Ask PHN: Types of Sexually Transmitted Diseases and Testing

By M. Ali
From PHN Issue 55, Winter 2024

Dear Prison Health News,
If you would be so kind (if you haven’t already done so), please explain the variety of sexually transmitted diseases such as trichomoniasis, herpes I vs. II, etc.

— Anonymous

Dear Anonymous,
Thank you for this great topic suggestion. Sexually transmitted diseases (STDs), which develop due to sexually transmitted infections (STIs), are very common, impact people of all genders, and can result from any type of sexual activity (vaginal, anal, oral, etc.). STIs can be caused by viruses, bacteria, fungi, or parasites. STDs don’t always cause symptoms or may only cause mild symptoms, so it’s important to get tested if you believe you may have been exposed. The good news is STDs are preventable, and most are treatable as well. Talking to your partner about STDs and how to stay safe while having sex is an important way of protecting your health. Prevention is always better than treatment.

While there are many sexually transmitted diseases, these are six common ones:

Chlamydia

• What is it: An STD caused by the bacteria Chlamydia trachomatis. If left untreated, it can spread to and permanently damage reproductive organs like fallopian tubes and the uterus or cause ectopic pregnancy (a life-threatening condition where pregnancy occurs outside of the uterus).
• How it spreads: Through vaginal, anal, or oral sex. Chlamydia can also be passed during childbirth from a pregnant person to their baby.
• Symptoms: Chlamydia often doesn’t cause any symptoms. However, you may notice abnormal vaginal or penile discharge, a burning sensation while peeing, or pain/swelling in one or more testicles.
• How to prevent it: Condoms, dental dams, and getting regular screening tests.
• Treatment/cure: Antibiotics can cure chlamydia. People who have it should avoid sexual activity until they’ve completed their antibiotic course to avoid spreading the infection. Reinfection is common, so health care providers recommend retesting about three months after treatment ends.

Gonorrhea

• What is it: An STD caused by the bacteria Neisseria gonorrhoeae, which can cause genital, rectal, and throat infections. It is especially common in people aged 15-24. If left untreated, it can spread internally and cause serious health problems, including infertility.
• How it spreads: Through vaginal, anal, or oral sex. It can also be passed during childbirth from a pregnant person to their baby.
• Symptoms: Gonorrhea often doesn’t cause any symptoms and can be mistaken for a bladder or vaginal infection. However, you may notice pain or burning while peeing, increased vaginal discharge, vaginal bleeding between periods, yellow or white penile discharge, or swollen testicles (less common). Rectal symptoms include discharge, anal itching, soreness, or painful bowel movements. Throat infections can cause a sore throat.
• How to prevent it: Condoms (including internal condoms) and getting regular screening tests.
• Treatment/cure: Antibiotics can cure gonorrhea. While medication will stop the infection, it does not reverse any permanent damage it causes. Gonorrhea reinfection is common, so individuals should be retested 3 months after treatment.

Herpes (oral and genital)

• What is it: A chronic, lifelong viral infection caused by two types of viruses: herpes simplex virus 1 (HSV-1) and herpes simplex virus 2 (HSV-2). HSV-1 and HSV-2 can both cause infections around the mouth (oral herpes) or genitals (genital herpes), but most commonly HSV-1 infects the mouth and HSV-2 infects the genitals. Most adults are infected with HSV-1 at some point in their lives.
• How it spreads: Both types spread through skin-to-skin contact, especially through kissing and vaginal, anal, or oral sex. Herpes is not spread by touching shared objects (towels, toilet seats, bedding, etc.).
• Symptoms: Most people have no symptoms or mild symptoms. Oral herpes usually appears as a cold sore (blister on or around the mouth). A genital herpes “outbreak” is when one or more painful blisters appear on or around the genitals. Flu-like symptoms can occur with the first outbreak.
• How to prevent it: Condoms, including internal condoms (may not provide full protection if sores occur in areas a condom doesn’t cover). People can spread herpes even when they don’t have symptoms. But avoiding vaginal, anal, or oral sex when you or your partner has herpes symptoms (during an “outbreak”) lowers the risk.
• Treatment/cure: There is no cure, but antiviral medication can prevent or shorten daily outbreaks. Fortunately, herpes is not life-threatening. Herpes sores may make it easier to get HIV.

HPV

• What is it: An STD caused by the human papillomavirus (HPV), which has many strains. It can cause a variety of health problems, from genital warts to cervical cancer.
• How it spreads: HPV spreads through vaginal, anal, or oral sex, including close skin-to-skin touching during sex. It is most commonly spread through vaginal or anal sex.
• Symptoms: Genital warts that appear as a small bump or small group of bumps, vary in size, and can be raised or flat. Not all HPV strains cause warts, and most HPV infections don’t cause any symptoms.
• How to prevent it: Getting the HPV vaccine (given as a series of shots), which protects against HPV strains that cause the highest risk of cancer. All people aged 9 to 45 can get the HPV vaccine. Using condoms and dental dams reduces but does not eliminate the risk of infection. Getting screened for cervical cancer (“Pap smears”) between ages 21-65 if you have a vagina and cervix allows for early detection and treatment of cervical cancer caused by HPV (but not HPV itself).
• Treatment/cure: There is no treatment for HPV, but there are treatments for the problems it can cause, like topical cream for genital warts or surgery for genital warts and cervical precancer. Sometimes the body can clear HPV infections on its own.

Syphilis

• What is it: An STD that develops in stages, caused by the bacteria Treponema pallidum.
• How it spreads: Syphilis spreads by sexual skin-to-skin contact, including by having vaginal, anal, or oral sex with someone who has syphilis. It can also be passed during pregnancy from a pregnant person to their fetus. Syphilis cannot be spread by touching shared objects (e.g., toilet seats, doorknobs, clothing, etc.)
• Symptoms:
  – Primary stage: This first stage includes painless sores in or around the penis, vagina, anus, rectum, or lips that last 3-6 weeks and heal regardless of treatment. These can show up between 3 weeks and 3 months of being infected.
  – Secondary stage: This second stage may begin when the initial sores are healing or have healed. These symptoms usually start with a non-itchy rash on the palms of your hands, soles of your feet, or elsewhere on your body. You may also get sores in the mouth, vagina, or anus and flu-like symptoms. These symptoms can last 2-6 weeks at a time, for up to 2 years. They eventually go away even without treatment.
  – The latent (inactive) stage of syphilis does not have symptoms, but the infection is still there.
  – The third/late stage may occur years after the initial infection, if it was not treated. This stage can include serious problems with the brain, nerves and heart, including tumors, blindness and dementia.
• How to prevent it: Condoms, including internal condoms, and dental dams (but they may not provide full protection if sores are in areas a condom does not cover). Avoiding vaginal, anal, or oral sex when your partner has syphilis sores reduces your risk.
• Treatment/cure: Antibiotics can cure syphilis. They cannot reverse the damage caused by late-stage syphilis.

Trichomoniasis (“Trich”)

• What is it: An STD caused by the parasite Trichomoniasis vaginalis. It is the most common curable STD. Symptoms are more common in people with vaginas.
• How it spreads: Trichomoniasis spreads through sexual fluids. It is often passed through vaginal sex. It can also be passed through anal and oral sex, but this is uncommon. It is not spread through casual contact like kissing, hugging, or sharing food or drinks.
• Symptoms: Trichomoniasis often doesn’t cause symptoms. Symptoms, which may appear 5-28 days after infection, include itching, swelling, or soreness of genitals, burning after peeing or ejaculating, penile discharge, or white/yellow/ green vaginal discharge with a fishy smell.
• How to prevent it: Condoms and avoiding sharing sex toys.
• Treatment/cure: Antibiotics can cure trichomoniasis. Reinfection is common, so individuals should be retested 3 months after treatment. Because trich spreads so easily, it’s important for your sexual partners to get treated, too.