Graham King, M.D.
Family Medicine, Prenatal Care, Primary Care
The topic of sexually transmitted infections also called sexually transmitted diseases or STDs, may be uncomfortable to discuss, but it should be addressed directly. This is especially true given some discouraging trends and the prevalence of sexually transmitted infections locally and across the nation.
In 2018, 26 million cases of sexually transmitted infections were diagnosed in the U.S., with nearly half of these diagnoses among those age 15 to 24, according to the Centers for Disease Control and Prevention (CDC).
This is despite robust sex education programs taught in public schools and the availability of birth control, and testing and treatment, for high-risk age groups. Teens and young adults are more likely to use long-acting birth control to prevent unplanned pregnancy, but this can lead to a more relaxed approach on condom and other barrier use, thereby resulting in greater transmission of sexually transmitted infections.
Types of sexually transmitted infections
Sexually transmitted infections are generally acquired by sexual contact. The bacteria, viruses or parasites that cause sexually transmitted infections may pass from person to person in blood, semen, or vaginal and other bodily fluids.
These are the most common sexually transmitted infections:
This is the most frequently reported sexually transmitted infection in the U.S., and it is caused by bacteria. It is spread through exchange of bodily fluids. Most of the time, the person with chlamydia has no symptoms, or simply discomfort and discharge, but chlamydia can lead to more serious health problems if left untreated.
This sexually transmitted infection is caused by a virus and can present as painful open sores on the genitals. It is spread through exchange of bodily fluids when lesions are present. It is caused by herpes type 2, or HSV-2. Herpes type 1, or HSV-1, causes cold sores, and is not considered a sexually transmitted infection.
- Human immunodeficiency virus (HIV)
This virus is passed through the exchange of bodily fluids by contact with an infected partner. If untreated, HIV can develop into acquired immunodeficiency syndrome (AIDS).
- Human papilloma virus (HPV)
HPV is a viral infection that can cause genital warts. These unsightly lesions are found around the genitals and anus. HPV can be easily transmitted from partner to partner. There are more than 100 varieties of HPV, and some can lead to cancer.
Gonorrhea is caused by bacteria through the exchange of bodily fluids. It is commonly spread with chlamydia.
This bacterial infection starts as painless open sores on the genitals, mouth or anus, and it is spread by contact with open lesions of an infected partner.
This list is not comprehensive. The CDC maintains a complete list of sexually transmitted infections and statistics about them.
Long-term health consequences
Why do we care so much about sexually transmitted infection prevention? First, because it's important to slow the spread.
Much like what has been seen with the COVID-19 pandemic, when people do their part to protect their partners and themselves, they can lower the spread of diseases that can significantly affect everyone.
Also, some sexually transmitted infections can cause long-term health consequences, including:
As it progresses, HIV can develop into AIDS. In the past, patients would usually die of AIDS complications. Now many treatments are available that allow a long, normal and otherwise healthy life. These treatments require daily medicine, and some have significant side effects. These developments should never be viewed as a reassurance, as prevention is always the best method.
- Cervical changes or cancer
HPV is the leading cause of cervical changes, and it can lead to cervical cancer. It can cause abnormal tissue growth in some young women, and they need cancer prevention treatments like a procedure that freezes the surface of the cervix or a loop electrosurgical excision procedure, or LEEP, that removes a portion of the cervix. These treatments are effective for removing abnormal tissue, but they are painful. Healing can be painful, as well. The LEEP procedure could cause pregnancy complications like an early opening of the cervix.
Undiagnosed chlamydia and gonorrhea can result in an infection in the genitals that can move into the uterus or the fallopian tubes. A sexually transmitted infection can lead to scarring that can make in challenging to get pregnant or result in infertility.
- Lifelong infection
Once a person contracts herpes type 2, they have the virus for life. It cannot be cured. From then on, the goal is to suppress sores that develop and not spread sores to others, or a child if sores are present during vaginal delivery.
- Neurologic changes
If untreated, syphilis can cause permanent neurologic changes, including chronic joint pain, muscle pain, brain changes, confusion, illusions and chronic headaches. It also can damage the heart and other organs.
Preventing sexually transmitted infections
What can you do to keep from getting a sexually transmitted infection? How can you stop a sexually transmitted infection from spreading?
Recommendations can be controversial, and I will try to address everything to include those that are very sexually conservative to the open of sex practices:
- Practice abstinence
This is not having any sexual activity with other people. If you want a 100% guaranteed way not to acquire or transmit disease, no sexual contact is the only option. This includes not taking part in genital-to-genital, oral-to-genital or oral-to-oral sexual contact, especially if sores are present around the mouth or lips.
- Practice mutual monogamy
Being in a relationship where both partners are fully tested before sexual contact and remain monogamous with each other greatly reduces the transmission of sexually transmitted infections. Using condoms, which is highly recommended even if testing results are negative, reduces the risk even more.
- Get vaccinated
The HPV vaccination is a great way to prevent the risk of HPV infection. The CDC recommends that all 11- and 12-year-olds receive two doses of HPV vaccine at least six months apart. This is the best age to get vaccinated to protect against the virus before a person is exposed through sexual activity. Children as young as 9 can be vaccinated, as well. Research has shown that the two-dose schedule is effective for children under 15. Teens and young adults who begin the vaccine series later ― from ages 15 to 26 ― should receive three doses of the vaccine.
- Use condoms and dental dams consistently and correctly
The correct use of these types of barrier methods can greatly reduce the transmission of sexually transmitted infections. Always plan for proper use when taking part in sexual activity. When you leave your home, most people bring their phones, wallets, driver's license and credit cards. Why not condoms? Condom material breaks down over time, so make sure that it isn't expired. Also, confirm that you are using condoms approved by the Food and Drug Administration to prevent sexually transmitted infections.
Outdated misconceptions and opinions are common obstacles to the correct use of condoms. Some people claim that condoms lessen sensation or smell strange. Many new, quality condoms are advertised as ultrathin and increased sensation. Flavors make them more palatable, especially when taking part in oral sex. Some people claim that there isn't a good time to put on a condom during the heat of passion. If they choose, women can put a female condom in place hours before sexual activity. Also, demonstrating your concern for your partner's health by using a condom can be an aphrodisiac.
Dental dams are incredibly effective and used in many areas of the country. They are placed over the genitals or anal area during a sex act and create a barrier from bodily fluid transfer. They also come in flavors and scents. Couples, in which on partner has known genital warts or herpes, find dams help lower the risk of transmission.
Talk with your primary care provider about sexually transmitted infection testing and treatments.