Hesperian Health Guides
What are sexually transmitted infections?
HealthWiki > A Health Handbook for Women with Disabilities > Chapter 8: Sexual health: Preventing sexually transmitted infections including HIV/AIDS > What are sexually transmitted infections?
Sexually Transmitted Infections, or STIs, are infections passed from one person to another during sex. STIs can be passed from one person to another through any type of sex. It can be penis to vagina sex, or penis to anus sex, or oral sex (mouth to penis or mouth to vagina). Sometimes, STIs can be spread just by rubbing an infected penis or vagina against another person's genitals.
Contents
Untreated infections are dangerous
Many STIs can be treated with medicine. If they are not treated early, STIs can cause: infertility in both men and women; babies born too early, too small, or blind; pregnancy in the tubes; lasting pain in the belly (lower abdomen); cancer of the opening of the cervix; death from severe infection.
Signs of an STI:
You may have an STI if you have one or more of the following signs:
- unusual discharge from the vagina
- unusual smell from the vagina
- pain or an unusual feeling in your belly (lower abdomen), especially when having sex with the penis in the vagina
- itchiness, a rash, a bump, or a sore on your genitals
Depending on your disability, it may be difficult for you to tell if you have these signs. You may need to ask someone you trust to help you check for signs of an STI.
How to check for signs of STIs
If you are blind: When you wash your genitals, use your fingers to feel for any unusual discharge, lumps or soreness. Do this once a week. If you do it every day, it will be difficult for you to notice any changes.
If you have little or no hand control: If you are unable to use your fingers to feel your genitals for any changes, try to use a mirror to look for them instead. If you cannot hold the mirror, put it on the floor and crouch over it.
If you have a spinal cord injury: If you can feel and look at your genitals, do this once a week while you bathe. If you are unable to do this yourself, ask someone you trust to help you. You will probably not be able to feel if there is any pain in your belly or itching in your genitals. But if you have an STI and it does not get treated early, you may get dysreflexia. This is dangerous.
If you have limited or no movement in your legs: If possible, find a position in which you can either feel your genitals with your fingers while you wash, or use a mirror to look at them. If necessary, ask someone you trust to hold your legs steady.
Trichomonas
Trichomonas is a very uncomfortable and itchy STI. Men usually do not have any signs, but they can carry it in the penis and pass it to a woman during sex.
Signs:
- gray or yellow, bubbly discharge
- red and itchy genital area and vagina
- bad-smelling discharge
- pain or burning when you pass urine
If you are able to get tested and know for certain you have trichomonas, take one of the following medicines. If you cannot get tested, it is best to take the
medicines for gonorrhea, chlamydia, etc., because the infection may be caused by other STIs.
| Medicines for trichomonas | ||
|---|---|---|
| Medicine | How much to take | When and how to take |
| metronidazole | 400 to 500 mg | by mouth, 2 times a day for 7 days |
| or | ||
| metronidazole (avoid metronidazole in the first 3 months of pregnancy) | 2 grams (2000 mg) | by mouth in a single dose |
| or | ||
| clindamycin | 300 mg | by mouth, 2 times a day for 7 days |
IMPORTANT! Do not drink alcohol during the time you are taking metronidazole. Your partner should also be treated with the same medicine.
| ||
Gonorrhea (clap, gono, VD) and chlamydia
Gonorrhea and chlamydia are both serious infections. They are easy to cure if they are treated early. If not, they can cause severe infection and infertility in both women and men. The signs in a man usually begin 2 to 5 days after sex with an infected person. In a woman, the signs may not begin for weeks or even months. But both men and women can be infected and have no signs. Even a person with no signs can still give both gonorrhea and chlamydia to another person.
 The most common signs in a woman are:
|
 The most common signs in a man are:
|
Treatment:
If you have any of the signs for gonorrhea or chlamydia, and you have had unsafe sex with someone you think may have an infection, try to get tested to see which infection you have so you will know which medicine to take.
| Medicines for gonorrhea | |||||
|---|---|---|---|---|---|
| Medicine | How much to take | When and how to take | |||
| cefixime | 400 mg | by mouth, all at once | |||
| Medicines for chlamydia | |||||
|---|---|---|---|---|---|
| Medicine | How much to take | When and how to take | |||
| azithromycin | 1 g | by mouth, all at once | |||
| or | |||||
| doxycycline | 100 mg | 2 times a day for 7 days | |||
| or | |||||
| tetracycline | 500 mg | by mouth, 4 times a day for 7 days | |||
| or | |||||
| erythromycin | 500 mg | by mouth, 4 times a day for 7 days | |||
Unfortunately, tests are not always available, so it is often best to take medicines for more than one infection. A person can have several infections at the same time, caused not only by gonorrhea and chlamydia, but also by trichomonas, and
bacterial vaginosis. The
medicines for gonorrhea, chlamydia,... in the chart below will treat all these infections.
Pelvic inflammatory disease
Pelvic Inflammatory Disease (PID) is the name for an infection of any of the reproductive parts in a woman's lower abdomen. It is often called a `pelvic infection.' A pelvic infection can develop from an STI that was not cured, especially gonorrhea or chlamydia.
You may have one or more of these signs:
- pain in the lower belly
- high fever
- you feel very ill and weak
- green or yellow bad-smelling discharge from the vagina
- pain or bleeding during vaginal sex
Treatment:
Because this infection is usually caused by a mix of germs, more than one medicine must be used to cure it. Take the medicines listed in the chart below.| Medicines for gonorrhea, chlamydia, trichomonas, bacterial vaginosis, and PID | |||||
|---|---|---|---|---|---|
| If you have signs of these infections, and you cannot get tested to know which infection or infections you have, take a combination of these medicines. | |||||
| Medicine | How much to take | When and how to take | |||
| cefixime | 400 mg | by mouth in a single dose | |||
| AND | |||||
| azithromycin | 1 gram (1000 mg) | by mouth as a single dose | |||
| or | |||||
| erythromycin | 500 mg | by mouth, 4 times a day for 7 days | |||
| or | |||||
| amoxycillin | 500 mg | by mouth, 3 times a day for 7 days | |||
| or | |||||
| doxycycline | 100 mg | by mouth, 2 times a day for 7 days | |||
| (do not use doxycycline if you are pregnant or breastfeeding) | |||||
| or | |||||
| tetracycline | 500 mg | by mouth, 4 times a day for 7 days | |||
| (do not use tetracycline if you are pregnant or breastfeeding) | |||||
| AND | |||||
| metronidazole | 400 to 500 mg | by mouth, 2 times a day for 7 days | |||
| or 2 grams (2000 mg) | by mouth, in a single dose | ||||
| (avoid metronidazole in the first 3 months of pregnancy; instead use both clindamycin and tinidazole) | |||||
| OR | |||||
| clindamycin | 300 mg | by mouth, 2 times a day for 7 days | |||
| or 5 grams of 2% cream (one full applicator) | in the vagina at bedtime for 7 days | ||||
| and | |||||
| tinidazole | 2 grams (2000 mg) | by mouth in a single dose | |||
| or 500 mg | by mouth, 2 times a day for 5 days | ||||
IMPORTANT! Do not drink alcohol during the time you are taking metronidazole or tinidazole. Your partner should be treated with the same medicines. | |||||
Sores on the genitals (genital ulcers)
Most sores or ulcers on the genitals are sexually transmitted, but pressure sores, boils or injuries can also cause sores on the genitals. Any genital sores should be kept clean by washing with soap and clean water. Dry them carefully. Wash any cloth you dry them with before you or anyone else uses it again.
WARNING! When a person has a sore on the genitals, it is easy to get other infections through the sores--especially HIV and hepatitis B. To prevent infection, avoid sex until the sores heal.
Syphilis
Syphilis is a serious STI that affects the whole body. It can last for many years, getting worse and worse. Syphilis can be cured if it is treated early.
Signs:
- The first sign is a small, painless sore that can look like a pimple, blister, a flat wet wart, or an open sore. The sore lasts for only a few days or weeks and then goes away by itself. But the disease continues to spread throughout the body.
- Weeks or months later, the infected person may get a sore throat, mild fever, mouth sores, swollen joints, or a rash-- especially on the palms of the hands and soles of the feet. During this time the infected person can infect others.
- All of these signs usually go away by themselves, but the disease continues. Without treatment, syphilis can cause heart disease, paralysis, mental illness, and death.
Treatment:
For a complete cure of syphilis, the full treatment is essential.
- If signs have been present less than 1 year, inject 2.4 million Units of benzathine penicillin all at once—put half the dose into each buttock. Persons allergic to penicillin can take tetracycline, 500 mg, 4 times each day for 15 days.
- If signs have been present more than 1 year, inject 2.4 million Units of benzathine penicillin—half in each buttock—once a week for 3 weeks (a total of 7.2 million Units). If allergic to penicillin, take tetracycline, 500 mg, 4 times each day for 30 days.
NOTE: Pregnant or breastfeeding women who are allergic to penicillin can take erythromycin . Your partner should also be treated.
Chancroid
Chancroid is an STI that causes sores on the genitals. It can be cured with medicine if it is treated early. It is easily confused with syphilis.
Signs:
- one or more soft, painful sores on the genitals or anus that bleed easily
- enlarged, painful glands (bubos) may develop in the groin
- slight fever
| Medicines for Chancroid | |||||
|---|---|---|---|---|---|
| Medicine | How much to take | When and how to take | |||
| azithromycin | 1 g | by mouth, all at once | |||
| or | |||||
| erythromycin | 500 mg | by mouth, 4 times a day for 7 days | |||
| or | |||||
| ciprofloxacin (If you are pregnant, do not take ciprofloxacin.) | 500 mg | by mouth, 2 times a day for 3 days | |||
| NOTE: If you cannot tell for certain that your sores are caused by chancroid, or if you cannot get tested, it is probably best to also take the medicine for syphilis. | |||||
Genital herpes
Genital herpes is an STI caused by a virus. Small blisters appear on the genitals. Genital herpes is spread from person to person during sex. Occasionally genital herpes appears on the mouth from oral sex. (This is different from the kind of herpes that commonly occurs on the mouth, which is not spread by sex.)
The herpes virus produces sores that can come and go for months or years. There is no cure for herpes, but there is treatment that can make you feel better.
Signs:
- a tingling, itching, or hurting feeling of the skin in the genital area or thighs
- small painful blisters that can look like drops of water on the skin. They burst and form painful, open sores.
The first time you get herpes sores, they can last for 3 weeks or more. You can have fever, headaches, body aches, chills, and swollen lymph nodes in the groin. Though the sores go away, the infection does not. But the next outbreak will be milder.
Treatment:
Use acyclovir.
Pregnancy and herpes
A pregnant woman who is infected with herpes and has sores at the time of the birth can pass the virus to her baby. This can cause dangerous problems for the baby, especially if it is the mother’s first outbreak. The risk to the baby is less if the mother has had herpes before.
If you have herpes sores, try to give birth in a hospital. Doctors may do an operation to get the baby out (a c-section) so the baby does not get infected from the sores, or may give the baby medicines when it is born.
Genital warts (HPV)
Genital warts are caused by a virus called human papilloma virus (HPV). They look like warts on other parts of the body. It is possible to have HPV and not know it, especially when the warts are inside the vagina or inside the tip of the penis. And some people with HPV never get warts. Warts may go away without treatment, but this can take a long time. Usually they continue to get worse and should be treated. HPV is passed very easily from one person to another during sex.
Signs of HPV:
- itching
- painless, whitish or brownish bumps that have a rough surface
| In women, these bumps usually grow on the folds of skin around the opening to the vagina, inside the vagina, and around the anus. | In men, they usually grow on the penis or just inside it, and on the balls (scrotum), or the anus. |
warts on a woman |
 warts on a man |
Treatment:
These products to treat warts can usually be found in a pharmacy or chemist’s shop.
- Put some petroleum jelly (Vaseline) or other greasy ointment on the skin around each wart to protect the healthy skin.
- With a very small stick or toothpick, carefully put on a very small amount of 80% to 90% trichloroacetic acid (TCA) or bichloracetic acid (BCA) solution on the wart. Leave the acid on until the wart turns white.
- Wash the acid off after 2 hours or sooner if the burning feeling is very painful.
Apply 20% podophyllin solution in the same way until the wart turns brown. Podophyllin must be washed off 6 hours later.
The acid should burn the wart off, leaving a painful sore where the wart used to be. Keep the sores clean and dry. The sores should heal within a week or two. Watch them to make sure they do not get infected. Try not to have sex until they are gone, but if you must have sex, your partner should use a condom.
Several treatments are usually necessary to get rid of all the warts (it does not matter which solution you use). You can repeat the treatment after one week. Try not to get acid on a sore where a wart used to be. If there is too much irritation, wait longer before the next treatment.
Pregnancy and warts
Do not use podophyllin while you are pregnant. It will be absorbed into your skin and can harm the developing baby. Warts can spread and bleed during pregnancy, but the warts themselves will not harm the baby. Sometimes the warts will get much smaller after pregnancy .
Hepatitis (jaundice, yellow eyes)
Hepatitis is an inflammation of the liver usually caused by a virus, but also by bacteria, alcohol, or chemical poisoning. There are 3 major types of hepatitis (A, B, and C), and it can spread from person to person whether or not there are signs of the disease.
Hepatitis A is usually mild in small children and often more serious in older persons and pregnant women.
Hepatitis B is dangerous for everyone. It can lead to permanent damage to the liver (cirrhosis), liver cancer, and even death.
Hepatitis C is also very dangerous and can lead to permanent liver infections. Hepatitis C is a major cause of death for people with HIV/AIDS.
If you are pregnant and have signs of hepatitis, seek medical advice.
Signs:
- tired and weak feeling
- no appetite
- yellow eyes and/or skin (especially the palms of the hands and soles of the feet)
- pain in the belly or nausea
- dark-colored urine, and stools that look whitish
- sometimes a fever
- no signs at all
Treatment:
There is no medicine that will help. In fact, taking some medicines can hurt your liver even more.
Rest and drink lots of liquids. If you just do not want to eat, try drinking fruit juice, broth, or vegetable soup. To control vomiting, sip a cola or ginger drink. Drinking herbal teas like chamomile can also help. Ask the older women in your community about which herbs work best.
When you do feel like eating, do not eat a lot of protein from animals (meat, fish, eggs) because it makes the damaged liver work too hard. Also avoid food cooked with animal fat or vegetable oil. Instead, eat mainly fruits and fresh or steamed vegetables and only a little protein. Do not drink any alcohol for at least 6 months.
Prevention:
The hepatitis B and C viruses can both pass from person to person through sex, injections with non-sterile needles, transfusions of infected blood, and from mother to baby at birth. To prevent passing hepatitis to others, always use a condom during sex and make sure needles, syringes, and tools used for cutting or piercing the skin (such as for tattoos, circumcision, scarring, female genital cutting) are always boiled before use.
The hepatitis A virus passes from the stool of one person to the mouth of another person by way of contaminated water or food. To prevent others from getting sick, it is important to make sure the sick person's stools go down a latrine or toliet, or are buried, and to make sure the sick person is very clean. Everyone--the sick person, family members, caregivers--must try to stay clean and wash their hands often.
Vaccines are now available for hepatitis A and B, but they may be expensive or may not be available everywhere. If you are able to get a vaccination while you are pregnant, it will prevent the virus from passing from you to the baby.
What to do if you have an STI
If you or your partner have signs of an STI:
- start treatment right away. Early treatment will protect you from more serious problems later on, and will prevent the spread of infection to others.
- get tested, if possible. Go to a clinic or health center where you can be tested to know which STI you have. This way you will not have to take medicines you do not need. If it is not possible to get tested, you may have to take several medicines. Try to talk with an experienced health worker about treatment.
- help your partner get treated at the same time you do. If he does not, he will infect you again if you have sex. Urge him to take the proper medicine or to see a health worker.
- make sure you take all the medicine, even if your signs start to go away. Do not buy only part of the medicine. You (or your partner) will not be cured until you have taken all the required medicine .
- practice safer sex. If you do not protect yourself, you can always get another STI.