak they may also have flu-like symptoms such as fever, body aches, or swollen glands.

Repeat outbreaks of genital herpes are common, especially during the first year after infection. Repeat outbreaks are usually shorter and less severe than the first outbreak. Although the infection can stay in the body for the rest of your life, the number of outbreaks tends to decrease over a period of years.

You should be examined by your doctor if you notice any of these symptoms or if your partner has an STD or symptoms of an STD, such as an unusual sore, a smelly discharge, burning when urinating, or, for women specifically, bleeding between periods.

How will my doctor know if I have herpes?

Often times, your healthcare provider can diagnose genital herpes by simply looking at your symptoms. Providers can also take a sample from the sore(s) and test it. Have an honest and open talk with your health care provider and ask whether you should be tested for herpes or other STDs.

Can herpes be cured?

There is no cure for herpes. However, there are medicines that can prevent or shorten outbreaks. One of these herpes medicines can be taken daily, and makes it less likely that you will pass the infection on to your sex partner(s).

What happens if I don't get treated?

Genital herpes can cause painful genital sores and can be severe in people with suppressed immune systems. If you touch your sores or the fluids from the sores, you may transfer herpes to another part of your body, such as your eyes. Do not touch the sores or fluids to avoid spreading herpes to another part of your body. If you touch the sores or fluids, immediately wash your hands thoroughly to help avoid spreading your infection.

Some people who get genital herpes have concerns about how it will impact their overall health, sex life, and relationships. It is best for you to talk to a health care provider about those concerns, but it also is important to recognize that while herpes is not curable, it can be managed. Since a genital herpes diagnosis may affect how you will feel about current or future sexual relationships, it is important to understand how to talk to sexual partners about STDs. You can find one resource here: GYT Campaign.

If you are pregnant, there can be problems for you and your unborn child. See “I’m pregnant. How could genital herpes affect my baby?” above for information about this.

Can I still have sex if I have herpes?

If you have herpes, you should tell your sex partner(s) and let him or her know that you do and the risk involved. Using condoms may help lower this risk but it will not get rid of the risk completely. Having sores or other symptoms of herpes can increase your risk of spreading the disease. Even if you do not have any symptoms, you can still infect your sex partners.

What is the link between genital herpes and HIV?

Genital herpes can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum. The genital sores caused by herpes can bleed easily. When the sores come into contact with the mouth, vagina, or rectum during sex, they increase the risk of giving or getting HIV if you or your partner has HIV.

 

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention

Personal health inquiries and information about STDs:

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

Resources:

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

Source: Centers for Disease Control and Prevention. HHS

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People who have STDs are more likely to get HIV, when compared to people who do not have STDs.

Are some STDs associated with HIV?

Yes. In the United States, people who get syphilis, gonorrhea, and herpes often also have HIV, or are more likely to get HIV in the future.

Why does having an STD put me more at risk for getting HIV?

If you get an STD you are more likely to get HIV than someone who is STD-free. This is because the same behaviors and circumstances that may put you at risk for getting an STD can also 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.

What activities can put me at risk for both STDs and HIV?

• Having anal, vaginal, or oral sex without a condom;
• Having multiple sex partners;
• Having anonymous sex partners;
• Having sex while under the influence of drugs or alcohol can lower inhibitions and result in greater sexual risk-taking.

What can I do to prevent getting STDs and HIV?

The only way to avoid STDs is to not have vaginal, anal, or oral sex. If you are sexually active, you can do the following things to lower your chances of getting STDs and HIV:

• Choose less risky sexual behaviors
• Use condoms consistently and correctly;
• Reduce the number of people with whom you have sex;
• Limit or eliminate drug and alcohol use before and during sex;
• Have an honest and open talk with your healthcare provider and ask whether you should be tested for STDs and HIV;
• Talk to your healthcare provider and find out if pre-exposure prophylaxis, or PrEP, is a good option for you to prevent HIV infection.

If I already have HIV, and then I get an STD, does that put my sex partner(s) at an increased risk for getting HIV?

It can. If you already have HIV, and then get another STD, it can put your HIV-negative partners at greater risk of getting HIV from you.

Your sex partners are less likely to get HIV from you if you

• Use antiretroviral therapy (ART).  ART reduces the amount of virus (viral load) in your blood and body fluids. ART can keep you healthy for many years, and greatly reduce your chance of transmitting HIV to sex partners, if taken consistently.
• Choose less risky sexual behaviors.
• Use condoms consistently and correctly.

The risk of getting HIV may also be reduced if your partner takes pre-exposure prophylaxis, or PrEP, after discussing this option with his or her healthcare provider and determining whether it is appropriate.

Will treating STDs prevent me from getting HIV?  

No. It’s not enough.  

If you get treated for an STD, this will help to prevent its complications, and prevent spreading STDs to your sex partners. Treatment for an STD other than HIV does not prevent the spread of HIV.

If you are diagnosed with an STD, talk to your doctor about ways to protect yourself and your partner(s) from getting reinfected with the same STD, or getting HIV.

 

People who have STDs are more likely to get HIV, when compared to people who do not have STDs.

Are STDs related to HIV?

Yes. In the United States, people who get syphilis, gonorrhea, and herpes often also have HIV or are more likely to get HIV in the future.  One reason is the behaviors that put someone at risk for one infection (not using condoms, multiple partners, anonymous partners) often put them at risk for other infections.  Also, because STD and HIV tend to be linked, when someone gets an STD it suggests they got it from someone who may be at risk for other STD and HIV.  Finally, a sore or inflammation from an STD may allow infection with HIV that would have been stopped by intact skin.

STDs can increase the risk of spreading HIV.

HIV-infected persons are more likely to shed HIV when they have urethritis or a genital ulcer. When HIV-infected persons get another STD such as gonorrhea or syphilis, it suggests that they were having sex without using condoms. If so, they may have spread HIV to their partners.

Some STDs are more closely linked to HIV than others.  

In the US, both syphilis and HIV are highly concentrated epidemics among men who have sex with men. In 2012, approximately 75% of persons reported with syphilis in the U.S. were MSM.  In Florida, in 2010, among all persons diagnosed with infectious syphilis 42% were also HIV infected. Men who get syphilis are at very high risk of being diagnosed with HIV in the future; among HIV-uninfected men who got syphilis in Florida in 2003, 22% were newly diagnosed with HIV by 2011.  HIV is more closely linked to gonorrhea than chlamydia (which is particularly common among young women).  Herpes is also commonly associated with HIV; a meta-analysis found persons infected with HSV-2 are at 3-fold increased risk for acquiring HIV infection.

Some activities can put people at increased risk for both STDs and HIV.

• Having anal, vaginal, or oral sex without a condom;
• Having multiple sex partners;
• Having anonymous sex partners;
• Having sex while under the influence of drugs or alcohol can lower inhibitions and result in greater sexual risk taking.

Does treating STDs prevent HIV?  

Not by itself. Given the close link between STD and HIV in many studies, it seems obvious that treating STDs should reduce the risk of HIV.  However, studies that have lowered the risk of STD in communities have not necessarily lowered the risk of HIV.  Risk of HIV was lowered in one community trial, but not in 3 others.  

• In Mwanza (Tanzania), improved STD treatment lowered 2-year HIV incidence by 40% in the intervention towns (1.2%) compared to other towns (1.9%).
• In Rakai (Uganda), a more intensive intervention (mass treatment and improved STD control) was done, leading to lower rates of syphilis and trichomoniasis, but the incidence of HIV was the same in intervention and comparison towns (1.5% per year).
• A third community trial found no difference in HIV incidence when behavioral plus STD control interventions were compared to usual services (Incidence rate ratio = 1.00), despite lower rates of syphilis (rate ratio 0.52) and gonorrhea (rate ratio 0.25).
• A fourth community trial found HIV incidence was slightly higher in communities that received a combination of interventions including improved STD treatment when compared to control communities (incidence rate ratio 1.27, not statistically significant).

Treating individuals for STDs has also not necessarily lowered their risk of acquiring HIV.

• One study found there was slightly lower risk of HIV seroconversion among female sex workers who had monthly exams for STD (5.3%) compared to sex workers who were examined when they had symptoms (7.6%, P=0.5); their rates of infection were lower for trichomonas (14% vs 7% P=0.07) but not for gonorrhea, chlamydia, or genital ulcers.
• A second trial in female sex workers found a slightly higher incidence of HIV among women who received monthly treatment with azithromycin (4%) compared to women who did not (3.2%, P=0.5) despite major differences in the incidence of infection with gonorrhea (relative risk RR 0.46), chlamydia (RR 0.38), and trichomoniasis (RR 0.56).

Three placebo-controlled trials have assessed the benefit to individuals from treatment with acyclovir to suppress genital herpes ulcers:

• One enrolled female sex workers who were infected with HSV but not HIV; it found no impact on HIV incidence in the acyclovir group (4.29%) compared to the placebo group (4.25%), though it also found no difference in reported episodes of genital ulceration or in measured HSV shedding.
• A second study of HIV acquisition among persons infected with HSV-2 included women and men who have sex with men; HIV incidence was similar in the acyclovir group (3.9%) and the placebo group (3.3%) despite a 47% reduction in observed genital ulcers in the acyclovir group.
• The third study looked at the effect of acyclovir on HIV transmission from heterosexuals infected with both HIV and HSV-2 to their HIV-uninfected partners; after removing 29% of new infections that were apparently acquired from an outside partner, the incidence was similar in the acyclovir group (1.8%) and the placebo group (1.9%, P=0.69) despite major reductions in genital ulcer disease (risk ratio 0.39).

Screening for STDs can help assess a person’s risk for getting HIV. Treatment of STDs is important to prevent the complications of those infections, and to prevent transmission to partners, but it should not be expected to prevent spread of HIV.  

What can people do to reduce their risk of getting STDs and HIV?

The only way to avoid STDs is to not have vaginal, anal, or oral sex. If people are sexually active, they can do the following things to lower their chances of getting STDs and HIV:

• Choose less risky sexual behaviors;
• Use condoms consistently and correctly;
• Reduce the number of people with whom they have sex;
• Limit or eliminate drug and alcohol use before and during sex;
• Have an honest and open talk with their healthcare provider and ask whether they should be tested for STDs and HIV.
• Talk with their healthcare provider and find out if pre-exposure prophylaxis, or PrEP, is a good option for them to prevent HIV infection.

If someone already has HIV, and subsequently gets an STD, does that put their sex partner(s) at an increased risk for getting HIV?

It can. HIV-negative sex partners are at greater risk of getting HIV from someone who is HIV-positive and acquires another STD. The HIV-negative sex partners of persons who are HIV-positive are less likely to get HIV if:

• HIV-positive persons use antiretroviral therapy (ART).  ART reduces the amount of virus (viral load) in blood and body fluids. ART can keep HIV-positive persons healthy for many years, and greatly reduce the chance of transmitting HIV to sex partners if taken consistently.
• Sex partners take pre-exposure prophylaxis (PrEP) after discussing this option with his/her healthcare provider and determining whether it is appropriate.
• Choose less risky sexual behaviors.
• Use condoms consistently and correctly.

Will treating someone for STDs prevent them from getting HIV?  

No. It’s not enough. Screening for STDs can help assess a person’s risk for getting HIV.  Treatment of STDs is important to prevent the complications of those infections, and to prevent transmission to partners, but it should not be expected to prevent spread of HIV.  

If someone HIV-positive is diagnosed with an STD, they should receive counseling about risk reduction and how to protect their sex partner(s) from getting re-infected with the same STD or getting HIV.

Where can I get more information?

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

CDC: Centers for Disease Control and Prevention. HHS

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Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. Some health effects caused by HPV can be prevented with vaccines.

What is HPV?

HPV is the most common sexually transmitted infection (STI). HPV is a different virus than HIV and HSV (herpes). HPV is so common that nearly all sexually active men and women get it at some point in their lives. 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.

How is HPV spread?

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. HPV can be passed even when an infected person has no signs or symptoms.

Anyone who is sexually active can get HPV, even if you have had sex with only one person. You also can develop symptoms years after you have sex with someone who is infected making it hard to know when you first became infected.

Does HPV cause health problems?

In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and 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 a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.

Does HPV cause cancer?

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, including the base of the tongue and tonsils (called oropharyngeal cancer).

Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.

There is no way to know which people who have HPV will develop cancer or other health problems. People with weak immune systems (including individuals with HIV/AIDS) may be less able to fight off HPV and more likely to develop health problems from it.

How can I avoid HPV and the health problems it can cause?

You can do several things to lower your chances of getting HPV.

Get vaccinated. HPV vaccines are safe and effective. They can protect males and females against diseases (including cancers) caused by HPV when given in the recommended age groups (see “Who should get vaccinated?” below). HPV vaccines are given in three shots over six months; it is important to get all three doses.

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 latex condoms the right way every time you have sex. This can lower your chances of getting HPV. But HPV can infect areas that are not covered by a condom - so condoms may not give full protection against getting HPV;
• Be in a mutually monogamous relationship – or have sex only with someone who only has sex with you.

Who should get vaccinated?

All boys and girls ages 11 or 12 years should get vaccinated.

Catch-up vaccines are recommended for males through age 21 and for females through age 26, if they did not get vaccinated when they were younger.

The vaccine is also recommended for gay and bisexual men (or any man who has sex with a man) through age 26. It is also recommended for men and women with compromised immune systems (including people living with HIV/AIDS) through age 26, if they did not get fully vaccinated when they were younger.

How do I know if I have 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.

There are HPV tests that can be used to screen for cervical cancer. These tests are recommended for screening only in women aged 30 years and older. They are not recommended to screen men, adolescents, or women under the age of 30 years.

Most people with HPV do not know they are infected and 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.

How common is HPV and the health problems caused by HPV?

HPV (the virus): About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that most sexually-active men and women will get at least one type of HPV at some point in their lives.

Health problems related to HPV include genital warts and cervical cancer.

Genital warts: About 360,000 people in the United States get genital warts each year.

Cervical cancer: More than 11,000 women in the United States get cervical cancer each year.

There are other conditions and cancers caused by HPV that occur in persons living in the United States.

I'm pregnant. Will having HPV affect my pregnancy?

If you are pregnant and have HPV, you can get genital warts or develop abnormal cell changes on your cervix. Abnormal cell changes can be found with routine cervical cancer screening. You should get routine cervical cancer screening even when you are pregnant.

Can I be treated for HPV or health problems caused by HPV?

There is no treatment for the virus itself. However, there are treatments for the health problems that HPV can cause:

1. Genital warts can be treated by you or your physician. If left untreated, genital warts may go away, stay the same, or grow in size or number.
2. Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. For more information visit www.cancer.org.
3. Other HPV-related cancer are also more treatable when diagnosed and treated early. For more information visit www.cancer.org. All STD Fact Sheets

Where can I get more information?

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

National HPV and Cervical Cancer Prevention Resource Center American Sexual Health Association (ASHA)
P. O. Box 13827
Research Triangle Park, NC
27709-3827
1-800-783-9877

CDC: Centers for Disease Control and Prevention, HHS

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Syphilis is a sexually transmitted disease (STD) that can have very serious complications when left untreated, but it is simple to cure with the right treatment.

What is syphilis?

Syphilis is an STD that can cause long-term complications if not treated correctly. Symptoms in adults are divided into stages. These stages are primary, secondary, latent, and late syphilis.

How is syphilis spread?

You can get syphilis by direct contact with a syphilis sore during vaginal, anal, or oral sex. Sores can be found on the penis, vagina, anus, in the rectum, or on the lips and in the mouth. Syphilis can also be spread from an infected mother to her unborn baby.

What does syphilis look like?

Syphilis has been called ‘the great imitator’ because it has so many possible symptoms, many of which look like symptoms from other diseases. The painless syphilis sore that you would get after you are first infected can be confused for an ingrown hair, zipper cut, or other seemingly harmless bump. The non-itchy body rash that develops during the second stage of syphilis can show up on the palms of your hands and soles of your feet, all over your body, or in just a few places. You could also be infected with syphilis and have very mild symptoms or none at all.

How can I reduce my risk of getting syphilis?

The only way to avoid STDs is to not have vaginal, anal, or oral sex.

If you are sexually active, you can do the following things to lower your chances of getting syphilis:

• Being in a long-term mutually monogamous relationship with a partner who has been tested and has negative STD test results;
• Using latex condoms the right way every time you have sex. Condoms prevent transmission of syphilis by preventing contact with a sore. Sometimes sores occur in areas not covered by a condom. Contact with these sores can still transmit syphilis.

Am I at risk for syphilis?

Any sexually active person can get syphilis through unprotected vaginal, anal, or oral sex. Have an honest and open talk with your health care provider and ask whether you should be tested for syphilis or other STDs. You should get tested regularly for syphilis if you are pregnant, are a man who has sex with men, have HIV infection, and/or have partner(s) who have tested positive for syphilis.

I’m pregnant. How does syphilis affect my baby?

If you are pregnant and have syphilis, you can give the infection to your unborn baby. Having syphilis can lead to a low birth weight baby. It can also make it more likely you will deliver your baby too early or stillborn (a baby born dead). To protect your baby, you should be tested for syphilis during your pregnancy and at delivery and receive immediate treatment if you test positive.

An infected baby may be born without signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies can have health problems such as cataracts, deafness, or seizures, and can die.

How do I know if I have syphilis?

Symptoms of syphilis in adults can be divided into stages:

Primary Stage

During the first (primary) stage of syphilis, you may notice a single sore, but there may be multiple sores. The sore is the location where syphilis entered your body. The sore is usually firm, round, and painless. Because the sore is painless, it can easily go unnoticed. The sore lasts 3 to 6 weeks and heals regardless of whether or not you receive treatment. Even though the sore goes away, you must still receive treatment so your infection does not move to the secondary stage.

Secondary Stage

During the secondary stage, you may have skin rashes and/or sores in your mouth, vagina, or anus (also called mucous membrane lesions). 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 can look like rough, red, or reddish brown spots on the palms of your hands and/or the bottoms of your feet. The rash usually won’t itch and it is sometimes so faint that you won’t notice it. Other symptoms you may have can include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue (feeling very tired). The symptoms from this stage will go away whether or not you receive treatment. Without the right treatment, your infection will move to the latent and possibly late stages of syphilis.

Latent and Late Stages

The latent stage of syphilis begins when all of the symptoms you had earlier disappear. If you do not receive treatment, you can continue to have syphilis in your body for years without any signs or symptoms. Most people with untreated syphilis do not develop late stage syphilis. However, when it does happen it is very serious and would occur 10–30 years after your infection began. Symptoms of the late stage of syphilis include difficulty coordinating your muscle movements, paralysis (not able to move certain parts of your body), numbness, blindness, and dementia (mental disorder). In the late stages of syphilis, the disease damages your internal organs and can result in death.

A syphilis infection is called an ‘early’ case if a patient has been infected for a year or less, such as during the primary or secondary stages of syphilis. People who have ‘early’ syphilis infections can more easily spread the infection to their sex partners. The majority of early syphilis cases are currently found among men who have sex with men, but women and unborn children are also at risk of infection.

How will my doctor know if I have syphilis?

Most of the time, a blood test can be used to test for syphilis. Some health care providers will diagnose syphilis by testing fluid from a syphilis sore.

Can syphilis be cured?

Yes, syphilis can be cured with the right antibiotics from your health care provider. However, treatment will not undo any damage that the infection has already done.

I’ve been treated. Can I get syphilis again?

Having syphilis once does not protect you from getting it again. Even after you’ve been successfully treated, you can still be re-infected. Only laboratory tests can confirm whether you have syphilis. Follow-up testing by your health care provider is recommended to make sure that your treatment was successful.

Because syphilis sores can be hidden in the vagina, anus, under the foreskin of the penis, or in the mouth, it may not be obvious that a sex partner has syphilis. Unless you know that your sex partner(s) has been tested and treated, you may be at risk of getting syphilis again from an untreated sex partner.

CDC

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Most people who have trichomoniasis do not have any symptoms.

Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

CDC-INFO Contact Center
1-800-CDC-INFO (1-800-232-4636)
TTY: (888) 232-6348
Contact CDC-INFO

 Source: Centers for Disease Control and Prevention, HHS

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Did I get scabies from my pet?

No. Animals do not spread human scabies. Pets can become infested with a different kind of scabies mite that does not survive or reproduce on humans but causes "mange" in animals. If an animal with "mange" has close contact with a person, the animal mite can get under the person’s skin and cause temporary itching and skin irritation. However, the animal mite cannot reproduce on a person and will die on its own in a couple of days. Although the person does not need to be treated, the animal should be treated because its mites can continue to burrow into the person’s skin and cause symptoms until the animal has been treated successfully.

Can scabies be spread by swimming in a public pool?

Scabies is spread by prolonged skin-to-skin contact with a person who has scabies. Scabies sometimes also can be spread by contact with items such as clothing, bedding, or towels that have been used by a person with scabies, but such spread is very uncommon unless the infested person has crusted scabies.

Scabies is very unlikely to be spread by water in a swimming pool. Except for a person with crusted scabies, only about 10-15 scabies mites are present on an infested person; it is extremely unlikely that any would emerge from under wet skin.

Although uncommon, scabies can be spread by sharing a towel or item of clothing that has been used by a person with scabies.

How can I remove scabies mites from my house or carpet?

Scabies mites do not survive more than 2-3 days away from human skin. Items such as bedding, clothing, and towels used by a person with scabies can be decontaminated by machine-washing in hot water and drying using the hot cycle or by dry-cleaning. Items that cannot be washed or dry-cleaned can be decontaminated by removing from any body contact for at least 72 hours.

Because persons with crusted scabies are considered very infectious, careful vacuuming of furniture and carpets in rooms used by these persons is recommended.

Fumigation of living areas is unnecessary.

How can I remove scabies mites from my clothes?

Scabies mites do not survive more than 2-3 days away from human skin. Items such as bedding, clothing, and towels used by a person with scabies can be decontaminated by machine-washing in hot water and drying using the hot cycle or by dry-cleaning. Items that cannot be washed or dry-cleaned can be decontaminated by removing from any body contact for at least 72 hours.

My spouse and I were diagnosed with scabies. After several treatments, he/she still has symptoms while I am cured. Why?

The rash and itching of scabies can persist for several weeks to a month after treatment, even if the treatment was successful and all the mites and eggs have been killed. Your health care provider may prescribe additional medication to relieve itching if it is severe. Symptoms that persist for longer than 2 weeks after treatment can be due to a number of reasons, including:

• Incorrect diagnosis of scabies. Many drug reactions can mimic the symptoms of scabies and cause a skin rash and itching; the diagnosis of scabies should be confirmed by a skin scraping that includes observing the mite, eggs, or mite feces (scybala) under a microscope. If you are sleeping in the same bed with your spouse and have not become reinfested, and you have not retreated yourself for at least 30 days, then it is unlikely that your spouse has scabies.
• Reinfestation with scabies from a family member or other infested person if all patients and their contacts are not treated at the same time; infested persons and their contacts must be treated at the same time to prevent reinfestation.
• Treatment failure caused by resistance to medication, by faulty application of topical scabicides, or by failure to do a second application when necessary; no new burrows should appear 24-48 hours after effective treatment.
• Treatment failure of crusted scabies because of poor penetration of scabicide into thick scaly skin containing large numbers of scabies mites; repeated treatment with a combination of both topical and oral medication may be necessary to treat crusted scabies successfully.
• Reinfestation from items (fomites) such as clothing, bedding, or towels that were not appropriately washed or dry-cleaned (this is mainly of concern for items used by persons with crusted scabies); potentially contaminated items (fomites) should be machine washed in hot water and dried using the hot temperature cycle, dry-cleaned, or removed from skin contact for at least 72 hours.
• An allergic skin rash (dermatitis); or
• Exposure to household mites that cause symptoms to persist because of cross-reactivity between mite antigens.

If itching continues more than 2-4 weeks or if new burrows or rash continue to appear, seek the advice of a physician; retreatment with the same or a different scabicide may be necessary.

If I come in contact with a person who has scabies, should I treat myself?

No. If a person thinks he or she might have scabies, he/she should contact a doctor. The doctor can examine the person, confirm the diagnosis of scabies, and prescribe an appropriate treatment. Products used to treat scabies in humans are available only with a doctor’s prescription.

Sleeping with or having sex with any scabies infested person presents a high risk for transmission. The longer a person has skin-to-skin exposure, the greater is the likelihood for transmission to occur. Although briefly shaking hands with a person who has non-crusted scabies could be considered as presenting a relatively low risk, holding the hand of a person with scabies for 5-10 minutes could be considered to present a relatively high risk of transmission. However, transmission can occur even after brief skin-to-skin contact, such as a handshake, with a person who has crusted scabies. In general, a person who has skin-to-skin contact with a person who has crusted scabies would be considered a good candidate for treatment.

To determine when prophylactic treatment should be given to reduce the risk of transmission, early consultation should be sought with a health care provider who understands:

1. the type of scabies (i.e. non-crusted vs crusted) to which a person has been exposed;
2. the degree and duration of skin exposure that a person has had to the infested patient;
3. whether the exposure occurred before or after the patient was treated for scabies; and,
4. whether the exposed person works in an environment where he/she would be likely to expose other people during the asymptomatic incubation period. For example, a nurse or caretaker who works in a nursing home or hospital often would be treated prophylactically to reduce the risk of further scabies transmission in the facility.

 Source: Centers for Disease Control and Prevention, HHS

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Hepatitis A FAQs for Health Professionals

Index of Questions

Overview and Statistics

What is the case definition for acute Hepatitis A?

The clinical case definition for acute viral hepatitis is 1) discrete onset of symptoms (e.g., nausea, anorexia, fever, malaise, or abdominal pain) and 2) jaundice or elevated serum aminotransferase levels. Because the clinical characteristics are the same for all types of acute viral hepatitis, Hepatitis A diagnosis must be confirmed by a positive serologic test for immunoglobulin M (IgM) antibody to Hepatitis A virus, or the case must meet the clinical case definition and occur in a person who has an epidemiologic link with a person who has laboratory-confirmed Hepatitis A (i.e., household or sexual contact with an infected person during the 15–50 days before the onset of symptoms).

The case definition for acute Hepatitis A is available at the following link: Acute Hepatitis A

Additional guidance on viral hepatitis surveillance and case management is available at http://www.cdc.gov/hepatitis/SurveillanceGuidelines.htm.

How common is Hepatitis A virus (HAV) infection in the United States?

Hepatitis A rates in the United States have declined by 95% since Hepatitis A vaccine first became available in 1995.

In 2012, 1,562 acute symptomatic cases of Hepatitis A were reported; The overall incidence rate for 2012 was 0.5 cases per 100,000. After adjusting for asymptomatic infection and underreporting, the estimated number of new infections was 3,000.

How is HAV transmitted?

• Person-to-person transmission through the fecal-oral route (i.e., ingestion of something that has been contaminated with the feces of an infected person) is the primary means of HAV transmission in the United States. Most infections result from close personal contact with an infected household member or sex partner.
• Common-source outbreaks and sporadic cases also can occur from exposure to fecally contaminated food or water. Uncooked HAV-contaminated foods have been recognized as a source of outbreaks. Cooked foods also can transmit HAV if the temperature during food preparation is inadequate to kill the virus or if food is contaminated after cooking, as occurs in outbreaks associated with infected food handlers. Waterborne outbreaks are infrequent in developed countries with well-maintained sanitation and water supplies.

Who is at increased risk for acquiring HAV infection?

• Travelers to countries with high or intermediate endemicity of HAV infection
• Men who have sex with men
• Users of injection and non-injection illegal drugs
• Persons with clotting factor disorders
• Persons working with nonhuman primates

What are the signs and symptoms of HAV infection?

• Fever
• Fatigue
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice

In children aged 70% of patients.

When symptoms occur, how long do they usually last?

Symptoms usually last less than 2 months, although 10%–15% of symptomatic persons have prolonged or relapsing disease for up to 6 months.

What is the incubation period for Hepatitis A?

The average incubation period for Hepatitis A is 28 days (range: 15–50 days).

How long does HAV survive outside the body? How can the virus be killed?

HAV can live outside the body for months, depending on the environmental conditions. The virus is killed by heating to >185 degrees F (>85 degrees C) for one minute. However, the virus can still be spread from cooked food if it is contaminated after cooking. Adequate chlorination of water, as recommended in the United States, kills HAV that enters the water supply.

Can Hepatitis A become chronic?

No. Hepatitis A does not become chronic.

Can persons become reinfected with HAV after recovering from Hepatitis A?

No. IgG antibodies to HAV, which appear early in the course of infection, provide lifelong protection against the disease.

How is HAV infection prevented?

Vaccination with the full, two-dose series of Hepatitis A vaccine is the best way to prevent HAV infection. Hepatitis A vaccine has been licensed in the United States for use in persons 12 months of age and older. The vaccine is recommended for persons who are more likely to get HAV infection or are more likely to get seriously ill if they get Hepatitis A, and for any person wishing to obtain immunity (see Who should be vaccinated against Hepatitis A?).

Immune globulin is available for short-term protection (approximately 3 months) against Hepatitis A, both pre- and post-exposure. Immune globulin must be administered within 2 weeks after exposure for maximum protection.

Good hygiene — including handwashing after using the bathroom, changing diapers, and before preparing or eating food — is also integral to Hepatitis A prevention, given that the virus is transmitted through the fecal–oral route. Environmental surfaces can be cleaned with a freshly prepared solution of 1:100 dilution of household bleach.

 Hepatitis A Vaccination

Who should be vaccinated against Hepatitis A?

Hepatitis A vaccination is recommended for all children at age 1 year, for persons who are at increased risk for infection, for persons who are at increased risk for complications from Hepatitis A, and for any person wishing to obtain immunity. The following groups are recommended to receive Hepatitis A vaccination:

Which Hepatitis A vaccines are licensed for use in the United States?

Two single-antigen Hepatitis A vaccines, HAVRIX® (manufactured by GlaxoSmithKline) and VAQTA® (manufactured by Merck & Co., Inc), are currently licensed in the United States. A combination vaccine, TWINRIX® (manufactured by GlaxoSmithKline), contains both HAV (in a lower dosage; see table) and Hepatitis B virus antigens. All are inactivated vaccines.

What are the dosages and schedules for Hepatitis A vaccines?

 Licensed dosages and schedules for HAVRIX ^{® 1}

Age	Dose (ELISA units)2	Volume (mL)	No. of doses	Schedule (mos)3
12 mos–18 yrs	720	0.5	2	0,6-12
≥19 years	1,440	1.0	2	0,6-12

¹Hepatitis A vaccine, inactivated, GlaxoSmithKline.
²Enzyme-linked immunosorbent assay units.
³0 months represents timing of the initial dose; subsequent numbers represent months after the initial dose.

Licensed dosages and schedules for VAQTA ® 1
Age	Dose (U.)2	Volume (mL)	No. of doses	Schedule (mos)3
12 mos–18 yrs	25	0.5	2	0,6-18
≥19 years	50	1.0	2	0,6-18

¹Hepatitis A vaccine, inactivated, Merck & Co., Inc.
²Units.
³0 months represents timing of the initial dose; subsequent numbers represent months after the initial dose.

TWINRIX ^{® 1} (HepAHepB) Vaccine Schedule (Not recommended for post exposure prophylaxis)

 Licensed dosages and schedules for TWINRIX ^{® 1}

Age	Dose (ELISA units)2	Volume (mL)	No. of doses	Schedule
≥ 18 yrs	720	1.0	3	0, 1, 6 mos
≥ 18 yrs	720	1.0	4	0, 7, 21–30 days + 12 mos3

¹Combined Hepatitis A and Hepatitis B vaccine, inactivated, GlaxoSmithKline.
²Enzyme-linked immunosorbent assay units.
³This 4-dose schedule enables patients to receive 3 doses in 21 days; this schedule is used prior to planned exposure with short notice and requires a fourth dose at 12 months.

How long does protection from Hepatitis A vaccine last?

A recent review by an expert panel, which evaluated the projected duration of immunity from vaccination, concluded that protective levels of antibody to HAV could be present for at least 25 years in adults and at least 14–20 years in children.

Can Hepatitis A vaccine be administered concurrently with other vaccines?

Yes. Hepatitis B, diphtheria, poliovirus (oral and inactivated), tetanus, oral and intramuscular typhoid, cholera, Japanese encephalitis, rabies, and yellow fever vaccines and immune globulin can be given at the same time that Hepatitis A vaccine is given, but at a different injection site.

Can a patient receive the first dose of Hepatitis A vaccine from one manufacturer and the second (last) dose from another manufacturer?

Yes. Although studies have not been done to examine this issue, there is no reason to believe that using single-antigen vaccine from different manufacturers would be a problem.

What should be done if the second (last) dose of Hepatitis A vaccine is delayed?

The second dose should be administered as soon as possible. The first dose does not need to be readministered.

Can Hepatitis A vaccine be given during pregnancy?

The safety of Hepatitis A vaccination during pregnancy has not been determined; however, because the vaccine is produced from inactivated HAV, the theoretical risk to the developing fetus is expected to be low. The risk associated with vaccination, however, should be weighed against the risk for Hepatitis A in women who might be at high risk for exposure to HAV.

Can Hepatitis A vaccine be given to immunocompromised persons (e.g., persons on hemodialysis or persons with AIDS)?

Yes. Because Hepatitis A vaccine is inactivated, no special precautions need to be taken when vaccinating immunocompromised persons.

Is it harmful to administer an extra dose(s) of Hepatitis A or Hepatitis B vaccine or to repeat the entire vaccine series if documentation of vaccination history is unavailable?

No. If necessary, administering extra doses of Hepatitis A or Hepatitis B vaccine is not harmful.

Should prevaccination testing be performed before administering Hepatitis A vaccine?

• Persons who were born in geographic areas with high or intermediate prevalence of HAV infection
• Older adolescents and adults in certain population groups (i.e., American Indians, Alaska Natives, and Hispanics)
• Adults in groups that have a high prevalence of infection (e.g., injection drug users)

Prevaccination testing might also be warranted for all older adults. The decision to test should be based on 1) the expected prevalence of immunity, 2) the cost of vaccination compared with the cost of serologic testing, and 3) the likelihood that testing will not interfere with initiation of vaccination.

Should postvaccination testing be performed?

No. Postvaccination testing is not indicated because of the high rate of vaccine response among adults and children. In addition, not all testing methods approved for routine diagnostic use in the United States have the sensitivity to detect low, but protective, anti-HAV concentrations after vaccination.

Which groups do NOT need routine vaccination against Hepatitis A?

Hepatitis A and International Travel

Who should receive protection against Hepatitis A before travel?

All susceptible persons traveling to or working in countries that have high or intermediate rates of Hepatitis A should be vaccinated or receive immune globulin (IG) before traveling. Persons from developed countries who travel to developing countries are at high risk for Hepatitis A. The risk for Hepatitis A exists even for travelers to urban areas, those who stay in luxury hotels, and those who report that they have good hygiene and that they are careful about what they drink and eat. For more information on international travel and HAV, see CDC's travel page at http://wwwn.cdc.gov/travel/yellowBookCh4-HepA.aspx .

How soon before travel should the first dose of Hepatitis A vaccine be given?

The first dose of Hepatitis A vaccine should be administered as soon as travel is considered.

Previously, Hepatitis A vaccination was recommended to be administered at least 2–4 weeks before departure to an area with intermediate or high rates of Hepatitis A. Travelers who were departing in less than 2 weeks were recommended to receive receive immune globulin (IG) for short-term protection.

However, on the basis of data indicating that immune globulin and vaccine have equivalent postexposure efficacy among healthy persons aged ≤40 years, the Advisory Committee on Immunization Practices (ACIP) has amended its guidelines for Hepatitis A vaccination for travelers. ACIP now recommends that one dose of single-antigen Hepatitis A vaccine administered at any time before departure may provide adequate protection for most healthy persons.

For optimal protection, older adults, immunocompromised persons, and persons with chronic liver disease or other chronic medical conditions who are planning to depart in ≤2 weeks should receive the initial dose of vaccine and also can simultaneously be administered IG (0.02 mL/kg) at a separate anatomic injection site.

What should be done if a traveler cannot receive Hepatitis A vaccine?

Travelers who are allergic to a vaccine component, who elect not to receive vaccine, or who are aged

What should be done for travelers less than 12 months of age?

Immune globulin is recommended because Hepatitis A vaccine is currently not approved for use in this age group.

Postexposure Prophylaxis for Hepatitis A

What are the current CDC guidelines for postexposure protection against Hepatitis A?

Until recently, an injection of immune globulin (IG) was the only recommended way to protect people after they have been exposed to Hepatitis A virus. In June 2007, U.S. guidelines were revised to allow for Hepatitis A vaccine to be used after exposure to prevent infection in healthy persons aged 1–40 years.

• For healthy persons aged 12 months–40 years, single-antigen Hepatitis A vaccine at the age-appropriate dose is preferred to IG because of the vaccine’s advantages, including long-term protection and ease of administration, as well as the equivalent efficacy of vaccine to IG.
• For persons aged 40 years and older, IG is preferred because of the absence of information regarding vaccine performance in this age group and because of the more severe manifestations of Hepatitis A in older adults. The magnitude of the risk of HAV transmission from the exposure should be considered in decisions to use vaccine or IG in this age group. 
• Vaccine can be used if IG cannot be obtained.
• IG should be used for children aged less than12 months, immunocompromised persons, persons with chronic liver disease, and persons who are allergic to the vaccine or a vaccine component (see Footnote).

Footnote:

• CDC does not have official guidance to define all subgroups of persons recommended to receive IG.
• IG is indicated for persons at increased risk of severe or fatal hepatitis A infection. These persons include adults older than 40 years of age, particularly adults 75 years and older, persons with chronic liver disease (e.g., cirrhosis), and those who are immunocompromised. 
• IG is indicated for persons with decreased response to hepatitis A vaccine. Based on available data such persons include those with HIV/AIDs, persons undergoing hemodialysis, recipients of solid organ, bone marrow or stem cell transplants, persons with chronic liver disease (e.g., cirrhosis), and other patients unlikely to develop an adequate immune response.  Also, antibody response after a single dose of hepatitis A vaccine in persons older than 40 years may be reduced, but data are limited.
• Immunocompromised persons generally are incapable of developing a normal immune response, usually as a result of disease, malnutrition, or immunosuppressive therapy.  IG is indicated for patients who might include those receiving high dose steroids, chemotherapy, immunomodulators, and those who have primary immunodeficiency conditions.  Clinical guidance should be obtained if the immune status is unclear.

Who requires protection (i.e., IG or Hepatitis A vaccine) after exposure to HAV?

• Household and sex contacts
• Persons who have shared illicit drugs with someone with Hepatitis A

Consideration should also be given to providing IG or Hepatitis A vaccine to persons with other types of ongoing, close personal contact with a person with Hepatitis A (e.g., a regular babysitter or caretaker).

• Postexposure prophylaxis (PEP) should be administered to all previously unvaccinated staff and attendees of child care centers or homes if 1) one or more cases of Hepatitis A are recognized in children or employees or 2) cases are recognized in two or more households of center attendees.
• In centers that provide care only to older children who no longer wear diapers, PEP need be administered only to classroom contacts of the index patient (i.e., not to children or staff in other classrooms).
• When an outbreak occurs (i.e., Hepatitis A cases in three or more families), PEP should also be considered for members of households that have diaper-wearing children attending the center.

Persons exposed to a common source, such as an infected food handler. If a food handler receives a diagnosis of Hepatitis A, post-exposure prophylaxis (PEP) should be administered to other food handlers at the same establishment. Because transmission to patrons is unlikely, PEP administration to patrons typically is not indicated but may be considered if 1) during the time when the food handler was likely to be infectious, the food handler both directly handled uncooked foods or foods after cooking and had diarrhea or poor hygienic practices, and 2) patrons can be identified and treated within 2 weeks of exposure.

In settings in which repeated exposures to HAV might have occurred, such as institutional cafeterias, stronger consideration of PEP use might be warranted.

If a case of Hepatitis A is found in a school, hospital, or office setting, what should be done?

If a single case of Hepatitis A is identified in a school (other than a child care setting in which children wear diapers), office, or other work setting, and if the source of infection is outside the school or work setting, PEP (i.e., injection of IG or Hepatitis A vaccine) is not routinely recommended. Similarly, when a person who has Hepatitis A is admitted to a hospital, staff should not routinely be administered PEP; instead, careful hygienic practices should be emphasized.

However, if it is determined that Hepatitis A has been spread among students in a school or among patients and staff in a hospital, PEP should be administered to unvaccinated persons who have had close contact with an infected person.

 Source: Centers for Disease Control and Prevention, HHS

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Where can I get more information?

Division of STD Prevention (DSTDP)
Centers for Disease Control and Prevention
www.cdc.gov/std

Resources:

CDC National Prevention Information Network (NPIN)
P.O. Box 6003
Rockville, MD 20849-6003
E-mail: npin-info@cdc.gov

Source: Centers for Disease Control and Prevention, HHS

 

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