Sex & fertility
STD signs, symptoms and testing
by Marcy Holmes, NP, Certified Menopause Clinician
Infections covered in this article:
To our way of thinking, a woman’s best protection from sexually transmitted
infections is knowledge — combined with a generous dose of self-respect! In
our article supporting
safe sex in midlife, we encourage women to place a high value on their sexual
health, offering practical guidance as well in how to avoid STD’s in the first
place. But if it’s too late for that, don’t waste time feeling guilty
— get testing and treatment, and move forward in creating health in your life.
Here’s what to look for in the way of symptoms and some basics about getting
tested.
Commonsense guidelines on STD screening and testing
- Many STD’s can be silent or asymptomatic.
- Regular Pap smears and pelvic exams are
an important self-care measure for all sexually active women.
- When you have a new partner in your life, we recommend STD testing as soon as possible
— not waiting for your annual Pap smear.
- Because one sexually transmitted infection (STI) can make the body more prone to
others, whenever one infection is found it’s best to be tested for as many
other STI’s as possible.
- If someone is being treated for any type of STI, treatment of their partner at the
same time is strongly advised.
Bacterial STD’s
- General info: Bacterial STD’s are relatively easy to treat
and cure once identified. However, antibiotic resistance is a growing concern in
some areas. Bacterial STD’s are of greatest concern only if they go unidentified
and untreated.
- Testing and diagnosis of bacterial STD’s as a group: Healthcare
providers evaluating a woman for bacterial STD’s will perform a pelvic exam,
checking for tenderness, inflammation, swollen lymph glands, and vaginal discharge.
They will collect vaginal and/or urine samples, and possibly draw blood to send
to a laboratory. At the laboratory, the specimens themselves may be examined for
identification by microscopy, or possibly cultured out for positive identification
Here are some specifics on common bacterial STD’s:
1. Syphilis
Caused by the spirochete bacterium Treponema pallidum.
Symptoms of syphilis
- Many signs and symptoms of syphilis are difficult to distinguish from other diseases.
- Primary symptoms: The heralding sign of infection is a lesion at the point of contact
(typically the genitalia), appearing anywhere from 10–90 days after exposure. This
lesion, known as a chancre, is generally quite firm in consistency, typically painless,
and may heal completely within 4–6 weeks. Another primary symptom of syphilis is
swelling of lymph nodes in groin. Because these symptoms are relatively benign,
people with syphilis may be unlikely to seek treatment at outset of infection.
- Secondary symptoms are much more noticeable, beginning anywhere from 1–6 months
after contracting the disease, and vary widely. These include changes of the skin,
such as a red or pink non-itchy rash; broad whitish lesions in moist areas of the
body, and mucous patches in the mouth or genitalia. These areas are highly infectious.
Other symptoms may include fever, sore throat, weight loss, headache, and neck stiffness.
- Latent syphilis: Signs and symptoms of latent syphilis are not obvious, but it is
still possible to detect an infection by examining a blood sample at this stage.
- Tertiary syphilis: If not caught and treated at an earlier stage, tertiary syphilis
symptoms generally develop anywhere from 1–10 years after initial infection, producing
a chronic inflammatory state in the body that may progress to painful joint disease
and debilitating neurological problems. At this point the infection is extremely
difficult to treat, as the immune system may have become unable to clear the body
of the organism.
Notes on syphilis: Even though syphilis is easily treated, unsafe
sexual behavior can cause it to rapidly spread within population subgroups (e.g.,
incidence doubled in a certain NYC population recently).
2. Gonorrhea
Caused by the bacterium Neisseria gonorrhoeae.
Symptoms of gonorrhea
- In women, the most common symptoms are pain with urination, vaginal discharge, and
bleeding between periods or after sex. Since the urethra and endocervical tissue
are the most common targets of infection for this bacterium, these are the areas
that characteristically become inflamed (urethritis and cervicitis). More advanced
symptoms may include cramps, pain, vomiting or fever, all potential indicators of
pelvic inflammatory disease (PID), which if left untreated can lead to damage of
the reproductive organs and ultimately to infertility in some cases.
- Between 30–60% of women with gonorrhea are asymptomatic or have “subclinical”
disease (meaning the illness remains below the surface of detection by most healthcare
clinicians.)
- Secondary symptoms are much more noticeable, beginning anywhere from 1–6 months
after contracting the disease, and vary widely. These include changes of the skin,
such as a red or pink non-itchy rash; broad whitish lesions in moist areas of the
body, and mucous patches in the mouth or genitalia. These areas are highly infectious.
Other symptoms may include fever, sore throat, weight loss, headache, and neck stiffness.
Notes on gonorrhea: Though rates of gonorrhea in the US have gone
down, gonorrhea resistance to conventional antibiotics has gone up, and it’s
now included on the list of superbugs that have strong resistance.
3. Chlamydia
Caused by sexually-transmitted bacterium Chlamydia trachomatis.
Symptoms of Chlamydia
- In women, the most common symptoms are pain with urination, pain with sex, lower
abdominal pain, and vaginal discharge.
- Chlamydia is of significant concern to women because it’s so often “silent”
— as many as 70–80% of women infected with it are asymptomatic. One of the
reasons regular pelvic exams are so important is because you can be exposed to this
over and over again, and again, if left untreated, it may progress into PID.
Notes on Chlamydia: Reinfection is possible, so it’s
important for both partners to be treated.
4. Bacterial vaginosis (BV)
Caused by disruption in balance of normal protective vaginal microflora,
with colonies of odor-producing bacteria such as Gardnerella taking over.
These odor-producing bacteria typically prefer a high vaginal pH, and therefore
activities and changes that upset the normal vaginal “ecology” are linked
with higher incidence, such as vaginal douching; a sudden increase in frequency
of sex (semen has a high pH); having an IUD placed. Low estrogen can also disrupt
vaginal pH balance.
Symptoms of BV
- Malodorous or otherwise abnormal vaginal discharge; vulvar burning, itching and
irritation; burning with urination (similar to trichomoniasis).
Notes on BV: BV can cause inflammation of the cervix and increased
vulnerability to STD infections. While BV is related to sexual activity, it is not
considered an STD because men do not carry the causal organism, and male partners
of women with BV do not require treatment.
Viral STD’s
General info about sexually transmitted viral infections: Unlike
bacterial STD’s, which can be cured, viral STI’s remain in the body
without necessarily causing any overt symptomatology, even after treatment. That
means that once you become infected, even if you do get testing and treatment, you
may continue to carry the virus, and therefore possibly infect others. We have,
however, seen cases where with good nutritional and immune support, these viruses
remain fully dormant.
Here are some specifics on common viral STD’s:
1. Herpes simplex virus (HSV)
Two types:
- Type I HSV (oral herpes)
- Type II HSV (genital herpes)
Caused by either type I or type II herpes simplex virus (HSV) strains.
Symptoms: In its characteristic form herpes causes painful, blister-like
sores. Primary symptoms are itching, tingling or burning at site of infection before
sores or blisters appear. Blisters may appear at any time within days of exposure
or years later, possibly accompanied by flu-like symptoms. The blister crusts over
and drops off in about 2 weeks. The virus then lies dormant in the body, but outbreaks
may recur. It may be infectious even when there are no symptoms.
- Type I appears mostly on the mouth and face as oral herpes or cold sores, but can
infect the genitals as well.
- Type II prefers the genitals, but it can affect the face with contact, too.
Notes on HSV: We now know that contact with the infected tissue
region can spread the virus at any time, not just when sores are present, and that
oral sex can pass both types from oral to genital tissues and back again.
Testing/diagnosis for herpes
- If an active herpes ulcer is present, the healthcare provider can swab it and send
it to a diagnostic laboratory. At the lab, these cells can be cultured out; or immediately
stained and examined for definitive features; or used to conduct what is known as
a PCR, or polymerase chain reaction test. The PCR test has been found to be the
most sensitive and accurate of these three, particularly as only tiny amounts of
the virus are needed to produce a positive result. However, it is not widely available
and is more expensive than other types of testing, so you may need to specifically
ask for this more definitive test. A negative culture does not necessarily mean
absence of infection.
- Sometimes an asymptomatic or mildly symptomatic patient in the earlier stages may
be asked by the provider to simply return when they experience an outbreak.
- Alternatively, a blood sample can be drawn and sent to check for antibodies against
the HSV-2 virus. This type of testing is called serology. In the past,
HSV antibody tests, called assays, were unable to distinguish between HSV-1 and
HSV-2, but nowadays there are newer assays that distinguish the two. Again, not
all laboratories conduct these tests, so you may need to specifically ask your provider
for a definitive test. Another newer finger-prick test is also now available for
clinicians to use right in their office at the time of visit, providing results
within 15 minutes.
2. Genital warts/HPV
Caused by certain strains of the human papillomavirus. Of over
100 strains of HPV, over 30 affect the anogenital region. Genital warts are associated
with types 6 or 11. Cervical cancer is most strongly associated with high-risk HPV
types 16, 18, 31, 33, and 35 in the US.
Symptoms of HPV: This can manifest as changes of the cervix, detected
via abnormal Pap smear results, or as condylomata (warts).
Testing/diagnosis of HPV: Atypical changes on Pap smear are usually
indicative of infection with high-risk types. However, detection of actual viral
genetic material or protein is the definitive means of diagnosis. Women with abnormal
results on Pap smear will be counseled to return for additional sampling of cervical
cells.
Notes on HPV: The new HPV vaccine Gardasil targets only strains
#16, 18, 6 and 11, and must be given prior to exposure to any of these strains in
order to be effective. We discuss this issue and various other aspects of human
papillomavirus in the following articles:
3. HIV/AIDS
Caused by a lentivirus (“slow virus”) transferred through
blood, semen, vaginal fluid, or breast milk. AIDS is a syndrome that is believed
to develop over time as a result of HIV infection.
Symptoms of HIV
- Many people do not experience any symptoms when first infected by HIV. Others may
experience a set of acute, flu-like symptoms known as acute HIV syndrome, that may
include fever, fatigue, headache, nausea, diarrhea, and possibly enlarged lymph
nodes, but all of which could be easily overlooked as being caused by some other
virus. At this stage, there is a high level of viral particles present as they spread
throughout the body, particularly through the lymphatic system.
- However, it takes the immune system time to rally and develop antibodies against
the infection. These antibodies generally develop within the first three months;
a process by which their numbers increase as the number of viral particles in the
system decreases. Most people then become asymptomatic for a period of time lasting
from several months to 10 or more years.
- Over time, however, the body’s immune mechanisms become worn down and the
virus prevails. Other “opportunistic” infections can gain a foothold
where they might not have in someone who wasn’t immunocompromised. This eventually
leads to the stage known as acquired immunodeficiency syndrome (AIDS),
where the body’s immune system becomes unable to fight off opportunistic infections
and other life-threatening illnesses.
Testing/diagnosis of HIV
- A healthcare provider will draw a blood sample to send for evaluation for HIV antibodies.
HIV-testing may require several steps before positive confirmation can be made.
- Two basic types of antibody tests are available: the enzyme-linked immunosorbent
assay (ELISA) test is used for initial screening, and a second, confirmatory
test called the Western blot.
- Both the above can return false-negative results for up to three months following
exposure.
- Other types of tests that are less commonly available can be used to more definitively
diagnose infection and determine how far advanced the infection may have become,
including measurement of the number of viral particles themselves and the number
of white blood cells of the type known as CD4.
- At the University of Maryland Institute of Human Virology, research scientists have
developed a more sensitive test, called immuno-PCR, that can detect the
presence of HIV virus particles earlier and at much lower levels, providing better
opportunity to treat and monitor infection.
4. Hepatitis B virus (HBV)
Caused by the blood-borne DNA virus Orthohepadnavirus.
Transmission occurs with exposure to infectious blood or other body fluids containing
blood, as with unprotected sexual contact.
Symptoms of hepatitis B
- In some people, infection may be completely asymptomatic.
- Primary symptoms of an acute infection are flu-like, and may include mild fever,
headache, body aches, fatigue, loss of appetite, nausea, vomiting, diarrhea, and
dark urine.
- This may progress to jaundice, with yellowing of the skin and eyes and clay-colored
stools.
- Chronic infection may be asymptomatic or cause inflammation of the liver, which
can progress to cirrhosis.
Testing/diagnosis of HBV
- Because hepatitis B induces the body to produce different antibodies or other biochemicals
in the blood depending on the stage of infection, different types of tests (called
assays) may be required for definitive diagnosis, depending on how long
it has been since the individual was exposed.
- The hepatitis B surface antigen (HBsAg) test looks for substances in the
blood that show whether a hepatitis infection is active, ongoing (chronic), or has
occurred in the past. This is the first and most frequently used test, but it may
not give an accurate response in the earliest stages of infection, before this viral
antigen is manufactured, or when more than six months have passed since infection
in persons who have cleared the infection. There are, however, other antigens and
particles in the blood that can be called on to confirm diagnosis.
Notes on HBV
- This is one of numerous unrelated viruses causing what we refer to as viral
hepatitis (A, B, C, D, E, and delta factor).
- In some people, the virus is self-limiting, meaning it clears itself within
weeks to months, with the individual making a full recovery and developing protective
immunity against the virus. In others it becomes a longstanding problem.
- Up to a third of the world’s population has been exposed to hepatitis B, but
with only 3–6% of the population becoming infected.
- Incidence is relatively low in the US (~2%) compared to pockets in South American
and the African and Asian continents.
- Individuals who continue for six months to test positive for HBsAG are considered
hepatitis B carriers.
- This disease can be prevented by having the recombinant hepatitis B vaccine.
5. Molluscum contagiosum (MC)
Caused by a common benign virus (Molluscum contagiosum,
or MC) that affects primarily children, being readily transmitted from contact with
infected individuals as well as surfaces such as chairs and toilet seats, but which
because it can also be sexually transmitted gets clumped with STI’s. (Transmission
is not exclusively through sexual contact.)
Symptoms of Molluscum contagiosum: Small, pearly, wart-like
skin bumps; sometimes with a dimpled or pored center that may produce white curd-like
exudate; may be itchy; may lead to secondary bacterial infection if left untreated,
particularly in moist areas of the body such as the genitals.
Testing/diagnosis of MC: The wart-like bumps have a distinctive
appearance, but identification can be confirmed by skin biopsy and less commonly
by stained smears of expressed cores. Though not common, it may be confused with
warts, chicken pox, moles, or other skin conditions.
Notes on MC: Even though the virus is typically self-limiting,
meaning it resolves by itself within a few months to years, treatment is preferable
to prevent spread, both to other areas on the body and to other individuals.
Other types of sexually transmitted infections
1. Trichomoniasis (“trich”)
Caused by the sexually-transmitted protozoan parasite Trichomonas
vaginalis.
Symptoms of trichomoniasis
- Main symptoms in women include malodorous, yellow-green discharge; inflammation
of the vaginal canal; and vulvar burning, itching and swelling. Burning with urination
can also occur.
- It is estimated that up to half of women with trichomoniasis are asymptomatic.
- Most men infected with Trichomonas do not experience symptoms, so they
are usually only treated if they have unusual swelling or discomfort with no other
detected cause, or because their female partner has been found to have it.
Testing/diagnosis of trichomoniasis: To screen for this disease,
the healthcare provider performs a pelvic exam and collects vaginal samples with
a swab. The sample may be inspected immediately in the office under a microscope,
but the Trichomonas organism is oftentimes missed (sensitivity of this
method is approximately 60–70%). The specimen can also be sent out for culture,
which is the most sensitive widely available method of diagnosis, with confirmation
generally requiring 3-7 days. Some labs have developed their own PCR tests (polymerase
chain reaction) for Trichomonas, and this method has been found
to be the most sensitive (approximately 84%) , but these tests are not widely available.19
Notes on trichomoniasis:
- Trich is very common and highly underdiagnosed. The World Health Organization (WHO)
refers to it as an “orphan pathogen,” meaning it is poorly understood,
underfunded, and often untreated.
- The inflammation associated with trichomoniasis has been connected with increased
susceptibility to other STD’s, including HIV.
- Reinfection is possible, so it’s important that both partners get immediate
treatment before resuming sexual activity.
2. Pubic lice (“crabs”)
Caused by a species of parasitic insect known as Pthirus pubis.
Humans are its only known host.
Symptoms of crabs
The first and most obvious symptom is itching in the genital area, though lice can
colonize other areas of the body. Visible signs include:
- Yellow-to-white ovoid nits (eggs), about the size of a pinhead;
- Slightly larger nymphal stages (of which there are three)
- Somewhat larger still, the grayish-white adult lice that may appear more red-brown
after feeding on blood. Nymphs and adults resemble tiny crabs under the microscope.
- Most infestations are also characterized by grey-blue or slate-colored skin at the
feeding site.
Testing/diagnosis of crabs: It’s hard not to notice that
you have crabs. If you’re itchy, take a closer look! They can be treated initially
with an over-the-counter product, but the longer you have them, the harder they
can be to get rid of, so see your practitioner if you need confirmation or your
first efforts at treating them without a prescription aren’t successful.
Note: Reinfection is a concern, so any sexual partners —
and everyone in the family — should be checked and treated.
Sexually transmitted infections have been around for at least as long as we have,
so they’ve had plenty of time to evolve and diversify — these are just
a few of the most common ones we see in women who visit our clinic. There are numerous
other types, and much more to discover and learn about them than we could possibly
cover here. For further reading, you may want to check out some of the links listed
on our references page on STI’s,
then go from there.
If you have the merest shadow of a doubt that you may have picked one up —
regardless of whether you may only have put your sexual health at risk but “got
away with it this time,” or, for whatever reason you may indeed have one despite
your best efforts at protection — please don’t beat yourself up about
it. The important thing is to get appropriate diagnosis and treatment.
Either way, your next best step is a trip to a qualified healthcare provider —
whether that’s your primary care provider, gynecologist, Planned Parenthood
or an STD clinic. And if you do test positive, remember, these infections are very
common — anyone who is sexually active risks getting one (or more), and everyone
deserves to receive the best, most effective treatment available in a nonjudgmental
atmosphere. To put things in perspective, think of STD’s simply as bugs you
don’t want — and bugs you wouldn’t want to pass along to anyone
else, either. With adequate prevention, treatment and self-care, you can greatly
reduce the health risks these infections pose to yourself and others.
Our Personal Program enhances your nutritional base
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
Our Personal Program is a great place to start
The Personal Program promotes natural hormonal balance with nutritional supplements,
our exclusive endocrine support formula, dietary and lifestyle guidance, and optional
phone consultations with our Nurse–Educators. It is a convenient, at-home
version of what we recommend to all our patients at the clinic.
If you have questions, don't hesitate to call us toll-free at
1-800-798-7902. We're here to listen and help.
Related to this article:
References & further reading on STD
symptoms and tests
Last Modified Date: 04/19/2011
Principal Author: Marcy Holmes, NP, Certified Menopause Clinician