What an infectious disease doctor wishes you knew about STDs and STIs

If you suspect you’ve been exposed to a sexually transmitted infection (STI) or are experiencing symptoms of a sexually transmitted disease (STD), talking to your doctor or medical provider can be your best defense against their related complications. Meanwhile, here’s what to know when it comes to common questions and misconceptions about STDs and STIs.

What’s the difference between an STI and an STD?

The difference between an STI and an STD typically lies in the fact that a substantial number of these infections can be present without signs or symptoms of a particular clinical disease. Hence, this is why they are referred to as STIs. When symptoms due to an STI develop, we categorize the infection as an STD. It is important to note that treatment can and often should begin when symptoms are not present.

What are the most common symptoms?

It is important to remember that a substantial number of STIs can be present without any symptoms. However, when symptoms are present, they can vary depending on the specific STI and the part of the body that is involved.

For example, chlamydia or gonorrhea of the genital tract can present with vaginal discharge in females and penile discharge in males. If they are present in the upper genital tract of females such as the uterus, fallopian tube, and ovaries (a condition known as pelvic inflammatory disease or PID), it can present with pain in the lower abdomen or the pelvis.

Other STIs, such as genital herpes, can cause recurrent outbreaks of painful genital vesicles or ulcers. Syphilis (also known as the “Great Imitator” because its large constellation of symptoms can mimic other non-STI conditions) can present with a genital and/or oral ulcers, which may not be painful, and a whole-body rash that can involve the palms of the hands and the soles of the feet. Syphilis during pregnancy can lead to infection of babies while in utero and result in a condition called congenital syphilis, which can have devastating health consequences for the baby.

Lastly, some strains of human papillomavirus (HPV), can present with wart-like lesions in the genital area (aka genital warts), while others are known to cause cancers (e.g., cervical, anal, penile, head and neck, etc.).

Will an STI/STD go away on its own?

While the body’s immune system may be able to fight off some STIs, we should not rely on this when deciding whether to seek testing and/or treatment. Ignoring symptoms and not seeking medical evaluation, testing and appropriate treatment in a timely fashion, can all result not only in negative health consequences for the person affected but also for sexual partners who may have been exposed.

Even if you don’t have symptoms, there’s a risk of passing the infection to your sexual partners. Some STIs can be passed through activities that may not involve intercourse but are associated with sharing/mixing of body fluids such as oral sex (including fellatio, cunnilingus, anilingus or rimming), kissing, sharing contaminated needles. There is even the risk of self-inoculation that can happen after touching the infected area and spreading the infection to other parts of the body, such as the eyes.

What happens if an STI/STD goes untreated?

In people with uteruses, infections such as gonorrhea and chlamydia that are left untreated, treated inappropriately, or not treated in a timely fashion can lead to pelvic inflammatory disease (PID), which can cause infertility, ectopic pregnancy and chronic pelvic pain.

In people with penises, these same STIs can lead to lead infection of the epididymis (epididymitis) and testicles (orchitis).

In the case of syphilis, untreated infection can lead to complications such as meningitis, blindness, hearing loss and strokes.

Furthermore, an untreated STI increases the risk of transmission not only to sexual partners but to unborn children. During pregnancy, STI transmission to the baby can cause blindness, pneumonia and still-birth, to name but a few potential problems.

Lastly, it’s important to remember that untreated STIs can increase the risk of getting and transmitting HIV.

When should I use an at-home STI/STD test and when should I see a doctor for a diagnosis?

There are several at-home testing kits available for different STIs, including HIV, chlamydia, gonorrhea, trichomoniasis, syphilis and others. While these tests can offer the convenience of self-testing in the privacy of home, it’s very important to be in communication with a medical provider to discuss the results and determine whether you should take a repeat or additional STI test.

Seek evaluation by a medical provider immediately for a positive test result. If you have STI/STD symptoms, proceed with a medical evaluation regardless of the home test result.

Communication with a medical provider can help determine the next steps to help you get appropriate STI/STD diagnosis and treatment as quickly as possible.

What is the difference between STD/STI screening and testing?

In general, we refer to screening when looking for an infection in people who don’t have signs or symptoms of disease; it’s typically based on risk factors such as age and sexual practices. Diagnostic testing confirms the specific infection that may be causing the signs or symptoms of a particular disease. With that said, it’s not uncommon for these terms to be used interchangeably in clinical practice.

Can STIs/STDs be cured?

Yes, some STIs/STDs, including chlamydia, gonorrhea, trichomoniasis and syphilis, are curable with appropriate treatment such as antibiotics. Other STIs, such as genital herpes. Aren’t curable in the sense that they remain in the body and cause episodic outbreaks. For these STIs, we can use antiviral medications to either shorten the severity and duration of outbreaks or to prevent/minimize the number of outbreaks that occur over time.

What treatment is available for STIs/STDs?

The type of treatment ultimately depends on the specific STI, but in general, antibiotics are the treatment of choice for chlamydia, gonorrhea, trichomoniasis and syphilis. Antiviral treatment is used to manage genital herpes outbreaks.

Appropriate screening based on national guidelines and recommendations and prompt diagnosis and treatment are the cornerstone of the management of STIs/STDs. Timely diagnosis and treatment can prevent short- and long-term complications in the affected individuals and help prevent transmission to sex partners and unborn children.

Can STIs/STDs be treated with natural remedies at home?

There are no recommended “natural remedies” as alternatives to the antibiotics and antivirals recommended for STIs/STDs treatment based on national guidelines.

In addition, there are several methods for prevention:

• Open discussions with sex partners and medical providers
• Practicing safe sex (e.g., using barrier protection such as condoms)
• Vaccinations (e.g., HPV vaccine, hepatitis A/B vaccines)
• HIV pre-exposure and post-exposure prophylaxis (PrEP and PEP) when indicated
• Regular medical check-ups and screenings

What are the most common STIs/STDs?

Over the last couple of years, we have seen a troubling trend in the rates of curable bacterial STIs. Consider these 2021 data from the Centers for Disease Control:

• 1.6 million cases of chlamydia represent about a 4% rate increase since 2020.
• Over 700,000 cases of gonorrhea represent about a 5% rate increase since 2020.
• More than 176,000 cases of syphilis represent a 32% rate increase since 2020.

We have also seen a disturbing 203% increase in congenital syphilis cases over the past five years.

It must be noted that the epidemic of STIs disproportionately affects vulnerable populations, including racial, ethnic and sexual/gender minority groups. Therefore, we need to enhance our local and national public health efforts to help support and care for those most in need.