by Eva F. Briggs, M.D.

Question
How do I know if I have an STD?

Answer
Sexually transmitted diseases (or infections, STIs) are like hitchhikers, happy to take a free ride from one person to the next. In the United States, the microorganisms that cause STDs complete that journey 19 million times every year, according to the Centers for Disease Control and Statistics. Here’s the rundown on a few of them.

CHLAMYDIA
Chlamydia trachomatis is a bacterial stealth expert. It causes no symptoms in three-quarters of infected women and half of infected men, according to the CDC. It can also mimic the burning of a urinary tract infection. If left untreated, chlamydia may spread to a woman’s pelvic organs, causing abdominal pain, back pain, fever or nausea.

Mild symptoms, such as discharge from the penis or cervix, often go away without treatment. But the disease isn’t gone. And in women, it silently continues to damage reproductive organs.

Symptomatic or not, infected people can transmit chlamydia to their partners via vaginal, anal or oral sex.

Severe infections can cause a man’s testicles to swell. In a woman, they can injure her tubes and ovaries, leading to pelvic pain, infertility or ectopic pregnancy. Occasionally, gonorrhea can also circulate through the bloodstream, resulting in fever, skin lesions and arthritis.

TRICHOMONIASIS
Trichomoniasis is an infection by a one-celled parasite. Men usually have no symptoms or develop penile irritation. Women may have vaginal burning and a frothy yellow-green discharge. Even without symptoms, or if they disappear, a person is still infectious.

The disease spreads through penile-vaginal intercourse or vulva to vulva contact. Men almost never transmit trichomoniasis to other men.

Wiggling protozoa appear in infected vaginal secretions under a microscope, or the lab can test a specimen. Trichomoniasis is difficult to diagnose in men.

A single dose of the antibiotic metronidazole cures trichomoniasis.

GENITAL HERPES
Only a minority of people infected with genital herpes ever develop characteristic blistering sores, so avoiding herpes infection isn’t easy. Skin that appears normal can still shed virus particles, even in people unaware that they are carriers. And skin around the genitals (not covered by a condom) can spread the disease, as well.

In those who have outbreaks, the first one is the most severe and painful. Many people never get a second episode, but if they do, it’s milder. The more severe the initial outbreak, the more likely it is to recur.

Swabs of blister fluid show the virus. When there are no sores, the disease is difficult to diagnose, but blood tests can help detect it.

Antiviral medicines shorten the duration of outbreaks. Taken regularly, they reduce recurrences but don’t eradicate the virus. Daily suppressive therapy can reduce your likelihood of transmitting it.

HPV
Human papilloma virus comes in a variety of strains. Some cause genital warts, an annoyance but not life-threatening. Other strains cause cervical cancer.

Located on the genital skin and adjacent areas, genital warts can be single or clustered, few or many. They spread by skin-to-skin contact during sexual acts.

Health-care providers can freeze, burn or cut them off, among other options. But there is no cure. The virus always remains in the skin—and contagious—even if it’s dormant.

In women, Pap smears can reveal changes associated with HPV in cervical cells. The new vaccine Gardasil protects against four types of HPV—those that cause 70 percent of cervical cancers and 90 percent of genital warts.

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GENERAL PREVENTION
The only sure way to prevent these and other sexually transmitted diseases is abstinence. Limiting your number of sexual partners and using barrier methods such as latex condoms can reduce your odds of contracting an STD.

Condoms aren’t foolproof, especially for diseases like herpes that occur in places not covered by condoms. But for maximum effectiveness, you must use condoms for every single sexual act. They can’t do their job when they’re still inside a foil wrapper.

EVA F. BRIGGS, M.D., is a member of our print magazine editorial board. She's a board-certified family physician in Marcellus, N.Y., and author of the medical legal thriller Crystal Crazy.

Last updated and/or approved: October 2007.
Original article appeared in summer 2007 issue.

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