Common STDs and STIs

Sexually transmitted infections

Sexually transmitted infections (STIs) are also called sexually transmitted diseases, or STDs. STIs are usually spread by having vaginal, oral, or anal sex. More than 9 million women in the United States are diagnosed with an STI each year.¹ Women often have more serious health problems from STIs than men, including infertility.

What is a sexually transmitted infection (STI)?

An STI is an infection passed from one person to another person through sexual contact. An infection is when a bacteria, virus, or parasite enters and grows in or on your body. STIs are also called sexually transmitted diseases, or STDs.

Some STIs can be cured and some STIs cannot be cured. For those STIs that cannot be cured, there are medicines to manage the symptoms.

Who gets STIs?

Nearly 20 million people in the United States get an STI each year. These infections affect women and men of all backgrounds and economic levels. But half of all new infections are among young people 15 to 24 years old.

How do STIs affect women?

Women often have more serious health problems from STIs than men:

1. Chlamydia and gonorrhea, left untreated, raise the risk of chronic pelvic pain and life-threatening ectopic pregnancy. Chlamydia and gonorrhea also can cause infertility.

2. Untreated syphilis in pregnant women results in infant death up to 40% of the time.

3. Women have a higher risk than men of getting an STI during unprotected vaginal sex. Unprotected anal sex puts women at even more risk for getting an STI than unprotected vaginal sex.

How do you get STIs?

STIs are spread in the following ways:

1. Having unprotected (without a condom) vaginal, oral, or anal sex with someone who has an STI. It can be difficult to tell if someone has an STI. STIs can be spread even if there are no signs or symptoms.

2. During genital touching. It is possible to get some STIs, such as syphilis and herpes, without having sex.

3. Through sexual contact between women who have sex only with other women

4. From a pregnant or breastfeeding woman to her baby

Can STIs cause health problems?

Yes. Each STI causes different health problems for women. Certain types of untreated STIs can cause or lead to:

1. Problems getting pregnant or permanent infertility

2. Problems during pregnancy and health problems for the unborn baby

3. Infection in other parts of the body

4. Organ damage

5. Certain types of cancer, such as cervical cancer

6. Death

Having certain types of STIs makes it easier for you to get HIV (another STI) if you come into contact with it.

What are the symptoms of STIs?

Many STIs have only mild symptoms or no symptoms at all. When women have symptoms, they may be mistaken for something else, such as a urinary tract infection or yeast infection. Get tested so that you can be treated for the correct infection.

How do I get tested for STIs?

Ask your doctor or nurse about getting tested for STIs. Your doctor or nurse can tell you what test(s) you may need and how they are done. Testing for STIs is also called STI screening.

STI testing can include:

1. Pelvic and physical exam. Your doctor looks for signs of infection, such as warts, rashes, or discharge.

2. Blood test. A nurse will draw some blood to test for an STI.

3. Urine test. You urinate (pee) into a cup. The urine is then tested for an STI.

4. Fluid or tissue sample. Your doctor or nurse uses a cotton swab to take fluid or discharge from an infected place on your body. The fluid is looked at under a microscope or sent to a lab for testing.

Find a clinic near you where you can get tested for STIs or get vaccines against hepatitis B and human papillomavirus (HPV).

Does a Pap test screen for STIs?

No. Pap testing is mainly used to look for cell changes that could be cancer or precancer. However, your doctor may test you for HPV in addition to doing the Pap test if you are older than 30.

If you want to be tested for STIs, you must ask your doctor or nurse.

Do I need to get tested for STIs?

If you are sexually active, talk to your doctor or nurse about STI testing. Which tests you will need and how often you need to get them will depend on you and your partner's sexual history.

You may feel embarrassed or that your sex life is too personal to share with your doctor or nurse. But being open and honest is the only way your doctor can help take care of you. Find out what screening tests you may need. Then talk to your doctor or nurse about what tests make sense for you.

How can I get free or low-cost STI testing?

Under the Affordable Care Act, most health insurance plans must cover the cost of STI screening or counseling at no cost to you.

1. If you have insurance, check with your insurance provider to find out what's included in your plan.

2. If you don't have insurance, find free or reduced cost testing and treatment for STIs.

3. If you have Medicare, find out how which STI tests are covered and how often.

4. If you have Medicaid, the benefits covered are different in each state, but certain benefits must be covered by every Medicaid program. Check with your state's program to find out what's covered.

For information about other services covered by the Affordable Care Act, visit HealthCare.gov.

How are STIs treated?

For some STIs, treatment may involve taking medicine by mouth or getting a shot. For other STIs that can't be cured, like herpes or HIV and AIDS, medicines can help reduce the symptoms.

If I have an STI, does my partner have it too?

Maybe. If the tests show that you have an STI, your doctor might want your partner to come in for testing. Or the doctor may give you a medicine to take home for your partner.

The STI may have spread to you or your partner from a former sex partner. This is why it is important to get tested after each new sex partner. Also, if you test positive for certain STIs (HIV, syphilis, or gonorrhea), some cities and states require you (or your doctor) to tell any past or current sex partners.

Do medicines sold over the Internet prevent or treat STIs?

No. Only use medicines prescribed or suggested by your doctor.

Some drugs sold over the Internet claim to prevent or treat STIs. And some of these sites claim their medicines work better than the medicines your doctor prescribes. But in most cases this is not true, and no one knows how safe these products are or even what is in them.

Buying prescription and over-the-counter drugs on the Internet means you may not know exactly what you're getting. An illegal Internet pharmacy may try to sell you unapproved drugs, drugs with the wrong active ingredient, drugs with too much or too little of the active ingredient, or drugs with dangerous ingredients.

How can I prevent an STI?

The best way to prevent an STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

1. Get vaccinated. There are vaccines to protect against HPV and hepatitis B.

2. Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get some STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.

3. Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.

4. Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.

5. Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.

6. Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.

7. Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

What research is being done on STIs and women?

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

1. Researchers are looking at ways to prevent STIs with vaccines and microbicides. A microbicide is a gel or a cream that can be applied inside the vagina or anus to protect against STIs, including HIV.

2. Scientists are working on vaccines to prevent HIV and herpes infections.

3. Many women do not show any signs or have any symptoms for certain STIs, or have very mild symptoms that can be mistaken for other things. Researchers are studying the reasons why many STIs have no symptoms, which can delay diagnosis.

Learn more about current research on STIs at Clinicaltrials.gov.

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

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), 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)

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

Sexually transmitted infections fact sheet (PDF, 183 KB)

Chlamydia

Chlamydia is a sexually transmitted infection (STI). Chlamydia is usually spread through vaginal, oral, or anal sex. Chlamydia is one of the most common STIs in women, especially young women ages 15 to 24. It often has no symptoms. Antibiotics can treat chlamydia. If left untreated, chlamydia can cause serious health problems for women, such as difficulty getting pregnant.

What is chlamydia?

Chlamydia is an STI that is

caused by the bacteria Chlamydia trachomatis. It is an especially serious problem for women because it can damage the female reproductive organs.

Who gets chlamydia?

Chlamydia is one of the most common STIs for women in the United States. In 2015, more than 1 million women in the United States were diagnosed with chlamydia.¹ It is most common in young women 15 to 24 years old.

How do you get chlamydia?

Chlamydia is spread through:

1. Vaginal, oral, or anal sex. Chlamydia can be spread even if there are no symptoms. This means you can get chlamydia from someone who has no symptoms.
2. Genital touching. A man does not need to ejaculate (come) for chlamydia to spread. Chlamydia can also be passed between women who have sex with women.
3. Childbirth from a mother to her baby

What are the symptoms of chlamydia?

Chlamydia is known as a "silent" infection, because most women who have chlamydia do not have symptoms. If you do have symptoms, you may not notice them until several weeks after you get chlamydia.

Symptoms may include:

1. Bleeding between periods
2. Burning when urinating
3. Fever
4. Low back pain
5. Lower abdominal pain
6. Nausea
7. Pain during sex
8. Unusual vaginal discharge

If you think you may have chlamydia, you and your sex partner(s) need to see a doctor as soon as possible.

Chlamydia that does not have any symptoms can still lead to future health problems (including not being able to get pregnant). The only way to know if you or a partner has chlamydia is to get tested.

Do I need to get tested for chlamydia?

• If you are 24 or younger and have sex, you need to get tested for chlamydia. Chlamydia is most common in women between 15 and 24 years old. You need to get tested if you have had any symptoms of chlamydia since your last negative test result or if your sex partner has chlamydia.

• If you are older than 24, you need to get tested if, in the past year or since your last test, you:

  • Had a new sex partner

  • Had your sex partner tell you they have chlamydia

  • Traded sex for money or drugs

  • Have had chlamydia or another STI in the past

  • Did not use condoms during sex and are in a relationship that is not monogamous, meaning you or your partner has sex with other people

You also need to be tested if you are pregnant or if you have any symptoms of chlamydia.

How is chlamydia diagnosed?

There are two ways that a doctor or nurse tests for chlamydia:

1. A urine test. This is the most common. You urinate (pee) into a cup. Your urine is then tested for chlamydia.
2. A swab test. Your doctor uses a cotton swab to take a fluid sample from an infected place (vagina, cervix, rectum, or throat). The fluid is then tested for chlamydia.

A Pap test is not used to detect chlamydia.

How is chlamydia treated?

Your doctor or nurse will prescribe antibiotics to treat chlamydia. Antibiotics can cure chlamydia. But they cannot fix any permanent damage done to your body, including scarring of your reproductive organs. For this reason, you should get tested and take the antibiotics as soon as possible.

For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for chlamydia with anyone. If symptoms do not go away after treatment, see your doctor or nurse.

Tell your doctor if you are pregnant. Your doctor can give you antibiotics that are safe to take during pregnancy.

What can happen if chlamydia is not treated?

Untreated chlamydia can cause serious health problems in women, including:

1. Pelvic inflammatory disease (PID), an infection of a woman's reproductive organs. PID can lead to chronic pelvic pain, pregnancy problems, and infertility (meaning you can't get pregnant). Untreated chlamydia is a common cause of PID. It affects about 10% to 15% of women with untreated chlamydia.
2. Increased risk of getting HIV (the virus that causes AIDS) from sexual activity

What should I do if I have chlamydia?

Chlamydia is easy to treat. But you need to be tested and treated as soon as possible.

If you have chlamydia:

1. See a doctor or nurse as soon as possible. Antibiotics will treat chlamydia, but they will not fix any permanent damage to your reproductive organs.
2. Take all of your medicine. Even if symptoms go away, you need to finish all of the antibiotics.
3. Tell your sex partner(s) so they can be tested and treated. If they are not tested and treated you could get chlamydia again.
4. Avoid sexual contact until you and your partner(s) have been treated and cured. Even after you finish your antibiotics, you can get chlamydia again if you have sex with someone who has chlamydia.
5. See your doctor or nurse again if you have symptoms that don't go away within a few days after finishing the antibiotics.

How does chlamydia affect pregnancy?

For pregnant women, chlamydia may lead to premature birth, or babies born before 37 weeks of pregnancy. Premature birth is the most common cause of infant death and can lead to long-term health and development problems in children.

Babies born to mothers who have chlamydia can get:

1. Infections in their eyes, called conjunctivitis (kuhn-junk-tih-VEYE-tuhss) or pinkeye. Signs include discharge from the eyes and swollen eyelids. The signs most often show up within two weeks after birth.
2. Pneumonia. Signs include congestion, cough, and rapid or labored breathing, although these are not always present. Signs most often show up one to three months after birth.

How can I prevent chlamydia?

The best way to prevent chlamydia or any STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

1. Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get chlamydia, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
2. Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
3. Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
4. Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
5. Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.
6. Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

Can women who have sex with women get chlamydia?

Yes. It is possible to get chlamydia, or any other STI, if you are a woman who has sex only with women. Chlamydia lives in the reproductive tract of an infected woman and can pass to a sex partner, whether male or female.

Talk to your partner about her sexual history before having sex, and ask your doctor or nurse for an STI test if you are at risk.

Did we answer your question about chlamydia?

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

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), 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 Sexual Health Association (link is external)
  Phone Number: 800-227-8922

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

Sources

1. Centers for Disease Control and Prevention. (2016). 2015 Sexually Transmitted Disease Surveillance, Table 4.

2. Centers for Disease Control and Prevention. 2016). 2015 Sexually Transmitted Disease Surveillance, Figure 5.

Chlamydia fact sheet (PDF, 122 KB)

Source: Office on Women's Health, HHS
 

Bacterial vaginosis

Bacterial vaginosis (BV) is a condition caused by changes in the amount of certain types of bacteria in your vagina. BV is common, and any woman can get it. BV is easily treatable with medicine from your doctor or nurse. If left untreated, it can raise your risk for sexually transmitted infections (STIs) and cause problems during pregnancy.

What is bacterial vaginosis (BV)?

Bacterial vaginosis (BV) is a condition caused by changes in the amount of certain types of bacteria in your vagina. BV can develop when your vagina has more harmful bacteria than good bacteria.

Who gets BV?

BV is the most common vaginal condition in women ages 15 to 44.¹ But women of any age can get it, even if they have never had sex.

You may be more at risk for BV if you:

• Have a new sex partner

• Have multiple sex partners

• Douche

• Do not use condoms or dental dams

• Are pregnant. BV is common during pregnancy. About 1 in 4 pregnant women get BV. The risk for BV is higher for pregnant women because of the hormonal changes that happen during pregnancy.

• Are African-American. BV is twice as common in African-American women as in white women.

• Have an intrauterine device (IUD), especially if you also have irregular bleeding

How do you get BV?

Researchers are still studying how women get BV. You can get BV without having sex, but BV is more common in women who are sexually active. Having a new sex partner or multiple sex partners, as well as douching, can upset the balance of good and harmful bacteria in your vagina. This raises your risk of getting BV.

What are the symptoms of BV?

Many women have no symptoms. If you do have symptoms, they may include:

• Unusual vaginal discharge. The discharge can be white (milky) or gray. It may also be foamy or watery. Some women report a strong fish-like odor, especially after sex.

• Burning when urinating

• Itching around the outside of the vagina

• Vaginal irritation

These symptoms may be similar to vaginal yeast infections and other health problems. Only your doctor or nurse can tell you for sure whether you have BV.

What is the difference between BV and a vaginal yeast infection?

BV and vaginal yeast infections are both common causes of vaginal discharge. They have similar symptoms, so it can be hard to know if you have BV or a yeast infection. Only your doctor or nurse can tell you for sure if you have BV.

With BV, your discharge may be white or gray but may also have a fishy smell. Discharge from a yeast infection may also be white or gray but may look like cottage cheese.

How is BV diagnosed?

There are tests to find out if you have BV. Your doctor or nurse takes a sample of vaginal discharge. Your doctor or nurse may then look at the sample under a microscope, use an in-office test, or send it to a lab to check for harmful bacteria. Your doctor or nurse may also see signs of BV during an exam.

Before you see a doctor or nurse for a test:

• Don't douche or use vaginal deodorant sprays. They might cover odors that can help your doctor diagnose BV. They can also irritate your vagina.

• Make an appointment for a day when you do not have your period.

How is BV treated?

BV is treated with antibiotics prescribed by your doctor.

If you get BV, your male sex partner won't need to be treated. But, if you are female and have a female sex partner, she might also have BV. If your current partner is female, she needs to see her doctor. She may also need treatment.

It is also possible to get BV again. Learn how to lower your risk for BV.

BV and vaginal yeast infections are treated differently. BV is treated with antibiotics prescribed by your doctor. Yeast infections can be treated with over-the-counter medicines. But you cannot treat BV with over-the-counter yeast infection medicine.

What can happen if BV is not treated?

If BV is untreated, possible problems may include:

• Higher risk of getting STIs, including HIV. Having BV can raise your risk of getting HIV, genital herpes, chlamydia, pelvic inflammatory disease, and gonorrhea. Women with HIV who get BV are also more likely to pass HIV to a male sexual partner.

• Pregnancy problems. BV can lead to premature birth or a low-birth-weight baby (smaller than 5 1/2 pounds at birth). All pregnant women with symptoms of BV should be tested and treated if they have it.

What should I do if I have BV?

BV is easy to treat. If you think you have BV:

• See a doctor or nurse. Antibiotics will treat BV.

• Take all of your medicine. Even if symptoms go away, you need to finish all of the antibiotic.

• Tell your sex partner(s) if she is female so she can be treated.

• Avoid sexual contact until you finish your treatment.

• See your doctor or nurse again if you have symptoms that don't go away within a few days after finishing the antibiotic.

Is it safe to treat pregnant women who have BV?

Yes. The medicine used to treat BV is safe for pregnant women. All pregnant women with symptoms of BV should be tested and treated if they have it.

If you do have BV, you can be treated safely at any stage of your pregnancy. You will get the same antibiotic given to women who are not pregnant.

How can I lower my risk of BV?

Researchers do not know exactly how BV spreads. Steps that might lower your risk of BV include:

• Keeping your vaginal bacteria balanced. Use warm water only to clean the outside of your vagina. You do not need to use soap. Even mild soap can cause irritate your vagina. Always wipe front to back from your vagina to your anus. Keep the area cool by wearing cotton or cotton-lined underpants.

• Not douching. Douching upsets the balance of good and harmful bacteria in your vagina. This may raise your risk of BV. It may also make it easier to get BV again after treatment. Doctors do not recommend douching.

• Not having sex. Researchers are still studying how women get BV. You can get BV without having sex, but BV is more common in women who have sex.

• Limiting your number of sex partners. Researchers think that your risk of getting BV goes up with the number of partners you have.

How can I protect myself if I am a female and my female partner has BV?

If your partner has BV, you might be able to lower your risk by using protection during sex.

• Use a dental dam every time you have sex. A dental dam is a thin piece of latex that is placed over the vagina before oral sex.

• Cover sex toys with condoms before use. Remove the condom and replace it with a new one before sharing the toy with your partner.

Did we answer your question about BV?

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

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, HHS
  Phone Number: 800-232-4636

• American College of Obstetricians and Gynecologists (link is external)
  Phone Number: 202-638-5577

• American Sexual Health Association (link is external)
  Phone Number: 919-361-8400

Bacterial vaginosis fact sheet (PDF, 168 KB)

Genital Herpes

Genital herpes is a sexually transmitted infection (STI). Genital herpes is usually spread by having vaginal, oral, or anal sex. One in five women ages 14 to 49 has genital herpes.¹ There is no cure for herpes. But you can take medicine to prevent outbreaks and to lower your risk of passing genital herpes to your partner.

What is genital herpes?

Genital herpes is an STI caused by the herpes simplex viruses type 1 (HSV-1) and type 2 (HSV-2). HSV-1 and HSV-2 cause the same symptoms, are both contagious, and are treated with the same medicine. But, they are different in some ways:

• HSV-1 most often causes infections of the mouth and lips, called cold sores or "fever blisters." Symptoms are often milder than genital herpes, and you may get fewer outbreaks. It can spread to the genital area during oral sex and cause genital herpes. If HSV-1 spreads to the genital area, it is still HSV-1.

• HSV-2 is the most common cause of genital herpes. It is spread through vaginal, oral, or anal sex. HSV-2 can spread to the mouth during oral sex. If HSV-2 spreads to the mouth or lips during oral sex, it is still HSV-2.

Who gets genital herpes?

Genital herpes is more common in women than men. One in five women ages 14 to 49 has genital herpes, compared with one in 10 men ages 14 to 49.

A woman's anatomy (body) puts her more at risk for genital herpes than men. Small tears in vaginal tissue can make it easier to get genital herpes.

Genital herpes is also much more common in African-American women. One in two African-American women between the ages of 14 and 49 is infected with HSV-2 that causes genital herpes.

How do you get genital herpes?

Genital herpes is spread through:

• Vaginal, oral, or anal sex. The herpes virus is usually spread through contact with open sores. But you also can get herpes from someone without any symptoms or sores.

• Genital touching

• Childbirth from a mother to her baby

• Breastfeeding if a baby touches an open sore

Does a cold sore on my mouth mean I have genital herpes?

No, a cold sore on your mouth usually means you have herpes simplex virus type 1 (HSV-1). You can get HSV-1 by kissing someone or sharing utensils, towels, razors, or lipstick with someone who has HSV-1.

HSV-1 cannot turn into HSV-2 (the type of genital herpes spread by sexual contact), but you can get a cold sore on your mouth from HSV-2 if you give oral sex to someone with HSV-2. Cold sores caused by HSV-1 or HSV-2 are contagious. You can spread it to other people or other parts of your body if you touch an open sore and then touch another part of your body. That means if you have a cold sore and give oral sex to someone, that person will get the herpes virus on his or her genitals.

Avoid touching your cold sore as much as possible. If you touch your cold sore, wash your hands right away to avoid spreading the infection to other parts of your body or other people.

What is the difference between genital herpes and genital warts?

Both genital herpes and genital warts are STIs, are spread through skin-to-skin contact, and are caused by a virus. But the viruses that cause genital herpes and genital warts are different:

• Herpes simplex virus (HSV) is the virus that causes genital herpes.

• Human papillomavirus (HPV) is the virus that causes genital warts.

There is no cure for either genital herpes or genital warts. But, different medicines can help manage the symptoms of herpes and treat the complications of HPV infections that can cause genital warts.

What are the symptoms of genital herpes?

Most women with genital herpes do not know they have it. But, if you get symptoms with the first outbreak of genital herpes, they can be severe. Genital herpes also can be severe and long-lasting in people whose immune systems do not work properly, such as women with HIV.

Within a few days of sexual contact with someone who has the herpes virus, sores (small red bumps that may turn into blisters) may show up where the virus entered your body, such as on your mouth or vagina. Some women might confuse mild sores for insect bites or something else. After a few days, sores become crusted and then heal without scarring. Sometimes, a second set of sores appear soon after the first outbreak, and symptoms can happen again.

The first signs of genital herpes usually show up two to 12 days after having sexual contact with someone who has herpes. Symptoms can last from two to four weeks. There are other early symptoms of genital herpes:

• Feeling of pressure in the abdomen

• Flu-like symptoms, including fever

• Itching or burning feeling in the genital or anal area

• Pain in the legs, buttocks, or genital area

• Swollen glands

• Unusual vaginal discharge

If you have any symptoms of genital herpes, see a doctor or nurse.

How is genital herpes diagnosed?

Often, your doctor can diagnose genital herpes by looking at visible sores. Your doctor or nurse may also use a cotton swab to take a fluid sample from a sore to test in a lab.

Genital herpes can be hard to diagnose, especially between outbreaks. Blood tests that look for antibodies to the herpes virus can help diagnose herpes in women without symptoms or between outbreaks.

A Pap test is not used to detect genital herpes.

How is genital herpes treated?

Herpes has no cure. But antiviral medicines can prevent or shorten outbreaks during the time you take the medicine. Also, daily suppressive therapy (for example, daily use of antiviral medicine) for herpes can lower your chance of spreading the infection to your partner.

Your doctor will either give you antiviral medicine to take right after getting outbreak symptoms or to take regularly to try to stop outbreaks from happening. Talk to your doctor about treatment options.

During outbreaks, you can take the following steps to speed healing and prevent spreading herpes to other parts of your body or to other people:

• Keep sores clean and dry.

• Try not to touch the sores.

• Wash your hands after any contact with the sores.

• Avoid all sexual contact from the time you first notice symptoms until the sores have healed.

Can genital herpes come back?

Yes. Genital herpes symptoms can come and go, but the virus stays inside your body even after all signs of the infection have gone away. The virus becomes "active" from time to time, leading to an outbreak. Some people have outbreaks only once or twice. Other people may have four or five outbreaks within a year. Over time, the outbreaks usually happen less often and are less severe.

Experts do not know what causes the virus to become active. Some women say the virus comes back when they are sick, under stress, out in the sun, or during their period.

What should I do if I have genital herpes?

If you have genital herpes:

• See a doctor or nurse as soon as possible for testing and treatment.

• Take all of the medicine. Even if symptoms go away, you need to finish all of the antiviral medicine.

• Tell your sex partner(s) so they can be tested and treated if necessary.

• Avoid any sexual contact while you are being treated for genital herpes or while you have an outbreak.

• Remember that genital herpes is a lifelong disease. Even though you may not have a genital herpes outbreak for long periods of time, you can still pass the virus to another person at any time. Talk with your doctor or nurse about how to prevent passing the virus to another person.

How does genital herpes affect pregnancy?

• If you get genital herpes during pregnancy, you can spread genital herpes to your baby during delivery.

• If you had genital herpes before pregnancy, your baby is still at risk of getting herpes, but the risk is lower.

Most women with genital herpes have healthy babies. But babies who get herpes from their mother have neonatal herpes. Neonatal herpes is a serious condition that can cause problems in a newborn baby such as brain damage, eye problems, or even death.

Can pregnant women take genital herpes medicine?

Researchers do not know if all antiviral medicines for genital herpes are safe for pregnant women. If you are pregnant, make sure you tell your doctor or nurse that you have genital herpes, even if you are not having an outbreak.

Can I breastfeed if I have genital herpes?

Yes, you can breastfeed if you have genital herpes, but not if you have a herpes sore on one of your breasts. If you have genital herpes, it is possible to spread the infection to any part of your breast, including your nipple and areola.

If you have any genital herpes sores on one or both of your breasts:

• You can keep breastfeeding as long as your baby or pumping equipment does not touch a herpes sore.

• Do not breastfeed from the breast with sores. Herpes is spread through contact with sores and can be dangerous to a newborn baby.

• Pump or hand-express your milk from the breast with sores until the sores heal. Pumping will help keep up your milk supply and prevent your breast from getting overly full and painful. You can store your milk to give to your baby in a bottle for another feeding. But if parts of your pump also touch the sore(s) while pumping, throw the milk away.

Can genital herpes cause other problems?

For most women, genital herpes does not usually cause serious health problems.

Women with HIV can have severe herpes outbreaks that are long-lasting. Herpes also may play a role in the spread of HIV. Herpes sores can make it easier for HIV to get into your body. Also, herpes can make people who are HIV-positive more likely to spread the infection to someone else.

How can I prevent genital herpes?

The best way to prevent genital herpes or any STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

• Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get some STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.

• Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.

• Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.

• Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.

• Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.

• Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

Can women who have sex with women get genital herpes?

Yes. It is possible to get genital herpes, or any other STI, if you are a woman who has sex only with women.

Talk to your partner about her sexual history before having sex, and ask your doctor or nurse about getting tested if you have signs or symptoms of genital herpes. Use a dental dam during oral sex and avoid sexual activity during an outbreak.

Did we answer your question about genital herpes?

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

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), 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)

• Herpes Resource Center, ASHA (link is external)
  Phone Number: 800-230-6039

Genital herpes fact sheet (PDF, 129 KB)

Genital warts

Genital warts are a type of sexually transmitted infection (STI) caused by the human papillomavirus (HPV). You can get genital warts through vaginal, oral, or anal sex. Genital warts appear as a small bump or group of bumps in the genital area. There is no treatment for HPV, but genital warts can be treated by your doctor.

What are genital warts?

Genital warts are a type of STI caused by the human papillomavirus (HPV). While there is no cure for HPV, you can get treated for genital warts. Genital warts appear as a small bump or group of bumps in the genital area. Some genital warts are so small you cannot see them.

Who gets genital warts?

About 400,000 Americans get genital warts each year. Researchers estimate that genital warts are more common in men.

How do you get genital warts?

Nearly all cases of genital warts are caused by HPV.

Genital warts are spread most often through direct skin-to-skin contact during vaginal or anal sex. HPV, the virus that causes genital warts, can be spread even if the person does not have any genital warts that you can see.

Rarely, genital warts are spread:

• By giving oral sex to someone who has HPV or genital warts

• By receiving oral sex from someone who has HPV or genital warts on his or her mouth, lips, or tongue

• During childbirth from a woman to her baby

What are the signs and symptoms of genital warts?

Genital warts usually appear as a small bump or group of bumps in the genital area. They are flesh-colored and can be flat or look bumpy like cauliflower. Some genital warts are so small you cannot see them.

In women, genital warts can grow:

• Inside the vagina

• On the vulva, cervix, or groin

• In or around the anus

• On the lips, mouth, tongue, or throat (this is very rare)

In men, genital warts can grow:

• On the penis

• On the scrotum, thigh, or groin

• In or around the anus

• On the lips, mouth, tongue, or throat (this is very rare)

Genital warts can cause itching, burning, and discomfort. Talk to your doctor if you think you have genital warts.

How long does it take for genital warts to appear?

Warts usually appear within months after having sexual contact with someone with the HPV types that cause genital warts. Sometimes the warts appear in just days or weeks, while other people do not show genital warts until years later. Some people may get HPV but never get genital warts.

How are genital warts treated?

There is no cure for HPV, but genital warts can be removed. If you decide to have warts removed, do not use over-the-counter medicines meant for other kinds of warts. There are special, prescription-only treatments for genital warts. Your doctor or nurse must prescribe the medicine for you.

Your doctor or nurse may apply a chemical to treat the warts in the doctor's office, or prescribe a cream for you to apply at home. Surgery is also an option. Your doctor may:

• Use an electric current to burn off the warts

• Use a light/laser to destroy warts

• Freeze off the warts

• Cut out the warts

Treatment can only remove the genital wart. Treatment does not cure HPV, the virus that causes genital warts.

Do I have to treat genital warts?

No. Some people choose not to treat genital warts. If left untreated, genital warts may go away, stay the same, or grow in size and number. Genital warts will not turn into cancer.

Even if you treat the genital warts, you can still spread genital warts and HPV, the virus that causes genital warts, to other people. Doctors do not know how long you are contagious after warts appear.

Could I still have HPV if I get my genital warts removed?

Yes. Even when warts are treated, you may still have HPV. This is why warts can come back after treatment. You can still spread HPV to other people after genital warts are removed.

How do genital warts affect pregnancy?

If you had genital warts that went away on their own or were treated, you will probably not have any problems during your pregnancy. Tell your doctor or nurse if you or your partner has ever had genital warts.

Genital warts in women during pregnancy might:

• Bleed and grow (in size and number) due to hormonal changes in the body during pregnancy.

• Block the birth canal. If this happens, you may need a cesarean section (C-section) delivery.

• Expose babies to HPV types that cause warts in the babies' airways. This very rare condition is called recurrent respiratory papillomatosis.

How can I prevent genital warts?

The best way to prevent genital warts or any STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

• Get vaccinated. The FDA recently approved one HPV vaccine (Gardasil 9) that protects against HPV types that cause most genital warts.

• Use condoms. Condoms are the best way to prevent STIs when you have sex. Make sure to put the condom on before the penis touches the vagina, mouth, or anus. HPV, the virus that causes genital warts, can infect areas that are not covered by a condom. You can get genital warts from direct skin-to-skin contact. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.

• Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.

• Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.

• Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.

• Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.

• Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

Can women who have sex with women get genital warts?

Yes. It is possible to get genital warts, or any other STI, if you are a woman who has sex only with women.

Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of genital warts.

Did we answer your question about genital warts?

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

Genital warts (PDF, 124 KB)

Gonorrhea

Gonorrhea is a sexually transmitted infection (STI). It is usually spread by having vaginal, oral, or anal sex. In 2014, gonorrhea affected more than 162,000 women in the United States.¹ Antibiotics can treat gonorrhea. If left untreated, it can cause serious health problems, including problems getting pregnant.

What is gonorrhea?

Gonorrhea is an STI that is caused by the bacteria Neisseria gonorrhoeae. It is an especially serious problem for women because it can damage the female reproductive organs.

Who gets gonorrhea?

In 2014, gonorrhea affected more than 162,000 women in the United States.¹ Gonorrhea most often affects women ages 15 to 24. But, gonorrhea is becoming more common in older women too.¹

How do you get gonorrhea?

Gonorrhea is spread through:

• Vaginal, oral, or anal sex. Gonorrhea can be spread even if there are no symptoms. This means you can get gonorrhea from someone who has no signs or symptoms.

• Genital touching. A man does not need to ejaculate (come) for gonorrhea to spread. Touching infected fluids from the vagina or penis and then touching your eyes can cause an eye infection. Gonorrhea can also be passed between women who have sex with women.

• Childbirth from woman to her baby

What are the signs and symptoms of gonorrhea?

Most women with gonorrhea do not have any signs or symptoms. If you do get symptoms, they are often mild and can be mistaken for a bladder or vaginal infection.

Signs or symptoms of gonorrhea depend on where you are first infected by the gonorrhea bacteria.

Signs and symptoms in the genital area can include:

• Pain or burning when urinating

• More vaginal discharge than usual

• Vaginal discharge that looks different than usual

• Bleeding between periods

• Pain in the pelvis or abdomen

Signs and symptoms in other parts of the body include:

• Rectum/anus: anal itching, pus-like discharge, bright red blood on toilet tissue, or painful bowel movements

• Eyes: pain, itching, sensitivity to light, pus-like discharge

• Throat: sore throat, swollen glands in your neck

• Joints (such as your knee): warmth, redness, swelling, or pain while moving

Gonorrhea can cause serious health problems, even if you do not have any signs or symptoms.

Do I need to get tested for gonorrhea?

• If you are 24 or younger and have sex, you need to get tested for gonorrhea. Gonorrhea is most common in women between ages 15 and 24.² You need to get tested if you have had any symptoms of gonorrhea since your last negative test result or if your sex partner has gonorrhea.

• If you are older than 24, you need to get tested if, in the past year or since your last test, you:²

  • Had a new sex partner

  • Had your sex partner tell you they have gonorrhea

  • Have had gonorrhea or another STI in the past

  • Traded sex for money or drugs in the past

  • Do not use condoms during sex and are in a relationship that is not monogamous, meaning you or your partner has sex with other people

You also need to get tested if you have any symptoms of gonorrhea.

Testing is very important, because women with untreated gonorrhea can develop serious health problems. If you are tested for gonorrhea, you also need to get tested for other STIs, including chlamydia, syphilis, and HIV.

How is gonorrhea diagnosed?

There are two ways that a doctor or nurse tests for gonorrhea:

• A urine test. This is the most common. You urinate (pee) into a cup. Your urine is then tested for gonorrhea.

• A swab test. Your doctor or nurse uses a cotton swab to take a fluid sample from an infected place (cervix, rectum, or throat). The fluid is then tested for gonorrhea.

A Pap test is not used to detect gonorrhea.

How is gonorrhea treated?

Your doctor or nurse will give you antibiotics to treat gonorrhea. The antibiotics are usually a pill you swallow.

Although antibiotics can cure gonorrhea, they cannot fix any permanent damage done to your body. For this reason, it is important to get tested and to take the antibiotics as soon as possible.

For the antibiotics to work, you must finish all of the antibiotics that your doctor gives you, even if the symptoms go away. Do not share your antibiotics for gonorrhea with anyone. If symptoms do not go away after treatment, see your doctor or nurse. It is possible to get gonorrhea again if you have sex with someone who has gonorrhea. Tell your recent sex partner(s) so they can be tested and treated.

What can happen if gonorrhea is not treated?

Gonorrhea that is not treated can cause serious health problems in women:

• Pelvic inflammatory disease (PID), an infection of a woman's reproductive organs. PID can lead to chronic pelvic pain, pregnancy problems, and infertility, meaning you can't get pregnant. Untreated gonorrhea is a common cause of PID.

• Higher risk of getting HIV or spreading HIV

• Although it does not happen very often, gonorrhea can cause widespread infection in other parts of the body, such as the blood, joints, heart, or brain. This can lead to death.

What should I do if I have gonorrhea?

Gonorrhea is easy to treat. But you need to get tested and treated as soon as possible.

If you have gonorrhea:

• See a doctor or nurse as soon as possible. Antibiotics will treat gonorrhea, but they will not fix any permanent damage to your reproductive organs.

• Take all of the antibiotics. Even if symptoms go away, you need to finish all of the antibiotics.

• Tell your sex partner(s) so they can be tested and treated. If they are not tested and treated you could get gonorrhea again.

• Avoid sexual contact until you and your partner(s) have been treated and cured. Even after you finish your antibiotics, you can get gonorrhea again if you have sex with someone who has gonorrhea.

• See your doctor or nurse again if you have symptoms that don't go away within a few days after finishing the antibiotics.

How does gonorrhea affect pregnancy?

For pregnant women, untreated gonorrhea raises the risk of:

• Miscarriage

• Premature birth (babies born before 37 weeks of pregnancy). Premature birth is the most common cause of infant death and can lead to long-term health and developmental problems in children.

• Low birth weight

• Water breaking too early. This can lead to premature birth.

Babies born to infected mothers are at risk for:

• Blindness. Treating the newborn's eyes with medicine right after birth can prevent eye infection. The U.S. Preventive Services Task Force strongly recommends — and most states require by law — that all babies be treated with medicated eye ointments soon after birth.⁵

• Joint infection

• Life-threatening blood infection

Treatment of gonorrhea as soon as it is found in pregnant women will lower the risk of these problems for both mother and baby. Your baby will get antibiotics if you have gonorrhea or if your baby has a gonorrheal eye infection.

How can I prevent gonorrhea?

The best way to prevent gonorrhea or any STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

• Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get gonorrhea, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.

• Get tested. Be sure you and your partner are tested for STIs. Talk to each other about your test results before you have sex.

• Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.

• Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.

• Do not douche. Douching removes some of the normal bacteria in the vagina, and may increase your risk of getting STIs.

• Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

Can women who have sex with women get gonorrhea?

Yes. It is possible to get gonorrhea, or any other STI, if you are a woman who has sex only with women.

Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of gonorrhea.

Did we answer your question about gonorrhea?

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

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), 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 Sexual Health Association (link is external)
  Phone Number: 800-227-8922

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

Gonorrhea (PDF, 123 KB)

Viral hepatitis

Hepatitis is inflammation of the liver. In the United States, viral hepatitis is usually caused by the hepatitis A, B, or C virus. Different types of hepatitis are spread different ways, including having sex, sharing needles, or eating unclean food. Sometimes, viral hepatitis goes away on its own. In others, the virus is life long and can lead to serious health problems. Vaccines can prevent hepatitis A and B, but not C. There are medicines to treat and sometimes cure hepatitis B and C.

What is viral hepatitis?

Viral hepatitis (HEP-uh-TY-tiss) is inflammation of the liver caused by the hepatitis virus. Inflammation happens when your immune system senses a danger, like a virus, and sends white blood cells to surround the area to protect your body. This causes redness, swelling, and sometimes pain.

Hepatitis damages the liver and can cause scarring of the liver, called cirrhosis (sur-ROH-siss). Cirrhosis can cause liver cancer, liver failure, and death. Your liver changes the food you eat into energy. It also cleans alcohol and other toxins from your blood, helps your stomach and intestines digest food, and makes proteins that your body needs to control and stop bleeding.

What are the different types of viral hepatitis?

The most common types of viral hepatitis in the United States are:

• Hepatitis A

• Hepatitis B

• Hepatitis C

Learn about other types of hepatitis.

Does viral hepatitis affect women differently than men?

Yes, certain types of viral hepatitis affect women differently than men.

Hepatitis A affects women and men in similar ways.

Hepatitis B affects women differently than men:

• Birth control. Women with severe liver damage may not be able to use birth control. This is because a damaged liver may have problems breaking down estrogen.

• Pregnancy. The risk of passing hepatitis B to your baby during pregnancy is high. Hepatitis B raises your risk for pregnancy complications. Talk to your doctor about taking hepatitis B medicine to lower the risk of passing hepatitis B to your baby. Certain hepatitis B medicines are safe to take during pregnancy but are not recommended for everyone. Learn more about hepatitis B during pregnancy. [PDF , 839 KB]

Hepatitis C affects women differently than men:

• Younger women. Research shows that acute (short-term) hepatitis C goes away on its own more often for younger women than men. Also, in women with chronic hepatitis C, liver damage usually happens more slowly than it does for men. Researchers think the hormone estrogen may help protect the liver from damage.

• Menstrual cycles. You may miss menstrual periods or have shorter periods. This can happen as a side effect of hepatitis medicines. Since hepatitis C is spread through blood, the risk of passing hepatitis C to a partner is higher during your menstrual period.

• Birth control. Women with severe liver damage may not be able to use birth control that contains estrogen. This is because a damaged liver may have problems breaking down estrogen.

• Pregnancy. Experts think the risk of passing hepatitis C to your baby during pregnancy is low. But hepatitis C raises your risk for pregnancy complications such as premature birth and gestational diabetes. Some hepatitis C medicines can also cause serious harm to your baby if taken during pregnancy.

• Menopause. Liver damage happens more quickly for women after menopause. Hepatitis C medicines also may not work as well for women after menopause as they do for men.

Who gets viral hepatitis?

Viral hepatitis is common in the United States and affects women and men. Hepatitis B and C are more common than hepatitis A. 

• In 2015, hepatitis A affected an estimated 2,500 Americans. The percentage of people with hepatitis A has gone down by 95% since the hepatitis A vaccine became available in 1995.

• Chronic hepatitis B may affect more than 1 million Americans. Asian-Americans and Pacific Islanders have the highest rates of hepatitis B infection. About 50% of the people living with Hepatitis B are Asian-Americans and Pacific Islanders.

Within this high-risk group, hepatitis B is usually passed from a mother to her baby during pregnancy. Babies born with hepatitis B are likely to have it their entire lives and are at higher risk of liver damage and liver cancer.

• Hepatitis C is the most common type of viral hepatitis infection in the United States. An estimated 3.5 million Americans have chronic hepatitis C. The CDC recommends that everyone born between 1945 and 1965 (also called baby boomers) get tested at least once for hepatitis C because it is so common in this age group.

How do you get hepatitis A?

Hepatitis A is found in an infected person’s stool (poop).

Hepatitis A is spread through:

• Eating or drinking contaminated food or water

  • You can get hepatitis A by eating food prepared by a person with the virus who didn’t wash his or her hands after using the bathroom and then touched the food.

  • You can get hepatitis A by eating raw or undercooked shellfish that came from sewage-contaminated water.

• Vaginal, oral, or anal sex. Hepatitis A can be spread even if the infected person has no symptoms.

• Touching unclean diaper changing areas or toilets. If an infant or toddler had hepatitis A and soiled the changing area, others who come into contact with the stool could become infected.

You are more likely to get hepatitis A if you travel out of the country to a developing country with poor sanitation or without access to clean water and have not gotten vaccinated for hepatitis A. Ask your doctor if you need a hepatitis A vaccination.

How do you get hepatitis B?

Hepatitis B is found in an infected person’s blood and other body fluids, such as semen and vaginal fluid.

Hepatitis B is usually spread through:

• Vaginal, oral, or anal sex. This is the most common way hepatitis B is spread. Hepatitis B can be spread even if the infected person has no symptoms.

• Birth to a mother who has hepatitis B

• Sharing or reusing needles, syringes, and drug preparation equipment such as cookers and cotton when injecting drugs. Hands or drug preparation equipment that have even tiny amounts of blood on them can spread hepatitis B.

• Accidental needle stick or other sharp instrument injury (higher risk for health care workers)

A less common way to spread hepatitis B is through pre-chewed food to a baby from a mother who has hepatitis B.  However, hepatitis B cannot be spread through breastfeeding.

How do you get hepatitis C?

Hepatitis C is found in an infected person’s blood and other body fluids.

Hepatitis C is usually spread through:

• Sharing or reusing needles, syringes, and drug preparation equipment such as cookers and cotton when injecting drugs. This is the most common way hepatitis C is spread in the United States. Hands or drug preparation equipment that have even tiny amounts of blood on them can also spread hepatitis C.

• Accidental needle stick or other sharp instrument injury (higher risk for health care workers)

Less common ways to spread hepatitis C

• Vaginal, oral, or anal sex

• Birth to a mother who has hepatitis, though this is rare

• Sharing personal items like razors and toothbrushes  

• Tattoos or body piercings

• Blood transfusions done in the United States before the 1990s (when hepatitis C testing began) or in other parts of the world where hepatitis C testing is less common

What are the symptoms of viral hepatitis?

The symptoms of viral hepatitis are similar for all types of hepatitis. They include:

• Low-grade fever (a temperature between 99.5°F and 101°F)

• Fatigue (tiredness)

• Loss of appetite

• Upset stomach

• Vomiting

• Stomach pain

• Dark urine

• Clay-colored bowel movements

• Joint pain

• Jaundice (JAWN-diss), which is when the skin and whites of the eyes turn yellow

People who are newly infected are most likely to have one or more of these symptoms, but some people with viral hepatitis do not have any symptoms. New hepatitis A infections usually cause symptoms, but as many as half the people with new hepatitis B and hepatitis C infections do not have symptoms.

Certain blood tests can show if you have hepatitis, even if you do not have symptoms. People with chronic hepatitis B or C often develop symptoms when their liver becomes damaged.

Do I need to get tested for hepatitis A?

Maybe. If you have symptoms of viral hepatitis, talk to your doctor or nurse about getting tested for hepatitis A.

Do I need to get tested for hepatitis B?

Maybe. All pregnant women need to be tested for hepatitis B during their first trimester of pregnancy. Also, about half the people with hepatitis B have symptoms after infection. This means you might have the infection without knowing it.

The U.S. Preventive Services Task Force recommends getting tested for hepatitis B if you are at high risk of infection:

• You were born in an area with medium or high rates of hepatitis B infection. Those areas are colored medium and dark blue on this map of hepatitis B around the world (PDF – 166 KB) from the CDC.

• Your parents were born in one of the high-risk areas, and you were not vaccinated against hepatitis B as a baby

• You live with, have sex with, or share needles with someone who has hepatitis B

• You have ever had sex with more than one partner and did not use a condom

• You inject drugs

• You receive dialysis

• You get medical treatments that weaken your immune system

• You have HIV 

Do I need to get tested for hepatitis C?

Maybe. Most people with hepatitis C don’t have any symptoms. This means you might have the infection without knowing it. The CDC recommends hepatitis C testing for some women without symptoms.

Ask your doctor about getting tested for hepatitis C if:

• You were born between 1945 and 1965

• You have ever injected drugs, even once

• You had a blood transfusion or organ transplant before 1992

• You received clotting factors made before 1987

• You have sex with or share needles with someone who has hepatitis C

• You have been on dialysis

• Your liver test results were not normal

• You have HIV

Why do all baby boomers need to be tested for viral hepatitis?

The CDC recommends that all Americans born between 1945 and 1965 (called baby boomers) get a one-time test for hepatitis C. This is because three in four adults with hepatitis C are baby boomers, and most baby boomers do not know they have it.

It’s likely that many baby boomers with hepatitis C were infected many years ago before the blood supply was tested for hepatitis C.

How is viral hepatitis diagnosed?

Talk to your doctor if you have symptoms of viral hepatitis. Your doctor will:

• Ask questions about your health history

• Do a physical exam

• Order blood tests that look for parts of the virus or antibodies that your body makes in response to the virus. Other tests may measure the amount of the virus in your blood.

How do I know if I have acute or chronic viral hepatitis?

Hepatitis A, B, and C all start out as an acute (short-term) infection. Some acute infections can develop into lifelong, chronic infections. Your doctor may do a blood test to see if the infection is acute or chronic.

• Hepatitis A causes acute infection only. Most people recover with no lasting health problems.

• Hepatitis B and C can cause both acute and chronic infections. Some people recover from the acute infection and cannot spread the infection to others. For other people, the infection develops into a chronic infection and can be spread to others.

How is acute (short-term) viral hepatitis treated?

Acute viral hepatitis usually goes away on its own. Hepatitis A causes only acute infection, but hepatitis B and C often cause chronic or lifelong infection. If you have acute hepatitis A, B, or C, you may feel sick for a few months before you get better.

Your doctor may recommend rest and making sure you get enough fluids. Avoid alcohol and certain medicines, like the pain reliever acetaminophen, because they can damage the liver during this time. Some people with acute viral hepatitis need to be hospitalized to manage the symptoms.

If you think you have hepatitis, go to the doctor right away.

How is chronic (long-term) viral hepatitis treated?

If you have chronic viral hepatitis, your treatment depends on the type of hepatitis you have:

• Hepatitis B. You will probably meet with your doctor regularly, every six to 12 months, to watch for signs of liver disease and liver cancer. If you plan to become pregnant in the future, talk to your doctor first. You may need antiviral medicines to treat hepatitis B, but many people do not need medicine. The Food and Drug Administration (FDA) has a list of approved medicines to treat hepatitis B.

• Hepatitis C. If you have hepatitis C, talk with your doctor about whether you need medicine. Recently approved antiviral medicines treat and may cure hepatitis C in adults. The FDA has a list of approved medicines to treat hepatitis C. If you have health insurance, ask about your copay or coinsurance and which medicines are covered under your plan.

What can happen if viral hepatitis is not treated?

Most people recover from hepatitis A with no treatment or long-lasting health problems.

Chronic hepatitis B and C can lead to serious health problems, such as:

1. Cirrhosis, or scarring of the liver
2. Liver cancer
3. Liver failure

People with liver failure may need a liver transplant to survive. In the United States, cirrhosis caused by chronic hepatitis C is currently the most common reason for needing a liver transplant. Viral hepatitis is also the most common cause of liver cancer.

What should I do if I think I have been exposed to viral hepatitis?

Call your doctor or your local or state health department if you think you may have been exposed.

• If you may have been exposed to hepatitis A or B, your doctor may recommend getting a vaccine (shot) to keep you from getting the infection.

• The CDC recommends that people who are exposed to hepatitis C, such as a health care worker after an accidental needle stick, get tested for hepatitis C infection. New antiviral medicines for hepatitis C cure most of the people who take them. If you have health insurance, ask about your copay and coinsurance and which medicines are covered under your plan.

How does viral hepatitis affect pregnancy?

Hepatitis B and C can cause problems during pregnancy and can be passed to your baby. The risk of passing the virus to your baby is higher with hepatitis B than C.

Research shows that pregnant women with hepatitis B or C may have a higher risk for certain pregnancy complications:

• Gestational diabetes 

• Low-birth-weight baby (less than 5 ½ pounds)

• Premature birth (also called preterm birth, or babies born before 37 weeks of pregnancy). Premature birth is the leading cause of infant death and raises the risk of health and developmental problems at birth and later in life.

Talk to your doctor if you think you may be pregnant or plan to become pregnant. Some antiviral medicines that treat hepatitis C, such as ribavirin, can cause serious birth defects if taken during pregnancy. 

I have viral hepatitis and am pregnant. Will my baby get the virus?

Maybe. Hepatitis B and C can be passed from a pregnant woman to her baby during childbirth.

• If you have hepatitis B, the risk of passing the infection to your baby is higher than if you have hepatitis C. Make sure your baby gets HBIG (hepatitis B immune globulin) and the first shot of hepatitis B vaccine within 12 hours of birth. Your baby will need two or three more shots of the vaccine over the next 1 to 15 months to help keep them from getting hepatitis B. The timing and total number of shots will depend on the type of vaccine and your baby’s age and weight. All babies should be vaccinated for hepatitis B. Talk to your doctor.

The hepatitis B vaccine is very important. Babies who become infected with hepatitis B have a 90% chance of developing chronic (long-term) hepatitis B. One in four people infected at birth will die of hepatitis B-related causes such as liver cancer or liver failure. Your doctor will test your baby after the last shot to make sure he or she is protected from the disease.

• If you have hepatitis C, the risk of passing the virus to your baby is believed to be low, but it is still possible. The only way to know if your baby becomes infected is by doing a test. The CDC recommends testing a child after he or she turns 18 months old. Most infants infected with hepatitis C at birth have no symptoms and do well during childhood.

Can I breastfeed my baby if I have viral hepatitis?

Yes, you can breastfeed your baby if you have viral hepatitis. You cannot pass viral hepatitis through breastmilk.

But, if you have hepatitis C and your nipple or the surrounding skin is cracked or bleeding, stop nursing your baby on that breast until the sores heal. You can pump or hand-express your milk from that breast until it heals. Throw any breastmilk from that breast away, because it might have been contaminated with hepatitis C from the cracked or bleeding skin.

Pumping the breast that is cracked or bleeding will help keep up your milk supply and prevent the breast from getting overly full and painful. You can feed your baby your milk from your healthy breast.

How can I prevent viral hepatitis?

You can lower your risk of getting viral hepatitis with the following steps. The steps work best when used together. No single step can protect you from every kind of viral hepatitis.

Steps to lower your risk of viral hepatitis:

• Get vaccinated. Getting vaccinated is the best way to prevent hepatitis A and B. There is no vaccine for hepatitis C. The hepatitis A and hepatitis B vaccines are recommended for anyone who wants protection from the viruses and for people with certain risk factors and health problems. Ask your doctor if you need the vaccines.

• Wash your hands after using the bathroom and changing diapers and before preparing or eating food.

• If you have sex, use condoms. Condoms lower your risk of getting or passing sexually transmitted infections (STIs), including viral hepatitis. Viral hepatitis can be passed through menstrual blood, vaginal fluid, and semen (cum). Make sure to put the condom on before the penis touches your vagina, mouth, or anus. Other methods of birth control like birth control pills, shots, implants, or diaphragms, will not protect you from viral hepatitis.

• Limit your number of sex partners. Your risk of getting viral hepatitis goes up with the number of lifetime sex partners you have.

• If you use needles or syringes for any reason, do not share them with others.

• Do not share personal items that could have blood on them, such as razors, nail clippers, toothbrushes, or glucose monitors.

• Do not get tattoos or body piercings from an unlicensed person or facility.

• Wear protective gloves if you have to touch another person’s blood.

• If you are a health care or public safety worker, get vaccinated for hepatitis A and B, and always follow recommended standard precautions and infection-control principles, including safe injection practices.

Do I need the viral hepatitis vaccines?

Maybe. The hepatitis A and B vaccines can protect you from getting infected. Talk to your doctor or nurse about getting the recommended vaccines.

There is no vaccine yet to prevent hepatitis C. But you can take other steps to lower your risk of getting hepatitis C.

Who should get the hepatitis A vaccine?

The hepatitis A vaccine is given in two doses, six to 18 months apart. Two doses are needed for lasting protection.

The vaccine is recommended for:

• All children, starting at 1 year (12 to 23 months old)

• Men who have sex with men

• People who travel or work in a part of the world where hepatitis A is common, such as certain parts of Central or South America, Asia, Africa, and eastern Europe. See the CDC’s Traveler’s Health Information.

• People who use illegal drugs

• People who are treated with clotting factor concentrates, such as people with hemophilia (HEE-moh-FIL-ee-uh)

• People with chronic liver disease

• People who work with hepatitis A in a laboratory or with hepatitis A–infected primates

• Members of households planning to adopt a child, or care for a newly arriving adopted child, from a country where hepatitis A is common. See the CDC’s Traveler’s Health information page for international adoptions.

Who should get the hepatitis B vaccine?

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

• All children at birth

• All children and teens younger than 19 who have not been vaccinated

• Men who have sex with men

• People who live with or have sex with someone who is infected with hepatitis B

• People with more than one sex partner

• People who share equipment to inject drugs

• People with chronic liver or kidney disease

• People with HIV

• People younger than 60 with diabetes

• People whose jobs expose them to human blood or other body fluids

• Residents and staff of facilities for people with developmental disabilities

• People who travel to parts of the world where hepatitis B is common, such as Southeast Asia, sub-Saharan Africa, the Amazon Basin in South America, the Pacific Islands, parts of Eastern Europe, and parts of the Middle East. See the CDC’s Traveler’s Health information page. 

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

During your lifetime, you need:

• One series of the hepatitis A vaccine (two shots given at least 6 months apart)

• One series of the hepatitis B vaccine (three or four shots given over a 6-month period)

Most people don’t need a booster dose of either vaccine. But if you have had dialysis, a medical procedure to clean your blood, or have a weakened immune system, your doctor might recommend additional doses of the hepatitis B vaccine.

How can I get free or low-cost hepatitis A and B vaccines?

The hepatitis A and hepatitis B vaccines are covered under most insurance plans.

• If you have insurance, check with your insurance provider to find out what’s included in your plan.

• Medicare Part B covers hepatitis B vaccines for people at risk.

• If you have Medicaid, the benefits covered are different in each state. Check with your state's program.

Viral hepatitis (PDF, 90 KB)

Learn more about hepatitis

• Watch a video. Learn who is at risk for hepatitis C and what you need to know with this video (link is external) from the Food and Drug Administration.

• Find out your risk. Take the CDC’s 5-minute Hepatitis Risk Assessment to get personalized recommendations about vaccines you may need.

Source: Office on Women's Health, HHS

Trichomoniasis

Trichomoniasis (TRIK-uh-muh-NEYE-uh-suhss) or "trich" is a sexually transmitted infection (STI) caused by a parasite. The parasite is spread most often through vaginal, oral, or anal sex. It is one of the most common STIs in the United States and affects more women than men. It is treated easily with antibiotics, but many women do not have symptoms. If left untreated, trichomoniasis can raise your risk of getting HIV.

What is trichomoniasis?

Trichomoniasis is an STI caused by a parasite. It is one of the most common STIs in the United States.¹

Who gets trichomoniasis?

Trichomoniasis is more common in women than men. It affects more than 2 million women ages 14 to 49 in the United States.

Trichomoniasis affects more African-American women than white and Hispanic women. The risk for African-American women goes up with age and lifetime number of sex partners.

How do you get trichomoniasis?

Trichomoniasis is spread through:

• Vaginal, oral, or anal sex. Trichomoniasis can be spread even if there are no symptoms. This means you can get trichomoniasis from someone who has no signs or symptoms.

• Genital touching. A man does not need to ejaculate (come) for trichomoniasis to spread. Trichomoniasis can also be passed between women who have sex with women.

What are the symptoms of trichomoniasis?

Most infected women have no symptoms. If you do get symptoms, they might appear five to 28 days after exposure and can include:

• Irritation and itching in the genital area

• Thin or frothy discharge with an unusual foul odor that can be clear, white, yellowish, or greenish

• Discomfort during sex and when urinating

• Lower abdominal pain (this is rare)

If you think you may have trichomoniasis, you and your sex partner(s) need to see a doctor or nurse as soon as possible.

How is trichomoniasis diagnosed?

To find out whether you have trichomoniasis, your doctor or nurse may:

• Do a pelvic exam

• Use a cotton swab to take a fluid sample from your vagina to look for the parasite under a microscope

• Do a lab test, such as a DNA test or a fluid culture. A culture tests uses urine or a swab from your vagina. The parasite then grows in a lab. It takes up to a week for the parasite to grow enough to be seen.

A Pap test is not used to detect trichomoniasis.

If you have trichomoniasis, you need to be tested for other STIs too.

How is trichomoniasis treated?

Trichomoniasis is easily cured with one of two antibiotics:

• Metronidazole (me-truh-NYD-uh-zohl)

• Tinidazole (teye-NID-uh-zohl)

These antibiotics are usually a pill you swallow in a single dose.

If you are treated for trichomoniasis, your sex partner(s) needs to be treated too. Do not have sex until you and your sex partner(s) finish taking all of the antibiotics and have no symptoms.

What can happen if trichomoniasis is not treated?

Most people with trichomoniasis have no symptoms and never know they have it. Even without symptoms, it can be passed to others.

If you have trichomoniasis, you are at higher risk of getting HIV (the virus that causes AIDS) if you are exposed to HIV. If you are HIV-positive, having trichomoniasis also raises your risk of passing HIV to your sex partner(s). The Centers for Disease Control and Prevention recommends that women with HIV get screened for trichomoniasis at least once a year.

What should I do if I have trichomoniasis?

Trichomoniasis is easy to treat. But you need to be tested and treated as soon as possible.

If you have trichomoniasis:

• See a doctor or nurse as soon as possible. Antibiotics will treat trichomoniasis.

• Take all of your medicine. Even if symptoms go away, you need to finish all of the antibiotics.

• Tell your sex partner(s) so they can be tested and treated.

• Avoid sexual contact until you and your partner(s) have been treated and cured. Even after you finish your antibiotics, you can get trichomoniasis again if you have sex with someone who has trichomoniasis.

• See your doctor or nurse again if you have symptoms that don't go away within a few days after finishing the antibiotics.

How does trichomoniasis affect pregnancy?

Pregnant women with trichomoniasis are at higher risk of premature birth (babies born before 37 weeks of pregnancy) or a low-birth-weight baby (less than 5 1/2 pounds). Premature birth and a low birth weight raise the risk of health and developmental problems at birth and later in life.

The antibiotic metronidazole can be used to treat trichomoniasis during any stage of pregnancy. Talk to your doctor about the benefits and risks of taking any medicine during pregnancy.

Can I take medicine for trichomoniasis if I am breastfeeding?

You can take the antibiotic metronidazole if you are breastfeeding. Your doctor may suggest waiting 12 to 24 hours after taking metronidazole before breastfeeding. Do not take tinidazole if you are breastfeeding.

How can I prevent trichomoniasis?

The best way to prevent trichomoniasis or any STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

• Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get trichomoniasis, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.

• Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.

• Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.

• Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.

• Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.

• Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

Can women who have sex with women get trichomoniasis?

Yes. It is possible to get trichomoniasis, or any other STI, if you are a woman who has sex only with women.

Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have signs or symptoms of trichomoniasis.

Did we answer your question about trichomoniasis?

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

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), 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 Sexual Health Association (link is external)
  Phone Number: 800-227-8922

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

Sources

1. Centers for Disease Control and Prevention. (2017). Trichomoniasis – CDC Fact Sheet.

2. Centers for Disease Control and Prevention. (2017). Trichomoniasis Statistics

3. Centers for Disease Control and Prevention. (2016). 2015 Sexually Transmitted Diseases Treatment Guidelines; Diseases Characterized by Vaginal Discharge; Trichomoniasis.

Trichomoniasis fact sheet (PDF, 165 KB)

Syphilis

Syphilis is a sexually transmitted infection (STI). It is spread by vaginal, oral, or anal sex. A pregnant woman can also spread syphilis to her baby. Syphilis is easy to treat with medicine in the early stages. But without treatment, syphilis progresses to a late stage and can damage your body's organs, leading to severe illness and even death.

What is syphilis?

Syphilis is an STI caused by bacteria.

Who gets syphilis?

Syphilis is more common in men than women. In 2015, of the almost 24,000 people in the United States diagnosed in the first or second stage of syphilis, more than 2,200 were women. This number has gone up since 2014.¹ But, women with syphilis who are pregnant are at high risk for passing syphilis to their unborn babies. Untreated syphilis can cause stillbirth (babies who are born dead) or infant death soon after birth.

How do you get syphilis?

Syphilis is spread:

• Through direct contact with a syphilis sore or rash during vaginal, oral, or anal sex. Sores can be on or in the external genitals, vagina, anus, or rectum. They can also be on the lips or tongue or other parts of the body.

• From a mother to her baby during pregnancy, childbirth, or breastfeeding

What are the different stages of syphilis?

Syphilis has four stages:

1. Primary stage

2. Secondary stage

3. Inactive (latent) stage

4. Late (tertiary) stage

Each stage of syphilis has different symptoms. A person with syphilis can pass it to others during the primary and secondary stages.

What happens during the first (primary) stage of syphilis?

A sore appears in the first, or primary, stage. Sometimes, more than one sore appears. The time between infection with syphilis and the appearance of the sore can range from 10 to 90 days (average time is three weeks).

The sore is usually firm, round, small, and painless. It appears at the spot where the infection entered your body. In women this can include the vulva, vagina, cervix, anus, rectum, tongue, lips, or other parts of the body.²

In this stage, syphilis can be passed to others through contact with the sore during vaginal, oral, or anal sex. The sore usually lasts three to six weeks and heals on its own. But if the syphilis infection is not treated, it moves to the second stage.

What happens during the second (secondary) stage of syphilis?

The second stage can start as the sore is healing or up to several weeks after it has healed. It usually starts with a rash on one or more areas of the body.

Some or all of these signs or symptoms can appear:

• Skin rash with rough, red, or reddish-brown spots. The rash may appear on your stomach, chest, palms, or bottoms of your feet. The rash usually does not itch.

• Sores on the throat, mouth, or cervix

• Fever

• Swollen glands

• 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 during vaginal, oral, or anal sex. The rash and other symptoms will go away on their own. But without treatment, the syphilis infection will move to the latent and possibly late stages of disease.

What happens during the inactive (latent) stage of syphilis?

The inactive, or latent, stage of syphilis starts when symptoms from the first and second stages go away. The latent stage can last for many years. During this stage, the infection lives in your body even though you have no signs or symptoms.

You cannot pass syphilis to anyone else during the latent stage. But during the first year of latency, symptoms of the second stage (such as the rash or sore) may return in some women. If you have sores, you can infect others.

Without treatment, the infection may advance to the late stage.

What happens during the late (tertiary) stage of syphilis?

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, deafness, dementia, and other health problems. Late-stage syphilis can lead to death.

Late stage syphilis is very rare. You will only reach the late stage of syphilis if you do not receive treatment earlier.

Do I need to get tested for syphilis?

Ask your doctor or nurse about getting tested for syphilis if:

• You have signs or symptoms of syphilis

• You think you might have been exposed to someone with syphilis

• You have been diagnosed with another STI, including HIV

• You are pregnant. All pregnant women need to be tested for syphilis at their first checkup. Some pregnant women need to be tested again, later in the pregnancy. Ask your doctor or nurse about retesting.

• Your or your partner's sexual behavior puts you at risk for STIs (having sex with multiple partners, having unprotected sex, or having sex with men who have sex with men). Ask your doctor or nurse how often you should be retested.

How is syphilis diagnosed?

There are two ways that a doctor or nurse tests for syphilis:

• Taking a sample of your blood and sending it to a lab for testing

• Looking at fluid from a syphilis sore under a special type of microscope (this can only be done when you can see a sore)

A Pap test is not used to detect syphilis.

How is syphilis treated?

Penicillin (an antibiotic) is the best medicine to treat syphilis at all stages. How much penicillin you have to take and how long you have to take it for depend on the stage of syphilis and your symptoms. One dose of penicillin is usually enough to treat people who have had syphilis for less than one year. If you are in a later stage of syphilis, you may need more medicine.

Do not have sex until the syphilis sores are completely gone. Your sex partners need to be tested. If they have syphilis, they will need to take penicillin.

Syphilis can be cured if it is found early and treated. Syphilis can damage the heart or brain if it is not treated in the early stages. Syphilis can be cured in the later stages, but it may not be possible to fix the damage done to the heart or brain.

What if I have an allergy to medicine used to treat syphilis?

The medicine used to treat syphilis is penicillin. If you are allergic to penicillin, other medicines might work during the early stages of syphilis.

You cannot take these other medicines during pregnancy. If you are pregnant and allergic to penicillin, your doctor will work with you to help you become less sensitive to the penicillin before you are treated with it.

In late syphilis, penicillin will prevent further harm, but it cannot fix any permanent damage already done to internal organs.

What can happen if syphilis is not treated?

Without treatment, syphilis can lead to severe illness and even death.

Having syphilis also raises your risk of getting or giving HIV, the virus that causes AIDS. The open sores caused by syphilis make it easier for HIV to spread through sexual contact. If you have a syphilis sore, you are two to five times more likely to get HIV if exposed through sex.

How does syphilis affect pregnancy?

Pregnant women can pass syphilis to their babies during pregnancy or birth. Syphilis can cause miscarriage, stillbirth, or the baby's death soon after birth. Untreated syphilis in pregnant women results in infant death in up to 40% of cases.

Babies born to mothers who have syphilis may not have signs or symptoms of syphilis at birth. But if not treated right away, the baby may develop serious problems within a few weeks. These include:

• Skin sores and rashes

• Fever

• Jaundice

• Anemia

• Swollen liver and spleen

Untreated syphilis in babies can cause developmental delays, seizures, or death.

How is syphilis treated during pregnancy?

The U.S. Preventive Services Task Force recommends that all pregnant women be tested for syphilis.⁵ Pregnant women with syphilis need to be treated right away with penicillin. For women who are allergic to penicillin, no other medicines are available for treatment. Your doctor will help you become less sensitive to the penicillin so it can be used before your baby is born.

Treatment with penicillin will prevent passing syphilis to the baby. But women who are treated during the second half of pregnancy are at risk of premature labor and problems with their unborn baby.

Can I breastfeed if I have syphilis?

Yes, you can breastfeed if you have syphilis, but not if you have a sore on one or both of your breasts. If you have syphilis, it is possible to spread the infection to any part of your breast, including your nipple and areola. You can then spread syphilis to your baby.

If you have any syphilis sores on one or both of your breasts:

• You can keep breastfeeding as long as your baby or pumping equipment does not touch a sore.

• Pump or hand-express your milk from the breast with sores until the sores heal. Pumping will help keep up your milk supply and prevent your breast from getting overly full and painful. You can store your milk to give to your baby in a bottle for another feeding. But if parts of your breast pump also touch the sore(s) while pumping, throw the milk away.

What should I do if I have syphilis?

Syphilis can be treated. But you need to be tested and treated as soon as possible.

If you have syphilis:

• See a doctor or nurse as soon as possible. Penicillin will treat syphilis, but it will not fix any permanent damage done to your internal organs.

• Take all of your medicine. Even if the symptoms go away, you still need to finish all of the penicillin. If symptoms continue after treatment, see your doctor or nurse.

• Tell your sex partner(s) so they can be tested and treated. If they are not tested and treated you could get syphilis again.

• Avoid any sexual activity while you are being treated for syphilis. Don't have sexual contact until the syphilis sores are completely healed.

• After you have completed treatment for syphilis, get retested after 6 months and 12 months. Your doctor or nurse may recommend more frequent follow-up tests.

• Get tested for HIV. If your test result is negative, ask your doctor or nurse if you need to be retested and when.

How can I prevent syphilis?

The best way to prevent syphilis or any STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

• Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to spread syphilis, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Also, other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.

• Get tested. Be sure you and your partner are tested for STIs. Talk to each other about your test results before you have sex.

• Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.

• Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.

• Do not douche. Douching removes some of the normal bacteria in the vagina, and may increase your risk of getting STIs.

• Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

Can women who have sex with women get syphilis?

Yes. It is possible to get syphilis, or any other STI, if you are a woman who has sex only with women.

Talk to your partner about her sexual history before having sex, and ask your doctor or nurse about getting tested if you have signs or symptoms of syphilis. Use a dental dam during oral sex and avoid sexual activity during an outbreak.

Did we answer your question about syphilis?

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

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), 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 Sexual Health Association (link is external)
  Phone Number: 800-227-8922

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

1. U.S. Preventive Services Task Force. (2015). Screening for Syphilis Infection in Pregnancy (link is external).

Syphilis fact sheet (PDF, 153 KB)

Source: Office on Women's Health, HHS

Human papillomavirus

Human papillomavirus, or HPV, is the most common sexually transmitted infection (STI) in the United States. About 80% of women will get at least one type of HPV at some point in their lifetime.¹ It is usually spread through vaginal, oral, or anal sex. Many women do not know they have HPV, because it usually has no symptoms and usually goes away on its own. Some types of HPV can cause illnesses such as genital warts or cervical cancer. There is a vaccine to help you prevent HPV.

What is human papillomavirus (HPV)?

HPV is the name for a group of viruses that includes more than 100 types. More than 40 types of HPV can be passed through sexual contact. The types that infect the genital area are called genital HPV.

Who gets HPV?

Genital HPV is the most common STI in the United States for both women and men. About 79 million Americans have HPV. It is so common that 80% of women will get at least one type of HPV at some point in their lifetime.

How do you get HPV?

HPV is spread through:

• Vaginal, oral, or anal sex. HPV can be spread even if there are no symptoms. This means you can get HPV from someone who has no signs or symptoms.

• Genital touching. A man does not need to ejaculate (come) for HPV to spread. HPV can also be passed between women who have sex with women.

• Childbirth from a woman to her baby

What are the symptoms of HPV?

Most people with HPV do not have any symptoms. This is one reason why women need regular Pap tests. Experts recommend that you get your first Pap test at age 21. The Pap test can find changes on the cervix caused by HPV. If you are a woman between ages 30 and 65, your doctor might also do an HPV test with your Pap test every five years. This is a DNA test that detects most types of HPV.

Another way to tell if you have an HPV infection is if you have genital warts. 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. Doctors can usually diagnose warts by looking at the genital area.

What health problems can HPV cause?

HPV usually goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems including:

• Cervical cancer

• Other genital cancers (such as cancers of the vulva, vagina, penis, or anus)

• Oropharyngeal cancer (cancer of the back of the throat, including the base of the tongue and tonsils)

• Genital warts

• Recurrent respiratory papillomatosis (a rare condition that causes warts to grow in the respiratory tract)

Do I need to get tested for HPV?

• If you are 21 to 29 years old, your doctor might suggest the HPV test if you have had an unusual or unclear Pap test result. The test will help determine if HPV caused the abnormal cells on your cervix. Most women younger than 30 do not need the HPV test, because the immune system fights off HPV within two years in 90% of cases in that age group.

• If you are 30 years or older, you may choose to have the HPV test along with the Pap test to screen for cervical cancer.

• If results of both tests are normal, your chance of getting cervical cancer in the next few years is very low. Your doctor might then say that you can wait up to five years for your next HPV screening.

How does HPV affect pregnancy?

HPV does not affect your chances of getting pregnant, but it may cause problems during pregnancy.

Some possible problems during pregnancy include:

• Cervical cell changes. Continue to get regular cervical cancer screening during and after pregnancy to help your doctor find any changes.

• Genital warts that bleed and grow. Hormonal changes during pregnancy can cause any genital warts that you had before getting pregnant or that you get during pregnancy to bleed and grow (in size and number).

• Cesarean section. If genital warts block the birth canal, you may need to have a cesarean section (C-section).

• Health problems in the baby. A woman with genital HPV can — very rarely — pass it on to her baby. Babies and children may develop growths in their airways from HPV. This rare but potentially serious condition is called recurrent respiratory papillomatosis.

Can HPV be cured?

No, HPV has no cure. Most often, HPV goes away on its own. If HPV does not go away on its own, there are treatments for the genital warts and cervical cell changes caused by HPV.

How can I prevent HPV?

There are two ways to prevent HPV. One way is get an HPV vaccine. The other way to prevent HPV or any STI is to not have sexual contact with another person.

If you do have sex, lower your risk of getting an STI with the following steps:

• Use condoms. Condoms are the best way to prevent STIs when you have sex. Although HPV can also happen in female and male genital areas that are not protected by condoms, research shows that condom use is linked to lower cervical cancer rates. The HPV vaccine does not replace or decrease the need to wear condoms. Make sure to put the condom on before the penis touches the vagina, mouth, or anus. Also, other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.

• Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.

• Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.

• Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.

• Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.

• Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

What is the HPV vaccine?

The HPV vaccine prevents cervical cancer in women. The Food and Drug Administration (FDA) approved the HPV vaccine to prevent HPV and related diseases, including cervical cancer.

When can I get the HPV vaccine?

Experts recommend the HPV vaccine for 11 or 12 year olds. The HPV vaccine works best when you get it before you have any type of sexual contact with anyone else. The Food and Drug Administration (FDA)  approved the HPV vaccine for girls and women from 9 through 26.

If you are 26 or younger and never had the HPV vaccine, or did not get all of the HPV shots, ask your doctor or nurse about getting vaccinated.

The HPV vaccine is given in two or three doses, over a 6 to 12-month period. Spacing out the HPV shots helps your immune system develop the antibodies against HPV. The schedule for HPV vaccine shots depend on the age and health history of the person getting it.

Talk to your doctor to find out if getting vaccinated is recommended for you based on your age and health history.

Do I need the HPV vaccine if I have already had sexual contact?

Yes. You can still benefit from the HPV vaccine if you have already had sexual contact. The vaccine can protect you from HPV types you haven't gotten yet. However, the vaccine is recommended for most people only if you are 26 years old or younger.

If I get the HPV vaccine, do I still need to use a condom?

Yes. The vaccine does not replace or decrease the need to wear condoms. Using condoms lowers your risk of getting other types of HPV and other STIs.

Do I still need a Pap test if I got the HPV vaccine?

Yes. There are three reasons why:

1. Although the HPV vaccine protects against many of the HPV types that cause cervical cancer, it does not prevent all HPV types that cause cervical cancer.

2. You might not be fully protected if you did not get all the vaccine doses (or at the recommended ages).

3. You might not fully benefit from the vaccine if you were vaccinated after getting one or more types of HPV before vaccination.

Could I have HPV even if my Pap test was normal?

Yes. You can have HPV but still have a normal Pap test. Changes on your cervix might not show up right away; or they might never appear. For women 30 years and older who get an HPV test and a Pap test, a negative result on both the Pap and HPV tests means no cervical changes or HPV were found on the cervix. This means you have a very low chance of developing cervical cancer in the next few years.

If I had HPV that went away on its own, can I get it again?

Yes. There are many types of HPV, so you can get it again.

Can women who have sex with women get HPV?

Yes. It is possible to get HPV, or any other STI, if you are a woman who has sex only with women.

Talk to your partner about her sexual history before having sex, and ask your doctor about getting tested if you have symptoms of HPV.

Did we answer your question about HPV?

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

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

• National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), CDC, HHS
  Phone Number: 800-232-4636

• American Sexual Health Association (link is external)
  Phone Number: 800-227-8922

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

Sources

1. Myers, E.R., McCrory, D.C., Nanda, K., Bastian, L., Matchar, D.B. (2000). Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol; 151:1158–1170.

2. Centers for Disease Control and Prevention. (2017). Genital HPV Infection - Fact Sheet.

3. U.S. Preventive Services Task Force. (2016). Cervical Cancer: Screening (link is external).

4. Centers for Disease Control and Prevention. (2013). Incidence, Prevalence, and Cost of Sexually Transmitted Infections in the United States (PDF, 1.6 MB).

5. Centers for Disease Control and Prevention. (2016). HPV Vaccine – Questions and Answers.

6. Centers for Disease Control and Prevention. (2012). Human papillomavirus-associated cancers—United States, 2004–2008. Morbidity and Mortality Weekly Report; 61(15):258–261.

Human papillomavirus resources

Human papillomavirus fact sheet (PDF, 122 KB)

Source: Office on Women's Health, HHS

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an infection of a woman's reproductive organs. In 2013, about 88,000 women ages 15–44 in the United States were diagnosed with PID.¹ PID is often caused by a sexually transmitted infection (STI). If left untreated, PID can cause problems getting pregnant, problems during pregnancy, and long-term pelvic pain.

What is PID?

PID is an infection of a woman's reproductive organs. The reproductive organs include the uterus (womb), fallopian tubes, ovaries, and cervix.

PID can be caused by many different types of bacteria. Usually PID is caused by bacteria from STIs. Sometimes PID is caused by normal bacteria found in the vagina.

Who gets PID?

PID affects about 5% of women in the United States.² Your risk for PID is higher if you:³