Our Bodies, Ourselves (60 page)

Sexually transmitted infections (STIs)—also called sexually transmitted diseases (STDs)—are a variety of mostly bacterial and viral infections (diseases) that are passed from one person to another primarily through anal, vaginal, or oral sex.

STIs are among the most commonly reported diseases in the United States today. The most recent national estimates suggest that there are approximately 19 million new cases of
STIs each year, half of them among fifteen- to twenty-four-year-olds.
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Approximately one in four young women between the ages of fourteen and nineteen in the United States is infected with one or more of the most common STIs.
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The STIs most common in the United States are human papillomavirus (HPV), genital herpes, trichomoniasis, chlamydia, gonorrhea, syphilis, hepatitis B, and human immunodeficiency virus (HIV)—the virus that causes AIDS. All of these STIs are covered in detail in this chapter. Other infections that can be transmitted via several different routes, including sex—such as hepatitis A and C, cytomegalovirus (CMV), and molluscum contagiosum—are not addressed here. If you have sexual contact outside the United States or with someone who is from another country and are being checked or tested for STIs, tell your health-care provider.

STIs can be spread through semen, vaginal fluids, and anal secretions, and through discharge from sores or lesions caused by STIs. HIV and hepatitis B can also be spread by contact with the blood of an infected person. Herpes and HPV are usually spread through skin-to-skin contact with the affected area.

The risk of transmission is greatest during anal and vaginal intercourse, but STIs also can be transmitted by oral sex and, less commonly, by unwashed sex toys. Most STIs can be transmitted from one person to another even when there are no obvious signs of infection, and even several years after a person was infected.

The only 100 percent sure way to protect against STIs is to abstain from having sex. But you can be sexually active and still greatly reduce your chances of getting an STI. Your risk of infection depends on whether your partner has an STI, what kind of sexual contact you have, and whether you use protection.

Statistically, people who have more than one sex partner are more likely to get an STI. People who have one partner at a time generally have less risk than people who have multiple partners. If you have only one partner, however, you may still be at high risk if your partner has other partners in addition to you.

You can reduce your risk of getting an STI by getting vaccinated against HPV and hepatitis B (see “Vaccinations to Prevent STIs” below) and by following safer sex practices—practices that prevent the exchange of blood, semen, or vaginal fluids. Using condoms consistently and correctly is an essential component of safer sex. (For a thorough discussion of prevention and protection methods, see
Chapter 10
, “Safer Sex.”)

The most common symptom is having no noticeable symptoms and not knowing you have an STI—which is why prevention and screening are important for everyone who is sexually active. Most women with chlamydia or gonorrhea infections don't realize that there is anything wrong unless they are tested or infected partners notify them of exposure.

Some untreated STIs may lead to pelvic inflammatory disease (PID). Painful symptoms can include abdominal pain and fever, at which point the fallopian tubes may be blocked and fertility already permanently damaged. The CDC estimates that untreated STIs cause at least 24,000 women to become infertile each year in the United States.
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If STI symptoms occur at all, they can include

• Itching, discharge.

• Unusual smell from the vagina or anus. Take note when the color or smell of your vaginal fluids changes.

• Growths, bumps, blisters, sores, or rashes, often around the genitals or anal area.

• Sharp pain in the lower abdomen.

• Pain or burning while urinating or having sex.

• Bleeding between menstrual cycles.

If you have any of these symptoms, abstain from sex and consult a health-care provider immediately. It might be something other than an STI, but it's still good to get it looked at. Even a garden-variety yeast infection, causing vaginitis, can irritate the lining of the vagina and make you more vulnerable to getting a STI. Get yourself checked and treated.

A few infections may appear as more general symptoms, although these may be transient. People infected with HIV, for example, may experience a set of flulike symptoms such as high fever, sore throat, swollen glands, extreme fatigue, and rash within the first month after becoming infected.

The cancer-causing types of HPV have no noticeable symptoms and are detected only when abnormal cervical cells appear on a Pap test.

For more information on possible symptoms for specific STIs, see
“Bacteria- and Parasite-Caused STIs,”
, and
“Viral STIs.”

STIs that are caused by bacteria, protozoa, and other small organisms—such as chlamydia, gonorrhea, syphilis, and trichomoniasis—can be cured with medication. However, curable in this case means that the progression of the infection can be stopped and the organism eliminated; any long-term damage already done to your body, including damage to your fertility, can't be reversed. This is why STIs should be detected and treated as soon as possible.

Genital-area infestations caused by skin parasites such as crabs (lice) and scabies (mites) cause itching and rash and can be passed along through sexual or nonsexual contact (towels, sheets, clothes). Parasites can be cured by using medicated creams and lotions.

Viral STIs—such as genital herpes, some HPV strains, HIV, and hepatitis A, B, and C—can be treated to relieve symptoms or slow infection progression, but medicine will not cure (or eliminate) the infection. Each of these viruses behaves differently. (For information on how to treat specific viruses, see
“Viral STIs.”
)

Any STI can alter healthy tissue and increase vulnerability to other STIs, including HIV. Why does this happen? STIs may cause skin cracks, sores, inflammation, or lesions on the vulva or in the vagina, making it easier for HIV to get into the bloodstream. Also, HIV targets white blood cells, which fight infection. When you have an STI, your body sends more white blood cells into the genital area to deal with it. Unfortunately, this means more target cells for HIV to infect, and this raises the risk of HIV taking hold in the body after exposure.
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Since most STIs have no apparent symptoms, it's a good idea to get screened before you have sex with someone new, if you have more than one partner, or if you think or know your partner has had sex with someone else. (For information on specific STI screening guidelines, see
“Screening,”
)

If you think you or your partner(s) has been exposed to an infection, go for testing and possible treatment right away, and encourage your partner(s) to do the same. Remember, you might have an STI and not have any noticeable symptoms. (See
“Where to Go for Care.”
)

Most STIs disproportionately affect women, especially young women. Nearly half of all new STI cases occur in people age fifteen to twenty-four,
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though this age group accounts for only one-quarter of the sexually active population. Adolescents and young adults are at greater risk because they are more likely to have unprotected intercourse and to have short, consecutive relationships, are biologically more susceptible to infection, and face obstacles to getting sexual and reproductive health care.

The reported rates of chlamydia and gonorrhea, for example, are highest among females fifteen to nineteen years old,
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and many people acquire HPV infection during their adolescent years.

Racial and ethnic minorities face different rates of risk, with African Americans being the most severely affected by STIs. They represent 12 percent of the U.S. population but in 2008–2009 accounted for about 71 percent of reported gonorrhea cases and approximately half of all chlamydia and syphilis cases—48 percent and 52 percent, respectively, according to the CDC's “Sexually Transmitted Disease Surveillance” report, which tracks reported cases of chlamydia, gonorrhea, and syphilis.

The risk is greatest for those living in poor urban communities, where the number of people with STIs is statistically larger. Economic status, racial segregation, disparities in incarceration rates, and limited access to affordable and quality health care are some of the factors that contribute to increased STI rates.
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(For more information, see
“Who Gets Infected?”
)