The Centers for Disease Control (CDC) reports that 20 million new STD cases occur each year. One in five North American adults has a sexually transmitted disease (STD), which costs the U.S. healthcare system nearly $16 billion annually (sexually transmitted diseases, April 2021;48(4):208-221). Worldwide, 31% of adults have genital human papillomavirus (HPV), which can cause genital and oral cancers (Lancet Global Health2023 Sep;11(9):e1345-e1362).
STDs include bacterial, viral and parasitic infections that are usually acquired through vaginal, oral or anal sex and can also be spread through blood transfusions or shared needles. Herpes can be spread through skin-to-skin contact. There are more than 100 types of sexually transmitted diseases; the most common viruses include chlamydia, gonorrhea, human immunodeficiency virus (HIV/AIDS), human papillomavirus (HPV), syphilis, trichomoniasis, and genital warts. Chlamydia, gonorrhea, syphilis and trichomoniasis are easily treated and cured if caught early, but they often go undetected because they may cause mild or no symptoms.
symptom: You can get an STD and have no symptoms at all, but you will usually experience discomfort in your mouth, genitals, bladder, and/or anus, as well as painful or frequent urination. You may also suffer from:
• Genital or oral discharge
• Sores, blisters, or lumps on your genitals or mouth
• Itching and redness in the genital area
• Vaginal odor
• Itching or bleeding from the genitals, mouth, or anus
• abdominal pain
• fever
prevention: Condoms can reduce infection, but most STDs can be spread by any skin-to-skin or liquid contact. The only way to know that you can’t catch an STI from an infected partner is to avoid anal, vaginal, oral, and skin-to-skin contact.
vaccine: Vaccines to prevent human papillomavirus (HPV) have been available since 2006. The CDC recommends that boys and girls should be vaccinated starting at age 9, and men and women should be vaccinated by age 26. People between the ages of 26 and 45 should discuss vaccination options with their doctor. Hepatitis B vaccination is also recommended.
Diagnosis and treatment
If a person has persistent genital symptoms, most doctors will:
• Check smears for trichomonas, bacterial vaginosis and lice
• Culture herpes from blister packs
• Obtain urethral, oral, or rectal culture or nucleic acid amplification testing for gonorrhea
• Perform urethral or urine culture or nucleic acid amplification to test for chlamydia
• Get blood tests for syphilis, HIV, hepatitis B and C, and herpes
• Get a urine test: urinalysis and look for trichomonas
• Swab testing for HPV, chlamydia, gonorrhea and herpes
Home testing kits are available to test for chlamydia, gonorrhea, syphilis, trichomoniasis and hepatitis C.
If you have urinary tract symptoms and believe you may have an STD, but testing doesn’t reveal the cause, you need help. Some infectious disease doctors will have you take two oral antibiotics, such as doxycycline and ampicillin, for two weeks. If that fails, they may give you intravenous antibiotics. This is not a recommended practice because most doctors are afraid of treating patients without a clear diagnosis, and some doctors are very critical of this approach.
In one study, giving doxycycline to high-risk men within 24-72 hours of sexual intercourse reduced the incidence of syphilis, gonorrhea, and chlamydia by two-thirds. All subjects in the study reported having an STD within the previous year (New England Journal of Medicine, April 6, 2023; 388:1296-1306).Other similarly reported studies can be found at clinical infectious diseasesMar 2020;70(6):1247-1253; Journal of the American Medical Association2019;321(14):1380-1390; and Lancet Infectious Diseases, 2018 Mar;18(3):233-234.
My advice
Advice to avoid sex has failed miserably in reducing the incredibly high rates of sexually transmitted diseases. Every new sexual encounter puts you at significant risk for contracting an STD. Most people don’t get STDs when they are in an exclusive relationship with an equally exclusive partner. Many people continue to experience urinary tract symptoms even after receiving treatment for sexually transmitted diseases. Antibiotic treatment is not recommended in routine medical practice, but many people improve with this therapy.
Dr. Gabe Mirkin is a villager. For more information, please visit www.drmirkin.com.