Common Women's Health Problems

Acknowledgedment: Women's Health Topics in this Section was Prepared
by the Office on Women's Health

Content

Urinary Tract Infection Fact Sheet

Nancy's story

It was a normal day at work, but I was tired and felt like I had to pass urine the whole day. But when I went to the bathroom, not much came out. When I did pass urine, it burned and smelled bad — and looked cloudy too. These problems lasted a few days. So I called my doctor, and she said it sounded like a urinary tract infection, or UTI. I went to her office, and she asked me to pass urine into a cup. She tested the urine and told me I had a UTI. She called my drug store and ordered pills for me. I took all of the pills she prescribed, and then the UTI and the symptoms were gone.

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What is a urinary (YOOR-uh-nair-ee) tract infection (UTI)?

A UTI is an infection anywhere in the urinary tract. The urinary tract makes and stores urine and removes it from the body. Parts of the urinary tract include:


Image source: The National Kidney and Urologic
Diseases Information Clearinghouse (NKUDIC)
 

What causes UTIs?

Bacteria (bak-TIHR-ee-uh), a type of germ that gets into your urinary tract, cause a UTI. This can happen in many ways:

Female genitals

What are the signs of a UTI?

If you have an infection, you may have some or all of these signs:

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How does a doctor find out if I have a urinary tract infection (UTI)?

To find out if you have a UTI, your doctor will need to test a clean sample of your urine. The doctor or nurse will give you a clean plastic cup and a special wipe. Wash your hands before opening the cup. When you open the cup, don’t touch the inside of the lid or inside of the cup. Put the cup in easy reach. Separate the labia, the outer lips of the vagina, with one hand. With your other hand, clean the genital area with the wipe. Wipe from front to back. Do not touch or wipe the anus. While still holding the labia open, pass a little bit of urine into the toilet. Then, catch the rest in the cup. This is called a “clean-catch” sample. Let the rest of the urine fall into the toilet.

If you are prone to UTIs, your doctor may want to take pictures of your urinary tract with an x-ray or ultrasound. These pictures can show swelling, stones, or blockage. Your doctor also may want to look inside your bladder using a cystoscope (SISS-tuh-skohp). It is a small tube that's put into the urethra to see inside of the urethra and bladder.

How is a UTI treated?

UTIs are treated with antibiotics (an-tuh-beye-OT-iks), medicines that kill the bacteria that cause the infection. Your doctor will tell you how long you need to take the medicine. Make sure you take all of your medicine, even if you feel better! Many women feel better in one or two days.

If you don't take medicine for a UTI, the UTI can hurt other parts of your body. Also, if you're pregnant and have signs of a UTI, see your doctor right away. A UTI could cause problems in your pregnancy, such as having your baby too early or getting high blood pressure. Also, UTIs in pregnant women are more likely to travel to the kidneys.

Will a UTI hurt my kidneys?

If treated right away, a UTI is not likely to damage your kidneys or urinary tract. But UTIs that are not treated can cause serious problems in your kidneys and the rest of your body.

How can I keep from getting UTIs?

These are steps you can take to try to prevent a UTI. But you may follow these steps and still get a UTI. If you have symptoms of a UTI, call your doctor.

I get UTIs a lot. Can my doctor do something to help?

About one in five women who get UTIs will get another one. Some women get three or more UTIs a year. If you are prone to UTIs, ask your doctor about your treatment options. Your doctor may ask you to take a small dose of medicine every day to prevent infection. Or, your doctor might give you a supply of antibiotics to take after sex or at the first sign of infection. “Dipsticks” can help test for UTIs at home. They are useful for some women with repeat UTIs. Ask your doctor if you should use dipsticks at home to test for UTI. Your doctor may also want to do special tests to see what is causing repeat infections. Ask about them.

More information on urinary tract infection

For more information about urinary tract infection, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Urinary tract infection fact sheet was reviewed by:

Magda Barini-García, M.D., M.P.H.
Senior Medical Advisor
Center for Quality
Health Resources and Services Administration
Rockville, MD

Kristene Whitmore, M.D.
Director, Pelvic and Sexual Health Institute
Graduate Hospital
Philadelphia, PA

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Pelvic Inflammatory Disease

What is pelvic inflammatory disease (PID)?

Female reproductive system

Pelvic inflammatory disease (PID) is an infection of a woman's pelvic organs. The pelvic organs include the uterus (womb), fallopian tubes (fuh-LOH-pee-uhn toobs), ovaries, and cervix.

What causes PID?

A woman can get PID if bacteria (germs) move up from her vagina and infect her pelvic organs. Many different types of bacteria can cause PID. But, most cases of PID are caused by bacteria that cause 2 common sexually transmitted infections (STIs) — gonorrhea (gah-nuh-REE-uh) and chlamydia (kluh-MI-dee-uh). It can take from a few days to a few months for an infection to travel up from the vagina to the pelvic organs.

You can get PID without having an STI. Normal bacteria found in the vagina and on the cervix can sometimes cause PID. No one is sure why this happens.  

How common is PID?

Each year in the United States, more than 1 million women have an episode of PID. More than 100,000 women become infertile each year because of PID. Also, many ectopic pregnancies that occur are due to problems from PID.

Are some women more likely to get PID?

Yes. You’re more likely to get PID if you:

How do I know if I have PID?

Many women don't know they have PID because they don't have any symptoms. For women who have them, symptoms can range from mild to severe. The most common symptom of PID is pain in your lower abdomen (stomach area). Other symptoms include:

PID can come on fast with extreme pain and fever, especially if it’s caused by gonorrhea.

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Are there any tests for PID?

If you think that you may have PID, see a doctor right away. If you have pain in your lower abdomen (stomach area), your doctor will perform a physical exam. This will include a pelvic (internal) exam. Your doctor will check for:

Your doctor will also test you for STIs, including HIV and syphilis (SI-fuh-luhs), urinary tract infection, and if needed, pregnancy. If needed, your doctor may do other tests.

These tests will help your doctor find out if you have PID, or if you have a different problem that looks like PID.

How is PID treated?

PID can be cured with antibiotics (drugs that kill bacteria). Most of the time, at least two antibiotics are used that work against a wide range of bacteria. Your doctor will work with you to find the best treatment for you. You must take all your medicine, even if your symptoms go away. This helps to make sure your infection is fully cured. You should see your doctor again 2 to 3 days after starting treatment to make sure the antibiotics are working.

Without treatment, PID can lead to severe problems like infertility, ectopic pregnancy, and chronic pelvic pain.

Any damage done to your pelvic organs before you start treatment likely cannot be undone. Still, don't put off getting treatment. If you do, you may not be able to have children. If you think you may have PID, see a doctor right away.

Your doctor may suggest going into the hospital to treat your PID if you:

If you still have symptoms or if the abscess doesn't go away after treatment, you may need surgery. Problems caused by PID, such as constant pelvic pain and scarring, are often hard to treat. But, sometimes they get better after surgery.

What if my partner is infected?

Even if your sex partner doesn't have any symptoms, she or he could still be infected with bacteria that can cause PID. Take steps to protect yourself from being infected again.

My friend was told she can't get pregnant because she has PID. Is this true?

The more times you have PID, the more likely it is that you won't be able to get pregnant. When you have PID, bacteria infect the tubes or cause inflammation of the tubes. This turns normal tissue into scar tissue. Scar tissue can block your tubes and make it harder to get pregnant. Even having just a little scar tissue can keep you from getting pregnant without infertility treatment.

How can I keep myself from getting PID?

PID is most often caused by an STI that hasn't been treated. You can keep from getting PID by not getting an STI.

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What should I do if I think I have an STI?

If you think you may have an STI, see a doctor right away. You may feel scared or shy about asking for information or help. Keep in mind, the sooner you seek treatment, the less likely the STI will cause you severe harm. And the sooner you tell your sex partner(s) that you have an STI, the less likely they are to infect you again or spread the disease to others.

To learn about STIs or get tested, contact your doctor, local health department, or an STI and family planning clinic. The American Social Health Association (ASHA) keeps lists of clinics and doctors who provide treatment for STIs. Call ASHA at 800-227-8922. You can get information from the phone line without leaving your name.

More information on pelvic inflammatory disease

For more information about pelvic inflammatory disease, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Pelvic inflammatory disease fact sheet was reviewed by:

Dr. Songhai Barclift, M.D.
Lieutenant Commander
HIV/AIDS Bureau
Health Resources and Services Administration
U.S. Department of Health and Human Service

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Polycystic ovary syndrome (PCOS) fact sheet

What is polycystic ovary syndrome (PCOS)?

Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman's:

With PCOS, women typically have:

How many women have PCOS?

Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. As many as 5 million women in the United States may be affected. It can occur in girls as young as 11 years old.

What causes PCOS?

The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.

A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen. High androgen levels can lead to:

What are the symptoms of PCOS?

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:

Why do women with PCOS have trouble with their menstrual cycle and fertility?

The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.

In women with PCOS, the ovary doesn't make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.

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Normal ovary and polycystic ovary

 

Does PCOS change at menopause?

Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.

How do I know if I have PCOS?

There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.

Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.

Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.

Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.

Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.

Vaginal ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (en-do-MEE-tree-uhm) (lining of the womb). This lining may become thicker if your periods are not regular.

How is PCOS treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:

Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:

This helps to lower blood glucose (sugar) levels, improve the body's use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.

Birth control pills. For women who don't want to get pregnant, birth control pills can:

Keep in mind that the menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone (proh-JES-tuh-rohn), like Provera, to control the menstrual cycle and reduce the risk of endometrial cancer (See Does PCOS put women at risk for other health problems?). But, progesterone alone does not help reduce acne and hair growth.

Diabetes medications. The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved by the U.S Food and Drug Administration (FDA) for this use. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.

Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births (twins, triplets). Treatment options include:

Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.

Surgery. "Ovarian drilling" is a surgery that may increase the chance of ovulation. It’s sometimes used when a woman does not respond to fertility medicines. The doctor makes a very small cut above or below the navel (belly button) and inserts a small tool that acts like a telescope into the abdomen (stomach). This is called laparoscopy (lap-uh-RAHS-kuh-pee). The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But, these effects may only last a few months. This treatment doesn't help with loss of scalp hair or increased hair growth on other parts of the body.

Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Spironolactone (speer-on-oh-LAK-tone) (Aldactone), first used to treat high blood pressure, has been shown to reduce the impact of male hormones on hair growth in women. Finasteride (fin-AST-uhr-yd) (Propecia), a medicine taken by men for hair loss, has the same effect. Anti-androgens are often combined with birth control pills.  These medications should not be taken if you are trying to become pregnant.

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Before taking Aldactone, tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed while taking this medicine. Women who may become pregnant should not handle Propecia.

Other options include:

Other treatments. Some research has shown that bariatric (weight loss) surgery may be effective in resolving PCOS in morbidly obese women. Morbid obesity means having a BMI of more than 40, or a BMI of 35 to 40 with an obesity-related disease. The drug troglitazone (troh-GLIT-uh-zohn) was shown to help women with PCOS. But, it was taken off the market because it caused liver problems. Similar drugs without the same side effect are being tested in small trials.

Researchers continue to search for new ways to treat PCOS. To learn more about current PCOS treatment studies, visit ClinicalTrials.gov. Talk to your doctor about whether taking part in a clinical trial might be right for you.

How does PCOS affect a woman while pregnant?

Women with PCOS appear to have higher rates of:

Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).

Researchers are studying whether the diabetes medicine metformin can prevent or reduce the chances of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.

Metformin is an FDA pregnancy category B drug. It does not appear to cause major birth defects or other problems in pregnant women. But, there have only been a few studies of metformin use in pregnant women to confirm its safety. Talk to your doctor about taking metformin if you are pregnant or are trying to become pregnant. Also, metformin is passed through breastmilk. Talk with your doctor about metformin use if you are a nursing mother.

Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:

Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.

Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.

I have PCOS. What can I do to prevent complications?

If you have PCOS, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOS, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:

How can I cope with the emotional effects of PCOS?

Having PCOS can be difficult. You may feel:

Getting treatment for PCOS can help with these concerns and help boost your self-esteem. You may also want to look for support groups in your area or online to help you deal with the emotional effects of PCOS. You are not alone and there are resources available for women with PCOS.

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More information on polycystic ovary syndrome (PCOS)

For more information about polycystic ovary syndrome (PCOS), call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Polycystic ovary syndrome (PCOS) fact sheet was reviewed by:

Esther Eisenberg, M.D., M.P.H.
Professor of Obstetrics and Gynecology, Vanderbilt University
Medical Officer, Reproductive Sciences Branch
The Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health

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Osteoporosis fact sheet

 Anna's story

I used to think that women don't need to worry about frail bones until they get older. I was wrong! I recently learned that women of all ages need to take steps to help keep their bones strong. Millions of women already have or are at risk of osteoporosis. So, I do what I can to keep my bones as strong as they can be. I make sure to get enough calcium and vitamin D, I don't smoke or drink too much alcohol, and I try to walk with my neighbor in the mornings. I also talked to my doctor about taking medicine to help build bone mass and asked my doctor about a bone density test. Strong bones will lower my risk of breaking a bone and keep me healthy as I age.

What is osteoporosis?

Osteoporosis (OS-tee-oh-poh-ROH-sis) is a disease of the bones. People with osteoporosis have bones that are weak and break easily.

A broken bone can really affect your life. It can cause severe pain and disability. It can make it harder to do daily tasks on your own, such as walking.

What bones does osteoporosis affect?

Osteoporosis affects all bones in the body. However, breaks are most common in the hip, wrist, and spine, also called vertebrae (VUR-tuh-bray). Vertebrae support your body, helping you to stand and sit up. See the picture below.

Osteoporosis in the vertebrae can cause serious problems for women. A fracture in this area occurs from day-to-day activities like climbing stairs, lifting objects, or bending forward. Signs of osteoporosis:

  • Sloping shoulders

  • Curve in the back

  • Height loss

  • Back pain

  • Hunched posture

  • Protruding abdomen

What increases my chances of getting osteoporosis?

There are several risk factors that raise your chances of developing osteoporosis. Some of these factors are things you can control, while some you can’t control.

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Factors that you can’t control:

  • Being female

  • Getting older

  • Menopause

  • Having a small, thin body (under 127 pounds)

  • Having a family history of osteoporosis

  • Being white or Asian, but African American women and Latinas are also at risk

  • Not getting your period (if you should be getting it)

  • Having a disorder that increases your risk of getting osteoporosis, (such as rheumatoid arthritis, type 1 diabetes, premature menopause, anorexia nervosa)

  • Not getting enough exercise

  • Long-term use of certain medicines, including:

    • Glucocorticoids (GLOO-koh-KOR-ti-koids) — medicines used to treat many illnesses, including arthritis, asthma, and lupus

    • Some antiseizure medicines

    • Gonadotropin (GOH-nad-oo-TROO-pin) -releasing hormone — used to treat endometriosis (en-doh-mee-tree-O-sis)

    • Antacids with aluminum — the aluminum blocks calcium absorption

    • Some cancer treatments

    • Too much replacement thyroid hormone

Factors that you can control:

  • Smoking

  • Drinking too much alcohol. Experts recommend no more than 1 drink a day for women.

  • A diet low in dairy products or other sources of calcium and vitamin D

  • Not getting enough exercise

You may also develop symptoms that are warning signs for osteoporosis. If you develop the following, you should talk to your doctor about any tests or treatment you many need:

  • Loss in height, developing a slumped or hunched posture, or onset of sudden unexplained back pain.

  • You are over age 45 or a post-menopausal and you break a bone.

How can I find out if I have weak bones?

There are tests you can get to find out your bone density. This is related to how strong or fragile your bones are. One test is called dual-energy X-ray absorptiometry (DXA or dexa). A DXA scan takes X-rays of your bones. Screening tools also can be used to predict the risk of having low bone density or breaking a bone. Talk with your doctor or nurse about this test or tools to assess risk.

When should I get a bone density test?

If you are age 65 or older, you should get a bone density test to screen for osteoporosis. If you are younger than 65 and have risk factors for osteoporosis, ask your doctor or nurse if you need a bone density test before age 65. Bone density testing is recommended for older women whose risk of breaking a bone is the same or greater than that of a 65?year?old white woman with no risk factors other than age. To find out your fracture risk and whether you need early bone density testing, your doctor will consider factors such as:

  • Your age and whether you have reached menopause

  • Your height and weight

  • Whether you smoke

  • Your daily alcohol use

  • Whether your mother or father has broken a hip

  • Medicines you use

  • Whether you have a disorder that increases your risk of getting osteoporosis

How can I prevent weak bones?

The best way to prevent weak bones is to work on building strong ones. No matter how old you are, it is never too late to start. Building strong bones during childhood and the teen years is one of the best ways to keep from getting osteoporosis later. As you get older, your bones don’t make new bone fast enough to keep up with the bone loss. And after menopause, bone loss happens more quickly. But there are steps you can take to slow the natural bone loss with aging and to prevent your bones from becoming weak and brittle.

1. Get enough calcium each day.

Bones contain a lot of calcium. It is important to get enough calcium in your diet. You can get calcium through foods and/or calcium pills, which you can get at the grocery store or drug store. Getting calcium through food is definitely better since the food provides other nutrients that keep you healthy. Talk with your doctor or nurse before taking calcium pills to see which kind is best for you. Taking more calcium pills than recommended doesn't improve your bone health. So, try to reach these goals through a combination of food and supplements.

Here’s how much calcium you need each day.

Daily calcium requirements

Ages

Milligrams(mg) per day

9-18

1,300

19-50

1,000

51 and older

1,200

Pregnant or nursing women need the same amount of calcium as other women of the same age.

Here are some foods to help you get the calcium you need. Check the food labels for more information.

Foods containing calcium

Food

Portion

Milligrams

Plain, fat free yogurt

1 cup

452

Milk (fat-free)

1 cup

306

Milk (1 percent low-fat)

1 cup

290

Tofu with added calcium

1/2 cup

253

Spinach, frozen

1/2 cup

146

White beans, canned

1/2 cup

106

The calcium amounts of these foods are taken from the United States Department of Agriculture’s Dietary Guidelines for Americans. 

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2. Get enough vitamin D each day.

It is also important to get enough vitamin D, which helps your body absorb calcium from the food you eat. Vitamin D is produced in your skin when it is exposed to sunlight. You need 10 to 15 minutes of sunlight to the hands, arms, and face, two to three times a week to make enough vitamin D. The amount of time depends on how sensitive your skin is to light. It also depends on your use of sunscreen, your skin color, and the amount of pollution in the air. You can also get vitamin D by eating foods, such as milk, or by taking vitamin pills. Vitamin D taken in the diet by food or pills is measured in international units (IU). Look at the pill bottle or food label for the IU amount.

Here’s how much vitamin D you need each day: 

Daily vitamin D requirements

Ages

IU per day

19-70

600

71+

800

Although it’s difficult to get enough vitamin D through food, here are some foods that can help. Check the food labels for more information.

Foods containing vitamin D

Food

Portion

IU

Salmon, cooked

3 1/2 oz

360

Milk, vitamin D fortified

1 cup

98

Egg (vitamin D is in the yolk)

1 whole

20

These foods and IU counts are from the National Institutes of Health Office on Dietary Supplements.

White milk is a good source of vitamin D, most yogurts are not.

3. Eat a healthy diet.

Other nutrients (like vitamin K, vitamin C, magnesium, and zinc, as well as protein) help build strong bones too. Milk has many of these nutrients. So do foods like lean meat, fish, green leafy vegetables, and oranges.  

4. Get moving.

Being active helps your bones by:

  • Slowing bone loss

  • Improving muscle strength

  • Helping your balance

Do weight-bearing physical activity, which is any activity in which your body works against gravity. There are many things you can do:

  • Walk

  • Dance

  • Run

  • Climb stairs

  • Garden

  • Jog

  • Hike

  • Play tennis

  • Lift weights

  • Yoga

  • Tai chi

5. Don’t smoke.

Smoking raises your chances of getting osteoporosis. It harms your bones and lowers the amount of estrogen in your body. Estrogen is a hormone made by your body that can help slow bone loss.

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6. Drink alcohol moderately.

If you drink, don’t drink more than one alcoholic drink per day. Alcohol can make it harder for your body to use the calcium you take in. And, importantly, too much at one time can affect your balance and lead to falls.

7. Make your home safe.

Reduce your chances of falling by making your home safer. Use a rubber bath mat in the shower or tub. Keep your floors free from clutter. Remove throw rugs that may cause you to trip. Make sure you have grab bars in the bath or shower.

8. Think about taking medicines to prevent or treat bone loss.

Talk with your doctor or nurse about the risks and benefits of medicines for bone loss.

How can I help my daughter have strong bones?

Act now to help her build strong bones to last a lifetime. Girls ages 9-18 are in their critical bone-building years. Best Bones Forever!® is a national education effort to encourage girls ages 9-14 to eat more foods with calcium and vitamin D and get more physical activity. There is also a website for the parents. This site gives parents the tools and information they need to help their daughters build strong bones during the critical window of bone growth — ages 9-18.

What if dairy foods make me sick or I don't like to eat them? How can I get enough calcium?

If you’re lactose intolerant, it can be hard to get enough calcium. Lactose is the sugar that is found in dairy products like milk. Lactose intolerance means your body has a hard time digesting foods that contain lactose. You may have symptoms like gas, bloating, stomach cramps, diarrhea, and nausea. Lactose intolerance can start at any age but often starts when you get older.

Lactose-reduced and lactose-free products are sold in food stores. There’s a great variety, including milk, cheese, and ice cream. You can also take pills or liquids before eating dairy foods to help you digest them. You can buy these pills at the grocery store or drug store. Please note: If you have symptoms of lactose intolerance, see your doctor or nurse. These symptoms could also be from a different, more serious illness.

People who are lactose intolerant or who are vegans (eat only plant-based foods) can choose from other food sources of calcium, including canned salmon with bones, sardines, Chinese cabbage, bok choy, kale, collard greens, turnip greens, mustard greens, broccoli, and calcium-fortified orange juice. Some cereals also have calcium added. You can also take calcium pills. Talk to your doctor or nurse first to see which one is best for you.

Do men get osteoporosis?

Yes. In the U.S., over two million men have osteoporosis. Men over age 50 are at greater risk. So, keep an eye on the men in your life, especially if they are over 70 or have broken any bones.

How will pregnancy affect my bones?

To grow strong bones, a baby needs a lot of calcium. The baby gets his or her calcium from what you eat (or the supplements you take). In some cases, if a pregnant woman isn’t getting enough calcium, she may lose a little from her bones, making them less strong. So, pregnant women should make sure they are getting the recommended amounts of calcium and vitamin D. Talk to your doctor about how much you should be getting.

Will I suffer bone loss during breastfeeding?

Although bone density can be lost during breastfeeding, this loss tends to be temporary. Several studies have shown that when women have bone loss during breastfeeding, they recover full bone density within six months after weaning.

How is osteoporosis treated?

If you have osteoporosis, you may need to make some lifestyle changes and also take medicine to prevent future fractures. A calcium-rich diet, daily exercise, and drug therapy are all treatment options.

These different types of drugs are approved for the treatment or prevention of osteoporosis:

  • Bisphosphonates (bis-fos-fo-nates) — Bisphosphonates are approved for both prevention and treatment of postmenopausal osteoporosis. Drugs in this group also can treat bone loss, and in some cases, can help build bone mass.

  • SERMs — A class of drugs called estrogen agonists/antagonists, commonly referred to as selective estrogen receptor modulators (SERMs) are approved for the prevention and treatment of postmenopausal osteoporosis. They help slow the rate of bone loss.

  • Calcitonin (kal-si-TOE-nin) — Calcitonin is a naturally occurring hormone that can help slow the rate of bone loss.

  • Menopausal hormone therapy (MHT) — These drugs, which are used to treat menopausal symptoms, also are used to prevent bone loss. But recent studies suggest that this might not be a good option for many women. The Food and Drug Administration (FDA) has made the following recommendations for taking MHT:Parathyroid hormone or teriparatide (terr-ih-PAR-a-tyd) — Teriparatide is an injectable form of human parathyroid hormone. It helps the body build up new bone faster than the old bone is broken down.

    • Take the lowest possible dose of MHT for the shortest time to meet treatment goals.

    • Talk about using other osteoporosis medications instead.

Your doctor can tell you what treatments might work best for you.

More information on osteoporosis

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

  • National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, HHS
    Phone: 877-226-4267 or 301-495-4484 (301-565-2966)

  • National Institute on Aging, NIH, HHS
    Phone: 301-496-1752 (TDD: 800-222-4225)

  • National Osteoporosis Foundation
    Phone: 800-231-4222 or 202-223-2226

  • Osteoporosis and Related Bone Diseases National Resource Center, NIH, HHS
    Phone: 800-624-2663

  • U.S. Food and Drug Administration, HHS

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.

Osteoporosis fact sheet was reviewed by:

Dr. Joan A. McGowan, Ph.D.
Director, Division of Musculoskeletal Diseases
National Institute of Arthritis and Musculoskeletal and Skin Diseases
National Institutes of Health

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Premenstrual syndrome (PMS) fact sheet

What is premenstrual syndrome (PMS)?

Premenstrual (pree-MEN-struhl) syndrome (PMS) is a group of symptoms linked to the menstrual cycle. PMS symptoms occur 1 to 2 weeks before your period (menstruation or monthly bleeding) starts. The symptoms usually go away after you start bleeding. PMS can affect menstruating women of any age and the effect is different for each woman. For some people, PMS is just a monthly bother. For others, it may be so severe that it makes it hard to even get through the day. PMS goes away when your monthly periods stop, such as when you get pregnant or go through menopause.

What causes PMS?

The causes of PMS are not clear, but several factors may be involved. Changes in hormones during the menstrual cycle seem to be an important cause. These changing hormone levels may affect some women more than others. Chemical changes in the brain may also be involved. Stress and emotional problems, such as depression, do not seem to cause PMS, but they may make it worse. Some other possible causes include:

  • Low levels of vitamins and minerals

  • Eating a lot of salty foods, which may cause you to retain (keep) fluid

  • Drinking alcohol and caffeine, which may alter your mood and energy level

What are the symptoms of PMS?

PMS often includes both physical and emotional symptoms, such as:

  • Acne

  • Swollen or tender breasts

  • Feeling tired

  • Trouble sleeping

  • Upset stomach, bloating, constipation, or diarrhea

  • Headache or backache

  • Appetite changes or food cravings

  • Joint or muscle pain

  • Trouble with concentration or memory

  • Tension, irritability, mood swings, or crying spells

  • Anxiety or depression

Symptoms vary from woman to woman.

How do I know if I have PMS?

Your doctor may diagnose PMS based on which symptoms you have, when they occur, and how much they affect your life. If you think you have PMS, keep track of which symptoms you have and how severe they are for a few months. Record your symptoms each day on a calendar or PMS symptom tracker (PDF, 66 KB). Take this form with you when you see your doctor about your PMS.

Your doctor will also want to make sure you don’t have one of the following conditions that shares symptoms with PMS:

  • Depression

  • Anxiety

  • Menopause

  • Chronic fatigue syndrome (CFS)

  • Irritable bowel syndrome (IBS)

  • Problems with the endocrine (EN-doh-kryn) system, which makes hormones

How common is PMS?

There’s a wide range of estimates of how many women suffer from PMS. The American College of Obstetricians and Gynecologists estimates that at least 85 percent of menstruating women have at least 1 PMS symptom as part of their monthly cycle. Most of these women have fairly mild symptoms that don’t need treatment. Others (about 3 to 8 percent) have a more severe form of PMS, called premenstrual dysphoric (dis-FOHR-ik) disorder (PMDD). See "What is premenstrual dysphoric disorder (PMDD)?" below to learn more.

PMS occurs more often in women who:

  • Are between their late 20s and early 40s

  • Have at least 1 child

  • Have a family history of depression

  • Have a past medical history of either postpartum depression or a mood disorder

What is the treatment for PMS?

Many things have been tried to ease the symptoms of PMS. No treatment works for every woman. You may need to try different ones to see what works for you. Some treatment options include:

  • Lifestyle changes

  • Medications

  • Alternative therapies

Lifestyle changes

If your PMS isn’t so bad that you need to see a doctor, some lifestyle changes may help you feel better. Below are some steps you can take that may help ease your symptoms.

  • Exercise regularly. Each week, you should get:Eat healthy foods, such as fruits, vegetables, and whole grains.

    • Two hours and 30 minutes of moderate-intensity physical activity;

    • One hour and 15 minutes of vigorous-intensity aerobic physical activity; or

    • A combination of moderate and vigorous-intensity activity; and

    • Muscle-strengthening activities on 2 or more days.

  • Avoid salt, sugary foods, caffeine, and alcohol, especially when you’re having PMS symptoms.

  • Get enough sleep. Try to get about 8 hours of sleep each night.

  • Find healthy ways to cope with stress. Talk to your friends, exercise, or write in a journal. Some women also find yoga, massage, or relaxation therapy helpful.

  • Don’t smoke.

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Medications

Over-the-counter pain relievers may help ease physical symptoms, such as cramps, headaches, backaches, and breast tenderness. These include:

  • Ibuprofen (eye-byu-PROH-fuhn) (for instance, Advil, Motrin, Midol Cramp)

  • Ketoprofen (key-toh-PROH-fuhn) (for instance, Orudis KT)

  • Naproxen (nuh-PROK-suhn) (for instance, Aleve)

  • Aspirin

In more severe cases of PMS, prescription medicines may be used to ease symptoms. One approach has been to use drugs that stop ovulation, such as birth control pills. Women on the pill report fewer PMS symptoms, such as cramps and headaches, as well as lighter periods.

Researchers continue to search for new ways to treat PMS. To learn more about current PMS treatment studies, visit the clinicaltrials.gov website. Talk to your doctor about whether taking part in a clinical trial might be right for you.

Alternative therapies

Certain vitamins and minerals have been found to help relieve some PMS symptoms. These include:

  • Folic acid (400 micrograms)

  • Calcium with vitamin D (see chart below for amounts)

  • Magnesium (400 milligrams)

  • Vitamin B-6 (50 to 100 mg)

  • Vitamin E (400 international units)

Amounts of calcium you need each day

Ages

Milligrams per day

9-18

1300

19-50

1000

51 and older

1200

Pregnant or nursing women need the same amount of calcium as other women of the same age.

Some women find their PMS symptoms relieved by taking supplements such as:

  • Black cohosh

  • Chasteberry

  • Evening primrose oil

Talk with your doctor before taking any of these products. Many have not been proven to work and they may interact with other medicines you are taking.

What is Premenstrual Dysphoric Disorder (PMDD)?

A brain chemical called serotonin (ser-uh-TOH-nuhn) may play a role in Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS. The main symptoms, which can be disabling, include:

  • Feelings of sadness or despair, or even thoughts of suicide

  • Feelings of tension or anxiety

  • Panic attacks

  • Mood swings or frequent crying

  • Lasting irritability or anger that affects other people

  • Lack of interest in daily activities and relationships

  • Trouble thinking or focusing

  • Tiredness or low energy

  • Food cravings or binge eating

  • Trouble sleeping

  • Feeling out of control

  • Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain

You must have 5 or more of these symptoms to be diagnosed with PMDD. Symptoms occur during the week before your period and go away after bleeding starts.

Making some lifestyle changes may help ease PMDD symptoms. See “What is the treatment for PMS?” above to learn more.

Antidepressants called selective serotonin reuptake inhibitors (SSRIs) have also been shown to help some women with PMDD. These drugs change serotonin levels in the brain. The Food and Drug Administration (FDA) has approved 3 SSRIs for the treatment of PMDD:

  • Sertraline (SUHR-truh-leen) (Zoloft)

  • Fluoxetine (floo-AYK-suh-teen) (Sarafem)

  • Paroxetine (puh-ROCK-suh-teen) HCI (Paxil CR)

Yaz (drospirenone (droh-SPIR-uh-nohn) and ethinyl (ETH-uh-nil) estradiol (es-truh-DEYE-ohl)) is the only birth control pill approved by the FDA to treat PMDD. Individual counseling, group counseling, and stress management may also help relieve symptoms.

More information on premenstrual syndrome (PMS)

For more information about premenstrual syndrome (PMS), call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

  • American College of Obstetricians and Gynecologists
    Phone: 202-638-5577

  • National Institute of Mental Health, NIH, HHS
    Phone: 866-615-6464 or 301-443-4513 (TDD: 866-415-8051 or 301-443-8431)

  • The Hormone Foundation
    Phone: 800-467-6663

Songhai Barclift, M.D.
Lieutenant Commander
HIV/AIDS Bureau
Health Resources and Services Administration
U.S. Department of Health and Human Services

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Young Women & Period Problems

Menstruation is a woman’s monthly bleeding, often called your “period.” When you menstruate, your body discards the monthly buildup of the lining of your uterus (womb). Menstrual blood and tissue flow from your uterus through the small opening in your cervix and pass out of your body through your vagina.

Your Menstrual Cycle

 

Thyroid disease

Your thyroid produces thyroid hormone, which controls many activities in your body, including how fast you burn calories and how fast your heart beats. Diseases of the thyroid cause it to make either too much or too little of the hormone. Depending on how much or how little hormone your thyroid makes, you may often feel restless or tired, or you may lose or gain weight. Women are more likely than men to have thyroid diseases, especially right after pregnancy and after menopause.

What is the thyroid?

Your thyroid is a small butterfly-shaped gland found at the base of your neck, just below your Adam's apple. This gland makes thyroid hormone that travels in your blood to all parts of your body. The thyroid hormone controls your body's metabolism in many ways, including how fast you burn calories and how fast your heart beats.

Diagram of the thyroid gland

Thyroid gland

For the National Cancer Institute © 2012 Terese Winslow LLC, U.S. Govt. has certain rights.

How do thyroid problems affect women?

Women are more likely than men to have thyroid disease. One in eight women will develop thyroid problems during her lifetime. In women, thyroid diseases can cause:

  • Problems with your menstrual period. Your thyroid helps control your menstrual cycle. Too much or too little thyroid hormone can make your periods very light, heavy, or irregular. Thyroid disease also can cause your periods to stop for several months or longer, a condition called amenorrhea. If your body's immune system causes thyroid disease, other glands, including your ovaries, may be involved. This can lead to early menopause (before age 40).

  • Problems getting pregnant. When thyroid disease affects the menstrual cycle, it also affects ovulation. This can make it harder for you to get pregnant.

  • Problems during pregnancy. Thyroid problems during pregnancy can cause health problems for the mother and the baby.

Sometimes, symptoms of thyroid problems are mistaken for menopause symptoms. Thyroid disease, especially hypothyroidism, is more likely to develop after menopause.

Are some women more at risk for thyroid disease?

Yes. You may want to talk to your doctor about getting tested if you:

  • Had a thyroid problem in the past

  • Had surgery or radiotherapy affecting the thyroid gland

  • Have a condition such as goiter, anemia, or type 1 diabetes

Screening for thyroid disease is not recommended for most women.

What kinds of thyroid disease affect women?

These thyroid diseases affect more women than men:

What is hypothyroidism?

Hypothyroidism is when your thyroid does not make enough thyroid hormones. It is also called underactive thyroid. This slows down many of your body's functions, like your metabolism.

The most common cause of hypothyroidism in the United States is Hashimoto's disease. In people with Hashimoto's disease, the immune system mistakenly attacks the thyroid. This attack damages the thyroid so that it does not make enough hormones.

Hypothyroidism also can be caused by:

  • Hyperthyroidism treatment (radioiodine)

  • Radiation treatment of certain cancers

  • Thyroid removal

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What are the signs and symptoms of hypothyroidism?

Symptoms of hypothyroidism develop slowly, often over several years. At first, you may feel tired and sluggish. Later, you may develop other signs and symptoms of a slowed-down metabolism, including:

  • Feeling cold when other people do not

  • Constipation

  • Muscle weakness

  • Weight gain, even though you are not eating more food

  • Joint or muscle pain

  • Feeling sad or depressed

  • Feeling very tired

  • Pale, dry skin

  • Dry, thinning hair

  • Slow heart rate

  • Less sweating than usual

  • A puffy face

  • A hoarse voice

  • More than usual menstrual bleeding

You also may have high LDL or "bad" cholesterol, which can raise your risk for heart disease.

How is hypothyroidism treated?

Hypothyroidism is treated with medicine that gives your body the thyroid hormone it needs to work normally. The most common medicines are man-made forms of the hormone that your thyroid makes. You will likely need to take thyroid hormone pills for the rest of your life. When you take the pills as your doctor tells you to, the pills are very safe.

What is hyperthyroidism?

Hyperthyroidism, or overactive thyroid, causes your thyroid to make more thyroid hormone than your body needs. This speeds up many of your body's functions, like your metabolism and heart rate.

The most common cause of hyperthyroidism is Graves' disease. Graves' disease is a problem with the immune system.

What are the signs and symptoms of hyperthyroidism?

At first, you might not notice the signs or symptoms of hyperthyroidism. Symptoms usually begin slowly. But, over time, a faster metabolism can cause symptoms such as:

  • Weight loss, even if you eat the same or more food (most but not all people lose weight)

  • Eating more than usual

  • Rapid or irregular heartbeat or pounding of your heart

  • Feeling nervous or anxious

  • Feeling irritable

  • Trouble sleeping

  • Trembling in your hands and fingers

  • Increased sweating

  • Feeling hot when other people do not

  • Muscle weakness

  • Diarrhea or more bowel movements than normal

  • Fewer and lighter menstrual periods than normal

  • Changes in your eyes that can include bulging of the eyes, redness, or irritation

Hyperthyroidism raises your risk for osteoporosis, a condition that causes weak bones that break easily. In fact, hyperthyroidism might affect your bones before you have any of the other symptoms of the condition. This is especially true of women who have gone through menopause or who are already at high risk of osteoporosis.

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How is hyperthyroidism treated?

Your doctor's choice of treatment will depend on your symptoms and the cause of your hyperthyroidism. Treatments include:

  • Medicine.

    • Antithyroid medicines block your thyroid from making new thyroid hormone. These drugs do not cause lasting damage to the thyroid.

    • Beta-blockers block the effects of thyroid hormone on your body. These medicines can be helpful in slowing your heart rate and treating other symptoms until one of the other forms of treatment can take effect. Beta-blockers do not reduce the amount of thyroid hormones that are made.

  • Radioiodine. This treatment kills the thyroid cells that make thyroid hormones. Often, this causes permanent hypothyroidism.

  • Surgery. Thyroid surgery removes most or all of the thyroid. This may cause permanent hypothyroidism.

What is thyroiditis?

Thyroiditis is inflammation of the thyroid. It happens when the body's immune system makes antibodies that attack the thyroid.

Causes of thyroiditis include:

Two common types of thyroiditis are Hashimoto's disease and postpartum thyroiditis.

What is postpartum thyroiditis?

Postpartum thyroiditis, or inflammation of the thyroid after giving birth, affects 10% of women. It often goes undiagnosed because symptoms are much like the "baby blues" that may follow delivery. Women with postpartum thyroiditis may feel very tired and moody.

Postpartum thyroiditis typically happens in two phases, though not everyone with the condition goes through both phases:

  • The first phase starts 1 to 4 months after giving birth and typically last 1 to 2 months. In this phase, you may have signs and symptoms of hyperthyroidism because the damaged thyroid leaks thyroid hormones out into the bloodstream.

  • The second phase starts about 4 to 8 months after delivery and lasts 6 to 12 months. In this phase, you may have signs and symptoms of hypothyroidism because the thyroid has lost most of its hormones or because the immune attack is over and the thyroid may recover later.

Who is at risk for postpartum thyroiditis?

Your immune system may cause postpartum thyroiditis. If you have an autoimmune disease, like type 1 diabetes, your risk is higher.

Your risk is also higher if:

  • Have a personal history or family history of thyroid disorders

  • Had postpartum thyroiditis after a previous pregnancy

  • Have chronic viral hepatitis

How is postpartum thyroiditis treated?

Treatment for postpartum thyroiditis depends on the phase of the disease and what symptoms you have. For example, if you get symptoms of hyperthyroidism in the first phase, your treatment may include medicines to slow down the heart rate.

In most women who have postpartum thyroiditis, the thyroid returns to normal within 12 to 18 months after symptoms start. But if you have a history of postpartum thyroiditis, your risk is higher for developing permanent hypothyroidism within 5 to 10 years.

What is a goiter?

A goiter is an unusually enlarged thyroid gland. It may happen only for a short time and may go away on its own without treatment. Or it could be a symptom of another thyroid disease that requires treatment. Goiter is more common in women than in men and especially in women before menopause.

Some common causes of goiter include:

Usually, the only symptom of a goiter is a swelling in your neck. It may be large enough that you can see it or feel the lump with your hand. A very large goiter can also cause a tight feeling in your throat, coughing, or problems swallowing or breathing.

Your doctor will do tests to see if it is caused by another thyroid disease.

How is goiter treated?

You may not need treatment if your thyroid works normally and the symptoms do not bother you.

If you do need treatment, medicine should make the thyroid shrink back to near normal size. You may need surgery to take out part or most of the thyroid.

What are thyroid nodules?

A thyroid nodule is a swelling in one section of the thyroid gland. The nodule may be solid or filled with fluid or blood. You may have just one thyroid nodule or many.

Thyroid nodules are common and affect four times as many women as men.7 Researchers do not know why nodules form in otherwise normal thyroids.

What are the signs and symptoms of thyroid nodules?

Most thyroid nodules do not cause symptoms and are not cancerous.8 Some thyroid nodules make too much thyroid hormone, causing hyperthyroidism. Sometimes, nodules grow so big that they cause problems with swallowing or breathing. About one-third of nodules are found by the patient, another third by the doctor, and the other third through an imaging test of the neck.

You can sometimes see or feel a thyroid nodule yourself. Stand in front of a mirror and raise your chin slightly. Look for a bump on either side of your windpipe below your Adam's apple. If the bump moves up and down when you swallow, it may be a thyroid nodule. Ask your doctor to look at it.

How are thyroid nodules treated?

Treatment depends on the type of nodule or nodules that you have. Treatments include:

  • Watchful waiting. If your nodule is not cancerous, your doctor may decide to just watch your condition. You will get regular physical exams, blood tests, and perhaps thyroid ultrasound tests. If your nodule does not change, you may not need further treatment.

  • Surgery. Surgery may be necessary to take out nodules that may be cancerous or large nodules that cause problems breathing or swallowing.

  • Radioiodine. This type of treatment is helpful if you have nodules that make too much thyroid hormone. Radioiodine causes nodules to shrink and make smaller amounts of thyroid hormone.

What is thyroid cancer?

Thyroid cancer happens when cancer cells form from the tissues of the thyroid gland.

Most people with thyroid cancer have a thyroid nodule that does not cause any symptoms. If you do have symptoms, you may have swelling or a lump in your neck. The lump may cause problems swallowing. Some people get a hoarse voice.

To tell if the lump or nodule is cancerous, your doctor will order certain tests. Most thyroid nodules are not cancerous.

For more information about thyroid cancer, visit the National Cancer Institute's thyroid cancer page.

Who is at risk for thyroid cancer?

About three times as many women get thyroid cancer as men. The number of women with thyroid cancer is also going up. By 2020, the number of women with thyroid cancer is expected to double, from 34,000 women to more than 70,000 women.

Thyroid cancer is more common in women who:

  • Are between the ages of 25 and 65

  • Had radiation therapy to the head or neck, especially in childhood, to treat cancer

  • Have a history of goiter

  • Have a family history of thyroid cancer

How is thyroid cancer treated?

The main treatment for thyroid cancer is surgery to take out the whole thyroid gland or as much of it as can be safely removed. Surgery alone can cure thyroid cancer if the cancer is small and has not yet spread to lymph nodes.

Your doctor may also use radioiodine therapy after surgery. Radioiodine therapy destroys any thyroid cancer cells that were not removed during surgery or that have spread to other parts of the body.

Your doctor may also talk with you about other treatments for thyroid cancer. Learn more about thyroid cancer treatments at the National Cancer Institute.

How are thyroid diseases diagnosed?

It can be hard to tell if you have a thyroid disease. The symptoms are the same as many other health problems. Your doctor may start by asking about your health history and if any of your family members has had thyroid disease. Your doctor may also give you a physical exam and check your neck for thyroid nodules.

Depending on your symptoms, your doctor may also do other tests, such as:

  • Blood tests. Testing the level of thyroid stimulating hormone (TSH) in your blood can help your doctor figure out if your thyroid is overactive or underactive. TSH tells your thyroid to make thyroid hormones. Depending on the results, your doctor might do another blood test to check levels of one or both thyroid hormones in your blood.

  • Radioactive iodine uptake test. For this test, you swallow a liquid or capsule that holds a small dose of radioactive iodine (radioiodine). The radioiodine collects in your thyroid because your thyroid uses iodine to make thyroid hormone.

High levels of radioiodine mean that your thyroid makes too much of the thyroid hormone. Low levels mean that your thyroid does not make enough thyroid hormone.

  • Thyroid scan. A thyroid scan uses the same radioiodine dose that was given by mouth for your uptake test. You lie on a table while a special camera makes an image of your thyroid on a computer screen. This test shows the pattern of iodine uptake in the thyroid.

    Three types of nodules show up in this test:

    • "Hot" nodules. These thyroid nodules show up on the scan more brightly than normal thyroid nodules. They take up more radioiodine than the surrounding thyroid. They also make more hormone than normal thyroids. Less than 1% of these nodules are cancerous.

    • "Warm" nodules. These nodules take up the same amount of radioiodine as normal thyroid and make a normal amount of hormones. Only 5% to 8% of these nodules are cancerous.

    • "Cold" nodules. These nodules show up as as dark areas on the scan. They do not take up much radioiodine and do not make thyroid hormones. Many nodules are cold. Up to 15% of these nodules are cancerous.

  • Thyroid ultrasound. The thyroid ultrasound uses sound waves to make a picture of the thyroid on a computer screen. This test can help your doctor tell what type of nodule you have and how large it is. You may need more thyroid ultrasounds over time to see if your nodule is growing or shrinking.

Ultrasound may also be helpful in finding thyroid cancer, although by itself it cannot be used to diagnose thyroid cancer.

  • Thyroid fine needle biopsy. This test tells whether thyroid nodules have normal cells in them. Your doctor may numb an area on your neck. Your doctor will then stick a very thin needle into the thyroid to take out some cells and fluid. A doctor will then look at the cells under a microscope to see if they are normal. Cells that are not normal could mean thyroid cancer.

Can thyroid disease cause problems getting pregnant?

Both hyperthyroidism and hypothyroidism can make it harder for you to get pregnant. This is because problems with the thyroid hormone can upset the balance of the hormones that cause ovulation. Hypothyroidism can also cause your body to make more prolactin, the hormone that tells your body to make breastmilk. Too much prolactin can prevent ovulation.

Thyroid problems can also affect the menstrual cycle. Your periods may be heavier or irregular, or you may not have any periods at all for several months or longer (called amenorrhea).

How does thyroid disease affect pregnancy?

Pregnancy-related hormones raise the level of thyroid hormones in the blood. Thyroid hormones are necessary for the baby's brain development while in the womb.

It can be harder to diagnose thyroid problems during pregnancy because of the change in hormone levels that normally happen during pregnancy. But it is especially important to check for problems before getting pregnant and during pregnancy. Uncontrolled hyperthyroidism and hypothyroidism can cause problems for both mother and baby.

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Hyperthyroidism that is not treated with medicine during pregnancy can cause:

  • Premature birth (birth of the baby before 39 to 40 weeks, or full-term)

  • Preeclampsia, a serious condition starting after 20 weeks of pregnancy. Preeclampsia causes high blood pressure and problems with the kidneys and other organs. The only cure for preeclampsia is childbirth.

  • Thyroid storm (sudden, severe worsening of symptoms)

  • Fast heart rate in the newborn, which can lead to heart failure, poor weight gain, or an enlarged thyroid that can make it hard to breathe

  • Low birth weight (smaller than 5 pounds)

  • Miscarriage

Hypothyroidism that is not treated with medicine during pregnancy can cause:

  • Anemia (lower than normal number of healthy red blood cells)

  • Preeclampsia

  • Low birth weight (smaller than 5 pounds)

  • Miscarriage

  • Stillbirth

  • Problems with the baby's growth and brain development

Did we answer your question about thyroid diseases?

For more information about thyroid diseases, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

  • National Cancer Institute (NCI), NIH
    Phone Number: 800-422-6237

  • National Endocrine and Metabolic Diseases Information Service, NIDDK, NIH
    Phone Number: 800-860-8747

  • American Thyroid Association (link is external)

  • Hormone Health Network (link is external)
    Phone Number: 800-467-6663

  • Thyroid Cancer Survivors' Association, Inc. (link is external)
    Phone Number: 877-588-7904

Thyroid disease fact sheet (PDF, 163 KB)

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Infertility fact sheet

What is infertility?

Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant:

Infertility can happen if there are problems with any of these steps.

Is infertility a common problem?

Yes. About 10 percent of women (6.1 million) in the United States ages 15-44 have difficulty getting pregnant or staying pregnant, according to the Centers for Disease Control and Prevention (CDC).

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by women's problems. Another one third of fertility problems are due to the man. The other cases are caused by a mixture of male and female problems or by unknown problems.

What causes infertility in men?

Infertility in men is most often caused by:

Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

What increases a man's risk of infertility?

A man's sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include:

What causes infertility in women?

Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

Ovulation problems are often caused by polycystic ovarian syndrome (PCOS). PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is the most common cause of female infertility. Primary ovarian insufficiency (POI) is another cause of ovulation problems. POI occurs when a woman's ovaries stop working normally before she is 40. POI is not the same as early menopause.

Less common causes of fertility problems in women include:

What things increase a woman's risk of infertility?

Many things can change a woman's ability to have a baby. These include:

How does age affect a woman's ability to have children?

Many women are waiting until their 30s and 40s to have children. In fact, about 20 percent of women in the United States now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

Aging decreases a woman's chances of having a baby in the following ways:

How long should women try to get pregnant before calling their doctors?

Most experts suggest at least one year. Women 35 or older should see their doctors after six months of trying. A woman's chances of having a baby decrease rapidly every year after the age of 30.

Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have:

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It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

How will doctors find out if a woman and her partner have fertility problems?

Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners' health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.

In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.

In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:

Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available.

Some common tests of fertility in women include:

Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So don't worry if the problem is not found right away.

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery.

Doctors recommend specific treatments for infertility based on:

Doctors often treat infertility in men in the following ways:

In women, some physical problems can also be corrected with surgery.

A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.

What medicines are used to treat infertility in women?

Some common medicines used to treat infertility in women include:

Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:

What is assisted reproductive technology (ART)?

Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos. The embryos are then put back in the woman's body.

How often is assisted reproductive technology (ART) successful?

Success rates vary and depend on many factors. Some things that affect the success rate of ART include:

The U.S. Centers for Disease Control and Prevention (CDC) collects success rates on ART for some fertility clinics. According to a 2006 CDC report on ART, the average percentage of ART cycles that led to a live birth were:

ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses. But this is a problem that can be prevented or minimized in several different ways.

What are the different types of assisted reproductive technology (ART)?

Common methods of ART include:

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

Surrogacy

Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.

Gestational carrier

Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man's sperm and the embryo is placed inside the carrier's uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.

Recent research by the Centers for Disease Control and Prevention showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don’t know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.

More information on infertility

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

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.

Infertility fact sheet was reviewed by:

Esther Eisenberg, M.D., M.P.H.
Reproductive Sciences Branch
Eunice Kennedy Shriver
National Institute of Child Health and Human Development
Bethesda, MD

Kelly Brumbaugh, M.P.H., C.H.E.S.
Renee Brown-Bryant, M.S.
Lee Warner, Ph.D.
Division of Reproductive Health
Centers for Disease Control and Prevention
Atlanta, GA

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Ovarian cysts

Ovarian cysts are fluid-filled sacs in the ovary. They are common and usually form during ovulation. Ovulation happens when the ovary releases an egg each month. Many women with ovarian cysts don't have symptoms. The cysts are usually harmless.

What are ovarian cysts?

A cyst is a fluid-filled sac. It can form in many places in the body. Ovarian cysts form in or on the ovaries.

A diagram of the female reproductive system, with labels for the uterus, endometrium, Fallopian tube, ovary, cervix, myometrium, and vagina.

What are the different types of ovarian cysts?

The most common types of ovarian cysts (called functional cysts) form during the menstrual cycle. They are usually benign (not cancerous).

The two most common types of cysts are:

  • Follicle cysts. In a normal menstrual cycle, an ovary releases an egg each month. The egg grows inside a tiny sac called a follicle. When the egg matures, the follicle breaks open to release the egg. Follicle cysts form when the follicle doesn't break open to release the egg. This causes the follicle to continue growing into a cyst. Follicle cysts often have no symptoms and go away in one to three months.

  • Corpus luteum cysts. Once the follicle breaks open and releases the egg, the empty follicle sac shrinks into a mass of cells called corpus luteum. Corpus luteum makes hormones to prepare for the next egg for the next menstrual cycle. Corpus luteum cysts form if the sac doesn't shrink. Instead, the sac reseals itself after the egg is released, and then fluid builds up inside. Most corpus luteum cysts go away after a few weeks. But, they can grow to almost four inches wide. They also may bleed or twist the ovary and cause pain. Some medicines used to cause ovulation can raise the risk of getting these cysts.

Other types of benign ovarian cysts are less common:

  • Endometriomas are caused by endometriosis. Endometriosis happens when the lining of the uterus (womb) grows outside of the uterus.

  • Dermoids come from cells present from birth and do not usually cause symptoms.

  • Cystadenomas are filled with watery fluid and can sometimes grow large.

In some women, the ovaries make many small cysts. This is called polycystic ovary syndrome (PCOS). PCOS can cause problems with the ovaries and with getting pregnant.

Malignant (cancerous) cysts are rare. They are more common in older women. Cancerous cysts are ovarian cancer. For this reason, ovarian cysts should be checked by your doctor. Most ovarian cysts are not cancerous.

Who gets ovarian cysts?

Ovarian cysts are common in women with regular periods. In fact, most women make at least one follicle or corpus luteum cyst every month. You may not be aware that you have a cyst unless there is a problem that causes the cyst to grow or if multiple cysts form. About 8% of premenopausal women develop large cysts that need treatment.1

Ovarian cysts are less common after menopause. Postmenopausal women with ovarian cysts are at higher risk for ovarian cancer.

At any age, see your doctor if you think you have a cyst. See your doctor also if you have symptoms such as bloating, needing to urinate more often, pelvic pressure or pain, or abnormal (unusual) vaginal bleeding. These can be signs of a cyst or other serious problem.

What causes ovarian cysts?

The most common causes of ovarian cysts include:

  • Hormonal problems. Functional cysts usually go away on their own without treatment. They may be caused by hormonal problems or by drugs used to help you ovulate.

  • Endometriosis. Women with endometriosis can develop a type of ovarian cyst called an endometrioma. The endometriosis tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.

  • Pregnancy. An ovarian cyst normally develops in early pregnancy to help support the pregnancy until the placenta forms. Sometimes, the cyst stays on the ovary until later in the pregnancy and may need to be removed.

  • Severe pelvic infections. Infections can spread to the ovaries and fallopian tubes and cause cysts to form.

What are the symptoms of ovarian cysts?

Most ovarian cysts are small and don't cause symptoms.

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If a cyst does cause symptoms, you may have pressure, bloating, swelling, or pain in the lower abdomen on the side of the cyst. This pain may be sharp or dull and may come and go.

If a cyst ruptures, it can cause sudden, severe pain.

If a cyst causes twisting of an ovary, you may have pain along with nausea and vomiting.

Less common symptoms include:

  • Pelvic pain

  • Dull ache in the lower back and thighs

  • Problems emptying the bladder or bowel completely

  • Pain during sex

  • Unexplained weight gain

  • Pain during your period

  • Unusual (not normal) vaginal bleeding

  • Breast tenderness

  • Needing to urinate more often

How are ovarian cysts found?

If you have symptoms of ovarian cysts, talk to your doctor. Your doctor may do a pelvic exam to feel for swelling of a cyst on your ovary.

If a cyst is found, your doctor will either watch and wait or order tests to help plan treatment. Tests include:

  • Ultrasound. This test uses sound waves to create images of the body. With ultrasound, your doctor can see the cyst's:

    • Shape

    • Size

    • Location

    • Mass (whether it is fluid-filled, solid, or mixed)

  • Pregnancy test to rule out pregnancy

  • Hormone level tests to see if there are hormone-related problems

  • Blood test. If you are past menopause, your doctor may give you a test to measure the amount of cancer-antigen 125 (CA-125) in your blood. The amount of CA-125 is higher with ovarian cancer. In premenopausal women, many other illnesses or diseases besides cancer can cause higher levels of CA-125.

Are ovarian cysts ever an emergency?

Yes, sometimes. If your doctor told you that you have an ovarian cyst and you have any of the following symptoms, get medical help right away:

  • Pain with fever and vomiting

  • Sudden, severe abdominal pain

  • Faintness, dizziness, or weakness

  • Rapid breathing

These symptoms could mean that your cyst has broken open, or ruptured. Sometimes, large, ruptured cysts can cause heavy bleeding.

Will my ovarian cyst require surgery?

Maybe. The National Institutes of Health estimates that 5% to 10% of women have surgery to remove an ovarian cyst. Only 13% to 21% of these cysts are cancerous.2

Your cyst may require surgery if you are past menopause or if your cyst:

  • Does not go away after several menstrual cycles

  • Gets larger

  • Looks unusual on the ultrasound

  • Causes pain

If your cyst does not require surgery, your doctor may:

  • Talk to you about pain medicine. Your doctor may recommend over-the-counter medicine or prescribe stronger medicine for pain relief.

  • Prescribe hormonal birth control if you have cysts often. Hormonal birth control, such as the pill, vaginal ring, shot, or patch, help prevent ovulation. This may lower your chances of getting more cysts.

What types of surgeries remove ovarian cysts?

If your cyst requires surgery, your doctor will either remove just the cyst or the entire ovary.

Surgery can be done in two different ways:

  • Laparoscopy (lap-uh-ROSS-kuh-pee). With this surgery, the doctor makes a very small cut above or below your belly button to look inside your pelvic area and remove the cyst. This is often recommended for smaller cysts that look benign (not cancerous) on the ultrasound.

  • Laparotomy (lap-uh-ROT-uh-mee). Your doctor may choose this method if the cyst is large and may be cancerous. This surgery uses a larger cut in the abdomen to remove the cyst. The cyst is then tested for cancer. If it is likely to be cancerous, it is best to see a gynecologic oncologist, who  may need to remove the ovary and other tissues, like the uterus.

Can ovarian cysts lead to cancer?

Yes, some ovarian cysts can become cancerous. But most ovarian cysts are not cancerous.

The risk for ovarian cancer increases as you get older. Women who are past menopause with ovarian cysts have a higher risk for ovarian cancer. Talk to your doctor about your risk for ovarian cancer. Screening for ovarian cancer is not recommended for most women.3 This is because testing can lead to "false positives."  A false positive is a test result that says a woman has ovarian cancer when she does not.

Can ovarian cysts make it harder to get pregnant?

Typically, no. Most ovarian cysts do not affect your chances of getting pregnant. Sometimes, though, the illness causing the cyst can make it harder to get pregnant. Two conditions that cause ovarian cysts and affect fertility are:

  • Endometriosis, which happens when the lining of the uterus (womb) grows outside of the uterus. Cysts caused by endometriosis are called endometriomas.

  • Polycystic ovary syndrome (PCOS), one of the leading causes of infertility (problems getting pregnant). Women with PCOS often have many small cysts on their ovaries.

How do ovarian cysts affect pregnancy?

Ovarian cysts are common during pregnancy. Typically, these cysts are benign (not cancerous) and harmless.4 Ovarian cysts that continue to grow during pregnancy can rupture or twist or cause problems during childbirth. Your doctor will monitor any ovarian cyst found during pregnancy.

Can I prevent ovarian cysts?

No, you cannot prevent functional ovarian cysts if you are ovulating. If you get ovarian cysts often, your doctor may prescribe hormonal birth control to stop you from ovulating. This will help lower your risk of getting new cysts.

Did we answer your question about ovarian cysts?

For more information on ovarian cysts, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, HHS
    Phone Number: 800-370-2943 (TDD: 888-320-6942)

  • American Academy of Family Physicians (AAFP) (link is external)
    Phone Number: 800-274-2237

  • American College of Obstetricians and Gynecologists (ACOG) (link is external)
    Phone Number: 800-673-8444

  • American Society for Reproductive Medicine (link is external)
    Phone Number: 205-978-5000

Vaginal yeast infections

Most women will get a vaginal yeast infection at some point in their life. Symptoms of vaginal yeast infections include burning, itching, and thick, white discharge. Yeast infections are easy to treat, but it is important to see your doctor or nurse if you think you have an infection. Yeast infection symptoms are similar to other vaginal infections and sexually transmitted infections (STIs). If you have a more serious infection, and not a yeast infection, it can lead to major health problems.

What is a vaginal yeast infection?

A vaginal yeast infection is an infection of the vagina that causes itching and burning of the vulva, the area around the vagina. Vaginal yeast infections are caused by an overgrowth of the fungus Candida.

Diagram of the vulva. The following are labeled: Vulva, mons pubis, clitoris, urethral opening, inner and outer lips of the vagina, vaginal opening, perineum, anus.

Who gets vaginal yeast infections?

Women and girls of all ages can get vaginal yeast infections. Three out of four women will have a yeast infection at some point in their life. Almost half of women have two or more infections.1

Vaginal yeast infections are rare before puberty and after menopause.

Are some women more at risk for yeast infections?

Yes. Your risk for yeast infections is higher if:2

  • You are pregnant

  • You have diabetes and your blood sugar is not under control

  • You use a type of hormonal birth control that has higher doses of estrogen

  • You douche or use vaginal sprays

  • You recently took antibiotics such as amoxicillin or steroid medicines

  • You have a weakened immune system, such as from HIV

What are the symptoms of vaginal yeast infections?

The most common symptom of a vaginal yeast infection is extreme itchiness in and around the vagina.

Other signs and symptoms include:

  • Burning, redness, and swelling of the vagina and the vulva

  • Pain when urinating

  • Pain during sex

  • Soreness

  • A thick, white vaginal discharge that looks like cottage cheese and does not have a bad smell

You may have only a few of these symptoms. They may be mild or severe.

What causes yeast infections?

Yeast infections are caused by overgrowth of the microscopic fungus Candida.

Your vagina may have small amounts of yeast at any given time without causing any symptoms. But when too much yeast grows, you can get an infection.

Can I get a yeast infection from having sex?

Yes. A yeast infection is not considered an STI, because you can get a yeast infection without having sex. But you can get a yeast infection from your sexual partner. Condoms and dental dams may help prevent getting or passing yeast infections through vaginal, oral, or anal sex.

Should I call my doctor or nurse if I think I have a yeast infection?

Yes. Seeing your doctor or nurse is the only way to know for sure if you have a yeast infection and not a more serious type of infection.

The signs and symptoms of a yeast infection are a lot like symptoms of other more serious infections, such as STIs and bacterial vaginosis (BV). If left untreated, STIs and BV raise your risk of getting other STIs, including HIV, and can lead to problems getting pregnant. BV can also lead to problems during pregnancy, such as premature delivery.

How is a yeast infection diagnosed?

Your doctor will do a pelvic exam to look for swelling and discharge. Your doctor may also use a cotton swab to take a sample of the discharge from your vagina. A lab technician will look at the sample under a microscope to see whether there is an overgrowth of the fungus Candida that causes a yeast infection.

How is a yeast infection treated?

Yeast infections are usually treated with antifungal medicine. See your doctor or nurse to make sure that you have a vaginal yeast infection and not another type of infection.

You can then buy antifungal medicine for yeast infections at a store, without a prescription. Antifungal medicines come in the form of creams, tablets, ointments, or suppositories that you insert into your vagina. You can apply treatment in one dose or daily for up to seven days, depending on the brand you choose.

Your doctor or nurse can also give you a single dose of antifungal medicine taken by mouth, such as fluconazole (floo-CON-uh-zohl). If you get more than four vaginal yeast infections a year, or if your yeast infection doesn't go away after using over-the-counter treatment, you may need to take regular doses of antifungal medicine for up to six months.

Is it safe to use over-the-counter medicines for yeast infections?

Yes, but always talk with your doctor or nurse before treating yourself for a vaginal yeast infection. This is because:

  • You may be trying to treat an infection that is not a yeast infection. Studies show that two out of three women who buy yeast infection medicine don't really have a yeast infection.2 Instead, they may have an STI or bacterial vaginosis (BV). STIs and BV require different treatments than yeast infections and, if left untreated, can cause serious health problems.

  • Using treatment when you do not actually have a yeast infection can cause your body to become resistant to the yeast infection medicine. This can make actual yeast infections harder to treat in the future.

  • Some yeast infection medicine may weaken condoms and diaphragms, increasing your chance of getting pregnant or an STI when you have sex. Talk to your doctor or nurse about what is best for you, and always read and follow the directions on the medicine carefully.

How do I treat a yeast infection if I'm pregnant?

During pregnancy, it's safe to treat a yeast infection with vaginal creams or suppositories that contain miconazole or clotrimazole.

Do not take the oral fluconazole tablet to treat a yeast infection during pregnancy. It may cause birth defects.3

Can I get a yeast infection from breastfeeding?

Yes. Yeast infections can happen on your nipples or in your breast (commonly called "thrush") from breastfeeding. Yeast thrive on milk and moisture. A yeast infection you get while breastfeeding is different from a vaginal yeast infection. However, it is caused by an overgrowth of the same fungus.

Symptoms of thrush during breastfeeding include:

  • Sore nipples that last more than a few days, especially after several weeks of pain-free breastfeeding

  • Flaky, shiny, itchy, or cracked nipples

  • Deep pink and blistered nipples

  • Achy breast

  • Shooting pain in the breast during or after feedings

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If you have any of these signs or symptoms or think your baby might have thrush in his or her mouth, call your doctor. Learn more about thrush in our Breastfeeding section.

If I have a yeast infection, does my sexual partner need to be treated?

Maybe. Yeast infections are not STIs. But it is possible to pass yeast infections to your partner during vaginal, oral, or anal sex.

  • If your partner is a man, the risk of infection is low. About 15% of men get an itchy rash on the penis if they have unprotected sex with a woman who has a yeast infection. If this happens to your partner, he should see a doctor. Men who haven't been circumcised and men with diabetes are at higher risk.

  • If your partner is a woman, she may be at risk. She should be tested and treated if she has any symptoms.

How can I prevent a yeast infection?

You can take steps to lower your risk of getting yeast infections:

  • Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection.

  • Do not use scented feminine products, including bubble bath, sprays, pads, and tampons.

  • Change tampons, pads, and panty liners often.

  • Do not wear tight underwear, pantyhose, pants, or jeans. These can increase body heat and moisture in your genital area.

  • Wear underwear with a cotton crotch. Cotton underwear helps keep you dry and doesn't hold in warmth and moisture.

  • Change out of wet swimsuits and workout clothes as soon as you can.

  • After using the bathroom, always wipe from front to back.

  • Avoid hot tubs and very hot baths.

  • If you have diabetes, be sure your blood sugar is under control.

Does yogurt prevent or treat yeast infections?

Maybe. Studies suggest that eating eight ounces of yogurt with "live cultures" daily or taking Lactobacillus acidophilus capsules can help prevent infection.4,5

But, more research still needs to be done to say for sure if yogurt with Lactobacillus or other probiotics can prevent or treat vaginal yeast infections. If you think you have a yeast infection, see your doctor or nurse to make sure before taking any over-the-counter medicine.

What should I do if I get repeat yeast infections?

If you get four or more yeast infections in a year, talk to your doctor or nurse.

About 5% of women get four or more vaginal yeast infections in one year. This is called recurrent vulvovaginal candidiasis (RVVC). RVVC is more common in women with diabetes or weak immune systems, such as with HIV, but it can also happen in otherwise healthy women.

Doctors most often treat RVVC with antifungal medicine for up to six months. Researchers also are studying the effects of a vaccine to help prevent RVVC (link is external).

Did we answer your question about vaginal yeast infections?

For more information on vaginal yeast infections, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

  • Centers for Disease Control and Prevention (CDC), HHS
    Phone Number: 800-232-4636

  • National Institute of Allergy and Infectious Diseases (NIAID), NIH, HHS
    Phone Number: 866-284-4107 (TDD: 800-877-8339)

  • American College of Obstetricians and Gynecologists (ACOG) (link is external)
    Phone Number: 800-673-8444

  • Planned Parenthood Federation of America (link is external)
    Phone Number: 800-230-7526

Vaginal yeast infection (PDF, 169 KB)
Image of syphilis bacteria

Treponema pallidum, the bacteria that cause syphilis.

Credit: NIAID

Syphilis fact sheet

  • What is syphilis?
  • How is syphilis spread?
  • What are the symptoms of syphilis?
  • How do I find out if I have syphilis?
  • How is syphilis treated?
  • What happens if syphilis isn't treated?
  • Can syphilis cause problems during pregnancy?
  • How can I keep from getting syphilis?
  • Who should get tested for syphilis?
  • I just found out I have syphilis. What should I do?
  • More information on syphilis

What is syphilis?

Syphilis (SIF-uh-luhss) is a sexually transmitted infection (STI) caused by bacteria (germ). It progresses in stages. Syphilis is easy to cure in its early stages. But without treatment, it can hurt your body's organs, leading to severe illness and even death.

How is syphilis spread?

Syphilis is spread through direct contact with a syphilis sore or rash during vaginal, anal, or oral sex. The bacteria can enter the body through the penis, anus, vagina, mouth, or through broken skin. An infected pregnant woman can also pass the disease to her unborn child. Syphilis is not spread by contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

What are the symptoms of syphilis?

Each stage of syphilis has different symptoms. A person infected with syphilis can pass it to others during the first two stages.

Primary stage
A single sore, called a chancre (SHANG-kuhr), appears in the first, or primary stage. Sometimes, more than one sore appears. The time between infection with syphilis and the start of the chancre can range between 10 to 90 days (21 days average). The chancre is usually firm, round, small, and painless. It appears at the spot where the infection entered the body, such as the vulva, vagina, cervix, tongue, lips, or other parts of the body. In this stage, syphilis can be passed to others through contact with the chancre during vaginal, anal, or oral sex. The chancre lasts 3 to 6 weeks and heals with or without treatment. If the infection is not treated, it moves to the secondary stage.

Secondary stage
The secondary stage can start as the chancre is healing or a few weeks after it has healed. It typically starts with a rash on 1 or more areas of the body. Some or all of these symptoms can appear:

  • Skin rash with rough, red, or reddish-brown spots both on the palms of the hands and bottoms of the feet. The rash usually does not itch. Rashes on other parts of the body may not look the same.
  • Sores on the throat, mouth, or cervix
  • Fever
  • Swollen glands
  • Sore throat
  • Patchy hair loss
  • Headaches and muscle aches
  • Weight loss
  • Tiredness

In this stage, the infection can be passed to others through contact with open sores or rash during vaginal, anal, or oral sex. Rash and other symptoms will go away with or without treatment. But without treatment, the infection will move to the latent and possibly late stages of disease.

Latent stage
The latent, or hidden, stage starts when symptoms from the first and second stages go away. The latent stage can last for many, many years. During this stage, the infection lives in the body even though there are no signs or symptoms. The infection cannot be passed to others during the latent stage. Sometimes, symptoms from the secondary phase come back. If this happens, the infection can be passed to others until the symptoms go away again. Without treatment, the infection will advance to the late stage in some people.

Late stage
About 15 percent of people with untreated syphilis will advance to the late stage. This can happen within a few years or as many as 20 years or more after first becoming infected. In the late stage, the disease can hurt your organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage can lead to nerve problems, paralysis, blindness, dementia, and other health problems. Some people may die from the disease. You will only reach the late stage if you do not receive treatment earlier. If you have syphilis, get treated as soon as possible to avoid these problems.

How do I found out if I have syphilis?

A doctor can tell if you have syphilis. The most common ways include:

  • Taking a sample of your blood and sending it to a lab for testing.
  • Looking at the fluid from a syphilis sore under a special type of microscope. This can only be done during primary and secondary stages, when a sore is present.

How is syphilis treated?

Penicillin (an antibiotic) is the preferred drug to treat syphilis at all stages. The dose and length of treatment depends on the stage of syphilis and symptoms of the disease. For people who are allergic to penicillin, other drugs might work during the first and second stages. But they cannot be used by pregnant women. In late syphilis, treatment will prevent further harm, but damage already done to body organs cannot be reversed. Treatment does not protect you from getting syphilis again. You can get syphilis again after being cured if you are exposed to it.

What happens if syphilis isn't treated?

Without treatment, syphilis can lead to severe illness and even death. Having syphilis also increases your risk of getting or giving HIV, the disease that causes AIDS. The open sores caused by syphilis make it easier for HIV to spread through sexual contact. If you have syphilis, you are thought to be 2 to 5 times more likely to get HIV if exposed. Untreated syphilis also can cause problems during pregnancy.

Can syphilis cause problems during pregnancy?

Yes. Pregnant women can pass syphilis to their babies during pregnancy and childbirth. It can cause miscarriage, stillbirth, or death soon after birth. An infected baby may be born without signs of disease. However, if not treated right away, the baby may have serious problems within a few weeks. Babies born with syphilis may develop skin sores, rashes, fever, jaundice, anemia, or a swollen liver and spleen. Untreated babies may become developmentally delayed, have seizures, or die.

All pregnant women should be tested for syphilis. Pregnant women with syphilis are treated right away with penicillin. For women who are allergic to penicillin, no other drugs are available for treatment. So, doctors try to help women with this allergy become less sensitive to the penicillin so it can be used. Penicillin will prevent passing syphilis to the baby. But women who are treated during the second half of pregnancy still are at risk of premature labor and problems with the unborn baby.

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How can I keep from getting syphilis?

There are steps you can take to lower your risk of getting syphilis:

  • Don't have sex. The surest way to keep from getting syphilis is to practice abstinence. This means not having vaginal, oral, or anal sex.
  • Be faithful. Having a sexual relationship with one partner who has been tested for syphilis 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. Syphilis sores can occur in places that are covered by a condom, as well as areas that are not covered. So, using a condom the right way and every time you have vaginal, anal, or oral sex might lower your risk. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex use a male latex condom. A dental dam might offer some protection during oral sex (mouth to vagina/anus).
  • Know that some methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs, including syphilis. If you use one of these methods, be sure to also use a latex condom every time you have sex.
  • Talk with your sex partner(s) about STIs and using condoms. It's up to you to make sure you are protected. Remember, it's your body! For more information, call the Centers for Disease Control and Prevention at 800-232-4636.
  • 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 partners can help you protect your health and the health of others.
  • Have a yearly pelvic exam. Ask your doctor if you should be tested for syphilis or other STIs, and how often you should be retested. Testing for many STIs is simple and often can be done during your checkup. The sooner syphilis is found, the more likely it can be cured quickly and easily.
  • Avoid using drugs or drinking too much alcohol. These activities may lead to risky sexual behavior such as not wearing a condom.

Who should get tested for syphilis?

Ask your doctor about getting tested for syphilis if:

  • You have symptoms and signs of syphilis.
  • You think you might have been exposed to someone with syphilis.
  • You are pregnant. All pregnant women should be tested for syphilis at their first prenatal checkup. Some pregnant women should be tested again, later in the pregnancy. Ask your doctor about retesting.
  • Your or your partner's sexual behavior puts you at risk for STIs (such as having sex with multiple partners, having unprotected sex, or having sex with men who have sex with men). Ask your doctor how often you should be retested.
  • You are a sex worker.
  • You have exchanged sex for drugs.
  • You are in prison.

I just found out I have syphilis. What should I do?

  • Follow all your doctor's treatment orders. Even if the symptoms go away, you still need to finish treatment. If symptoms continue after treatment, see your doctor.
  • Avoid any sexual activity while you are being treated for syphilis. Don't have sexual contact until the syphilis sores are completely healed.
  • Tell your sex partner(s). Your sex partner(s) should get tested for syphilis and treated if needed.
  • After you have completed treatment for syphilis, get retested after 6 months and 12 months. Some doctors recommend more frequent follow-up tests.
  • Get tested for HIV. If your test result is negative, ask your doctor if you need to be retested and when.
  • Once you have been treated and cured, take steps to lower your risk from getting syphilis again.

More information on syphilis

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

  • American Social Health Association
    Phone: 800-227-8922 or 919-361-8400
  • Centers for Disease Control and Prevention, HHS
    Phone: 800-232-4636 (TDD: 888-232-6348)
  • National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, HHS
    Phone: 800-232-4636 (TDD: 888-232-6348)
  • National Institute of Allergy and Infectious Diseases, NIH, HHS
    Phone: 866-284-4107 or 301-496-5717 (TDD: 800-877-8339)
  • National Prevention Information Network, CDC, HHS
    Phone: 800-458-5231
  • Planned Parenthood Federation of America
    Phone: 800-230-7526 

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 Viral hepatitis fact sheet

ARE YOU AT RISK? Millions of Americans have VIRAL HEPATITIS. Take this online assessment to see if you're at risk.

What is hepatitis?

Hepatitis (he-puh-TEYE-tuhs) means inflammation (swelling) of the liver. Hepatitis can be caused by:

Hepatitis is most often caused by one of several viruses, which is why it is often called viral hepatitis. The most common types of viral hepatitis in the United States are hepatitis A, hepatitis B, and hepatitis C.

This fact sheet focuses on viral hepatitis. You can learn more about other kinds of hepatitis from the National Library of Medicine.

What are the signs of viral hepatitis?

Some people with viral hepatitis have no signs of the infection. Symptoms, if they do appear, can include:

How do you get viral hepatitis?

You can get hepatitis A by eating food or drinking water contaminated with feces (stool) from a person infected with the virus or by anal-oral contact. Some ways you can get this type of hepatitis include:

You can get hepatitis B if you come into contact with an infected person's:

The virus can also be passed from an infected mother to her baby during childbirth.

Hepatitis C is also spread through contact with the blood of an infected person. This usually happens when people use contaminated needles to inject drugs.

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Do I need to be tested for hepatitis?

This depends on your risk factors. Ask your doctor about testing if:

You can live with hepatitis C for a long time without knowing it, so it is important to discuss your risk with your doctor.

How is viral hepatitis diagnosed?

If you think you might have viral hepatitis, see your doctor. To diagnose your illness, your doctor will:

Hepatitis infections are diagnosed with blood tests that look for parts of the virus or antibodies your body makes in response to the virus.

What's the difference between acute viral hepatitis and chronic viral hepatitis?

Acute viral hepatitis is a short-term, viral infection. It happens when you first get infected with the virus and can be mild or severe. In some cases, acute infection leads to chronic infection. Chronic viral hepatitis is a long-lasting infection that can last a lifetime.

Hepatitis A only causes acute infection. Hepatitis viruses B and C can cause both acute and chronic infections. Chronic hepatitis B and C are serious health problems. They can lead to:

How is viral hepatitis treated?

Viral hepatitis will often get better on its own after several weeks to several months. However, when hepatitis becomes a chronic or long-term illness, the infection may need to be treated with specific medications called antivirals.

If you think you have any type of viral hepatitis, talk to your doctor about what treatments may be right for you. 

How common is viral hepatitis?

In the United States in 2007, there were an estimated:

An estimated 800,000 to 1.4 million people have chronic hepatitis B and 3.2 million people have chronic hepatitis C in the United States. Between 75 and 85 percent of people who get infected with the hepatitis C virus develop a chronic infection.

How can I prevent viral hepatitis infection?

Below are the best methods for preventing the hepatitis viruses most commonly seen in the United States.

Hepatitis A prevention

Hepatitis B prevention

Hepatitis C prevention

If you are a health care or public safety worker, always follow routine barrier precautions and safely handle needles and other sharp objects.

If you are pregnant, your doctor will test your blood for hepatitis B. If you are an infected mother, your baby should be given hepatitis B immune globulin (H-BIG) and the hepatitis B vaccine within 12 hours after birth. If you have chronic hepatitis B, make sure your babies get all of their hepatitis B shots in the first six months of life.

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Who should get viral hepatitis vaccines?

The hepatitis A vaccine is given in two doses, six to 18 months apart. The vaccine is recommended for:

The hepatitis B vaccine is usually given in three doses over six months. The vaccine is recommended for:

How long do the hepatitis A and B vaccines protect you?

Only one series of the hepatitis A vaccine (two shots) and hepatitis B vaccine (three shots) is needed during a person's lifetime. Most people don't need a booster dose of either vaccine. But, if you have had hemodialysis (hee-moh-dy-AL-uh-suhs) (medical procedure to purify blood) or have a weakened immune system, your doctor might recommend a booster dose of the hepatitis B vaccine.

Is it safe to visit someone with hepatitis?

It is safe to visit someone with viral hepatitis. You cannot get hepatitis through casual contact. It is fine to shake hands with, hug, or kiss someone who is infected with any type of viral hepatitis.

How does a pregnant woman pass hepatitis B virus to her baby?

During birth, blood from the mother gets inside the baby's body. If the mother has hepatitis B virus in her blood, her baby will likely become infected. But this can be prevented by having the baby receive all of the shots in the hepatitis B vaccine series. A very small number of babies get infected before birth.

If I have hepatitis B, what does my baby need so that she doesn't get the virus?

Make sure your baby gets the hepatitis B vaccine and hepatitis B immune globulin (H-BIG) within 12 hours of birth. Your baby will need two or three more shots of vaccine over the next one to 15 months to help prevent hepatitis B. The timing and total number of shots will depend on the type of vaccine and baby's age and weight.

The vaccine is very important. More than 90 percent of babies who are exposed to the virus, but don't get the vaccine, develop chronic hepatitis B. Your baby should be tested after the last vaccine shot to make sure he or she is protected from the disease.

Can I breastfeed my baby if I have hepatitis B?

Yes, you can breastfeed your baby if you have hepatitis B. Make sure your baby gets the hepatitis B vaccine and hepatitis B immune globulin (H-BIG). Take good care of your nipples to prevent cracking and bleeding. If your nipples are cracking or bleeding, avoid nursing your baby on that breast until the sores heal. Until they heal, you can pump your milk to keep up your milk supply. But, you should throw away this pumped milk. Do not feed it to your baby.

More information on viral hepatitis

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

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.

Viral hepatitis fact sheet was reviewed by:

Dr. Cynthia Jorgensen, Ph.D.
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention

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Varicose veins and spider veins fact sheet

What are varicose veins and spider veins?

Varicose (VAR-i-kos) veins are enlarged veins that can be blue, red, or flesh-colored. They often look like cords and appear twisted and bulging. They can be swollen and raised above the surface of the skin. Varicose veins are often found on the thighs, backs of the calves, or the inside of the leg. During pregnancy, varicose veins can form around the vagina and buttocks.

Spider veins are like varicose veins but smaller. They also are closer to the surface of the skin than varicose veins. Often, they are red or blue. They can look like tree branches or spiderwebs with their short, jagged lines. They can be found on the legs and face and can cover either a very small or very large area of skin.

What causes varicose veins and spider veins?

Varicose veins can be caused by weak or damaged valves in the veins. The heart pumps blood filled with oxygen and nutrients to the whole body through the arteries. Veins then carry the blood from the body back to the heart. As your leg muscles squeeze, they push blood back to the heart from your lower body against the flow of gravity. Veins have valves that act as one-way flaps to prevent blood from flowing backwards as it moves up your legs. If the valves become weak, blood can leak back into the veins and collect there. (This problem is called venous insufficiency.) When backed-up blood makes the veins bigger, they can become varicose.

Spider veins can be caused by the backup of blood. They can also be caused by hormone changes, exposure to the sun, and injuries.

How common are abnormal leg veins?

About 50 to 55 percent of women and 40 to 45 percent of men in the United States suffer from some type of vein problem. Varicose veins affect half of people 50 years and older.

What factors increase my risk of varicose veins and spider veins?

Many factors increase a person's chances of developing varicose or spider veins. These include:

Why do varicose veins and spider veins usually appear in the legs?

Most varicose and spider veins appear in the legs due to the pressure of body weight, force of gravity, and task of carrying blood from the bottom of the body up to the heart.

Compared with other veins in the body, leg veins have the toughest job of carrying blood back to the heart. They endure the most pressure. This pressure can be stronger than the one-way valves in the veins.

What are the signs of varicose veins?

Varicose veins can often be seen on the skin. Some other common symptoms of varicose veins in the legs include:

Are varicose veins and spider veins dangerous?

Spider veins rarely are a serious health problem, but they can cause uncomfortable feelings in the legs. If there are symptoms from spider veins, most often they will be itching or burning. Less often, spider veins can be a sign of blood backup deeper inside that you can’t see on the skin. If so, you could have the same symptoms you would have with varicose veins.

Varicose veins may not cause any problems, or they may cause aching pain, throbbing, and discomfort. In some cases, varicose veins can lead to more serious health problems. These include:

Should I see a doctor about varicose veins?

You should see a doctor about varicose veins if:

If you’re having pain, even if it’s just a dull ache, don’t hesitate to get help. Also, even if you don’t need to see a doctor about your varicose veins, you should take steps to keep them from getting worse (see How can I prevent varicose veins and spider veins? ).

How are varicose veins diagnosed?

Your doctor may diagnose your varicose veins based on a physical exam. Your doctor will look at your legs while you’re standing or sitting with your legs dangling. He or she may ask you about your symptoms, including any pain you’re having. Sometimes, you may have other tests to find out the extent of the problem and to rule out other disorders.

You might have an ultrasound, which is used to see the veins’ structure, check the blood flow in your veins, and look for blood clots. This test uses sound waves to create pictures of structures in your body.

Although less likely, you might have a venogram. This test can be used to get a more detailed look at blood flow through your veins.

If you seek help for your varicose veins, there are several types of doctors you can see, including:

Each of these specialists do some or all of the procedures for treating varicose veins. You might start out by asking your regular doctor which specialist he or she recommends. You also might check with your insurance plan to see if it would pay for a particular provider or procedure.

How are varicose and spider veins treated?

Varicose veins are treated with lifestyle changes and medical treatments. These can:

Your doctor may recommend lifestyle changes if your varicose veins don’t cause many symptoms. If symptoms are more severe, your doctor may recommend medical treatments. Some treatment options include:

Compression stockings

Compression stockings put helpful pressure on your veins. There are 3 kinds of compression stockings:

Sclerotherapy
Sclerotherapy (SKLER-o-ther-a-pee) is the most common treatment for both spider veins and varicose veins. The doctor uses a needle to inject a liquid chemical into the vein. The chemical causes the vein walls to swell, stick together, and seal shut. This stops the flow of blood, and the vein turns into scar tissue. In a few weeks, the vein should fade. This treatment does not require anesthesia and can be done in your doctor's office. You can return to normal activity right after treatment.

The same vein may need to be treated more than once. Treatments are usually done every 4 to 6 weeks. You may be asked to wear gradient compression stockings after sclerotherapy to help with healing and decrease swelling. This treatment is very effective when done correctly.

Possible side effects include:

There is a type of sclerotherapy called ultrasound-guided sclerotherapy (or echo-sclerotherapy). This type of sclerotherapy uses ultrasound imaging to guide the needle. It can be useful in treating veins that cannot be seen on the skin’s surface. It may be used after surgery or endovenous techniques if the varicose veins return. This procedure can be done in a doctor’s office. Possible side effects include skin sores, swelling, injection into an artery by mistake, or deep vein thrombosis (a potentially dangerous blood clot).

Surface laser treatments

In some cases, laser treatments can effectively treat spider veins and smaller varicose veins. This technique sends very strong bursts of light through the skin onto the vein. This makes the vein slowly fade and disappear. Not all skin types and colors can be safely treated with lasers.

No needles or incisions are used, but the heat from the laser can be quite painful. Cooling helps reduce the pain. Laser treatments last for 15 to 20 minutes. Generally, 2 to 5 treatments are needed to remove spider veins in the legs. Laser therapy usually isn’t effective for varicose veins larger than 3 mm (about a tenth of an inch). You can return to normal activity right after treatment.

Possible side effects of lasers include:

Endovenous techniques (radiofrequency and laser)

These methods for treating the deeper veins of the legs, called the saphenous (SAF-uh-nuhs) veins, have replaced surgery for most patients with severe varicose veins. These techniques can be done in a doctor’s office.

The doctor puts a very small tube, called a catheter, into the vein. A small probe is placed through the tube. A device at the tip of the probe heats up the inside of the vein and closes it off. The device can use radiofrequency or laser energy to seal the vein. The procedure can be done using just local anesthesia. You might have slight bruising after treatment.

Healthy veins around the closed vein take over the normal flow of blood. The symptoms from the varicose vein improve. Usually, veins on the surface of the skin that are connected to the treated varicose vein will also shrink after treatment. If they don’t, these connected veins can be treated with sclerotherapy or other techniques.

Surgery

Surgery is used mostly to treat very large varicose veins. Types of surgery for varicose veins include:

How can I prevent varicose veins and spider veins?

Not all varicose and spider veins can be prevented. But, there are some steps you can take to reduce your chances of getting new varicose and spider veins. These same things can help ease discomfort from the ones you already have:

Can varicose and spider veins return even after treatment?

Current treatments for varicose veins and spider veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.

The single most important thing you can do to slow down the development of new varicose veins is to wear gradient compression support stockings as much as possible during the day.

More information on varicose veins and spider veins

For more information about varicose veins and spider veins, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

Varicose veins and spider veins fact sheet was reviewed by:

Robert J. Min, M.D.
Chairman of Radiology
Weill Cornell Medical College

Melvin Rosenblatt, M.D.
Chairman, Public Education Committee
American College of Phlebology

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Sexual assault fact sheet

What is sexual assault?

Sexual assault and abuse is any type of sexual activity that you do not agree to, including:

Sexual assault can be verbal, visual, or anything that forces a person to join in unwanted sexual contact or attention. Examples of this are voyeurism (when someone watches private sexual acts), exhibitionism (when someone exposes him/herself in public), incest (sexual contact between family members), and sexual harassment. It can happen in different situations:  in the home by someone you know, on a date, or by a stranger in an isolated place.

Rape is a common form of sexual assault. It is committed in many situations — on a date, by a friend or an acquaintance, or when you think you are alone. Educate yourself on “date rape” drugs. They can be slipped into a drink when a victim is not looking. Never leave your drink unattended — no matter where you are. Attackers use date rape drugs to make a person unable to resist assault. These drugs can also cause memory loss so the victim doesn’t know what happened.

Rape and sexual assault are never the victim’s fault — no matter where or how it happens.

What do I do if I've been sexually assaulted?

These are important steps to take right away after an assault:

While at the hospital:

Where else can I go for help?

If you are sexually assaulted, it is not your fault. Don’t be afraid to ask for help or support. Help is available. You can call these organizations:

There are many organizations and hotlines in every state and territory. These crisis centers and agencies work hard to stop assaults and help victims. Find contact information for these organizations. You also can obtain the numbers of shelters, counseling services, and legal assistance in your phone book or online.

How can I lower my risk of sexual assault?

There are things you can do to reduce your chances of being sexually assaulted. Follow these tips from the National Crime Prevention Council.

How can I help someone who has been sexually assaulted?

You can help someone who is abused or who has been assaulted by listening and offering comfort. Go with her or him to the police, the hospital, or to counseling. Reinforce the message that she or he is not at fault and that it is natural to feel angry and ashamed.

More information on sexual assault

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

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.

Sexual assault fact sheet was reviewed by:

Joyce Lukima
National Sexual Violence Resource Center
Pennsylvania Coalition Against Rape

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Date rape drugs fact sheet

What are date rape drugs?

These are drugs that are sometimes used to assist a sexual assault. Sexual assault is any type of sexual activity that a person does not agree to. It can include touching that is not okay; putting something into the vagina; sexual intercourse; rape; and attempted rape. These drugs are powerful and dangerous. They can be slipped into your drink when you are not looking. The drugs often have no color, smell, or taste, so you can't tell if you are being drugged. The drugs can make you become weak and confused — or even pass out — so that you are unable to refuse sex or defend yourself. If you are drugged, you might not remember what happened while you were drugged. Date rape drugs are used on both females and males.

The three most common date rape drugs are:

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These drugs also are known as "club drugs" because they tend to be used at dance clubs, concerts, and "raves."

The term "date rape" is widely used. But most experts prefer the term "drug-facilitated sexual assault." These drugs also are used to help people commit other crimes, like robbery and physical assault. They are used on both men and women. The term "date rape" also can be misleading because the person who commits the crime might not be dating the victim. Rather, it could be an acquaintance or stranger.

What do the drugs look like?

What effects do these drugs have on the body?

These drugs are very powerful. They can affect you very quickly and without your knowing. The length of time that the effects last varies. It depends on how much of the drug is taken and if the drug is mixed with other drugs or alcohol. Alcohol makes the drugs even stronger and can cause serious health problems — even death.

Rohypnol

The effects of Rohypnol can be felt within 30 minutes of being drugged and can last for several hours. If you are drugged, you might look and act like someone who is drunk. You might have trouble standing. Your speech might be slurred. Or you might pass out. Rohypnol can cause these problems:

GHB

GHB takes effect in about 15 minutes and can last 3 or 4 hours. It is very potent: A very small amount can have a big effect. So it's easy to overdose on GHB. Most GHB is made by people in home or street "labs." So, you don't know what's in it or how it will affect you. GHB can cause these problems:

Ketamine

Ketamine is very fast-acting. You might be aware of what is happening to you, but unable to move. It also causes memory problems. Later, you might not be able to remember what happened while you were drugged. Ketamine can cause these problems:

Are these drugs legal in the United States?

Some of these drugs are legal when lawfully used for medical purposes. But that doesn't mean they are safe. These drugs are powerful and can hurt you. They should only be used under a doctor's care and order.

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Is alcohol a date rape drug? What about other drugs?

Any drug that can affect judgment and behavior can put a person at risk for unwanted or risky sexual activity. Alcohol is one such drug. In fact, alcohol is the drug most commonly used to help commit sexual assault. When a person drinks too much alcohol:

The club drug "ecstasy" (MDMA) has been used to commit sexual assault. It can be slipped into someone's drink without the person's knowledge. Also, a person who willingly takes ecstasy is at greater risk of sexual assault. Ecstasy can make a person feel "lovey-dovey" towards others. It also can lower a person's ability to give reasoned consent. Once under the drug's influence, a person is less able to sense danger or to resist a sexual assault.

Even if a victim of sexual assault drank alcohol or willingly took drugs, the victim is not at fault for being assaulted. You cannot "ask for it" or cause it to happen.

How can I protect myself from being a victim?

Are there ways to tell if I might have been drugged and raped?

It is often hard to tell. Most victims don't remember being drugged or assaulted. The victim might not be aware of the attack until 8 or 12 hours after it occurred. These drugs also leave the body very quickly. Once a victim gets help, there might be no proof that drugs were involved in the attack. But there are some signs that you might have been drugged:

What should I do if I think I've been drugged and raped?

More information on date rape drugs

For more information about date rape drugs, call womenshealth.gov at 800-994-9662 (TDD: 888-220-5446) or contact the following organizations:

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.

Date rape drugs fact sheet was reviewed by:

Susan Weiss
Chief, Science Policy Branch
National Institute on Drug Abuse

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Mammograms fact sheet

What is a mammogram?

A mammogram is a low-dose x-ray exam of the breasts to look for changes that are not normal. The results are recorded on x-ray film or directly into a computer for a doctor called a radiologist to examine.

A mammogram allows the doctor to have a closer look for changes in breast tissue that cannot be felt during a breast exam. It is used for women who have no breast complaints and for women who have breast symptoms, such as a change in the shape or size of a breast, a lump, nipple discharge, or pain. Breast changes occur in almost all women. In fact, most of these changes are not cancer and are called “benign,” but only a doctor can know for sure. Breast changes can also happen monthly, due to your menstrual period.

What is the best method of detecting breast cancer as early as possible?

A high-quality mammogram plus a clinical breast exam, an exam done by your doctor, is the most effective way to detect breast cancer early. Finding breast cancer early greatly improves a woman's chances for successful treatment.

Like any test, mammograms have both benefits and limitations. For example, some cancers can't be found by a mammogram, but they may be found in a clinical breast exam.

Checking your own breasts for lumps or other changes is called a breast self-exam (BSE). Studies so far have not shown that BSE alone helps reduce the number of deaths from breast cancer. BSE should not take the place of routine clinical breast exams and mammograms.

If you choose to do BSE, remember that breast changes can occur because of pregnancy, aging, menopause, menstrual cycles, or from taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for breasts to be swollen and tender right before or during a menstrual period. If you notice any unusual changes in your breasts, contact your doctor.

How is a mammogram done?

You stand in front of a special x-ray machine. The person who takes the x-rays, called a radiologic technician, places your breasts, one at a time, between an x-ray plate and a plastic plate. These plates are attached to the x-ray machine and compress the breasts to flatten them. This spreads the breast tissue out to obtain a clearer picture. You will feel pressure on your breast for a few seconds. It may cause you some discomfort; you might feel squeezed or pinched. This feeling only lasts for a few seconds, and the flatter your breast, the better the picture. Most often, two pictures are taken of each breast — one from the side and one from above. A screening mammogram takes about 20 minutes from start to finish.

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Are there different types of mammograms?

A digital mammogram also uses x-rays to produce an image of the breast, but instead of storing the image directly on film, the image is stored directly on a computer. This allows the recorded image to be magnified for the doctor to take a closer look. Current research has not shown that digital images are better at showing cancer than x-ray film images in general. But, women with dense breasts who are pre- or perimenopausal, or who are younger than age 50, may benefit from having a digital rather than a film mammogram. Digital mammography may offer these benefits:

How often should I get a mammogram?

The United States Preventive Services Task Force (USPSTF) recommends:

What can mammograms show?

The radiologist will look at your x-rays for breast changes that do not look normal and for differences in each breast. He or she will compare your past mammograms with your most recent one to check for changes. The doctor will also look for lumps and calcifications.

If calcifications are grouped together in a certain way, it may be a sign of cancer. Depending on how many calcium specks you have, how big they are, and what they look like, your doctor may suggest that you have other tests. Calcium in the diet does not create calcium deposits, or calcifications, in the breast.

What if my screening mammogram shows a problem?

If you have a screening test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order some of these tests:

Where can I get a high-quality mammogram?

Women can get high-quality mammograms in breast clinics, hospital radiology departments, mobile vans, private radiology offices, and doctors’ offices. The Food and Drug Administration (FDA) certifies mammography facilities that meet strict quality standards for their x-ray machines and staff and are inspected every year. You can ask your doctor or the staff at the mammography center about FDA certification before making your appointment. A list of FDA-certified facilities can be found on the Internet.

Your doctor, local medical clinic, or local or state health department can tell you where to get no-cost or low-cost mammograms. You can also call the National Cancer Institute's Cancer Information Service toll free at 800-422-6237.

What if I have breast implants?

Women with breast implants should also have mammograms. A woman who had an implant after breast cancer surgery in which the entire breast was removed (mastectomy) should ask her doctor whether she needs a mammogram of the reconstructed breast.

If you have breast implants, be sure to tell your mammography facility that you have them when you make your appointment. The technician and radiologist must be experienced in x-raying patients with breast implants. Implants can hide some breast tissue, making it harder for the radiologist to see a problem when looking at your mammogram. To see as much breast tissue as possible, the x-ray technician will gently lift the breast tissue slightly away from the implant and take extra pictures of the breasts.

How do I get ready for my mammogram?

First, check with the place you are having the mammogram for any special instructions you may need to follow before you go. Here are some general guidelines to follow:

Are there any problems with mammograms?

Although they are not perfect, mammograms are the best method to find breast changes that cannot be felt. If your mammogram shows a breast change, sometimes other tests are needed to better understand it. Even if the doctor sees something on the mammogram, it does not mean it is cancer.

As with any medical test, mammograms have limits. These limits include:

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More information on mammograms

Mammograms fact sheet was reviewed by:

Worta McCaskill-Stevens, M.D.
Community Oncology and Prevention Trials Research Group
Division of Cancer Prevention
National Cancer Institute, National Institutes of Health

Richard E. Manrow, Ph.D.
Associate Director, Office of Cancer Content Management
Office of Communications and Education
National Cancer Institute, National Institutes of Health.

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Oral health fact sheet

  • What is oral health?
  • What are the most common oral health problems?
  • What are some other problems I might have with my mouth?
  • How might problems in my mouth be linked to health problems in other parts of my body?
  • I'm afraid of the dentist. What can I do to make my visit better?
  • As a woman, why do I have to worry about oral health?
  • I'm pregnant. Do I need to take special care of my mouth?
  • I'm a new mother. What can I do for my baby's oral health?
  • I'm starting cancer treatment. How can I best take care of my mouth?
  • I'm confused! What type of toothpaste or mouthwash should I use?
  • I'm not happy with the stains on my teeth. How can I safely whiten them?
  • What small, easy steps can I take to have healthy teeth and gums?
  • More information on oral health

 

Celia's Story

I started having pain in my mouth about 10 months ago. At first I just ignored it. I hoped it would go away on its own. But it didn't. I told my daughter about it and she said, "Mom, you need to see a dentist." But I didn't make an appointment. I was afraid. I waited several more months and the pain got worse and worse. Then, my gums started bleeding when I brushed my teeth. Now I was really nervous to see the dentist. I was afraid and thought the treatment would hurt worse than the pain I was already having. Also, I felt embarrassed that I had waited so long to make an appointment. So my daughter made the appointment for me. She even went with me to the dentist. And do you know what? It wasn't bad at all! Dental treatments have gotten so much better! I explained to my dentist that I was very anxious, and she made sure that I was comfortable through my whole visit. Now I plan to schedule regular cleanings to keep myself healthy!

What is oral health?

The word "oral" refers to the mouth, which includes your teeth, gums, jawbone, and supporting tissues. Taking good care of your oral health can prevent disease in your mouth. Oral health can affect the health of your entire body. Good oral health does not just mean you have pretty teeth. Your whole mouth needs care to be in good health.

What are the most common oral health problems?

The most common oral health problems are cavities and gum disease.

Cavities
We are all at risk of tooth decay, or cavities. (Cavities look like chalky white and/or brown holes on your teeth). Bacteria (germs) that naturally live in our mouths use sugar in food to make acids. Over time, the acids destroy the outside layer of your teeth. Then cavities and other tooth harm occur.

Gum diseases
Gum diseases are infections caused by bacteria, along with mucus and other particles that form a sticky plaque on your teeth. Plaque that is left on teeth hardens and forms tartar. Gingivitis (jin-juh-VEYE-tuhss) is a mild form of gum disease. It causes red, swollen gums. It can also make the gums bleed easily. Gingivitis can be caused by plaque buildup. And the longer plaque and tartar stay on teeth, the more harm they do. Most gingivitis can be treated with daily brushing and flossing and regular cleanings at the dentist's office. This form of gum disease does not lead to loss of bone or tissue around the teeth. But if it is not treated, it can advance to periodontitis (pair-ee-oh-don-TEYE-tuhss). Then the gums pull away from the teeth and form infected "pockets." You may also lose supporting bone. If you have periodontitis, see your dentist for treatment. Otherwise your teeth may loosen over time and need to be removed.

Your risk of gum disease is higher if you:

  • Smoke
  • Have a disease such as diabetes or HIV/AIDS
  • Use methamphetamine

What are some other problems I might have with my mouth?

Bad breath. Bad breath is also called halitosis (hal-lih-TOH-suhss). Bad-smelling breath can be caused by several things, including:

  • Poor oral hygiene
  • Some foods
  • Dentures
  • Gum disease
  • Dry mouth
  • Tobacco use
  • Respiratory, digestive, or other health problems
  • Some medicines

Practicing good oral hygiene and avoiding tobacco and some foods often helps people with bad-smelling breath. You may want to try using a tongue scraper to clean food from your tongue. You could also just brush your tongue with your toothbrush. But if doing so doesn't seem to help or if you always need mouthwash to hide bad breath, talk to your dentist.

Burning mouth. People with this condition describe a burning feeling in the mouth or tongue. It is most common in postmenopausal women. The cause is unknown, but might be linked to:

  • Hormones
  • Dry mouth (which can be caused by many medicines and disorders such as Sjögren's syndrome or diabetes)
  • Taste problems
  • Nutritional deficiencies
  • Use of ACE inhibitors (blood pressure medicines)
  • Anxiety and depression
  • Dentures that do not fit
  • Infections (especially fungal infections)

Talk to your doctor or dentist if you have burning mouth. Treatment depends on the cause — if it can be determined — and might include adjusting your dentures, vitamin supplements, or pain or other medicines.

Canker sores. These sores are small ulcers inside the mouth. They have a white or gray base and a red border. Women are more likely than men to have canker sores that recur. The cause of canker sores is unknown. Risk factors include:

  • Fatigue
  • Stress
  • Having your period
  • A cut on the inside of your cheek or on your tongue
  • Allergies
  • Celiac disease
  • Crohn's disease

Canker sores most often heal on their own in one to three weeks. See your dentist if you get a large sore (larger than a half inch, or about the size of a dime). You may need medicine to treat it.

To help with pain:

  • Avoid hot, spicy foods
  • Use mild mouthwashes or salt water
  • Try over-the-counter pain medicines

No proven way exists to prevent canker sores. If you get them often, talk with your dentist.

Cold sores. These small, painful sores are caused by herpes simplex virus type 1. Once you are exposed to the virus, it can hide in your body for years. Things that trigger the virus and lead to cold sores include:

  • Getting too much sun
  • Having a cold or infection
  • Having your period
  • Feeling stressed

Cold sores can spread from person to person. They most often form on the lips and sometimes under the nose or chin. The sores heal in about 7 to 10 days without scarring. You can buy over-the-counter drugs to put on cold sores to help relieve pain. If you get cold sores a lot, talk with your doctor or dentist about a prescription for an antiviral drug. These drugs can help reduce healing time and the number of new sores.

Dry mouth. Dry mouth is also called xerostomia (ZEER-oh-STOM-mee-uh). This problem happens when you don't have enough saliva, or spit, in your mouth. Some reasons why people get dry mouth include:

  • Side effect of medicines or medical treatment, such as cancer treatments
  • Health problems, such as diabetes, Parkinson's disease, and Sjogren's syndrome
  • A blocked salivary gland

Dry mouth may make it hard to eat, swallow, taste, and speak. If left untreated, it can lead to cavities. This is because saliva helps break down bits of food and helps stop acid from forming plaque on your teeth. Treatment of dry mouth depends on the cause and can range from medicines to diet changes. To lessen the dryness, use artificial saliva, suck on sugarless candy, do not smoke, do not drink alcohol, and use a humidifier. Tell your doctor if you have dry mouth.

Oral cancer. This cancer can affect any part of the mouth and part of the throat. If you smoke or chew tobacco, you are at higher risk. Excessive alcohol use along with smoking raises your risk even more. However, nonsmokers can also develop oral cancer. To help protect yourself from lip cancer, use a lip balm with sunscreen (exposure to the sun can cause lip cancer).

Oral cancer most often occurs after age 40. It isn't always painful, so it may go undetected until the late stages. Ask your doctor to check for signs of oral cancer during your regular checkup. Oral cancer often starts as a tiny white or red spot or sore anywhere in the mouth. Other signs include:

  • A sore that bleeds easily or does not heal
  • A color change in the tissues of the mouth
  • A lump, rough spot, or other change
  • Pain, tenderness, or numbness anywhere in the mouth or on the lips
  • Problems chewing, swallowing, speaking, or moving the jaw or tongue
  • A change in the way the teeth fit together

Thrush. Thrush is also called oral candidiasis (CAN-dih-dye-uh-sis). These fungal infections appear as red, yellow, or white lesions, flat or slightly raised, in the mouth or throat. It can look like cottage cheese. This fungus lives naturally in your mouth. Your risk of getting thrush increases if:

  • You have a weak immune system
  • You don't make enough saliva
  • You take antibiotics

Treatment includes antifungal mouthwash or lozenges. If the infection spreads or your immune system is weak, you may need antifungal medicine.

Thrush is common among:        

  • Denture wearers
  • People who are very young or elderly
  • People with dry mouth
  • People with HIV or other chronic disease (like diabetes)

How might problems in my mouth be linked to health problems in other parts of my body?

The health of your mouth can be a sign of your body's health. Mouth problems are not just cavities, toothaches, and crooked or stained teeth. Many diseases, such as diabetes, heart disease, HIV, cancer, and some eating disorders are linked with oral health problems. Regular dental exams help you maintain good oral health and avoid related health problems.

Cancer. If you are being treated for cancer, you may develop sores or other problems with your mouth. Pay attention to your mouth each day, and remember to brush and floss gently. Call your doctor or nurse if you notice a mouth problem, or if an old problem gets worse. See also: I'm starting cancer treatment. How can I best take care of my mouth?

Diabetes. People with diabetes are at special risk for gum disease. Gum disease can lead to painful chewing and even tooth loss. Dry mouth, often a symptom of undetected diabetes, can cause soreness, ulcers, infections, and tooth decay. People with diabetes can also get thrush. Smoking makes these problems worse. By controlling your blood glucose, brushing and flossing every day, and visiting a dentist regularly, you can help prevent gum disease. If your diabetes is not under control, you are more likely to develop problems in your mouth.

Heart disease.  Before some dental treatments, patients who have certain heart conditions or joint replacements may take antibiotics. These people may be at risk of getting an infection when bacteria that lives in the mouth goes into the bloodstream during treatment. Antibiotics lower this risk. Talk to your doctor or dentist if you are not sure whether you should take antibiotics before dental treatment.

HIV. Oral problems are common in people with HIV because of a weak immune system. These problems can make it hard to eat. If mouth pain or tenderness makes it hard to chew and swallow, or if you can't taste food like you used to, you may not eat enough. The most common mouth problems linked with HIV can be treated.

Nutrition problems. Sometimes people who are missing teeth have to limit their food choices because of chewing problems. This can lead to a lack of vitamins in the body. If you are missing teeth and have trouble chewing, check with your doctor to make sure you are eating the right foods.

I'm afraid of the dentist. What can I do to make my visit better?

Many people get nervous at the thought of visiting the dentist. Don'tlet your nerves stop you from having regular appointments, though. Waiting too long to take care of your teeth may make things worse. Here are a few tips to make your visit easier:

  • Tell the dentist and dental staff that you are feeling anxious. Getting your concerns out in the open will let your dentist adapt the treatment to your needs.
  • Try to choose a time for your dental visit when you're less likely to be rushed or under pressure. For some people, that means a Saturday or an early-morning appointment.
  • If the sound of the drill bothers you, bring a portable audio player and headset so you can listen to your favorite music. During the dental visit you might try visualizing yourself someplace relaxing, like on a warm beach.
  • Ask your dentist if there are medications he or she can give you to help you relax (this is sometimes called "sedation dentistry").

As a woman, why do I have to worry about oral health?

Everyone needs to take care of their oral health. But female hormones can lead to an increase in some problems, such as:

  • Cold sores and canker sores
  • Dry mouth
  • Changes in taste
  • Higher risk of gum disease

Taking good care of your teeth and gums can help you avoid or lessen oral health problems.

I'm pregnant. Do I need to take special care of my mouth?

Yes! If you are pregnant, you have special oral health needs.

Before you become pregnant, it is best to have regular dental checkups. You want to keep your mouth in good health before your pregnancy.

Also, remember that what you eat affects the development of your unborn child — including teeth. Your baby's teeth begin to grow during the third and sixth months of pregnancy, so it is important that you eat a balanced diet that includes calcium, protein, phosphorous, and vitamins A, C, and D.

If you are pregnant:

  • Have a complete oral exam early in your pregnancy. Because you are pregnant, your dentist might not take routine x-rays. But if you need x-rays, the health risk to your unborn baby is small.
  • Remember dental work during pregnancy is safe. The best time for treatment is between the 14th and 20th weeks. In the last months, you might be uncomfortable sitting in a dental chair.
  • Have all needed dental treatments. If you avoid treatment, you may risk your own and your baby's health.
  • Use good oral hygiene to control your risk of gum diseases. Pregnant women may have changes in taste and develop red, swollen gums that bleed easily. This condition is called pregnancy gingivitis. Both poor oral hygiene and higher hormone levels can cause pregnancy gingivitis. Until now, it was thought that having gum disease could raise your risk of having a low-birth-weight baby. Researchers have not been able to confirm this link, but studies are still under way to learn more.

I'm a new mother. What can I do for my baby's oral health?

You can do a lot! Below are some things you need to know about your baby's oral health.

  • The same germs that cause tooth decay in your mouth can be passed to your baby. Do not put your baby's items, such as toys, spoons, bottles, or pacifiers in your mouth.
  • Wipe your baby's teeth and gums with a clean gauze pad or baby toothbrush after each nursing and feeding. This can help remove sugars found in milk that can cause tooth decay and also get your baby used to having her teeth cleaned on a regular basis.
  • If you bottle-feed your baby, try to finish bottle weaning by age 1. Avoid giving your baby bottles or pacifiers at naps and bedtime. Sucking on a bottle when lying down can cause cavities and lead to "baby bottle tooth decay."
  • All babies should visit a dentist by age 1. The dentist will screen for problems in your baby's mouth. You will also be shown how to care for your child's teeth and mouth.
  • Talk with your doctor about the best water choices for infants. Fluoride is good for teeth. But too much fluoride can harm development of tooth enamel in infants.

I'm starting cancer treatment. How can I best take care of my mouth?

Cancer treatment can cause side effects in your mouth. A dental checkup before treatment starts can help prevent painful mouth problems. Serious side effects in the mouth can delay, or even stop, cancer treatment. To fight cancer best, your cancer care team should include a dentist. A dentist will help protect your mouth, teeth, and jaw bones from damage caused by head and neck radiation and chemotherapy.

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I'm confused! What type of toothpaste or mouthwash should I use?

So many different kinds of toothpaste are available today. Some say they're made for whitening, others for reducing gingivitis and plaque, and others for sensitive teeth. Before choosing toothpaste for your family, know the basics.

 

  • As long as toothpaste contains fluoride and its box has the American Dental Association's (ADA) seal of acceptance, it is good for your oral health. Beyond that, choosing toothpastes is a personal choice.
  • Mouthwashes claim to freshen your breath. But they really only mask breath odor for a few hours. If you always need to use a mouthwash to hide bad breath, see your dentist.
  • You can also use a tongue scraper to freshen breath. A tongue scraper removes food particles trapped in the pits along the tongue's surface. Brushing your tongue with your toothbrush can also remove these bits of food.

I'm not happy with the stains on my teeth. How can I safely whiten them?

There are three ways that you can whiten your teeth:

  • In-office bleaching
  • At-home bleaching
  • Whitening toothpastes

The first thing you should do before whitening your teeth is talk to your dentist. He or she will be able to help you decide the best option for you. Whiteners will not fix all kinds of stains. Also, if you have bonding or tooth-colored fillings, these will not be affected by whiteners and they may stand out if you whiten your teeth. Remember that a using a whitener does not make your mouth healthier.

In-office bleaching.
This kind of whitening, called "chairside bleaching," is done in your dentist's office. It may require more than one office visit. Each visit may take from 30 minutes to one hour. During chairside bleaching, the dentist puts a whitener on the teeth and uses a special light to make the whitener work. Lasers are sometimes used during tooth whitening to make the whitening agent work better.

At-home bleaching.
There are a few different products that can be used to whiten teeth at home. Some come from your dentist, and others can be bought over-the-counter. These contain peroxide(s), which bleach the tooth enamel. Most come in a gel and are placed in a mouth guard or tray that fits inside your mouth. They help many types of staining. Only the dentist-dispensed solutions have the American Dental Association (ADA) seal.

Other over-the-counter whitening products include whitening strips, paint-on products, gels, and trays. They have a low amount of peroxide. For better results, have a cleaning at the dentist before you use these products. These gels and trays do not have the ADA seal.

Whitening toothpastes.
All toothpastes help remove surface stains through mild abrasives. "Whitening" toothpastes that have the ADA seal have special polishing agents or chemicals that remove even more stains. Unlike bleaches, these products do not change the actual color of teeth. They help surface stains only.

Products used to whiten teeth can make teeth more sensitive. They can also bother your gums. These side effects most often go away after you stop using the product.

What small, easy steps can I take to have a healthy teeth and gums?

1. Brush your teeth at least twice each day with fluoride toothpaste.
Aim for first thing in the morning and before going to bed. Once a day, use floss or an interdental cleaner to remove food your toothbrush missed. Make sure you:

  • Drink water that contains added fluoride if you can. Fluoride protects against dental decay. Most public water systems in the United States have added fluoride. Check with your community's water or health department to find out if there is fluoride in your water. You also may want to use a fluoride mouth rinse, along with brushing and flossing, to help prevent tooth decay.
  • Gently brush all sides of your teeth with a soft-bristled brush. Round and short back-and-forth strokes work best.
  • Take time to brush along the gum line, and lightly brush your tongue to help remove plaque and food.
  • Ask your dentist or dental hygienist to show you the best way to floss your teeth.
  • Change your toothbrush every three months, or earlier if the toothbrush looks worn or the bristles spread out. A new toothbrush removes more plaque.
  • If you wear dentures, be sure to remove them at night and clean them before putting them back in the next morning.

2. Have a healthy lifestyle.

  • Eat healthy meals. Cut down on tooth decay by brushing after meals. Avoid snacking on sugary or starchy foods between meals.
  • Don't smoke. It raises your risk of gum disease, oral and throat cancers, and oral fungal infections. It also affects the color of your teeth and the smell of your breath.
  • Limit alcohol use to one drink per day for women. Heavy alcohol use raises your risk of oral and throat cancers. Using alcohol and tobacco together raises your risk of oral cancers more than using one alone.
  • Limit how much soda you drink. Even diet soda contains acids that can erode tooth enamel.

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3. Get regular checkups.

  • Have an oral exam once or twice a year. Your dentist may recommend more or fewer visits depending on your oral health. At most routine visits, the dentist and a dental hygienist will treat you. During regular checkups, dentists look for signs of diseases, infections, problems, injuries, and oral cancer.
  • See your dentist right away if:
    • Your gums bleed often
    • You see any red or white patches on the gums, tongue, or floor of the mouth
    • You have mouth or jaw pain that won't go away
    • You have sores that do not heal within two weeks
    • You have problems swallowing or chewing
  • Besides your dentist, there are other types of dental providers. Your dentist may send you to a specialist if you need extra care. Other providers include:
    • Dental hygienists: Members of the dental staff who clean gums and teeth and teach patients how to maintain good oral health.
    • Periodontists: Dentists who treat gum disease and place dental implants.
    • Oral surgeons: Dentists who operate on your mouth and supporting tissues.
    • Orthodontists: Dentists who straighten teeth and align jaws.
    • Endodontists: Dentists who perform root canals.
    • Prosthodontists: Dentists trained in restoring and replacing teeth.

4. Follow your dentist's advice.
Your dentist may suggest ways to keep your mouth healthy. He or she can teach you how to properly floss or brush. Follow any recommended steps or treatments to keep your mouth healthy.

5. If you have another health problem, think about how it may affect your oral health.
For instance, if you take medicines that give you a dry mouth, ask your doctor or nurse if there are other drugs you can use. Have an oral exam before starting cancer treatment. And if you have diabetes, practice good oral hygiene to prevent gum disease.

More information on oral health

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

  • Academy of General Dentistry
    Phone: 888-243-3368
  • American Dental Association
    Phone: 312-440-2500
  • Division of Oral Health, NCCDPHP, CDC, HHS
    Phone: 770-488-6054
  • National Institute of Dental and Craniofacial Research, NIH, HHS
    Phone: 866-232-4528
  • The Oral Cancer Foundation
    Phone: 949-646-8000

Oral health fact sheet was reviewed by:

Marian Mehegan, D.D.S., M.P.H.
CAPT, USPHS
Regional Women's Health Coordinator
USDHHS Office on Women's Health

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Women's Health: Birth Control, Emergency Contraception, & STDs/STIs

 Birth control methods fact sheet

What is the best method of birth control (or contraception)?

There is no "best" method of birth control. Each method has its pros and cons.

All women and men can have control over when, and if, they become parents. Making choices about birth control, or contraception, isn't easy. There are many things to think about. To get started, learn about birth control methods you or your partner can use to prevent pregnancy. You can also talk with your doctor about the choices.

Before choosing a birth control method, think about:

Keep in mind, even the most effective birth control methods can fail. But your chances of getting pregnant are lowest if the method you choose always is used correctly and every time you have sex.

What are the different types of birth control?

You can choose from many methods of birth control. They are grouped by how they work:

Types of birth control

Detailed information on each type is provided in the following charts. Talk with your doctor if you have questions about any of the choices.

Continuous abstinence
This means not having sex (vaginal, anal, or oral) at any time. It is the only sure way to prevent pregnancy and protect against sexually transmitted infections (STIs), including HIV.
Natural family planning/rhythm method

This method is when you do not have sex or use a barrier method on the days you are most fertile (most likely to become pregnant). You can read about barrier methods in the following chart.

A woman who has a regular menstrual cycle has about 9 or more days each month when she is able to get pregnant. These fertile days are about 5 days before and 3 days after ovulation, as well as the day of ovulation.

To have success with this method, you need to learn about your menstrual cycle. Then you can learn to predict which days you are fertile or "unsafe." To learn about your cycle, keep a written record of:

  • When you get your period
  • What it is like (heavy or light blood flow)
  • How you feel (sore breasts, cramps)

This method also involves checking your cervical mucus and recording your body temperature each day. Cervical mucus is the discharge from your vagina. You are most fertile when it is clear and slippery like raw egg whites. Use a basal thermometer to take your temperature and record it in a chart. Your temperature will rise 0.4 to 0.8° F on the first day of ovulation. You can talk with your doctor or a natural family planning instructor to learn how to record and understand this information.
Barrier methods — Put up a block, or barrier, to keep sperm from reaching the egg

Contraceptive sponge

This barrier method is a soft, disk-shaped device with a loop for taking it out. It is made out of polyurethane (pah-lee-YUR-uh-thayn) foam and contains the spermicide (SPUR-muh-syd) nonoxynol-9. Spermicide kills sperm.

Before having sex, you wet the sponge and place it, loop side down, inside your vagina to cover the cervix. The sponge is effective for more than one act of intercourse for up to 24 hours. It needs to be left in for at least 6 hours after having sex to prevent pregnancy. It must then be taken out within 30 hours after it is inserted.

Only one kind of contraceptive sponge is sold in the United States. It is called the Today Sponge. Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge.

Diaphragm, cervical cap, and cervical shield

These barrier methods block the sperm from entering the cervix (the opening to your womb) and reaching the egg.

  • The diaphragm is a shallow latex cup.
  • The cervical cap is a thimble-shaped latex cup. It often is called by its brand name, FemCap.
  • The cervical shield is a silicone cup that has a one-way valve that creates suction and helps it fit against the cervix. It often is called by its brand name, Lea's Shield.

The diaphragm and cervical cap come in different sizes, and you need a doctor to "fit" you for one. The cervical shield comes in one size, and you will not need a fitting.

Before having sex, add spermicide (to block or kill sperm) to the devices. Then place them inside your vagina to cover your cervix. You can buy spermicide gel or foam at a drug store.

All three of these barrier methods must be left in place for 6 to 8 hours after having sex to prevent pregnancy. The diaphragm should be taken out within 24 hours. The cap and shield should be taken out within 48 hours.

Female condom

This condom is worn by the woman inside her vagina. It keeps sperm from getting into her body. It is made of thin, flexible, manmade rubber and is packaged with a lubricant. It can be inserted up to 8 hours before having sex.  Use a new condom each time you have intercourse. And don't use it and a male condom at the same time.

Male condom

Male condoms are a thin sheath placed over an erect penis to keep sperm from entering a woman's body. Condoms can be made of latex, polyurethane, or "natural/lambskin". The natural kind do not protect against STIs. Condoms work best when used with a vaginal spermicide, which kills the sperm. And you need to use a new condom with each sex act.

Condoms are either:

  • Lubricated, which can make sexual intercourse more comfortable
  • Non-lubricated, which can also be used for oral sex. It is best to add lubrication to non-lubricated condoms if you use them for vaginal or anal sex. You can use a water-based lubricant, such as K-Y jelly. You can buy them at the drug store. Oil-based lubricants like massage oils, baby oil, lotions, or petroleum jelly will weaken the condom, causing it to tear or break.

Keep condoms in a cool, dry place. If you keep them in a hot place (like a wallet or glove compartment), the latex breaks down. Then the condom can tear or break.
Hormonal methods — Prevent pregnancy by interfering with ovulation, fertilization, and/or implantation of the fertilized egg

Oral contraceptives — combined pill ("The pill")

The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg.

Some women prefer the "extended cycle" pills. These have 12 weeks of pills that contain hormones (active) and 1 week of pills that don't contain hormones (inactive). While taking extended cycle pills, women only have their period three to four times a year.

Many types of oral contraceptives are available. Talk with your doctor about which is best for you.

Your doctor may advise you not to take the pill if you:

  • Are older than 35 and smoke
  • Have a history of blood clots
  • Have a history of breast, liver, or endometrial cancer

Antibiotics may reduce how well the pill works in some women. Talk to your doctor about a backup method of birth control if you need to take antibiotics.

Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

The patch

Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs in most women. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. You put on a new patch once a week for 3 weeks. You don't use a patch the fourth week in order to have a period.

Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.

Shot/injection

The birth control shot often is called by its brand name Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months. A new type is injected under the skin. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg.

The shot should not be used more than 2 years in a row because it can cause a temporary loss of bone density. The loss increases the longer this method is used. The bone does start to grow after this method is stopped. But it may increase the risk of fracture and osteoporosis if used for a long time.  

Vaginal ring

This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg.

It is commonly called NuvaRing, its brand name. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring.

Women should wait three weeks after giving birth to begin using birth control that contains both estrogen and progestin. These methods increase the risk of dangerous blood clots that could form after giving birth. Women who delivered by cesarean section or have other risk factors for blood clots, such as obesity, history of blood clots, smoking, or preeclampsia, should wait six weeks.
Implantable devices — Devices that are inserted into the body and left in place for a few years.

Implantable rod

This is a matchstick-size, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years.

Intrauterine devices or IUDs

An IUD is a small device shaped like a "T" that goes in your uterus. There are two types:

  • Copper IUD — The copper IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. If fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A doctor needs to put in your copper IUD. It can stay in your uterus for 5 to 10 years.
  • Hormonal IUD — The hormonal IUD goes by the brand name Mirena. It is sometimes called an intrauterine system, or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can't reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. A doctor needs to put in a hormonal IUD. It can stay in your uterus for up to 5 years.
Permanent birth control methods — For people who are sure they never want to have a child or they do not want more children

Sterilization implant (essure)

Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining.

It can take about 3 months for the scar tissue to grow, so it's important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes.

Surgical sterilization

For women, surgical sterilization closes the fallopian tubes by being cut, tied, or sealed. This stops the eggs from going down to the uterus where they can be fertilized. The surgery can be done a number of ways. Sometimes, a woman having cesarean birth has the procedure done at the same time, so as to avoid having additional surgery later.

For men, having a vasectomy (vuh-SEK-tuh-mee) keeps sperm from going to his penis, so his ejaculate never has any sperm in it. Sperm stays in the system after surgery for about 3 months. During that time, use a backup form of birth control to prevent pregnancy. A simple test can be done to check if all the sperm is gone; it is called a semen analysis.
Emergency contraception — Used if a woman's primary method of birth control fails. It should not be used as a regular method of birth control.

Emergency contraception (Plan B One-Step or Next Choice. It is also called the "morning after pill.")

Emergency contraception keeps a woman from getting pregnant when she has had unprotected vaginal intercourse. "Unprotected" can mean that no method of birth control was used. It can also mean that a birth control method was used but it was used incorrectly, or did not work (like a condom breaking). Or, a woman may have forgotten to take her birth control pills. She also may have been abused or forced to have sex. These are just some of the reasons women may need emergency contraception.

Emergency contraception can be taken as a single pill treatment or in two doses. A single dose treatment works as well as two doses and does not have more side effects. It works by stopping the ovaries from releasing an egg or keeping the sperm from joining with the egg. For the best chances for it to work, take the pill as soon as possible after unprotected sex. It should be taken within 72 hours after having unprotected sex.

A single-pill dose or two-pill dose of emergency contraception is available over-the-counter (OTC) for women ages 17 and older.

Can all types of birth control prevent sexually transmitted infections (STIs)?

No. The male latex condom is the only birth control method proven to help protect you from STIs, including HIV. Research is being done to find out how effective the female condom is at preventing STIs and HIV. For more information, see Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

How well do different kinds of birth control work? Do they have side effects?

All birth control methods work the best if used correctly and every time you have sex. Be sure you know the right way to use them. Sometimes doctors don't explain how to use a method because they assume you already know. Talk with your doctor if you have questions. They are used to talking about birth control. So don't feel embarrassed about talking to him or her.

Some birth control methods can take time and practice to learn. For example, some people don't know you can put on a male condom "inside out." Also, not everyone knows you need to leave a little space at the tip of the condom for the sperm and fluid when a man ejaculates, or has an orgasm.

Here is a list of some birth control methods with their failure rates and possible side effects.

Birth control methods, failure rates, and side effects
Method Failure rate (the number of pregnancies expected per 100 women) Some side effects and risks

Sterilization surgery for women

Less than 1 pregnancy
  • Pain
  • Bleeding
  • Complications from surgery
  • Ectopic (tubal) pregnancy

Sterilization implant for women
(Essure)

Less than 1 pregnancy
  • Pain
  • Ectopic (tubal) pregnancy

Sterilization surgery for men

Less than 1 pregnancy
  • Pain
  • Bleeding
  • Complications from surgery

Implantable rod
(Implanon)

Less than 1 pregnancy

Might not work as well for women who are overweight or obese.
  • Acne
  • Weight gain
  • Ovarian cysts
  • Mood changes
  • Depression
  • Hair loss
  • Headache
  • Upset stomach
  • Dizziness
  • Sore breasts
  • Changes in period
  • Lower interest in sex

Intrauterine device
(ParaGard, Mirena)

Less than 1 pregnancy
  • Cramps
  • Bleeding between periods
  • Pelvic inflammatory disease
  • Infertility
  • Tear or hole in the uterus

Shot/injection
(Depo-Provera)

Less than 1 pregnancy
  • Bleeding between periods
  • Weight gain
  • Sore breasts
  • Headaches
  • Bone loss with long-term use

Oral contraceptives (combination pill, or "the pill") 

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.
  • Dizziness
  • Upset stomach
  • Changes in your period
  • Changes in mood
  • Weight gain
  • High blood pressure
  • Blood clots
  • Heart attack
  • Stroke
  • New vision problems

Oral contraceptives (continuous/extended use, or "no-period pill")

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.
  • Same as combination pill
  • Spotting or bleeding between periods
  • Hard to know if pregnant

Oral contraceptives (progestin-only pill, or "mini-pill")

5 pregnancies

Being overweight may increase the chance of getting pregnant while using the pill.
  • Spotting or bleeding between periods
  • Weight gain
  • Sore breasts

Skin patch
(Ortho Evra)

5 pregnancies

May not work as well in women weighing more than 198 pounds.
  • Similar to side effects for the combination pill
  • Greater exposure to estrogen than with other methods

Vaginal ring (NuvaRing)

5 pregnancies
  • Similar to side effects for the combination pill
  • Swelling of the vagina
  • Irritation
  • Vaginal discharge

Male condom

11-16 pregnancies
  • Allergic reactions

Diaphragm with spermicide

15 pregnancies
  • Irritation
  • Allergic reactions
  • Urinary tract infection
  • Toxic shock if left in too long

Sponge with spermicide (Today Sponge)

16-32 pregnancies
  • Irritation
  • Allergic reactions
  • Hard time taking it out
  • Toxic shock if left in too long

Cervical cap with spermicide

17-23 pregnancies
  • Irritation
  • Allergic reactions
  • Abnormal Pap smear
  • Toxic shock if left in too long

Female condom

20 pregnancies
  • Irritation
  • Allergic reactions

Natural family planning (rhythm method)

25 pregnancies

None

Spermicide alone

30 pregnancies

It works best if used along with a barrier method, such as a condom.
  • Irritation
  • Allergic reactions
  • Urinary tract infection

Emergency contraception ("morning-after pill," "Plan B One-Step," "Next Choice")

1 pregnancy

It must be used within 72 hours of having unprotected sex.

Should not be used as regular birth control; only in emergencies.
  • Upset stomach
  • Vomiting
  • Lower stomach pain
  • Fatigue
  • Headache and dizziness
  • Irregular bleeding
  • Breast tenderness

 Where can I get birth control? Do I need to see a doctor?

Where you get birth control depends on what method you choose.

You can buy these forms over the counter:

You need a prescription for these forms:

You will need surgery or a medical procedure for:

Are there any foams or gels I can use to keep from getting pregnant?

You can buy spermicides over the counter. They work by killing sperm. They come in many forms:

Spermicides are put in the vagina no more than 1 hour before having sex. If you use a film, suppository, or tablet, wait at least 15 minutes before having sex so the spermicide can dissolve. Do not douche or rinse out your vagina for at least 6 to 8 hours after having sex. You will need to use more spermicide each time you have sex.

Spermicides work best if used along with a barrier method, such as a condom, diaphragm, or cervical cap. Some spermicides are made just for use with the diaphragm and cervical cap. Check the package to make sure you are buying what you need.

All spermicides contain sperm-killing chemicals. Some contain nonoxynol-9, which may raise your risk of HIV if you use it a lot. It irritates the tissue in the vagina and anus, so it can cause the HIV virus to enter the body more freely. Some women are sensitive to nonoxynol-9 and need to use spermicides without it. Medications for vaginal yeast infections may lower the effectiveness of spermicides. Also, spermicides do not protect against sexually transmitted infections.

How effective is withdrawal as a birth control method?

Not very! Withdrawal is when a man takes his penis out of a woman's vagina (or "pulls out") before he ejaculates, or has an orgasm. This stops the sperm from going to the egg. "Pulling out" can be hard for a man to do. It takes a lot of self-control.

Even if you use withdrawal, sperm can be released before the man pulls out. When a man's penis first becomes erect, pre-ejaculate fluid may be on the tip of the penis. This fluid has sperm in it. So you could still get pregnant.

Withdrawal does not protect you from STIs or HIV.

Everyone I know is on the pill. Is it safe?

Today's pills have lower doses of hormones than ever before. This has greatly lowered the risk of side effects. But there are still pros and cons with taking birth control pills. Pros include having:

Cons include a higher chance, for some women, of:

Many of these side effects go away after taking the pill for a few months. Women who smoke, are older than 35, or have a history of blood clots or breast or endometrial cancer are more at risk of bad side effects and may not be able to take the pill. Talk with your doctor about whether the pill is right for you.

Will birth control pills protect me from sexually transmitted infections (STIs), including HIV/AIDS?

No, they won't protect you. Birth control pills and most other birth control methods will not protect you from STIs, including HIV (the virus that causes AIDS). They only protect against pregnancy.

The male latex condom is the best birth control method that also can protect you from STIs, including HIV. If you are allergic to latex, polyurethane condoms are a good alternative. If your partner can't or won't use a male condom, female condoms also create a barrier that can help protect you from STIs.

It is important to only use latex or polyurethane condoms to protect you from STIs. "Natural" or "lambskin" condoms have tiny pores that may allow for the passage of viruses like HIV, hepatitis B, and herpes. If you use non-lubricated male condoms for vaginal or anal sex, you can add lubrication with water-based lubricants (like K-Y jelly) that you can buy at a drug store. Never use oil-based products, such as massage oils, baby oil, lotions, or petroleum jelly, to lubricate a male condom. These will weaken the condom, causing it to tear or break. Use a new condom with each sex act.

I've heard my girlfriends talking about dental dams — what are they?

The dental dam is a square piece of rubber that is used by dentists during oral surgery and other procedures. It is not a method of birth control. But it can be used to help protect people from STIs, including HIV, during oral-vaginal or oral-anal sex. It is placed over the opening to the vagina or the anus before having oral sex. You can buy dental dams at surgical supply stores.

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Emergency contraception (morning after pill, IUD)

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Emergency contraception can prevent pregnancy after unprotected sex or if your contraceptive method has failed – for example, a condom has split or you've missed a pill. There are two types: 

  • At a glance: emergency contraception
  • The emergency pill 
  • The IUD as emergency contraception
  • Where to get emergency contraception
  • Contraception for the future

There are two kinds of emergency contraceptive pill. Levonelle has to be taken within 72 hours (three days) of sex, and ellaOne has to be taken within 120 hours (five days) of sex. Both pills work by preventing or delaying ovulation (release of an egg).

The IUD can be inserted into your uterus up to five days after unprotected sex, or up to five days after the earliest time you could have ovulated. It may stop an egg from being fertilised or implanting in your womb.

Emergency contraception does not protect against sexually transmitted infections (STIs).

At a glance: facts about emergency contraception

The emergency pill

How the emergency pill works

How effective the emergency pill is at preventing pregnancy

How it affects your period 

Who can use the emergency pill 

During pregnancy and breastfeeding

If you're already using the pill, patch, vaginal ring or injection

Side effects of the emergency pill

The emergency pill and other medicines

Can I get the emergency pill in advance?

How the emergency pill works

Levonelle

Levonelle contains levonorgestrel, a synthetic version of the natural hormone progesterone. In a woman’s body, progesterone plays a role in ovulation and preparing the uterus for accepting a fertilised egg.

It’s not known exactly how Levonelle works, but it’s thought to work primarily by preventing or delaying ovulation. You can take Levonelle more than once in a menstrual cycle. It does not interfere with your regular method of contraception.

ellaOne

ellaOne contains ulipristal acetate, which means that it stops progesterone working normally. It prevents pregnancy mainly by preventing or delaying ovulation. ellaOne may prevent other types of hormonal contraception from working for a week after use, and it’s not recommended for use more than once in a menstrual cycle.

ellaOne used to be available only on prescription, but it is now available to buy in some pharmacies.

Levonelle and ellaOne do not protect you against pregnancy during the rest of your menstrual cycle and are not intended to be a regular form of contraception. Using the emergency contraceptive pill repeatedly can disrupt your natural menstrual cycle.

How effective is the emergency pill at preventing pregnancy?

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

Find a clinic near you

It can be difficult to know how many pregnancies the emergency pill prevents, because there is no way to know for sure how many women would have got pregnant if they did not take it.

A trial undertaken by the World Health Organization (WHO) indicated that levonorgestrel (the drug in Levonelle) prevented:

More recent studies suggest that the prevention rate might be lower, but still substantial.

A study published in 2010 showed that of 1,696 women who received the emergency pill within 72 hours of sex, 37 became pregnant (1,659 did not). Of 203 women who took the emergency pill between 72 and 120 hours after unprotected sex, there were three pregnancies. 

How it affects your period

After taking the emergency contraceptive pill, most women will have a normal period at the expected time. However, you may have your period later or earlier than normal.

If your period is more than seven days late, or is unusually light or short, contact your GP as soon as possible to check for pregnancy.

Who can use the emergency pill?

Most women can use the emergency contraceptive pill. This includes women who cannot usually use hormonal contraception, such as the combined pill and contraceptive patch.

Levonelle

The WHO does not identify any medical condition that would mean a woman shouldn’t use Levonelle.

ellaOne

The Faculty of Sexual and Reproductive Healthcare (FSRH) advises that ellaOne should not be used by women who: 

ellaOne will not be effective in women who are taking liver enzyme-inducing medication. For more information, read The emergency pill and other medicines.

Pregnancy and breastfeeding

Levonelle

There is no evidence that Levonelle harms a developing baby. It can be used even if there has been an earlier episode of unprotected sex in the menstrual cycle in addition to the current episode. Levonelle can be taken while breastfeeding. Although small amounts of the hormones contained in the pill may pass into your breast milk, it is not thought to be harmful to your baby.

ellaOne

There is limited information on the safety of ellaOne in pregnancy. The FSRH does not support the use of ellaOne if a woman might already be pregnant. The safety of ellaOne during breastfeeding is not yet known. The manufacturer recommends that you do not breastfeed for one week after taking this pill.

If you are already using the pill, patch, vaginal ring or contraceptive injection

If you need to take the emergency pill because you:

then you should: 

You should then continue taking your regular contraceptive pill as normal.

If you have taken Levonelle, you will need to use additional contraception, such as condoms, for:

If you have taken ellaOne, you will need to use additional contraception, such as condoms, for:

What are the side effects of using the emergency pill?

Taking the emergency contraceptive pill has not been shown to cause any serious or long-term health problems. However, it can sometimes have side effects. Common side effects include: 

Less common side effects include:

If you are concerned about any symptoms after taking the emergency contraceptive pill, contact your GP or speak to a nurse at a sexual health clinic. You should talk to a doctor or nurse if: 

The emergency pill and other medicines

The emergency contraceptive pill may interact with other medicines. These include: 

ellaOne cannot be used if you are already taking one of these medicines, as it may not be effective.

Levonelle may still be used, but the dose may need to be increased – your doctor or pharmacist can advise on this.

There should be no interaction between the emergency pill and most antibiotics. Two enzyme-inducing antibiotics (called rifampicin and rifabutin), used to treat or prevent meningitis or TB, may affect ellaOne while they’re being taken and for 28 days afterwards.

If you want to check that your medicines are safe to take with the emergency contraceptive pill, ask your GP or a pharmacist. You should also read the patient information leaflet that comes with your medicines. 

Can I get the emergency contraceptive pill in advance?

You may be able to get the emergency contraceptive pill in advance of having unprotected sex if:

Ask your GP or nurse for further information on getting advance emergency contraception.

The IUD as emergency contraception

An intrauterine device (IUD)

How the IUD works

The intrauterine device (IUD) is a small, T-shaped contraceptive device made from plastic and copper. It’s inserted into the uterus by a trained health professional. It may prevent an egg from implanting in your womb or being fertilised.

If you’ve had unprotected sex, the IUD can be inserted up to five days afterwards, to prevent pregnancy. It’s more effective at preventing pregnancy than the emergency pill, and it does not interact with any other medication.

You can also choose to have the IUD left in as an ongoing method of contraception.

How effective the IUD is at preventing pregnancy

There are several types of IUD. Newer ones have more copper and are more than 99% effective. Fewer than two women in 100 who use a newer IUD over five years will get pregnant. IUDs with less copper in them are less effective than this, but are still effective. The IUD is more effective than the emergency pill at preventing pregnancy after unprotected sex.

Who can use the IUD

Most women can use an IUD, including women who have never been pregnant and those who are HIV positive. Your GP or clinician will ask about your medical history to check if an IUD is suitable for you.

You should not use an IUD if you have:

Women who have had an ectopic pregnancy or recent abortion, or who have an artificial heart valve, must consult their GP or clinician before having an IUD fitted.

Pregnancy and breastfeeding

The IUD should not be inserted if there is a risk that you may already be pregnant – for example, if you have had previous unprotected sex in the same menstrual cycle. The IUD can be used safely if you’re breastfeeding.

What are the side effects of the IUD

Complications after having an IUD fitted are rare, but can include pain, infection, damage to the womb or expulsion (the IUD coming out of your womb). If you use the IUD as an ongoing method of regular contraception, it may make your periods longer, heavier or more painful.

The IUD and other medicines

The emergency IUD will not react with any other medication.

Where can I get emergency contraception?

You can get the emergency contraceptive pill and the IUD for free from:

You can also get the emergency contraceptive pill free from:

The doctor or nurse you see may ask for the following information:

You can buy the emergency contraceptive pill from most pharmacies if you're aged 16 or over (you need to be 18 or over to buy ellaOne) and from some organisations such as bpas or Marie Stopes. The cost varies, but it will be around £30.

Contraception for the future

If you're not using a regular method of contraception, you might consider doing so in order to lower the risk of unintended pregnancy. Long-acting reversible contraception (LARC) offers the most reliable protection against pregnancy, and you don't have to think about it every day or each time you have sex.

LARC methods are the:

The contraceptive injection

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the injection.

  • At a glance: the contraceptive injection
  • How it works
  • Who can use it
  • Advantages and disadvantages
  • Risks
  • Where you can get it

There are three types of contraceptive injections in the UK: Depo-Provera, which lasts for 12 weeks, Sayana Press, which lasts for 13 weeks, and Noristerat, which lasts for eight weeks. The most popular is Depo-Provera. Noristerat is usually used for only short periods of time – for example, if your partner is waiting for a vasectomy.

The injection contains progestogen. This thickens the mucus in the cervix, stopping sperm reaching an egg. It also thins the womb lining and, in some, prevents the release of an egg.

At a glance: the contraceptive injection

  • If used correctly, the contraceptive injection is more than 99% effective. This means that less than one woman in 100 who use the injection will become pregnant in a year.
  • The injection lasts for eight, 12 or 13 weeks (depending on the type), so you don't have to think about contraception every day or every time you have sex.
  • It can be useful for women who might forget to take the contraceptive pill every day.
  • It can be useful for women who can't use contraception that contains oestrogen.
  • It's not affected by medication.
  • The contraceptive injection may provide some protection against cancer of the womb and pelvic inflammatory disease.
  • Side effects can include weight gain, headaches, mood swings, breast tenderness and irregular bleeding. The injection can't be removed from your body, so if you have side effects they'll last as long as the injection and for some time afterwards.
  • Your periods may become more irregular or longer, or stop altogether (amenorrhoea). Treatment is available if your bleeding is heavy or longer than normal – talk to your doctor or nurse about this.
  • It can take up to one year for your fertility to return to normal after the injection wears off, so it may not be suitable if you want to have a baby in the near future.
  • Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones. 
  • The injection does not protect against sexually transmitted infections (STIs). By using condoms as well as the injection, you'll help to protect yourself against STIs.

How the injection works

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

Find a clinic near you

The contraceptive injections Depo-Provera and Noristerat are usually given into a muscle in your bottom, although sometimes may be given in a muscle in your upper arm. Sayana Press is given under the skin (subcutaneously) rather than into a muscle, in the abdomen or thigh.

The contraceptive injection works in the same way as the implant. It steadily releases the hormone progestogen into your bloodstream. Progestogen is similar to the natural hormone progesterone, which is released by a woman's ovaries during her period.

The continuous release of progestogen:

  • stops a woman releasing an egg every month (ovulation) 
  • thickens the mucus from the cervix (neck of the womb), making it difficult for sperm to pass through to the womb and reach an unfertilised egg 
  • makes the lining of the womb thinner, so that it is unable to support a fertilised egg

The injection can be given at any time during your menstrual cycle, as long as you and your doctor are reasonably sure you are not pregnant.

When it starts to work

If you have the injection during the first five days of your cycle, you will be immediately protected against becoming pregnant. 

If you have the injection on any other day of your cycle, you will not be protected against pregnancy for up to seven days. Use condoms or another method of contraception during this time.

After giving birth

You can have the contraceptive injection at any time after you have given birth, if you are not breastfeeding. If you are breastfeeding, the injection will usually be given after six weeks, although it may be given earlier if necessary.

  • If you start injections on or before day 21 after giving birth, you will be immediately protected against becoming pregnant.
  • If you start injections after day 21, you will need to use additional contraception for the following seven days.

Heavy and irregular bleeding is more likely to occur if you have the contraceptive injection during the first few weeks after giving birth.

It is safe to use contraceptive injections while you are breastfeeding.

After a miscarriage or abortion

You can have the injection immediately after a miscarriage or abortion, and you will be protected against pregnancy straight away. If you have the injection more than five days after a miscarriage or abortion, you'll need to use additional contraception for seven days.

Who can use the injection?

Most women can be given the contraceptive injection. It may not be suitable if you:

  • think you might be pregnant 
  • want to keep having regular periods 
  • have bleeding in between periods or after sex 
  • have arterial disease or a history of heart disease or stroke
  • have a blood clot in a blood vessel (thrombosis) 
  • have liver disease 
  • have migraines 
  • have breast cancer or have had it in the past 
  • have diabetes with complications 
  • have cirrhosis or liver tumours
  • are at risk of osteoporosis  

Advantages and disadvantages of the injection

The main advantages of the contraceptive injection are:

  • each injection lasts for either eight, 12 or 13 weeks 
  • the injection does not interrupt sex 
  • the injection is an option if you cannot use oestrogen-based contraception, such as the combined pill, contraceptive patch or vaginal ring
  • you do not have to remember to take a pill every day
  • the injection is safe to use while you are breastfeeding 
  • the injection is not affected by other medicines
  • the injection may reduce heavy, painful periods and help with premenstrual symptoms for some women
  • the injection offers some protection from pelvic inflammatory disease (the mucus from the cervix may stop bacteria entering the womb) and may also give some protection against cancer of the womb

Using the contraceptive injection may have some disadvantages, which you should consider carefully before deciding on the right method of contraception for you. These are as follows:

Disrupted periods

Your periods may change significantly during the first year of using the injection. They will usually become irregular and may be very heavy, or shorter and lighter, or stop altogether. This may settle down after the first year, but may continue as long as the injected progestogen remains in your body.

It can take a while for your periods and natural fertility to return after you stop using the injection. It takes around eight to 12 weeks for injected progestogen to leave the body, but you may have to wait longer for your periods to return to normal if you are trying to get pregnant.

Until you are ovulating regularly each month, it can be difficult to work out when you are at your most fertile. In some cases, it can take three months to a year for your periods to return to normal.

Weight gain

You may put on weight when you use the contraceptive injection, particulaly if you are under 18 years old and are overweight with a BMI (body mass index) of 30 or over.   

Other side effects that some women report are:

  • headaches
  • acne
  • tender breasts
  • changes in mood
  • loss of sex drive

Depo-Provera, oestrogen and bone risk

Using Depo-Provera affects your natural oestrogen levels, which can cause thinning of the bones, but it does not increase your risk of breaking a bone. This isn't a problem for most women, because the bone replaces itself when you stop the injection, and it doesn't appear to cause any long-term problems.

Thinning of the bones may be a problem for women who already have an increased risk of developing osteoporosis (for example, because they have low oestrogen, or a family history of osteoporosis). It may also be a concern for women under 18, because the body is still making bone at this age. Women under 18 may use Depo-Provera, but only after careful evaluation by a doctor.

Will other medicines affect the injection?

No – the contraceptive injection is not affected by other medication.

Risks

There is a small risk of infection at the site of the injection. In very rare cases, some people may have an allergic reaction to the injection.

Where you can get it

Most types of contraception are available free in the UK. Contraception is free to all women and men through the NHS. You can get contraception at:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics 
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call 0300 123 7123 for more information)

Find your nearest sexual health clinic by searching your postcode or town.

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first. 

Find out more about the medicines used in the contraceptive injection.

Medicines for Contraceptive implants and injections

Over-the-counter medicineOver-the-counter medicine. Medicine with this icon can be bought without a prescription.

E-Etonogestrel-(a generic version of Implanon)

I-Implanon

N-Norethisterone enantate

  -Noristerat (a brand of Norethisterone Enantate)

Contraceptive Implant

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method is the implant.

  • At a glance: facts about the contraceptive implant
  • How it works
  • Who can use it
  • Advantages and disadvantages
  • Risks
  • Where you can get it

The contraceptive implant is a small flexible tube about 40mm long that's inserted under the skin of your upper arm. It's inserted by a trained professional, such as a doctor, and lasts for three years. 

The implant stops the release of an egg from the ovary by slowly releasing progestogen into your body. Progestogen thickens the cervical mucus and thins the womb lining. This makes it harder for sperm to move through your cervix, and less likely for your womb to accept a fertilised egg.

At a glance: the implant

  • If implanted correctly, it's more than 99% effective. Fewer than one woman in 1,000 who use the implant as contraception will get pregnant in one year.
  • It's very useful for women who know they don't want to get pregnant for a while. Once the implant is in place, you don't have to think about contraception for three years. 
  • It can be useful for women who can't use contraception that contains oestrogen. 
  • It's very useful for women who find it difficult to take a pill at the same time every day. 
  • If you have side effects, the implant can be taken out. You can have the implant removed at any time, and your natural fertility will return very quickly.
  • When it's first put in, you may feel some bruising, tenderness or swelling around the implant. 
  • In the first year after the implant is fitted, your periods may become irregular, lighter, heavier or longer. This usually settles down after the first year. 
  • A common side effect of the implant is that your periods stop (amenorrhoea). It's not harmful, but you may want to consider this before deciding to have an implant. 
  • Some medications can make the implant less effective, and additional contraceptive precautions need to be followed when you are taking these medications (see Will other medicines affect the implant?).
  • The implant does not protect against sexually transmitted infections (STIs). By using condoms as well as the implant, you'll help to protect yourself against STIs.

How the implant works

The implant steadily releases the hormone progestogen into your bloodstream. Progestogen is similar to the natural hormone progesterone, which is released by a woman's ovaries during her period.

The continuous release of progestogen:

  • stops a woman releasing an egg every month (ovulation) 
  • thickens the mucus from the cervix (entrance to the womb), making it difficult for sperm to pass through to the womb and reach an unfertilised egg
  • makes the lining of the womb thinner so that it is unable to support a fertilised egg

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

Find a clinic near you

The implant can be put in at any time during your menstrual cycle, as long as you and your doctor are reasonably sure you are not pregnant. In the UK, Nexplanon is the main contraceptive implant currently in use. Implants inserted before October 2010 were called Implanon. Since October 2010, insertion of Implanon has decreased as stocks are used up, and Nexplanon has become the most commonly used implant.

Both types of implant work in the same way, but Nexplanon is designed to reduce the risk of insertion errors and is visible on an X-ray or CT (computerised tomography) scan. There is no need for existing Implanon users to have their implant removed and replaced by Nexplanon ahead of its usual replacement time.

Nexplanon is a small, thin, flexible tube about 4cm long. It is implanted under the skin of your upper arm by a doctor or nurse. A local anaesthetic is used to numb the area. The small wound made in your arm is closed with a dressing and does not need stitches.

Nexplanon works for up to three years before it needs to be replaced. You can continue to use it until you reach the menopause, when a woman’s monthly periods stop (at around 52 years of age). The implant can be removed at any time by a specially trained doctor or nurse. It only takes a few minutes to remove, using a local anaesthetic.

As soon as the implant has been removed, you will no longer be protected against pregnancy.

When it starts to work

If the implant is fitted during the first five days of your menstrual cycle, you will be immediately protected against becoming pregnant. If it is fitted on any other day of your menstrual cycle, you will not be protected against pregnancy for up to seven days, and should use another method, such as condoms.  

After giving birth

You can have the contraceptive implant fitted after you have given birth, usually after three weeks.

  • If it is fitted on or before day 21 after the birth, you will be immediately protected against becoming pregnant. 
  • If it is fitted after day 21, you will need to use additional contraception, such as condoms, for the following seven days.

It is safe to use the implant while you are breastfeeding.

After a miscarriage or abortion

The implant can be fitted immediately after a miscarriage or an abortion, and you will be protected against pregnancy straight away.

Who can use the implant

Most women can be fitted with the contraceptive implant. It may not be suitable if you:

  • think you might be pregnant
  • want to keep having regular periods 
  • have bleeding in between periods or after sex
  • have arterial disease or a history of heart disease or stroke
  • have a blood clot in a blood vessel (thrombosis)
  • have liver disease 
  • have migraines
  • have breast cancer or have had it in the past
  • have diabetes with complications
  • have cirrhosis or liver tumours
  • are at risk of osteoporosis  

Advantages and disadvantages of the implant

The main advantages of the contraceptive implant are:

  • it works for three years
  • the implant does not interrupt sex
  • it is an option if you cannot use oestrogen-based contraception, such as the combined contraceptive pill, contraceptive patch or vaginal ring
  • you do not have to remember to take a pill every day
  • the implant is safe to use while you are breastfeeding
  • your fertility should return to normal as soon as the implant is removed
  • implants offer some protection against pelvic inflammatory disease (the mucus from the cervix may stop bacteria entering the womb) and may also give some protection against cancer of the womb
  • the implant may reduce heavy periods or painful periods after the first year of use
  • after the contraceptive implant has been inserted, you should be able to carry out normal activities

Using a contraceptive implant may have some disadvantages, which you should consider carefully before deciding on the right method of contraception for you. These include:

Disrupted periods

Your periods may change significantly while using a contraceptive implant. Around 20% of women using the implant will have no bleeding, and almost 50% will have infrequent or prolonged bleeding. Bleeding patterns are likely to remain irregular, although they may settle down after the first year.

Although these changes are not harmful, they may not be acceptable for some women. Your GP may be able to help by providing additional medication if you have prolonged bleeding.

Other side effects that some women report are:

  • headaches
  • acne
  • nausea
  • breast tenderness
  • changes in mood
  • loss of sex drive

These side effects usually stop after the first few months. If you have prolonged or severe headaches or other side effects, tell your doctor.

Some women put on weight while using the implant, but there is no evidence to show that the implant causes weight gain.

Will other medicines affect the implant?

Some medicines can reduce the implant's effectiveness. These include:

  • medication for HIV
  • medication for epilepsy
  • complementary remedies, such as St John's Wort
  • an antibiotic called rifabutin (which can be used to treat tuberculosis)
  • an antibiotic called rifampicin (which can be used to treat several conditions, including tuberculosis and meningitis)

These are called enzyme-inducing drugs. If you are using these medicines for a short while (for example, rifampicin to protect against meningitis), it is recommended that you use additional contraception during the course of treatment and for 28 days afterwards. The additional contraception could be condoms, or a single dose of the contraceptive injection. The implant can remain in place if you have the injection.

Women taking enzyme-inducing drugs in the long term may wish to consider using a method of contraception that isn't affected by their medication.

Always tell your doctor that you are using an implant if you are prescribed any medicines. Ask your doctor or nurse for more details about the implant and other medication.

Risks of the implant

In rare cases, the area of skin where the implant has been fitted can become infected. If this happens, the area will be cleaned and may be treated with antibiotics.

Where you can get the contraceptive implant

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call 0300 123 7123 for more information)

Find your nearest sexual health clinic by searching by postcode or town.

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents (or carer) as long as they believe you fully understand the information you're given, and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Page last reviewed: 31/12/2014

Next review due: 31/12/2016

IUS (intrauterine system)

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this happening by keeping the egg and sperm apart or by stopping egg production. One method of contraception is the IUS, or intrauterine system (sometimes called the hormonal coil).

  • At a glance: facts about the IUS
  • How the IUS works
  • Who can use the IUS
  • Advantages and disadvantages of the IUS
  • Risks of the IUS
  • Where to get the IUS

An IUS is a small, T-shaped plastic device that is inserted into your womb (uterus) by a specially trained doctor or nurse.

The IUS releases a progestogen hormone into the womb. This thickens the mucus from your cervix, making it difficult for sperm to move through and reach an egg. It also thins the womb lining so that it's less likely to accept a fertilised egg. It may also stop ovulation (the release of an egg) in some women.

The IUS is a long-acting reversible contraceptive (LARC) method. It works for five years or three years, depending on the type, so you don't have to think about contraception every day or each time you have sex. Two brands of IUS are used in the UK – Mirena and Jaydess. 

You can use an IUS whether or not you've had children.

At a glance: facts about the IUS

  • It's more than 99% effective.Less than one in every 100 women who use Mirena will get pregnant in five years, and less than one in 100 who use Jaydess will get pregnant in three years.
  • It can be taken out at any time by a specially trained doctor or nurse and your fertility quickly returns to normal.
  • The IUS can make your periods lighter, shorter or stop altogether, so it may help women who have heavy periods or painful periods. Jaydess is less likely than Mirena to make your periods stop altogether.
  • It can be used by women who can't use combined contraception (such as the combined pill) – for example, those who have migraines.
  • Once the IUS is in place, you don't have to think about contraception every day or each time you have sex.
  • Some women may experience mood swings, skin problems or breast tenderness.  
  • There's a small risk of getting an infection after it's inserted.
  • It can be uncomfortable when the IUS is put in, although painkillers can help with this.
  • The IUS can be fitted at any time during your monthly menstrual cycle, as long as you're definitely not pregnant. Ideally, it should be fitted within seven days of the start of your period, because this will protect against pregnancy straight away. You should use condoms for seven days if the IUS is fitted at any other time.
  • The IUS does not protect against sexually transmitted infections (STIs). By using condoms as well as the IUS, you'll help to protect yourself against STIs.

How the IUS works

How it prevents pregnancy 

Having an IUS fitted

How to tell whether an IUS is still in place

Removing an IUS

How it prevents pregnancy

The IUS is similar to the IUD (intrauterine device), but works in a slightly different way. Rather than releasing copper like the IUD, the IUS releases a progestogen hormone, which is similar to the natural hormone progesterone that's produced in a woman's ovaries.

Progestogen thickens the mucus from the cervix (opening of the womb), making it harder for sperm to move through it and reach an egg. It also causes the womb lining to become thinner and less likely to accept a fertilised egg. In some women, the IUS also stops the ovaries from releasing an egg (ovulation), but most women will continue to ovulate.

If you're 45 or older when you have the IUS fitted, it can be left until you reach menopause or you no longer need contraception.

Having an IUS fitted

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

Find a clinic near you

An IUS can be fitted at any stage of your menstrual cycle, as long as you are not pregnant. If it's fitted in the first seven days of your cycle, you will be protected against pregnancy straight away. If it's fitted at any other time, you need to use another method of contraception (such as condoms) for seven days after it's fitted.

Before you have an IUS fitted, you will have an internal examination to determine the size and position of your womb. This is to make sure that the IUS can be positioned in the correct place.

You may also be tested for any existing infections, such as STIs. It is best to do this before an IUS is fitted so that any infections can be treated. You may be given antibiotics at the same time as an IUS is fitted.

It takes about 15 to 20 minutes to insert an IUS:

  • the vagina is held open, like it is during a cervical screening (smear) test
  • the IUS is inserted through the cervix and into the womb

The fitting process can be uncomfortable or painful for some women, and you may also experience cramps afterwards.

You can ask for a local anaesthetic or painkillers before having the IUS fitted. Discuss this with your GP or nurse beforehand. An anaesthetic injection itself can be painful, so many women have the procedure without one.

Once an IUS is fitted, it will need to be checked by a doctor after three to six weeks to make sure everything is fine. Speak to your GP or clinician if you have any problems after this initial check or if you want the IUS removed.

Also speak to your GP if you or your partner are at risk of getting an STI, as this can lead to infection in the pelvis.

See your GP or go back to the clinic if you:

  • have pain in your lower abdomen
  • have a high temperature
  • have smelly discharge

This may mean you have an infection.

How to tell if an IUS is still in place

An IUS has two thin threads that hang down a little way from your womb into the top of your vagina. The GP or clinician that fits your IUS will teach you how to feel for these threads and check that the IUS is still in place.

Check your IUS is in place a few times in the first month and then after each period at regular intervals.

It is highly unlikely that your IUS will come out, but if you can't feel the threads or if you think the IUS has moved, you may not be fully protected against pregnancy. See your doctor or nurse straight away and use extra contraception, such as condoms, until your IUS has been checked. If you've had sex recently, you may need to use emergency contraception.

Your partner shouldn't be able to feel your IUS during sex. If he can feel the threads, get your GP or clinician to check that your IUS is in place. They may be able to cut the threads a little. If you feel any pain during sex, go for a check-up with your GP or clinician.

Removing an IUS

Your IUS can be removed at any time by a trained doctor or nurse.

If you're not going to have another IUS put in and you don't want to become pregnant, use another contraceptive method (such as condoms) for seven days before you have the IUS removed. Sperm can live for seven days in the body and could fertilise an egg once the IUS is removed. As soon as an IUS is taken out, your normal fertility should return.

Who can use an IUS

Most women can use an IUS, including women who have never been pregnant and those who are HIV positive. Your GP or clinician will ask about your medical history to check if an IUS is the most suitable form of contraception for you.

Your family and medical history will determine whether or not you can use an IUS. For example, this method of contraception may not be suitable for you if you have:

  • breast cancer, or have had it in the past five years
  • cervical cancer 
  • liver disease
  • unexplained vaginal bleeding between periods or after sex
  • arterial disease or history of serious heart disease or stroke
  • an untreated STI or pelvic infection
  • problems with your womb or cervix

An IUS may not be suitable for women who have untreated STIs. A doctor will usually give you a check-up to make sure you don't have any existing infections.

Using an IUS after giving birth

An IUS can usually be fitted four to six weeks after giving birth (vaginal or caesarean). You'll need to use alternative contraception from three weeks (21 days) after the birth until the IUS is put in. In some cases, an IUS can be fitted within 48 hours of giving birth. It is safe to use an IUS when you're breastfeeding, and it won't affect your milk supply.

Using an IUS after a miscarriage or abortion

An IUS can be fitted by an experienced doctor or nurse straight after an abortion or miscarriage, as long as you were pregnant for less than 24 weeks. If you were pregnant for more than 24 weeks, you may have to wait a few weeks before an IUS can be fitted.

Advantages and disadvantages of the IUS

Although an IUS is an effective method of contraception, there are several things to consider before having an IUS fitted.

Advantages of the IUS

  • It works for five years (Mirena) or three years (Jaydess). 
  • It's one of the most effective forms of contraception available in the UK.
  • It doesn't interrupt sex.
  • An IUS may be useful if you have heavy or painful periods because your periods usually become much lighter and shorter, and sometimes less painful – they may stop completely after the first year of use.
  • It can be used safely if you're breastfeeding. 
  • It's not affected by other medicines.
  • It may be a good option if you can't take the hormone oestrogen, which is used in the combined contraceptive pill. 
  • Your fertility will return to normal when the IUS is removed.

There's no evidence that an IUS will affect your weight or that having an IUS fitted will increase the risk of cervical cancer, cancer of the uterus or ovarian cancer. Some women experience changes in mood and libido, but these changes are very small.

Disadvantages of the IUS

  • Some women won't be happy with the way that their periods may change. For example, periods may become lighter and more irregular or, in some cases, stop completely. Your periods are more likely to stop completely with Mirena than with Jaydess.
  • Irregular bleeding and spotting are common in the first six months after having an IUS fitted. This is not harmful and usually decreases with time.
  • Some women experience headaches, acne and breast tenderness after having the IUS fitted.
  • An uncommon side effect of the IUS is the appearance of small fluid-filled cysts on the ovaries – these usually disappear without treatment.
  • An IUS doesn't protect you against STIs, so you may also have to use condoms when having sex. If you get an STI while you have an IUS fitted, it could lead to pelvic infection if it's not treated.
  • Most women who stop using an IUS do so because of vaginal bleeding and pain, although this is uncommon. Hormonal problems can also occur, but these are even less common.

Risks of the IUS

Complications caused by an IUS are rare and usually happen in the first six months after it has been fitted. These include:

Damage to the womb

In rare cases (fewer than one in 1,000 insertions) an IUS can perforate (make a hole in) the womb or neck of the womb (cervix) when it is put in. This can cause pain in the lower abdomen, but doesn't usually cause any other symptoms. If the doctor or nurse fitting your IUS is experienced, the risk of perforation is extremely low.

If perforation occurs, you may need surgery to remove the IUS. Contact your GP straight away if you feel a lot of pain after having an IUS fitted. Perforations should be treated immediately.

Pelvic infections

Pelvic infections may occur in the first 20 days after the IUS has been inserted.

The risk of infection from an IUS is extremely small (fewer than one in 100 women who are at low risk of STIs will get an infection). A GP or clinician will usually recommend an internal examination before fitting an IUS to be sure that there are no existing infections.

Rejection

Occasionally, the IUS is rejected (expelled) by the womb or it can move (this is called displacement). This is not common and is more likely to happen soon after it has been fitted. Your doctor or nurse will teach you how to check that your IUS is in place.

Ectopic pregnancy

If the IUS fails and you become pregnant, your IUS should be removed as soon as possible if you are continuing with the pregnancy. There's a small increased risk of ectopic pregnancy if a woman becomes pregnant while using an IUS.

Where to get the IUS

Most types of contraception are available for free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – they also offer contraceptive and STI testing services
  • some young people’s services (call 0300 123 7123 for more information)

Find sexual health services near you, including contraception clinics.

Contraception services are free and confidential, including for people under the age of 16.

If you're under 16 and want contraception, the doctor, nurse or pharmacist won't tell your parents or carer as long as they believe you fully understand the information you're given and your decisions. Doctors and nurses work under strict guidelines when dealing with people under 16.

They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

IUD (intrauterine device)

A woman can get pregnant if a man’s sperm reaches one of her eggs (ova). Contraception tries to stop this by keeping the egg and sperm apart or by stopping eggs being produced. One method of contraception is the intrauterine device, or IUD (sometimes called a coil).

  • At a glance: facts about the IUD
  • How the IUD works
  • Who can use the IUD
  • Advantages and disadvantages of the IUD
  • Risks of the IUD
  • Where you can get an IUD

An IUD is a small T-shaped plastic and copper device that’s inserted into your womb (uterus) by a specially trained doctor or nurse. 

The IUD works by stopping the sperm and egg from surviving in the womb or fallopian tubes. It may also prevent a fertilised egg from implanting in the womb.

The IUD is a long-acting reversible contraceptive (LARC) method. This means that once it's in place, you don't have to think about it each day or each time you have sex. There are several types and sizes of IUD.

You can use an IUD whether or not you've had children.  

At a glance: facts about the IUD

  • There are different types of IUD, some with more copper than others. IUDs with more copper are more than 99% effective. This means that fewer than one in 100 women who use an IUD will get pregnant in one year. IUDs with less copper will be less effective. 
  • An IUD works as soon as it's put in, and lasts for five to 10 years, depending on the type.
  • It can be put in at any time during your menstrual cycle, as long as you're not pregnant.
  • It can be removed at any time by a specially trained doctor or nurse and you'll quickly return to normal levels of fertility.
  • Changes to your periods (for example, being heavier, longer or more painful) are common in the first three to six months after an IUD is put in, but they're likely to settle down after this. You might get spotting or bleeding between periods. 
  • There's a very small chance of infection within 20 days of the IUD being fitted. 
  • There's a risk that your body may expel the IUD.
  • If you get pregnant, there's an increased risk of ectopic pregnancy (when the egg implants outside the womb). But because you're unlikely to get pregnant, the overall risk of ectopic pregnancy is lower than in women who don't use contraception. 
  • Having the IUD put in can be uncomfortable. Ask the doctor or nurse about pain relief.
  • An IUD may not be suitable for you if you've had previous pelvic infections.
  • The IUD does not protect against sexually transmitted infections (STIs). By using condoms as well as the IUD, you'll help to protect yourself against STIs.

How the IUD works

How it prevents pregnancy

Having an IUD fitted

How to tell whether an IUD is still in place

Removing an IUD

How it prevents pregnancy

The IUD is similar to the IUS (intrauterine system) but works in a different way. Instead of releasing the hormone progestogen like the IUS, the IUD releases copper. Copper changes the make-up of the fluids in the womb and fallopian tubes, stopping sperm surviving there. IUDs may also stop fertilised eggs from implanting in the womb.

There are types and sizes of IUD to suit different women. IUDs need to be fitted by a trained doctor or nurse at your GP surgery, local contraception clinic or sexual health clinic.

An IUD can stay in the womb for five to 10 years, depending on the type. If you're 40 or over when you have an IUD fitted, it can be left in until you reach the menopause or until you no longer need contraception.

Having an IUD fitted

An IUD can be fitted at any time during your menstrual cycle, as long as you are not pregnant. You'll be protected against pregnancy straight away.

Before you have an IUD fitted, you will have an internal examination to find out the size and position of your womb. This is to make sure that the IUD can be put in the correct place.

You can get contraception at:

  • most GP surgeries
  • community contraception clinics
  • some GUM clinics
  • sexual health clinics
  • some young people's services

Find a clinic near you

You may also be tested for infections, such as STIs. It's best to do this before an IUD is fitted so that you can have treatment (if you need it) before the IUD is put in. Sometimes, you may be given antibiotics at the same time as the IUD is fitted.

It takes about 15 to 20 minutes to insert an IUD. The vagina is held open, like it is during a cervical screening (smear) test, and the IUD is inserted through the cervix and into the womb.

The fitting process can be uncomfortable and sometimes painful. You may get cramps afterwards. You can ask for a local anaesthetic or painkillers before having the IUD fitted. An anaesthetic injection itself can be painful, so many women have the procedure without.

You may get pain and bleeding for a few days after having an IUD fitted. Discuss this with your GP or nurse beforehand.  

The IUD needs to be checked by a doctor after three to six weeks. Speak to your doctor or nurse if you have any problems before or after this first check or if you want the IUD removed.

Speak to your doctor or nurse if you or your partner are at risk of getting an STI. This is because STIs can lead to an infection in the pelvis.

See your GP or go back to the clinic where your IUD was fitted as soon as you can if you:

  • have pain in your lower abdomen
  • have a high temperature
  • have a smelly discharge

These may mean you have an infection.

How to tell whether an IUD is still in place

An IUD has two thin threads that hang down a little way from your womb into the top of your vagina. The doctor or nurse who fits your IUD will teach you how to feel for these threads and check that it is still in place.

Check your IUD is in place a few times in the first month, and then after each period or at regular intervals. 

It's very unlikely that your IUD will come out, but if you can't feel the threads, or if you think the IUD has moved, you may not be fully protected against getting pregnant. See your doctor or nurse straight away and use an extra method of contraception, such as condoms, until your IUD has been checked. If you've had sex recently, you may need to use emergency contraception.

Your partner shouldn't be able to feel your IUD during sex. If he can feel the threads, get your doctor or nurse to check that your IUD is in place. They may be able to cut the threads to a shorter length. If you feel any pain during sex, go for a check-up.

Removing an IUD

An IUD can be removed at any time by a trained doctor or nurse.

If you're not going to have another IUD put in and you don't want to get pregnant, use another method (such as condoms) for seven days before you have the IUD removed. This is to stop sperm getting into your body. Sperm can live for up to seven days in the body and could make you pregnant once the IUD is removed.

As soon as an IUD is taken out, your normal fertility should return. 

Who can use an IUD

Most women can use an IUD. This includes women who have never been pregnant and those who are HIV positive. Your doctor or nurse will ask about your medical history to check if an IUD is the most suitable form of contraception for you.

You should not use an IUD if you have:

  • an untreated STI or a pelvic infection 
  • problems with your womb or cervix 
  • any unexplained bleeding from your vagina – for example, between periods or after sex

Women who have had an ectopic pregnancy or recent abortion, or who have an artificial heart valve, must consult their GP or clinician before having an IUD fitted.

You should not be fitted with an IUD if there's a chance that you are already pregnant or if you or your partner are at risk of catching STIs. If you or your partner are unsure, go to your GP or a sexual health clinic to be tested.

Using an IUD after giving birth

An IUD can usually be fitted four to six weeks after giving birth (vaginal or caesarean). You'll need to use alternative contraception from three weeks (21 days) after the birth until the IUD is fitted. In some cases, an IUD can be fitted within 48 hours of giving birth. An IUD is safe to use when you're breastfeeding and it won't affect your milk supply.

Using an IUD after a miscarriage or abortion

An IUD can be fitted straight away or within 48 hours after an abortion or miscarriage by an experienced doctor or nurse, as long as you were pregnant for less than 24 weeks. If you were pregnant for more than 24 weeks, you may have to wait a few weeks before having an IUD fitted. 

Advantages and disadvantages of the IUD

Although an IUD is an effective method of contraception, there are some things to consider before having one fitted.

Advantages of the IUD

  • Most women can use an IUD, including women who have never been pregnant.
  • Once an IUD is fitted, it works straight away and lasts for up to 10 years or until it's removed.
  • It doesn't interrupt sex.
  • It can be used if you're breastfeeding.
  • Your normal fertility returns as soon as the IUD is taken out
  • It's not affected by other medicines.

There's no evidence that having an IUD fitted will increase the risk of cancer of the cervix, endometrial cancer (cancer of the lining of the womb) or ovarian cancer. Some women experience changes in mood and libido, but these changes are very small. There is no evidence that the IUD affects weight.

Disadvantages of the IUD

  • Your periods may become heavier, longer or more painful, though this may improve after a few months. 
  • An IUD doesn't protect against STIs, so you may have to use condoms as well. If you get an STI while you have an IUD, it could lead to a pelvic infection if not treated.
  • The most common reasons that women stop using an IUD are vaginal bleeding and pain.

Risks of the IUD

Complications after having an IUD fitted are rare. Most will appear within the first year after fitting.

Damage to the womb

In fewer than one in 1,000 cases, an IUD can perforate (make a hole in) the womb or neck of the womb (cervix) when it's put in. This can cause pain in the lower abdomen, but doesn't usually cause any other symptoms. If the doctor or nurse fitting your IUD is experienced, the risk of this is very low.

If perforation occurs, you may need surgery to remove the IUD. Contact your GP straight away if you feel a lot of pain after having an IUD fitted as perforations should be treated immediately.

Pelvic infections

Pelvic infections can occur in the first 20 days after the IUD is fitted. The risk of infection is very small. Fewer than one in 100 women who are at low risk of STIs will get a pelvic infection.

Rejection

Occasionally, the IUD is rejected (expelled) by the womb or can move (this is called displacement). This is more likely to happen soon after it has been fitted, although this is uncommon. Your doctor or nurse will teach you how to check that your IUD is in place.

Ectopic pregnancy

If the IUD fails and you become pregnant, your IUD should be removed as soon as possible if you're going to continue with the pregnancy. There's a small increased risk of ectopic pregnancy if a woman becomes pregnant while using an IUD.

Where to get an IUD

Most types of contraception are available free in the UK. Contraception is free to all women and men through the NHS. Places where you can get contraception include:

  • most GP surgeries – talk to your GP or practice nurse
  • community contraception clinics
  • some genitourinary medicine (GUM) clinics
  • sexual health clinics – these offer contraceptive and STI testing services
  • some young people’s services (call the sexual health line on 0300 123 7123 for details)

Find your nearest sexual health clinic by searching your postcode or town.

If you're under 16 and want contraception, the doctor, nurse or pharmacists won't tell your parents or carer, as long as they believe you fully understand the information you're given, and your decisions.

Doctors and nurses work under strict guidelines when dealing with people under 16. They'll encourage you to consider telling your parents, but they won't make you. The only time that a professional might want to tell someone else is if they believe you're at risk of harm, such as abuse. The risk would need to be serious, and they would usually discuss this with you first.

Source: NHS Choices, UK

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 Sexually transmitted infections (STI) fact sheet

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?

Tests for reproductive health

Bring our Tests for Reproductive Health (PDF, 306 KB) to your next checkup.

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:

Sexually transmitted infections testing site

Find an STI testing site near you.

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?

Screening tests

  • Find out what screening tests you might need

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.

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:

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:

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?

Did you know?
If you have HIV, do not breastfeed. You can pass the virus to your baby.

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:

Source: Office on Women's Health, HHS

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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:

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:

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:

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

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.

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

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

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:

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:

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

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

Collage of women

 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

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:

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

You should

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

Pelvic Inflammatory Disease (PID) - CDC Fact Sheet

Detailed Version

Detailed fact sheets are intended for physicians and individuals with specific questions about sexually transmitted diseases. Detailed fact sheets include specific testing and treatment recommendations as well as citations so the reader can research the topic more in depth.

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

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

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

Bacterial Vaginosis

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:

STDs and Pregnancy
STDs & Pregnancy

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.

Photo of woman in pain.

What happens if I don't get treated?

BV can cause some serious health risks, including

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

Photos of women. Sexually active females 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, need testing every year.

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:

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.

STDs and Pregnancy
STDs & Pregnancy

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?

illustration of female anatomy showing fallopian tubes, ovary, cervix, uterus, and vagina

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

Symptoms in men can include

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

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.

STDs and Infertility
STDs & Infertility

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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Gonorrhea - CDC Fact Sheet

three couples

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:

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:

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:

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

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).

Antibiotic-Resistant Gonorrhea

bacteria
 

 

 

 

 

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.

Photo of woman in pain.

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

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.

Gonorrhea - CDC Fact Sheet (Detailed Version)

Detailed Version

Detailed fact sheets are intended for physicians and individuals with specific questions about sexually transmitted diseases. Detailed fact sheets include specific testing and treatment recommendations as well as citations so the reader can research the topic more in depth.

What is gonorrhea?

Gonorrhea is a sexually transmitted disease (STD) caused by infection with the Neisseria gonorrhoeae bacterium. N. gonorrhoeae infects the mucous membranes of the reproductive tract, including the cervix, uterus, and fallopian tubes in women, and the urethra in women and men. N. gonorrhoeae can also infect the mucous membranes of the mouth, throat, eyes, and anus.

How common is gonorrhea?

Gonorrhea is a very common infectious disease. CDC estimates that, annually, 820,000 people in the United States get new gonorrheal infections, and less than half of these infections are detected and reported to CDC. CDC estimates that 570,000 of them were among young people 15-24 years of age. In 2013, 333,004 cases of gonorrhea were reported to CDC.2 

How do people get gonorrhea?

Gonorrhea is transmitted through sexual contact with the penis, vagina, mouth, or anus of an infected partner. Ejaculation does not have to occur for gonorrhea to be transmitted or acquired. Gonorrhea can also be spread perinatally from mother to baby during childbirth.

People who have had gonorrhea and received treatment may be reinfected if they have sexual contact with a person infected with gonorrhea.

Who is at risk for gonorrhea?

Any sexually active person can be infected with gonorrhea. In the United States, the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans 2.

What are the signs and symptoms of gonorrhea?

Many men with gonorrhea are asymptomatic 3, 4. When present, signs and symptoms of urethral infection in males include dysuria or a white, yellow, or green urethral discharge that usually appears one to fourteen days after infection 5. In cases where urethral infection is complicated by epididymitis, men with gonorrhea may also complain of testicular or scrotal pain.

Most women with gonorrhea are asymptomatic 6, 7. Even when a woman has symptoms, they are often so mild and nonspecific that they are mistaken for a bladder or vaginal infection 8, 9. The initial symptoms and signs in women include dysuria, increased vaginal discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of developing serious complications from the infection, regardless of the presence or severity of symptoms.

Symptoms of rectal infection in both men and women may include discharge, anal itching, soreness, bleeding, or painful bowel movements 10. Rectal infection also may be asymptomatic. Pharyngeal infection may cause a sore throat, but usually is asymptomatic 11, 12.

What are the complications of gonorrhea?

Untreated gonorrhea can cause serious and permanent health problems in both women and men.

In women, gonorrhea can spread into the uterus or fallopian tubes and cause pelvic inflammatory disease (PID). The symptoms may be quite mild or can be very severe and can include abdominal pain and fever 13. PID can lead to internal abscesses and chronic pelvic pain. PID can also damage the fallopian tubes enough to cause infertility or increase the risk of ectopic pregnancy.

In men, gonorrhea may be complicated by epididymitis. In rare cases, this may lead to infertility 14.

If left untreated, gonorrhea can also spread to the blood and cause disseminated gonococcal infection (DGI). DGI is usually characterized by arthritis, tenosynovitis, and/or dermatitis 15. This condition can be life threatening.

What about Gonorrhea and HIV?

Untreated gonorrhea can increase a person’s risk of acquiring or transmitting HIV, the virus that causes AIDS 16.

How does gonorrhea affect a pregnant woman and her baby?

If a pregnant woman has gonorrhea, she may give the infection to her baby as the baby passes through the birth canal during delivery. This can cause blindness, joint infection, or a life-threatening blood infection in the baby 17. Treatment of gonorrhea as soon as it is detected in pregnant women will reduce the risk of these complications. Pregnant women should consult a health care provider for appropriate examination, testing, and treatment, as necessary.

Who should be tested for gonorrhea?

Any sexually active person can be infected with gonorrhea. Anyone with genital symptoms such as discharge, burning during urination, unusual sores, or rash should stop having sex and see a health care provider immediately.

Also, anyone with an oral, anal, or vaginal sex partner who has been recently diagnosed with an STD should see a health care provider for evaluation.

Some people should be tested (screened) for gonorrhea even if they do not have symptoms or know of a sex partner who has gonorrhea 18. Anyone who is sexually active should discuss his or her risk factors with a health care provider and ask whether he or she should be tested for gonorrhea or other STDs.

CDC recommends yearly gonorrhea screening for 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.

People who have gonorrhea should also be tested for other STDs.

How is gonorrhea diagnosed?

Urogenital gonorrhea can be diagnosed by testing urine, urethral (for men), or endocervical or vaginal (for women) specimens using nucleic acid amplification testing (NAAT) 19. It can also be diagnosed using gonorrhea culture, which requires endocervical or urethral swab specimens.

If a person has had oral and/or anal sex, pharyngeal and/or rectal swab specimens should be collected either for culture or for NAAT (if the local laboratory has validated the use of NAAT for extra-genital specimens) 20.

What is the treatment for gonorrhea?

Gonorrhea can be cured with the right treatment. CDC now recommends dual therapy (i.e. using two drugs) for the treatment of gonorrhea. It is important to take all of the medication prescribed to cure gonorrhea. Medication for gonorrhea should not be shared with anyone. Although medication will stop the infection, it will not repair any permanent damage done by the disease. Antimicrobial resistance in gonorrhea is of increasing concern, and successful treatment of gonorrhea is becoming more difficult 21. If a person’s symptoms continue for more than a few days after receiving treatment, he or she should return to a health care provider to be reevaluated.

What about partners?

If a person has been diagnosed and treated for gonorrhea, he or she should tell all recent anal, vaginal, or oral sex partners (all sex partners within 60 days before the onset of symptoms or diagnosis) so they can see a health provider and be treated 20. This will reduce the risk that the sex partners will develop serious complications from gonorrhea and will also reduce the person’s risk of becoming reinfected. A person with gonorrhea and all of his or her sex partners must avoid having sex until they have completed their treatment for gonorrhea and until they no longer have symptoms. For tips on talking to partners about sex and STD testing, visit http://www.gytnow.org/talking-to-your-partner.

How can gonorrhea be prevented?

Latex condoms, when used consistently and correctly, can reduce the risk of transmission of gonorrhea. The surest way to avoid transmission of gonorrhea or other STDs is to abstain from sexual intercourse, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Antibiotic-Resistant Gonorrhea

The emergence of multidrug- and cephalosporin-resistant gonorrhea in the United States would make gonorrhea much more difficult to treat.

Gonorrhea has progressively developed resistance to the antibiotic drugs prescribed to treat it. Following the spread of gonococcal fluoroquinolone resistance, the cephalosporin antibiotics have been the foundation of recommended treatment for gonorrhea. The emergence of cephalosporin-resistant gonorrhea would significantly complicate the ability of providers to treat gonorrhea successfully, since we have few antibiotic options left that are simple, well-studied, well-tolerated and highly effective. It is critical to continuously monitor antibiotic resistance in Neisseria gonorrhoeae and encourage research and development of new treatment regimens.

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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Genital Herpes - CDC Fact Sheet

three couples

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.

Basic Fact Sheet

Basic fact sheets are presented in plain language for individuals with general questions about sexually transmitted diseases. The content here can be syndicated (added to your web site).

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:

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.

Genital Herpes - CDC Fact Sheet (Detailed)

Detailed Version

Detailed fact sheets are intended for physicians and individuals with specific questions about sexually transmitted diseases. Detailed fact sheets include specific testing and treatment recommendations as well as citations so the reader can research the topic more in depth.

What is genital herpes?

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2).

How common is genital herpes?

CDC estimates that, annually, 776,000 people in the United States get new herpes infections. Genital herpes infection is common in the United States. Nationwide, 15.5 % of persons aged 14 to 49 years have HSV-2 infection. The overall prevalence of genital herpes is likely higher than 15.5%, because an increasing number of genital herpes infections are caused by HSV-1. HSV-1 is typically acquired in childhood; as the prevalence of HSV-1 infection has declined in recent decades, people may have become more susceptible to genital herpes from HSV-1.

HSV-2 infection is more common among women than among men (20.3% versus 10.6% in 14 to 49 year olds). Infection is more easily transmitted from men to women than from women to men. HSV-2 infection is more common among non-Hispanic blacks (41.8%) than among non-Hispanic whites (11.3%). This disparity remains even among persons with similar numbers of lifetime sexual partners. For example, among persons with 2–4 lifetime sexual partners, HSV-2 is still more prevalent among non-Hispanic blacks (34.3%) than among non-Hispanic whites (9.1%) or Mexican Americans (13%). Most infected persons are unaware of their infection. In the United States, an estimated 87.4% of 14–49 year olds infected with HSV-2 have never received a clinical diagnosis.

The percentage of persons in the United States who are infected with HSV-2 decreased from 21.2% in 1988–1994 to 15.5% in 2007-2010.

How do people get genital herpes?

Infections are transmitted through contact with lesions, mucosal surfaces, genital secretions, or oral secretions. HSV-1 and HSV-2 can also be shed from skin that looks normal. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission most commonly occurs from an infected partner who does not have a visible sore and may not know that he or she is infected.  In persons with asymptomatic HSV-2 infections, genital HSV shedding occurs on 10% of days, and on most of those days the person has no signs or symptoms.

What are the symptoms of genital herpes?

Most individuals infected with HSV-1 or HSV-2 are asymptomatic, or have very mild symptoms that go unnoticed or are mistaken for another skin condition. As a result, 87.4% of infected individuals remain unaware of their infection.When symptoms do occur, they typically appear as one or more vesicles on or around the genitals, rectum or mouth. The average incubation period after exposure is 4 days (range, 2 to 12). 5 The vesicles break and leave painful ulcers that may take two to four weeks to heal. Experiencing these symptoms is referred to as having an "outbreak," or episode.

Clinical manifestations of genital herpes differ between the first and recurrent outbreaks of HSV. The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, and headache. Recurrent outbreaks of genital herpes are common, in particular during the first year of infection. Approximately half of patients who recognize recurrences have prodromal symptoms, such as mild tingling or shooting pains in the legs, hips and buttocks occurring hours to days before eruption of herpetic lesions. Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over time. Recurrences are much less frequent for genital HSV-1 infection than for genital HSV-2 infection.

What are the complications of genital herpes?

Genital herpes causes painful genital ulcers in many adults that can be severe and persistent in persons with suppressed immune systems, such as HIV-infected persons. Both HSV-1 and HSV-2 can also cause rare but serious complications such as blindness, encephalitis (inflammation of the brain), and aseptic meningitis (inflammation of the linings of the brain). Development of extragenital lesions in the buttocks, groin, thigh, finger, and eye may occur during the course of infection.

Some persons who contract genital herpes have concerns about how it will impact their overall health, sex life, and relationships. There can be can be considerable embarrassment, shame, and stigma associated with a herpes diagnosis and this can substantially interfere with a patient’s relationships. Clinicians can address these concerns by encouraging patients to recognize that while herpes is not curable, it is a manageable condition. Three important steps that providers can take for their newly-diagnosed patients are: giving information, providing support resources, and helping define options. 8 Since a genital herpes diagnosis may affect perceptions about existing or future sexual relationships, it is important for patients to understand how to talk to sexual partners about STDs. One resource can be found here: www.gytnow.org/talking-to-your-partner

There are also potential complications for a pregnant woman and her unborn child. See “How does herpes infection affect a pregnant woman and her baby?” below for information about this.

Photo of men holding hands.
HIV/AIDS & STDs

What is the link between genital herpes and HIV?

Genital ulcerative disease caused by herpes make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 4-fold increased risk of acquiring HIV, if exposed to HIV when genital herpes is present. This is because genital herpes can cause ulcers or breaks in the skin or mucous membranes (lining of the mouth, vagina, and rectum), which compromises the protection normally provided by the skin and mucous membranes against infections, including HIV. Herpetic genital ulcers can bleed easily, and when they come into contact with the mouth, vagina, or rectum during sex, they increase the risk of HIV transmission.

How does genital herpes affect a pregnant woman and her baby?

Neonatal herpes is one of the most serious complications of genital herpes. Healthcare providers should ask all pregnant women if they have a history of genital herpes. Herpes infection can be passed from mother to child during pregnancy, childbirth, or in the newborn period, resulting in a potentially fatal neonatal herpes infection. During pregnancy there is a higher risk of perinatal transmission during the first outbreak than with a recurrent outbreak, thus it is important that women avoid contracting herpes during pregnancy. Women should be counseled to abstain from intercourse during the third trimester with partners known to have or suspected of having genital herpes.

A woman with genital herpes may be offered antiviral medication from 36 weeks gestation through delivery to reduce the risk of a recurrent outbreak. Routine HSV screening of pregnant women is not recommended. However, at onset of labor, all women should undergo careful examination and questioning to evaluate for presence of prodromal symptoms or herpetic lesions. If herpes symptoms are present a cesarean delivery is recommended to prevent HSV transmission to the infant.

How is genital herpes diagnosed?

Numerous herpes diagnostic tests are available. Direct (or virologic) tests detect viable virus, viral antigen, or viral nucleic acid. Viral culture is currently the reference standard for diagnosing genital herpes. HSV culture requires collection of a sample from the sore and, once viral growth is seen, specific cell staining to differentiate between HSV-1 and HSV-2. Nucleic acid amplification techniques (NAATs), such as PCR, test for viral DNA or RNA and allow for more rapid and accurate results. Indirect (or serologic) tests are blood tests that detect antibodies to the herpes virus. Several ELISA-based serologic tests are FDA approved and available commercially. Older assays that do not accurately distinguish HSV-1 from HSV-2 antibody remain on the market, so providers should specifically request serologic type-specific assays when blood tests are performed for their patients. HSV-1 ELISA results are considered to be reliable because HSV-1 is ubiquitous in most populations. However, false positive HSV-2 ELISA results are more often seen when testing is done in populations with a lower prevalence of HSV-2.

For the symptomatic patient, testing with both direct and indirect assays can determine whether it is a new infection or a newly-recognized old infection. A primary infection would be supported by a positive virologic test and a negative serologic test, while the diagnosis of recurrent disease would be supported by positive virologic and serologic test results.

CDC does not recommend screening for HSV-1 or HSV-2 in the general population. Several scenarios where type-specific HSV tests may be useful include

Is there a cure or treatment for herpes?

There is no cure for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy (i.e. daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners.

Several clinical trials have tested vaccines against genital herpes infection, but there is currently no commercially available vaccine that is protective against genital herpes infection. One vaccine trial showed efficacy among women whose partners were HSV-2 infected, but only among women who were not infected with HSV-1. No efficacy was observed among men whose partners were HSV-2 infected. A subsequent trial testing the same vaccine showed some protection from genital HSV-1 infection, but no protection from HSV-2 infection.

How can herpes be prevented?

Correct and consistent use of latex condoms can reduce the risk of genital herpes.  However, outbreaks can occur in areas that are not covered by a condom.

The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Persons with herpes should abstain from sexual activity with partners when sores or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms, he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV.

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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STDs and HIV – CDC Fact Sheet

three couples

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

Basic Fact Sheet

Basic fact sheets are presented in plain language for individuals with general questions about sexually transmitted diseases.

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?

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:

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

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.

STDs and HIV – CDC Fact Sheet

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

Detailed Version

Detailed fact sheets are intended for physicians and individuals with specific questions about sexually transmitted diseases. Detailed fact sheets include specific testing and treatment recommendations as well as citations so the reader can research the topic more in depth.

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.

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.  

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

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

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:

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:

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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Genital HPV Infection - Fact Sheet

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

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 - CDC Fact Sheet

Pregnant woman, two men and young woman

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.

Basic Fact Sheet | Detailed Version | View Images of Symptoms

Basic fact sheets are presented in plain language for individuals with general questions about sexually transmitted diseases.

The content here can be syndicated (added to your web site).

Print Version 
Commercial Print Version

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.

Example of a primary syphilis sore.

Example of a primary syphilis sore.

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:

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.

Secondary rash from syphilis on palms of hands.

Secondary rash from syphilis on palms of hands.

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.

Secondary rash from syphilis on torso.

Secondary rash from syphilis on torso.

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?

Darkfield micrograph of Treponema pallidum.

Darkfield micrograph of Treponema pallidum.

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.

Basic Fact Sheet | Detailed Version | View Images of Symptoms

Detailed fact sheets are intended for physicians and individuals with specific questions about sexually transmitted diseases. Detailed fact sheets include specific testing and treatment recommendations as well as citations so the reader can research the topic more in depth.

What is syphilis?

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. Syphilis can cause long-term complications if not adequately treated.

How common is syphilis?

During 2013, there were 56,471 reported new cases of syphilis, compared to 48,893 estimated new diagnoses of HIV infection in 2012 and 333,004 cases of gonorrhea in 2013. Of syphilis cases, 17,535 were of primary and secondary (P&S) syphilis, the earliest and most transmissible stages of syphilis. During the 1990s, syphilis primarily occurred among heterosexual men and women of racial and ethnic minority groups; during the 2000s, however, cases increased among men who have sex with men (MSM). 1 In 2002, rates of P&S syphilis were highest among men 30–39 years-old, but in 2013, were highest among men 20–29 years-old. 2, 3 This epidemiologic shift reflects increasing cases reported among young MSM in recent years. 4 MSM accounted for 75% of all P&S syphilis cases in 2013.

Black, Hispanic, and other racial/ethnic minorities are disproportionately affected by P&S syphilis in the United States, with black Americans accounting for most of P&S syphilis among individuals who are not MSM. 3

While the rate of congenital syphilis (syphilis passed from pregnant women to their babies) has decreased in recent years, 3 more cases of congenital syphilis are reported in the United States than cases of perinatal HIV infection. During 2013, 350 cases of congenital syphilis were reported, compared to an estimated 162 cases of perinatal HIV infection during 2010. 5 Congenital syphilis rates were 10.4 times and 3.5 times higher among infants born to black and Hispanic mothers (29.0 and 9.7 cases per 100,000 live births, respectively) compared to white mothers (2.8 cases per 100,000 live births). 6

How do people get syphilis?

Syphilis is transmitted from person to person by direct contact with a syphilitic sore, known as a chancre. Chancres occur mainly on the external genitals, vagina, anus, or in the rectum. Chancres also can occur on the lips and in the mouth. Transmission of syphilis occurs during vaginal, anal, or oral sex. Pregnant women with the disease can transmit it to their unborn child.

How quickly do symptoms appear after infection?

The average time between infection with syphilis and the start of the first symptom is 21 days, but can range from 10 to 90 days.

What are the signs and symptoms in adults?

Syphilis has been called “The Great Pretender”, as its symptoms can look like many other diseases. However, syphilis typically follows a progression of stages that can last for weeks, months, or even years:

Primary Stage

The appearance of a single chancre marks the primary (first) stage of syphilis symptoms, but there may be multiple sores. The chancre is usually firm, round, and painless. It appears at the location where syphilis entered the body. Possibly because these painless chancres can occur in locations that make them difficult to find (e.g., the vagina or anus), smaller proportions of MSM and women are diagnosed in primary stage than men having sex with women only. 3 The chancre lasts 3 to 6 weeks and heals regardless of whether a person is treated or not. However, if the infected person does not receive adequate treatment, the infection progresses to the secondary stage.

Secondary Stage

Skin rashes and/or mucous membrane lesions (sores in the mouth, vagina, or anus) mark the second stage of symptoms. This stage typically starts with the development of a rash on one or more areas of the body. Rashes associated with secondary syphilis can appear when the primary chancre is healing or several weeks after the chancre has healed. The rash usually does not cause itching. The characteristic rash of secondary syphilis may appear as rough, red, or reddish brown spots both on the palms of the hands and the bottoms of the feet. However, rashes with a different appearance may occur on other parts of the body, sometimes resembling rashes caused by other diseases. Sometimes rashes associated with secondary syphilis are so faint that they are not noticed. Large, raised, gray or white lesions, known as condyloma lata, may develop in warm, moist areas such as the mouth, underarm or groin region. In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. The symptoms of secondary syphilis will go away with or without treatment, but without treatment, the infection will progress to the latent and possibly late stages of disease.

Latent and Late Stages

The latent (hidden) stage of syphilis begins when primary and secondary symptoms disappear. Without treatment, the infected person will continue to have syphilis infection in their body even though there are no signs or symptoms. Early latent syphilis is latent syphilis where infection occurred within the past 12 months. Late latent syphilis is latent syphilis where infection occurred more than 12 months ago. Latent syphilis can last for years.

The late stages of syphilis can develop in about 15% of people who have not been treated for syphilis, and can appear 10–20 years after infection was first acquired. In the late stages of syphilis, the disease may damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. Symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

Neurosyphilis

Syphilis can invade the nervous system at any stage of infection, and causes a wide range of symptoms varying from no symptoms at all, to headache, altered behavior, and movement problems that look like Parkinson’s or Huntington’s disease. 7 This invasion of the nervous system is called “neurosyphilis.”

Note: Health departments report syphilis by its stage of infection, noting “neurological manifestations,” rather than using the term neurosyphilis. 3

HIV infection and syphilis symptoms

Individuals who are HIV-positive can develop symptoms very different from the symptoms described above, including hypopigmented skin rashes. 8 HIV can also increase the chances of developing syphilis with neurological involvement. 9

How does syphilis affect a pregnant woman and her baby?

The syphilis bacterium can infect the baby of a woman during her pregnancy. All pregnant women should be tested for syphilis at the first prenatal visit. The syphilis screening test should be repeated during the third trimester (28 to 32 weeks gestation) and at delivery in women who are at high risk for syphilis, live in areas of high syphilis morbidity, are previously untested, or had a positive screening test in the first trimester. 10

Depending on how long a pregnant woman has been infected, she may have a high risk of having a stillbirth (a baby born dead) or of giving birth to a baby who dies shortly after birth; untreated syphilis in pregnant women results in infant death in up to 40 percent of cases. 6 Any woman who delivers a stillborn infant after 20 week’s gestation should also be tested for syphilis.

An infected baby born alive may not have any signs or symptoms of disease. However, if not treated immediately, the baby may develop serious problems within a few weeks. Untreated babies may become developmentally delayed, have seizures, or die. All babies born to mothers who test positive for syphilis during pregnancy should be screened for syphilis and examined thoroughly for evidence of congenital syphilis. 10

For pregnant women only penicillin therapy can be used to treat syphilis and prevent passing the disease to her baby; treatment with penicillin is extremely effective (success rate of 98%) in preventing mother-to-child transmission. 11 Pregnant women who are allergic to penicillin should be referred to a specialist for desensitization to penicillin.

How is syphilis diagnosed?

The definitive method for diagnosing syphilis is visualizing the spirochete via darkfield microscopy. This technique is rarely performed today because it is a technologically difficult method. Diagnoses are thus more commonly made using blood tests. There are two types of blood tests available for syphilis: 1) nontreponemal tests and 2) treponemal tests.

Nontreponemal tests (e.g., VDRL and RPR) are simple, inexpensive, and are often used for screening. However, they are not specific for syphilis, can produce false-positive results, and, by themselves, are insufficient for diagnosis. VDRL and RPR should each have their antibody titer results reported quantitatively. Persons with a reactive nontreponemal test should receive a treponemal test to confirm a syphilis diagnosis. This sequence of testing (nontreponemal, then treponemal test) is considered the “classical” testing algorithm.

Treponemal tests (e.g., FTA-ABS, TP-PA, various EIAs, and chemiluminescence immunoassays) detect antibodies that are specific for syphilis. Treponemal antibodies appear earlier than nontreponemal antibodies and usually remain detectable for life, even after successful treatment. If a treponemal test is used for screening and the results are positive, a nontreponemal test with titer should be performed to confirm diagnosis and guide patient management decisions. Based on the results, further treponemal testing may be indicated. For further guidance, please refer to the 2010 STD Treatment Guidelines. 10 This sequence of testing (treponemal, then nontreponemal, test) is considered the “reverse” sequence testing algorithm.Reverse sequence testing can be more convenient for laboratories, but its clinical interpretation is problematic, as this testing sequence can identify individuals not previously described (e.g., treponemal test positive, nontreponemal test negative), making optimal management choices difficult. 12

Special note: Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis. All women should be screened at their first prenatal visit. For patients who belong to communities and populations with high prevalence of syphilis and for patients at high risk, blood tests should also be performed during the third trimester (at 28–32 weeks) and at delivery. For further information on screening guidelines, please refer to the 2010 STD Treatment Guidelines. 10

All infants born to mothers who have reactive nontreponemal and treponemal test results should be evaluated for congenital syphilis. A quantitative nontreponemal test should be performed on infant serum and, if reactive, the infant should be examined thoroughly for evidence of congenital syphilis. Suspicious lesions, body fluids, or tissues (e.g., umbilical cord, placenta) should be examined by darkfield microscopy and/or special stains. Other recommended evaluations may include analysis of cerebrospinal fluid by VDRL, cell count and protein, CBC with differential and platelet count, and long-bone radiographs. For further guidance on evaluation of infants for congenital syphilis, please refer to the 2010 STD Treatment Guidelines. 10

What is the link between syphilis and HIV?

Genital sores caused by syphilis make it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 5-fold increased risk of acquiring HIV if exposed to that infection when syphilis is present. 13

Ulcerative STDs that cause sores, ulcers, or breaks in the skin or mucous membranes, such as syphilis, disrupt barriers that provide protection against infections. The genital ulcers caused by syphilis can bleed easily, and when they come into contact with oral and rectal mucosa during sex, increase the infectiousness of and susceptibility to HIV. Studies have observed that infection with syphilis was associated with subsequent HIV infection among MSM. 14, 15

Having other STDs can also indicate increased risk for becoming HIV infected. 14

What is the treatment for syphilis?

There are no home remedies or over-the-counter drugs that will cure syphilis, but syphilis is easy to cure in its early stages. A single intramuscular injection of long acting Benzathine penicillin G (2.4 million units administered intramuscularly) will cure a person who has primary, secondary or early latent syphilis. Three doses of long acting Benzathine penicillin G (2.4 million units administered intramuscularly) at weekly intervals is recommended for individuals with late latent syphilis or latent syphilis of unknown duration. Treatment will kill the syphilis bacterium and prevent further damage, but it will not repair damage already done.

Selection of the appropriate penicillin preparation is important to properly treat and cure syphilis. Combinations of some penicillin preparations (e.g., Bicillin C-R, a combination of benzathine penicillin and procaine penicillin) are not appropriate treatments for syphilis, as these combinations provide inadequate doses of penicillin. 16

Although data to support the use of alternatives to penicillin is limited, options for non-pregnant patients who are allergic to penicillin may include doxycycline, tetracycline, and for neurosyphilis, potentially probenecid. These therapies should be used only in conjunction with close clinical and laboratory follow-up to ensure appropriate serological response and cure. 10

Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested and receive treatment if necessary.

Who should be tested for syphilis?

Any person with signs or symptoms of primary infection, secondary infection, neurologic infection, or tertiary infection should be tested for syphilis.

Providers should routinely test persons who

Will syphilis recur?

Syphilis does not recur. However, having syphilis once does not protect a person from becoming infected again. Even following successful treatment, people can be re-infected. Patients with signs or symptoms that persist or recur or who have a sustained fourfold increase in nontreponemal test titer probably failed treatment or were reinfected. These patients should be retreated.

Because chancres can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Unless a person knows that their sex partners have been tested and treated, they may be at risk of being reinfected by an untreated partner. For further details on the management of sex partners, refer to the 2010 STD Treatment Guidelines. 10

How can syphilis be prevented?

Correct and consistent use of latex condoms can reduce the risk of syphilis only when the infected area or site of potential exposure is protected. However, a syphilis sore outside of the area covered by a latex condom can still allow transmission, so caution should be exercised even when using a condom. For persons who have latex allergies, synthetic non-latex condoms can be used but it is important to note that they have higher breakage rates than latex condoms. 17 Natural membrane condoms are not recommended for STD prevention. 18 Other individual-based interventions, such as the use of microbicide or male circumcision, do not prevent syphilis. 19

The surest way to avoid transmission of sexually transmitted diseases, including syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Partner-based interventions include partner notification – a critical component in preventing the spread of syphilis. Sexual partners of infected patients should be considered at risk and provided treatment per the 2010 STD Treatment Guidelines. 10

Transmission of an STD, including syphilis, cannot be prevented by washing the genitals, urinating, and/or douching after sex. Any unusual discharge, sore, or rash, particularly in the groin area, should be a signal to refrain from having sex and to see a doctor immediately.

Avoiding alcohol and drug use may also help prevent transmission of syphilis because these activities may lead to risky sexual behavior. It is important that sex partners talk to each other about their HIV status and history of other STDs so that preventive action can be taken.

CDC

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Trichomoniasis - CDC Fact Sheet

Photo of various individuals

Most people who have trichomoniasis do not have any symptoms.

What is trichomoniasis?

Trichomoniasis (or “trich”) is a very common sexually transmitted disease (STD) that is caused by infection with a protozoan parasite called Trichomonas vaginalis. Although symptoms of the disease vary, most women and men who have the parasite cannot tell they are infected.

How common is trichomoniasis?

Trichomoniasis is considered the most common curable STD. In the United States, an estimated 3.7 million people have the infection, but only about 30% develop any symptoms of trichomoniasis. Infection is more common in women than in men, and older women are more likely than younger women to have been infected.

Two Trichomonas vaginalis parasites, magnified (seen under a microscope)
Two Trichomonas vaginalis parasites, magnified (seen under a microscope)

How do people get trichomoniasis?

The parasite is passed from an infected person to an uninfected person during sex. In women, the most commonly infected part of the body is the lower genital tract (vulva, vagina, or urethra), and in men, the most commonly infected body part is the inside of the penis (urethra). During sex, the parasite is usually transmitted from a penis to a vagina, or from a vagina to a penis, but it can also be passed from a vagina to another vagina. It is not common for the parasite to infect other body parts, like the hands, mouth, or anus. It is unclear why some people with the infection get symptoms while others do not, but it probably depends on factors like the person’s age and overall health. Infected people without symptoms can still pass the infection on to others.

What are the signs and symptoms of trichomoniasis?

About 70% of infected people do not have any signs or symptoms. When trichomoniasis does cause symptoms, they can range from mild irritation to severe inflammation. Some people with symptoms get them within 5 to 28 days after being infected, but others do not develop symptoms until much later. Symptoms can come and go.

Men with trichomoniasis may feel itching or irritation inside the penis, burning after urination or ejaculation, or some discharge from the penis.

Women with trichomoniasis may notice itching, burning, redness or soreness of the genitals, discomfort with urination, or a thin discharge with an unusual smell that can be clear, white, yellowish, or greenish.

Having trichomoniasis can make it feel unpleasant to have sex. Without treatment, the infection can last for months or even years.
 

Photo of pregnant woman.STDs & Pregnancy

What are the complications of trichomoniasis?

Trichomoniasis can increase the risk of getting or spreading other sexually transmitted infections. For example, trichomoniasis can cause genital inflammation that makes it easier to get infected with the HIV virus, or to pass the HIV virus on to a sex partner.

How does trichomoniasis affect a pregnant woman and her baby?

Pregnant women with trichomoniasis are more likely to have their babies too early (preterm delivery). Also, babies born to infected mothers are more likely to have an officially low birth weight (less than 5.5 pounds).

How is trichomoniasis diagnosed?

It is not possible to diagnose trichomoniasis based on symptoms alone. For both men and women, your primary care doctor or another trusted health care provider must do a check and a laboratory test to diagnose trichomoniasis.

What is the treatment for trichomoniasis?

Trichomoniasis can be cured with a single dose of prescription antibiotic medication (either metronidazole or tinidazole), pills which can be taken by mouth. It is okay for pregnant women to take this medication. Some people who drink alcohol within 24 hours after taking this kind of antibiotic can have uncomfortable side effects.

People who have been treated for trichomoniasis can get it again. About 1 in 5 people get infected again within 3 months after treatment. To avoid getting reinfected, make sure that all of your sex partners get treated too, and wait to have sex again until all of your symptoms go away (about a week). Get checked again if your symptoms come back.

How can trichomoniasis be prevented?

Using latex condoms correctly every time you have sex will help reduce the risk of getting or spreading trichomoniasis. However, condoms don’t cover everything, and it is possible to get or spread this infection even when using a condom.

The only sure way to prevent sexually transmitted infections is to avoid having sex entirely. Another approach is to talk about these kinds of infections before you have sex with a new partner, so that you can make informed choices about the level of risk you are comfortable taking with your sex life.

If you or someone you know has questions about trichomoniasis or any other STD, especially with symptoms like unusual discharge, burning during urination, or a sore in the genital area, check in with a health care provider and get some answers.
 

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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Scabies Frequently Asked Questions (FAQs)

On this Page

  • What is scabies?
  • What is crusted (Norwegian) scabies?
  • How soon after infestation do symptoms of scabies begin?
  • What are the signs and symptoms of scabies infestation?
  • How did I get scabies?
  • How is scabies infestation diagnosed?
  • How long can scabies mites live?
  • Can scabies be treated?
  • Who should be treated for scabies?
  • How soon after treatment will I feel better?
  • Did I get scabies from my pet?
  • Can scabies be spread by swimming in a public pool?
  • How can I remove scabies mites from my house or carpet?
  • How can I remove scabies mites from my clothes?
  • My spouse and I were diagnosed with scabies. After several treatments, he/she still has symptoms while I am cured. Why?
  • If I come in contact with a person who has scabies, should I treat myself?

What is scabies?

Scabies is an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies.

Scabies is found worldwide and affects people of all races and social classes. Scabies can spread rapidly under crowded conditions where close body and skin contact is frequent. Institutions such as nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks. Child care facilities also are a common site of scabies infestations.

What is crusted (Norwegian) scabies?

Crusted scabies is a severe form of scabies that can occur in some persons who are immunocompromised (have a weak immune system), elderly, disabled, or debilitated. It is also called Norwegian scabies. Persons with crusted scabies have thick crusts of skin that contain large numbers of scabies mites and eggs. Persons with crusted scabies are very contagious to other persons and can spread the infestation easily both by direct skin-to-skin contact and by contamination of items such as their clothing, bedding, and furniture. Persons with crusted scabies may not show the usually signs and symptoms of scabies such as the characteristic rash or itching (pruritus). Persons with crusted scabies should receive quick and aggressive medical treatment for their infestation to prevent outbreaks of scabies.

How soon after infestation do symptoms of scabies begin?

If a person has never had scabies before, symptoms may take as long as 4-6 weeks to begin. It is important to remember that an infested person can spread scabies during this time, even if he/she does not have symptoms yet.

In a person who has had scabies before, symptoms usually appear much sooner (1-4 days) after exposure.

What are the signs and symptoms of scabies infestation?

The most common signs and symptoms of scabies are intense itching (pruritus), especially at night, and a pimple-like (papular) itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks. The rash also can include tiny blisters (vesicles) and scales. Scratching the rash can cause skin sores; sometimes these sores become infected by bacteria.

Tiny burrows sometimes are seen on the skin; these are caused by the female scabies mite tunneling just beneath the surface of the skin. These burrows appear as tiny raised and crooked (serpiginous) grayish-white or skin-colored lines on the skin surface. Because mites are often few in number (only 10-15 mites per person), these burrows may be difficult to find. They are found most often in the webbing between the fingers, in the skin folds on the wrist, elbow, or knee, and on the penis, breast, or shoulder blades.

The head, face, neck, palms, and soles often are involved in infants and very young children, but usually not adults and older children.

Persons with crusted scabies may not show the usual signs and symptoms of scabies such as the characteristic rash or itching (pruritus).

How did I get scabies?

Scabies usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies. Contact generally must be prolonged; a quick handshake or hug usually will not spread scabies. Scabies is spread easily to sexual partners and household members. Scabies in adults frequently is sexually acquired. Scabies sometimes is spread indirectly by sharing articles such as clothing, towels, or bedding used by an infested person; however, such indirect spread can occur much more easily when the infested person has crusted scabies.

How is scabies infestation diagnosed?

Diagnosis of a scabies infestation usually is made based on the customary appearance and distribution of the rash and the presence of burrows. Whenever possible, the diagnosis of scabies should be confirmed by identifying the mite, mite eggs, or mite fecal matter (scybala). This can be done by carefully removing a mite from the end of its burrow using the tip of a needle or by obtaining skin scraping to examine under a microscope for mites, eggs, or mite fecal matter. It is important to remember that a person can still be infested even if mites, eggs, or fecal matter cannot be found; typically fewer than 10-15 mites can be present on the entire body of an infested person who is otherwise healthy. However, persons with crusted scabies can be infested with thousands of mites and should be considered highly contagious.

How long can scabies mites live?

On a person, scabies mites can live for as long as 1-2 months. Off a person, scabies mites usually do not survive more than 48-72 hours. Scabies mites will die if exposed to a temperature of 50°C (122°F) for 10 minutes.

Can scabies be treated?

Yes. Products used to treat scabies are called scabicides because they kill scabies mites; some also kill eggs. Scabicides to treat human scabies are available only with a doctor’s prescription; no "over-the-counter" (non-prescription) products have been tested and approved for humans.

Always follow carefully the instructions provided by the doctor and pharmacist, as well as those contained in the box or printed on the label. When treating adults and older children, scabicide cream or lotion is applied to all areas of the body from the neck down to the feet and toes; when treating infants and young children, the cream or lotion also is applied to the head and neck. The medication should be left on the body for the recommended time before it is washed off. Clean clothes should be worn after treatment.

In addition to the infested person, treatment also is recommended for household members and sexual contacts, particularly those who have had prolonged skin-to-skin contact with the infested person. All persons should be treated at the same time in order to prevent reinfestation. Retreatment may be necessary if itching continues more than 2-4 weeks after treatment or if new burrows or rash continue to appear.

Never use a scabicide intended for veterinary or agricultural use to treat humans!

Who should be treated for scabies?

Anyone who is diagnosed with scabies, as well as his or her sexual partners and other contacts who have had prolonged skin-to-skin contact with the infested person, should be treated. Treatment is recommended for members of the same household as the person with scabies, particularly those persons who have had prolonged skin-to-skin contact with the infested person. All persons should be treated at the same time to prevent reinfestation.

Retreatment may be necessary if itching continues more than 2-4 weeks after treatment or if new burrows or rash continue to appear.

How soon after treatment will I feel better?

If itching continues more than 2-4 weeks after initial treatment or if new burrows or rash continue to appear (if initial treatment includes more than one application or dose, then the 2-4 time period begins after the last application or dose), retreatment with scabicide may be necessary; seek the advice of a physician.

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:

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

± Hepatitis A Vaccination

± Hepatitis A and International Travel

± Postexposure Prophylaxis for Hepatitis A

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.

Graph of Incidence of Hepatitis A, United States
 

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?

Who is at increased risk for acquiring HAV infection?

What are the signs and symptoms of HAV infection?

Some persons, particularly young children, are asymptomatic. When symptoms are present, they usually occur abruptly and can include the following:

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:

All children at age 1 year (i.e., 12–23 months).  Children who have not been vaccinated by age 2 can be vaccinated at subsequent visits.

Children and adolescents ages 2–18 who live in states or communities where routine Hepatitis A vaccination has been implemented because of high disease incidence. Before 2006, when Hepatitis A vaccination was first recommended for all children at age 1 year, vaccination had been targeted to children living in states or communities that had historically high rates of Hepatitis A. States, counties, and communities with existing Hepatitis A vaccination programs for children aged 2–18 years are encouraged to maintain these programs. In those communities, new efforts focused on routine vaccination of children at age 1 year should enhance, not replace, ongoing programs directed at a broader population of children.

Persons traveling to or working in countries that have high or intermediate rates of Hepatitis A. 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 (see Hepatitis A and International Travel for more information).

Men who have sex with men. Sexually active men (both adolescents and adults) who have sex with men should be vaccinated. Hepatitis A outbreaks among men who have sex with men have been reported frequently. Recent outbreaks have occurred in urban areas in the United States, Canada, and Australia.

Users of illegal injection and noninjection drugs. During the past two decades, outbreaks of Hepatitis A have been reported with increasing frequency among users of both injection and noninjection drugs (e.g., methamphetamine) in North America, Europe, and Australia.

Persons who have occupational risk for infection. Persons who work with HAV-infected primates or with HAV in a research laboratory setting should be vaccinated. No other groups have been shown to be at increased risk for HAV infection because of occupational exposure.

Persons who have chronic liver disease. Persons with chronic liver disease who have never had Hepatitis A should be vaccinated, as they have a higher rate of fulminant Hepatitis A (i.e., rapid onset of liver failure, often leading to death). Persons who are either awaiting or have received liver transplants also should be vaccinated.

Persons who have clotting-factor disorders. Persons who have never had Hepatitis A and who are administered clotting-factor concentrates, especially solvent detergent-treated preparations, should be vaccinated.

Household members and other close personal contacts of adopted children newly arriving from countries with high or intermediate hepatitis A endemicity.

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?

Prevaccination testing is recommended only in specific circumstances to reduce the costs of vaccinating people who are already immune to Hepatitis A, including

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?

Food service workers. Foodborne Hepatitis A outbreaks are relatively uncommon in the United States; however, when they occur, intensive public health efforts are required for their control.

Although persons who work as food handlers have a critical role in common-source foodborne outbreaks, they are not at increased risk for Hepatitis A because of their occupation. Consideration may be given to vaccination of employees who work in areas where community-wide outbreaks are occurring and where state and local health authorities or private employers determine that such vaccination is cost-effective.

Sewage workers. In the United States, no work-related outbreaks of Hepatitis A have been reported among workers exposed to sewage.

Health care workers. Health care workers are not at increased risk for Hepatitis A. If a patient with Hepatitis A is admitted to the hospital, routine infection-control precautions will prevent transmission to hospital staff.

Children under 12 months of age. Because of the limited experience with Hepatitis A vaccination among children in this age group, the vaccine is not currently licensed for children age

Child care center attendees. The frequency of outbreaks of Hepatitis A is not high enough in this setting to warrant routine Hepatitis A vaccination of staff. Hepatitis A vaccination is recommended for all children at 1 year of age, including children attending child day care centers.

Residents of institutions for developmentally disabled persons. Historically, Hepatitis A virus infections were common among persons with developmental disabilities living in institutions. The occurrence of HAV infection has diminished, and routine vaccination against Hepatitis A is no longer recommended for this population.

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.

Persons who have recently been exposed to HAV and who have not been vaccinated previously should be administered a single dose of single-antigen Hepatitis A vaccine or IG (0.02 mL/kg) as soon as possible, within 2 weeks after exposure. The guidelines vary by age and health status:

Footnote:

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

Close personal contacts. Close personal contacts of persons with serologically confirmed Hepatitis A (i.e., through a blood test), including:

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).

Child-care center staff, attendees, and attendees' household members

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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STDs & Pregnancy - CDC Fact Sheet

Women who are pregnant can become infected with the same sexually transmitted diseases (STDs) as women who are not pregnant. Pregnant women should ask their doctors about getting tested for STDs, since some doctors do not routinely perform these tests.

Montage of pregnant women. Ask your doctor about STDs.

Can pregnant women become infected with STDs?

Women who are pregnant can become infected with the same sexually-transmitted diseases (STDs) as women who are not pregnant. Pregnancy does not provide women or their babies any additional protection against STDs. Many STDs are ‘silent,’ or have no symptoms, so women may not know they are infected. A pregnant woman should be tested for STDs, including HIV (the virus that causes AIDS), as a part of her medical care during pregnancy. The results of an STD can be more serious, even life-threatening, for a woman and her baby if the woman becomes infected while pregnant. It is important that women be aware of the harmful effects of STDs and how to protect themselves and their children against infection. Sexual partners of infected women should also be tested and treated.

How do STDs affect a pregnant woman and her baby?

STDs can complicate pregnancy and may have serious effects on both a woman and her developing baby. Some of these problems may be seen at birth; others may not be discovered until months or years later. In addition, it is well known that infection with an STD can make it easier for a person to get infected with HIV1. Most of these problems can be prevented if the mother receives regular medical care during pregnancy. This includes tests for STDs starting early in pregnancy and repeated close to delivery, as needed.

Human Immunodeficiency Virus

Human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome, or AIDS. HIV destroys specific blood cells that are crucial to helping the body fight diseases. According to CDC’s 2011 HIV surveillance data, women make up 25% of all adults and adolescents living with diagnosed HIV infection in the United States2. The most common ways that HIV passes from mother to child are during pregnancy, labor and delivery, or through breastfeeding. However, when HIV is diagnosed before or during pregnancy and appropriate steps are taken, the risk of mother-to-child transmission can be lowered to less than 2%3. HIV testing is recommended for all pregnant women. A mother who knows early in her pregnancy that she is HIV-positive has more time to consult with her healthcare provider and decide on effective ways to protect her health and that of her unborn baby.

Syphilis

Syphilis is primarily a sexually transmitted disease, but may be passed to a baby by an infected mother during pregnancy. Passing syphilis to a developing baby can lead to serious health problems. Syphilis has been linked to premature births, stillbirths and, in some cases, death shortly after birth7. Untreated infants that survive tend to develop problems in multiple organs, including the brain, eyes, ears, heart, skin, teeth, and bones. Screening for syphilis should be performed in all pregnant women during their first prenatal medical visit and repeated in the third trimester, if the patient is considered to be at high risk.

Hepatitis B

Hepatitis B Adobe PDF file is a liver infection caused by the hepatitis B virus (HBV). A mother can pass the infection to her baby during pregnancy. While the risk of an infected mother passing HBV to her baby varies depending on when she becomes infected, the greatest risk happens when mothers become infected close to the time of delivery14 Infected newborns also have a high risk (up to 90%) of becoming chronic (lifelong) HBV carriers themselves15. Infants who have a lifelong infection with HBV are at an increased risk for developing chronic liver disease or liver cancer later in life. Approximately one in four infants who develop chronic HBV infection will eventually die from chronic liver disease13. Mother-to-child transmission of HBV can be prevented by screening pregnant women for the infection and providing treatment to at-risk infants shortly after birth. Information on mother-to-child transmission of HBV can be found at http://www.cdc.gov/hepatitis/HBV/PerinatalXmtn.htm.

Hepatitis C

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV), and can be passed from an infected mother to her child during pregnancy. Overall, an infected mother will pass the infection to her baby 10% of the time, but the chances are higher in certain subgroups, such as women who are also infected with HIV16. Regular testing of pregnant women for HCV is not recommended, however, it should be considered for individuals who have risk factors known to be linked to HCV, including injection drug use. In some studies, infants born to HCV-infected women have been shown to have an increased risk for being small for gestational age, premature, and having a low birth weight15. Newborn infants with HCV infection usually do not have symptoms, and a majority will clear the infection without any medical help. Liver disease tends to move forward more slowly in children infected with hepatitis C and they respond slightly better to treatment compared to adults.

Chlamydia

Chlamydia is the most common sexually transmitted bacterium in the United States4. Although the majority of chlamydial infections do not have symptoms, pregnant women may have abnormal vaginal discharge, bleeding after sex, or itching/burning with urination. Untreated chlamydial infection has been linked to problems during pregnancy, including preterm labor, premature rupture of the membranes surrounding the baby in the uterus, and low birth weight5. The newborn may also become infected during delivery as the baby passes through the birth canal. Neonatal (newborn) infections lead primarily to eye and lung infections. All pregnant women should be tested for chlamydia at their first prenatal visit. Repeat testing in the third trimester should be done for women at high risk.

Gonorrhea

Gonorrhea is a common STD in the United States. Untreated gonococcal infection in pregnancy has been linked to miscarriages, premature birth and low birth weight, premature rupture of the membranes surrounding the baby in the uterus, and infection of the fluid that surrounds the baby during pregnancy6. Gonorrhea can also infect an infant during delivery as the infant passes through the birth canal. If untreated, infants can develop eye infections. Because gonorrhea can cause problems in both the mother and her baby, it is important to accurately identify the infection, treat with effective antibiotics, and closely follow up to make sure that the infection has been cured.

Bacterial Vaginosis

Bacterial vaginosis (BV), a common cause of vaginal discharge in women of childbearing age, is a condition in which the ‘good’ and ‘bad’ bacteria in the vagina are out of balance. BV is often not considered an STD, but it is linked to sexual activity. There may be no symptoms or a woman may complain of a foul-smelling, fishy, vaginal discharge. BV during pregnancy has been linked to serious pregnancy complications, including premature rupture of the membranes surrounding the baby in the uterus, preterm labor, premature birth, infection of the fluid that surrounds the baby, as well as infection of the mother’s uterus after delivery8. Testing all pregnant women for bacterial vaginosis is not currently recommended. However, there is some evidence to support testing and treating BV among women at high risk for preterm delivery9-11. There are no known direct effects of BV on the newborn.

Trichomoniasis

Vaginal infection due to the parasite Trichomonas vaginalis is a very common STD. Symptoms can vary widely among those women infected. Although some women report no symptoms, others complain of itching, foul odor, discharge, and bleeding after sex. Pregnant women are not usually screened for the infection. However, pregnant women with abnormal vaginal discharge should be evaluated for Trichomonas vaginalis and treated appropriately. Infection in pregnancy has been linked to premature rupture of the membranes surrounding the baby in the uterus, preterm birth, and low birth weight infants12. Rarely, the female newborn can get the infection when passing through the birth canal during delivery and have vaginal discharge after birth.

Herpes Simplex Virus

Herpes Simplex Virus (HSV) is a virus that has two distinct types, HSV-1 and HSV-2. Infections of the newborn can be of either type, but most are caused by HSV-2. Overall the symptoms of genital herpes are similar in pregnant and non-pregnant women; however, the major concern regarding HSV infection relates to complications linked to infection of the newborn. Although transmission may occur during pregnancy and after delivery, 80 - 90% of HSV infections in newborns occur when the baby passes through the mother’s infected birth canal18. HSV infection can have very serious effects on newborns, especially if the mother’s first outbreak occurred late in pregnancy (third trimester). Women who are infected for the first time in late pregnancy have a high risk of infecting their baby. Cesarean section is recommended for all women in labor with active genital herpes lesions or early symptoms, such as vulvar pain and itching19-20.

Human Papillomavirus

Human papillomaviruses (HPV) are viruses that most commonly involve the lower genital tract, including the cervix (opening to the womb), vagina, and external genitalia. Genital warts are symptoms of HPV infection that can be seen, and they frequently increase in number and size during pregnancy. Genital warts often appear as small cauliflower-like clusters which may burn or itch. If a woman has genital warts during pregnancy, treatment may be delayed until after delivery. When large or spread out, genital warts can complicate a vaginal delivery. In cases where there are large genital warts that are blocking the birth canal, a cesarean section may be recommended. Infection of the mother may be linked to the development of laryngeal papillomatosis in the newborn. This is a rare growth in the larynx (voice box) that is not cancer17.

Should pregnant women be tested for STDs?

Screening and treating pregnant women for STDs is a vital way to prevent serious health complications to both mother and baby that may otherwise happen with infection. The sooner a woman begins receiving medical care during pregnancy, the better the health outcomes will be for herself and her unborn baby. The Centers for Disease Control and Prevention’s 2010 STD Treatment Guidelines recommend screening pregnant women for STDs1. The CDC screening recommendations are incorporated into the recommendations below.

Disease CDC Recommendation
Chlamydia Screen all pregnant women at first prenatal visit; 3rd trimester rescreen if younger than 25 years of age and/or high risk group
Gonorrhea

Screen all pregnant women at risk at first prenatal visit; 3rd trimester rescreen women at continued high risk

Risk factors include: women younger than 25 years, living in a high morbidity area, previous GC infection, other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, drug use
Syphilis Screen all pregnant women at first prenatal visit; during 3rd trimester rescreen women who are at high risk for syphilis or who live in areas with high numbers of syphilis cases, and/or those who were not previously tested or had a positive test in the first trimester
Bacterial Vaginosis Test pregnant women who have symptoms or are at high risk for preterm labor
Trichomoniasis Test pregnant women with symptoms
Herpes (HSV) Test pregnant women with symptoms
HIV Screen all pregnant women at first prenatal visit; rescreening in the third trimester recommended for women at high risk for getting HIV infection
Hepatitis B

Screen all pregnant women at first prenatal visit

Retest those who were not screened prenatally, those who engage in behaviors that put them at high risk for infection and those with signs or symptoms of hepatitis at the time of admission to the hospital for delivery

Risk factors include: having had more than one sex partner in the previous six months, evaluation or treatment for an STD, recent or current injection-drug use, and an HBsAg-positive sex partner
Human Papillomavirus There is not enough evidence to make a recommendation
Hepatitis C All pregnant women at high risk should be tested at first prenatal visit

photo of woman

Pregnant women should ask their doctors about getting tested for these STDs. It is also important that pregnant women discuss any symptoms they are experiencing and any high-risk sexual behavior that they engage in, since some doctors do not routinely perform these tests. Even if a woman has been tested in the past, she should be tested again when she becomes pregnant.

Can STDs be treated during pregnancy?

STDs, such as chlamydia, gonorrhea, syphilis, trichomoniasis and BV can all be treated and cured with antibiotics that are safe to take during pregnancy. STDs that are caused by viruses, like genital herpes, hepatitis B, hepatitis C, or HIV cannot be cured. However, in some cases these infections can be treated with antiviral medications or other preventive measures to reduce the risk of passing the infection to the baby. If a woman is pregnant or considering pregnancy she should be tested so she can take steps to protect herself and her baby.

How can pregnant women protect themselves against infection?

Latex male condoms, when used consistently and correctly, can reduce the risk of getting or giving STDs and HIV. The surest way to avoid STDs and HIV is to abstain from vaginal, anal, and oral sex or to be in a long-term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.

Glossary of Terms

  • Preterm labor – Labor that starts after 20 weeks but before the end of the 37th week of pregnancy.
  • Premature birth – Birth of a baby before the 37th week of pregnancy.
  • Premature rupture of membranes – Rupture of the membranes surrounding the baby in the uterus before the start of labor.
  • Low birth weight – Birth weight of less than 5.5 pounds.
  • Miscarriage – Death of the fetus before the 20th week of pregnancy.
  • Stillbirth – Death of the fetus after the 20th week of pregnancy.
  • Gestational age – Gestation is the period of time between conception and birth during which the fetus grows and develops inside the mother’s womb. Gestational age is the time measured from the first day of the mother’s last menstrual cycle to the current date, and it is measured in weeks.

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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