SEXUALLY TRANSMITTED INFECTIONS

Penetration and ejaculation are not required for transmission. Gonorrhea can be passed from an infected mother to her infant during birth.

Men are more likely to show symptoms of gonorrhea than woman, but most people don’t show symptoms at all. When symptoms do occur, they might appear 2-7 days after infection.

Males may experience:

• Thick, yellowish-green discharge from penis
• Testicular pain or swelling
• Itching penis

Females may experience:

• Increased vaginal discharge
• Pain in the abdomen or in the lower back
• Vaginal bleeding after intercourse or between menstrual periods
• Pain during intercourse

Both males and females may experience:

• Painful urination
• Pain, itching, bleeding, and/or mucus discharge of the rectum
• Redness, itching, and/or discharges of the eyes (for gonorrhea in the eyes)
• Throat infection

Condoms are helpful in preventing the spread of gonorrhea during vaginal and or anal sex. Condoms and dental damns can help prevent the spread during oral sex.

Testing is done by swabbing the infected area or by using a urine sample.

Gonorrhea is usually treated with dual therapy antibiotics. Do not have sex until the treatment is complete. Sexual partners who have been in contact within 60 days of the diagnosis will require testing and treatment.

• In women, gonorrhea can spread from the cervix to the uterus and fallopian tubes, an infection called Pelvic Inflammatory Disease (PID). This can then lead to chronic pelvic pain, risk of ectopic pregnancies, and infertility.
• In men, gonorrhea can cause testes infection.
• For pregnant women, gonorrhea can also cause miscarriage, preterm birth, premature rupture of membranes, or infection. It can be passed from mother to child during birth, causing an eye infection or a severe infection in the blood.
• In both men and women, gonorrhea can cause arthritis, infertility, or severe infection in the blood.

Chlamydia is a bacterial infection. It is one of the most common STIs in the world. The majority of infections are among people 15-24 years of age.

• Chlamydia can be spread through unprotected oral, vaginal or anal sex with an infected partner
• Penetration and ejaculation are not required for transmission
• It can also pass from an infected mother to her infant during birth

Around 70% percent of women and 50% of men with chlamydia have no symptoms. When symptoms do occur, they might only appear several weeks after initial exposure to the bacteria. Chlamydia is typically more serious for women than for men, but women are also less likely than men to have symptoms.

Females may experience:

• Vaginal bleeding after intercourse or between menstrual periods
• Vaginal discharge
• Pain in the abdomen or in the lower back
• Pain during intercourse

Males may experience:

• Itchy urethra
• Clear, watery or milky discharge from the penis
• Testicular pain or swelling

Both males and females may experience:

• Pain or burning while urinating
• Pain, itching, bleeding, and/or mucus discharge of the rectum (for chlamydia in the anus)
• Redness, itching, and/or discharges of the eyes (for chlamydia in the eyes)
• Sore throat, cough, swollen lymph nodes, and/or fever (for chlamydia in the throat)

Condoms are helpful in preventing the spread of gonorrhea during vaginal and or anal sex. Condoms and dental damns can help prevent the spread during oral sex.

Swabs can be used to test areas that may be infected. A urine test can also be done.

Antibiotics are used to treat uncomplicated genital infections. Sexual partners who have had contact with an infected person within 60 days of diagnosis will require testing and treatment.

• In women, chlamydia can spread from the cervix to the uterus and fallopian tubes, an infection called Pelvic Inflammatory Disease (PID). This can then lead to chronic pelvic pain, ectopic pregnancies, and infertility.
• In men, chlamydia can cause inflammation of the testicles, prostate and scrotum. It can also cause infertility in rare cases.
• Chlamydia can also cause another form of STI called lymphogranuloma venerum, also known as LGV or venereal disease. LGV can cause ulcerating sores or lumps inside or outside of the genitals.
• For pregnant women, chlamydia can also cause miscarriage, preterm birth and low birth weight. The infection can also be passed from mother to child during birth, causing an eye infection or even pneumonia.
• If left untreated, chlamydia can cause rashes, sores, and joint pain in both men and women.

Syphilis is caused by the bacteria Treponema pallidum. Rates of syphilis cases in Canada have significantly increased in recent years.

Syphilis can be transmitted through unprotected oral, vaginal, and or anal sex with an infected partner, including through mutual masturbation and sharing sex toys. It can spread by direct contact with bacteria contained in syphilitic sores or rashes. It can also be passes from an infected mother to her infant during birth. In rare cases, it can be transmitted from sharing unclean needles, receiving a blood transfusion or organ transplant, or breastfeeding.

Syphilis can progress through four stages: primary, secondary, latent and tertiary, with each stage producing different symptoms. Many of the symptoms mimic that of other illnesses, which often makes it very difficult to diagnose. Some people may not experience any symptoms at all and others may have some symptoms but not others. As a person progresses from stage to stage, the symptoms of syphilis may go away on their own, but this does not mean that the infection is gone.

Primary syphilis (3 days – 3 months after exposure)

• Individuals may develop a small painful sore. The sore will heal on its own without treatment, but this does not mean the infection is gone or that the person is no longer contagious.

Secondary syphilis (6 weeks – 6 months after exposure)

• There are a wide range of symptoms including:
  • Flu-like symptoms
  • Patchy hair loss
  • Muscle and joint pain
  • Rashes (particularly on the palms and soles of the feet)
  • Fever
  • Swollen glands
  • A general feeling of being unwell
  • Weight loss
  • Flat, smooth warts in the genital area
  • Headaches
  • Eye infection
  • Meningitis
• These symptoms typically disappear on their own but this does not mean the person is no longer infected.
• Secondary symptoms usually last 3-12 weeks but may persist for years until the person moves into the latent stage.

Latent syphilis

• Generally there are no symptoms in the latent stage, but for the first year after infection, lesions or rashes of primary or secondary syphilis can recur and the infection can be transmitted.
• During this time the syphilis bacteria may continue to multiply and infect the body.

Tertiary syphilis (2-30 years or more)

• Tertiary syphilis occurs in 40% of untreated infected persons. This stage is very destructive. It is the stage at which the long-term damage caused by syphilis bacteria results in various major health complications, affecting the brain, heart, bones, or blood vessels. In some cases, these complications can lead to death.

Condoms are helpful in preventing the spread of gonorrhea during vaginal and or anal sex. Condoms and dental damns can help prevent the spread during oral sex.

Testing for syphilis is done by swabbing the infected area or by blood test.

People infected with syphilis are typically treated with injectable penicillin. Partner notification is important. How far back in time you go depends on the stage of syphilis, but any partners within the last 3 months, long-term partners and children should be notified and tested.

• If left untreated, syphilis can cause potentially life-threatening complications, and permanent damage to the brain, heart, bones, and blood vessels. Sometimes, syphilis can cause mental disorders or neurological problems. In very rare cases, untreated syphilis infection can be fatal.
• Because syphilis can cause lesions and sores on the genitals or anus, it increases the risk of transmitting or becoming infected with HIV.
• If an infected mother passes syphilis to her infant during birth, it can result in fetal death or congenital syphilis (this includes birth defects and developmental delay).
• Talk to a doctor before starting to have sex again.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the world today. Approximately 75% of sexually active Canadians will have at least one HPV infection in their lifetime, with the highest rates of HPV infection occurring in young people aged 15-24.

HPV can be passed through oral, vaginal, or anal sex with an infected partner. HPV can also be transmitted through other intimate contact including genital rubbing. HPV can also be passed to an infant during delivery, although this is rare.

Genital warts:

• No symptoms
• Itchiness
• Discomfort during intercourse
• Bleeding with intercourse or with shaving
• Warts on the penis or vulva, which appear as small cauliflower-like growths
• During pregnancy, warts may increase in size and number and then regress/resolve after delivery

Cervical cancer:

• Often no symptoms
• Bleeding between periods or after intercourse
• Found after an abnormal Pap test

Other cancers caused by HPV:

• HPV has been associated with some cancers on the vulva, in the anus, on the penis, and in the throat. Atypical symptoms from these areas, especially bleeding, itchiness, or pain should prompt a visit to the doctor.

• Most genital warts are diagnosed by visual inspection. If there is any doubt, a biopsy can be taken.
• An HPV DNA test is generally recommended for women over 30 whose Pap test results show specific abnormalities, however testing recommendations differ by province.
• Cervical cancer can be screened for by Pap tests and a blood test looking for HPV DNA.
• Although the Pap test and HPV DNA test are only available for women, men can be examined by their doctor for genital warts caused by HPV and for signs of cancers of the penis, anus, and mouth and throat.

• There is no known way to eradicate the virus once you are infected.
• People with conditions affecting their immune system, including HIV, cancer, on immune suppressant medication for organ transplantation, and auto-immune conditions (such as systemic lupus erythematosis) need more frequent screening for HPV.
• There are treatments for genital warts and cell changes caused by the virus, but these do not cure the virus itself.
• Once you have an HPV infection, the immune system will most often clear the virus, in most people, within one to two years.
• HPV infections can reoccur in the future.

Vaccination is up to 90% effective at preventing the HPV types responsible for most genital warts and HPV-related cancers.

The latest 9-valent vaccine protects against the nine HPV types that are known to cause approximately 90% of cervical cancers, 80% of cervical pre-cancers, 75% of HPV-related vulvar, vaginal and anal cancers and pre-cancers, and over 90% of genital warts.

Numerous scientific studies and clinical trials were done to ensure that HPV vaccines are safe. People who were subjects of the studies had very few serious side effects. The most common is temporary soreness at the site of injection. In some cases, HPV vaccination is not recommended, such as in the case of women who are pregnant or breastfeeding or people who have certain blood conditions or an immune disorder.

In Alberta Gardasil is free for females age 9 to 45 and males ages 9 to 26. Three doses are required. If you are not eligible for the vaccine it may be covered under your insurance.

Herpes is the most common cause of genital ulcerations. Herpes is caused by the Herpes simplex virus. There are two types of this virus, HSV-1 and HSV-2. HSV-1 is primarily associated with oral infection, and HSV-2 is associated with genital infection. HSV-2 is present in about 20% of adults.

• HSV-2 is most commonly transmission by unprotected anal or vaginal intercourse
• It can also be transmitted from the mother to the baby during pregnancy and delivery
• HSV- 1 is most commonly transmitted by oral or genital sex
• Up to 70% of all genital HSV-2 infections are transmitted when people are not having any symptoms or lesions. This is called “asymptomatic shedding.”

Primary Infection:

• Flu-like symptoms including fever, headache and sore muscles
• Swollen lymph nodes
• Inflammation in the nervous system (aseptic meningitis) in up to one quarter of cases
• Pain while urinating
• Genital pain
• Presence of genital ulcers
• Symptoms resolve after approximately 15 to 23 days

Recurrent Infection:

• Slightly less severe than initial infection
• A slight tingling, itching, or burning may be a sign that an active outbreak is coming
• These can be triggered by stressors (such as illness, surgery, emotional stress), the menstrual cycle, sexual intercourse, surgery, and some medications
• Infection from oral sex can cause sores inside the mouth or on the lips of both men and women
• Symptoms typically appear within two to twenty days of infection
• Symptoms resolve after approximately 9 to 11 days

• Use condoms during sexual intercourse
• Avoid sexual intercourse if your partner is having a prodrome (early symptoms)
• Avoid sexual intercourse if you or your partner is having active genital or oral lesions

Herpes is tested by swabbing an active lesions. Sexual partners from the 60 days prior to prodrome onset should be informed if you had an outbreak of herpes.

There is no cure for herpes. However, antiviral medication is effective to decrease the duration and severity of outbreaks. To be most effective, these treatments must be started immediately after the prodrome symptoms appear.

• By themselves HSV-1 and HSV-2 are generally not considered a serious health risk.
• Infected pregnant women can pass the virus to infants during birth, causing lesions and possibly life-threatening infections of the central nervous system of the baby.
• In very small number of cases HSV can cause meningitis or encephalitis (inflammation of the brain).
• Herpes infection of the eye can cause scarring of the cornea and even blindness.
• Herpes increases the risk of transmission of HIV, the virus that causes AIDS. People with HIV can have particularly severe outbreaks of HSV, which can be a sign they have