STIs are caused by bacteria and viruses spread through sexual contact.
Infections can be found in body fluids such as semen, on the skin of the genitals and areas around them, and some also in the mouth, throat, and rectum.
Some STIs cause no symptoms. Others may cause discomfort or pain. If not treated, some can cause pelvic inflammatory disease, infertility, chronic pelvic pain, and cervical cancer. Over time, HIV suppresses the immune system. Some STIs can also greatly increase the chance of becoming infected with HIV.
STIs spread in a community because an infected person has sex with an uninfected person. The more sexual partners a person has, the greater his or her risk of either becoming infected with STIs or transmitting STIs.
Who Is at Risk?
Many women seeking family planning services—women in stable, mutually faithful, long-term relationships—face little risk of getting an STI. Some clients may be at high risk for STIs, however, or have an STI now. Clients who might benefit most from discussion of STI risk include those who do not have steady partners, unmarried clients, and anyone, married or unmarried, who asks or expresses concern about STIs or HIV, or that her partner may have other partners.
The risk of acquiring an STI, including HIV, depends on a person’s behavior, the behavior of that person’s sexual partner or partners, and how common those diseases are in the community. By knowing what STIs and what sexual behavior are common locally, a health care provider can better help a client assess her or his own risk.
Understanding their own risk for HIV and other STIs helps people decide how to protect themselves and others. Women are often the best judges of their own STI risk, especially when they are told what behaviors and situations can increase risk.
Sexual behavior that can increase exposure to STIs includes:
-
Sex with a partner who has STI symptoms
-
A sex partner who has recently been diagnosed with or treated for an STI
-
Sex with more than one partner—the more partners, the more risk
-
Sex with a partner who has sex with others and does not always use condoms
-
Where many people in the community are infected with STIs, sex without a condom may be risky with almost any new partner
In certain situations people tend to change sexual partners often, to have many partners, or to have a partner who has other partners—all behaviors that increase the risk of STI transmission. This includes people who:
-
Have sex for money, food, gifts, shelter, or favors
-
Move to another area for work or travel often for work, such as truck driving
-
Have no established long-term sexual relationship, as is common among sexually active adolescents and young adults
-
Are the sexual partners of these people
What Causes STIs?
Several types of organisms cause STIs. Those caused by organisms such as bacteria generally can be cured. STIs caused by viruses generally cannot be cured, although they can be treated to relieve symptoms.
|
STI
|
Type |
Sexual
transmission |
Nonsexual
transmission |
Curable? |
|
Chancroid
|
Bacterial |
Vaginal, anal, and
oral sex |
None |
Yes |
|
Chlamydia
|
Bacterial |
Vaginal and anal sex
Rarely, from
genitals to mouth |
From mother
to child during
pregnancy |
Yes |
|
Gonorrhea
|
Bacterial |
Vaginal and anal sex,
or contact between
mouth and genitals |
From mother
to child during
delivery |
Yes |
|
Hepatitis B
|
Viral |
Vaginal and anal
sex, or from penis
to mouth |
In blood, from
mother to child
during delivery
or in breast
milk |
No |
|
Herpes
|
Viral |
Genital or oralcontact with anulcer, including
vaginal and analsex; also genital
contact in area without ulcer |
From mother
to child during
pregnancy or
delivery |
No |
|
HIV
|
Viral |
Vaginal and analsex
Very rarely, oral sex |
In blood, from
mother to
child during
pregnancy ordelivery or inbreast milk |
No |
|
Human
papillomavirus
|
Viral |
Skin-to-skin and
genital contact or
contact between
mouth and genitals |
From mother
to child during
delivery |
No |
|
Syphilis
|
Bacterial |
Genital or oral
contact with an
ulcer, including
vaginal and anal sex |
From mother
to child during
pregnancy or
delivery
|
Yes |
|
Trichomoniasis
|
Parasite |
Vaginal, anal, and
oral sex |
From mother
to child during
delivery
|
Yes |
More About HIV and AIDS
HIV is the virus that causes acquired immune deficiency syndrome (AIDS). HIV slowly damages the body’s immune system, reducing its ability to fight other diseases.
People can live with HIV for many years without any signs or symptoms of infection. Eventually, they develop AIDS—the condition when the body’s immune system breaks down and is unable to fight certain infections, known as opportunistic infections.
There is no cure for HIV infection or AIDS, but antiretroviral (ARV) therapy can slow how the disease progresses, improve the health of those with AIDS, and prolong life. ARVs also can reduce mother-to-child transmission at the time of delivery. Opportunistic infections can be treated.
Family planning providers can help with prevention and treatment efforts for HIV/AIDS, particularly in countries where many people are infected with HIV, by:
– Counseling about ways to reduce risk of infection (see Choosing a Dual Protection Strategy).
– Refer clients for HIV counseling and testing and for HIV care and treatment if the clinic does not offer such services.
Symptoms of Sexually Transmitted Infections
Early identification of STIs is not always possible. For example, chlamydia and gonorrhea often have no noticeable signs or symptoms in women. Early identification, however, is important both to avoid passing on the infection and to avoid more serious long-term health consequences. To help detect STIs early, a provider can:
-
Ask whether the client or the client’s partner has genital sores or unusual discharge.
-
Look for signs of STIs when doing a pelvic or genital examination for another reason.
-
Know how to advise a client who may have an STI.
-
If the client has signs or symptoms, promptly diagnose and treat, or else refer for appropriate care.
-
Advise clients to notice genital sores, warts, or unusual discharge in themselves or in their sexual partners.
| Symptoms |
Possible cause |
Discharge from the penis—pus, clear or yellow-green drip
|
Commonly: Chlamydia, gonorrhea
Sometimes: Trichomoniasis |
Abnormal vaginal bleeding or bleeding after sex
|
Chlamydia, gonorrhea, pelvic inflammatory disease |
| Burning or pain during urination |
Chlamydia, gonorrhea, herpes |
| Lower abdominal pain or pain during sex |
Chlamydia, gonorrhea, pelvicinflammatory disease |
| Swollen and/or painful testicles |
Chlamydia, gonorrhea |
| Itching or tingling in the genital area |
Commonly: Trichomoniasis
Sometimes: Herpes |
Blisters or sores on the genitals, anus, surrounding areas, or mouth
|
Herpes, syphilis, chancroid |
Warts on the genitals, anus, or surrounding areas
|
Human papillomavirus |
Unusual vaginal discharge—changes
from normal vaginal discharge in colour, consistency, amount, and/or odor
|
Most commonly: Bacterial vaginosis,
candidiasis (not STIs; see Common
Vaginal Infection Often Confused
With Sexually Transmitted
Infections, below)
Commonly: Trichomoniasis
Sometimes: Chlamydia, gonorrhea |
Common Vaginal Infections Often Confused With Sexually Transmitted Infections
The most common vaginal infections are not sexually transmitted. Instead, they usually are due to an overgrowth of organisms normally present in the vagina. Common infections of the reproductive tract that are not sexually transmitted include bacterial vaginosis and candidiasis (also called yeast infection or thrush).
In most areas these infections are much more common than STIs.
-
Researchers estimate that between 5% and 25% of women have bacterial vaginosis and between 5% and 15% have candidiasis at any given time.
-
Vaginal discharge due to these infections may be similar to discharge caused by some STIs such as trichomoniasis. It is important to reassure clients with such symptoms that they may not have an STI—particularly if they have no other symptoms and are at low risk for STIs.
-
Bacterial vaginosis and trichomoniasis can be cured with antibiotics such as metronidazole; candidiasis can be cured with anti-fungal medications such as fluconazole. Without treatment, bacterial vaginosis can lead to pregnancy complications and candidiasis can be transmitted to a newborn during delivery.
Washing the external genital area with unscented soap and clean water, and not using douches, detergents, disinfectants, or vaginal cleaning or drying agents are good hygiene practices. They may also help some women avoid vaginal infections.
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