Sexually transmitted infections (STIs) are more commonplace than most people would think; especially when most persons who are infected don’t show symptoms for it. There are roughly 25 STIs worldwide. Most of them can’t kill you, but left untreated they can do serious damage to your body, including leaving you infertile.

STI TRANSMISSION

Most STIs, are as their name suggests, transmitted by sexual activities i.e. genital to genital contact, vaginal intercourse, anal intercourse, and oral sex. A few one can be transmitted without there being any sexual activity at all e.g. pubic lice ‘crabs’ and trichomoniasis via shared bedding or bath towels, but this mode of transmission is rarer.

STI TESTING

Testing for STIs is different from testing for HIV. There is no anonymous testing for an STI, and some STIs are reportable. This means that if you receive a positive test result for a reportable STI, Toronto Public Health will make a follow-up call to you, to ensure that you have contacted your recent sexual partners who may have also been infected.

Here is a quick summary on the STIs of note for Toronto:

Name: Syphilis

How it’s transmitted: Vaginal, oral and/or anal sex with someone who has syphilis.

Mother to child (MTC) transmission during pregnancy (bacteria crosses the placenta), if mother is infected.

Signs and symptoms: A sore (1 or more) that is firm, round, small and painless, with a reddish-brown colour appearing a week or two after being infected. The sore(s) appears where syphilis entered the body. The sore will heal, but you are still infected with syphilis.

Damage it can cause if left untreated: Syphilis can progress to patchy hair loss, headaches, weight loss, muscle aches and fatigue. The late stages of syphilis can cause damage to brain, nerves, eyes, heart, blood vessels, liver, bones and joints that shows up years later, difficulty coordinating muscle movements, paralysis, numbness, gradual blindness and dementia.

Treatment: At its 1st stage syphilis is treated by a single injection of penicillin (or other antibiotic, if the person has a penicillin allergy). Persons who’ve had syphilis for longer than a year will require a longer treatment of antibiotics. Blood tests after treatment ensures that syphilis was successfully cured. Of note, for late stage syphilis cases the treatment will NOT repair the damage that was done to the body.

Special Note on Syphilis and HIV/AIDS: In addition to increasing the risk of HIV transmission by 3 to 5 fold, there are severe complications for persons who HIV-positive and co-infected with syphilis .Syphilis typically progresses from stages 1 through 3, if there is no treatment, over the course of several months to a few years.

However, when a person is co-infected with HIV and syphilis the progression is much more rapid, as the immune system is too weak to effectively fight the syphilis bacteria, and more serious damage can occur e.g. neurosyphilis (syphilis in the brain) that can lead to increased chance of a stroke

Name: Chlamydia

How it’s transmitted: Vaginal, oral and/or anal sex with someone who has Chlamydia,

Mother to child (MTC) transmission during birth, if mother is infected (baby at risk for eye and chest infections)

Signs and symptoms: These appear 7 to 21 days after being infected. However, most women & some guys have no symptoms

In women:

• Discharge from the vagina, pain with sex, change in period (i.e. bleeding/spotting between periods), hurts/burns when you pee, fever & nausea (sometimes)

In Men:

• Watery, white or yellow drip from penis, hurts or burns when you pee

Damage it can cause if left untreated:

• Infertility, can become a more serious infection such as Pelvic Inflammatory Disease

Treatment:

• Antibiotics prescribed by your doctor. Partners will need to be treated as well. Don’t have sex with current/new sexual partners until your infection has cleared. If you do have sex, you MUST use a condom.

Name: Gonorrhea

How it’s transmitted: Vaginal, oral and/or anal sex with someone who has Gonorrhea,

Mother to child (MTC) transmission during birth if mother is infected (baby at risk for eye infections)

Signs and symptoms: These usually appear 2-21 days after sex:

In women:

• Thick yellow or white discharge from vagina
• Pain with sex, change in period (i.e. bleeding/spotting between periods)
• Cramps and pain in lower abdomen
• Hurts/burns when you pee
• Fever & nausea (sometimes)

In Men:

• Thick white or yellow drip from penis and/or ass
• Hurts or burns when you pee
• Need to urinate often

Damage it can cause if left untreated:

• Infertility, Pelvic Inflammatory Disease, can cause heart complications, skin disease, arthritis and blindness

Treatment: Antibiotics prescribed by your doctor, followed sometimes by treatment for Chlamydia (as Gonorrhea and Chlamydia are often found together). All sexual partners must be tested and treated if they have gonorrhea as well. NO SEX should occur until the infection has cleared up.

Name: Genital Herpes (a.k.a. Herpes)

How it’s transmitted: Close skin contact with someone who has the virus; vaginal, anal and oral sex with someone infected with herpes. Mother to Child transmission during birth if the mother is infected

Signs and symptoms:

• After 1-30 days painful, red blisters, little sores or ulcers, flu-like symptoms, and sometimes discharge can appear. Blisters can be on vaginal/penis area.
• There is sometime itching and burning before the blisters appear a.k.a. ring of fire.
• Blisters last 1-3 weeks.  The outbreak can re-occur several times through out an infected person’s life.

Damage it can cause if left untreated:

• Care must be taken not to touch the herpes sores and touch another uninfected area of the body, or the virus can be transmitted to that area. You cannot die from herpes, but re-occurring outbreaks can become more painful and frequent without treatment.

Treatment:

• Unfortunately, there is no cure for herpes. There are anti-viral treatments that help with the healing of the blisters, and shorten the attack and pain associated with the blisters. You’re partner may or may not catch herpes. The risk of transmission is increased when open sores are present. You can still pass on the virus to sexual partners even if no sores/blisters are present. However, being on antiviral drugs, reduces your chances of passing the virus to your partner.
• Condoms provide some protection, but it is limited. Female condoms are more effective protection as they cover more of the external female vaginal area.

Name: Trichomoniasis a.k.a Trich

How it’s transmitted: It’s a parasite that’s passed on through vaginal, anal, or oral sex by an infected sexual partner, and possibly shared sex toys.

Signs and symptoms: Trichomoniasis may not show symptoms, so even if your partner doesn't have symptoms, he or she should still be tested.

In women:

These symptoms appeared between 5 days to a month of last having sex with a partner:

• Stronger than usual odor
• Frothy, yellow-green discharge from the vagina
• Sex is painful
• Burns when you urinate
• Severe itching
• Abdominal pain (rare)

In Men:

• Symptoms in men are rare and include a pale white discharge from the penis and painful or difficult urination.

Damage it can cause if left untreated:

• Untreated trichomoniasis has been linked to an increased risk for HIV infection. Infected pregnant women are at risk for premature birth, low birth weight, and infection or rupture of the placenta. In men there is the risk of inflammation of the prostate and inflammation of the bladder.

Treatment:

• A single serving of antibiotics or over a course of 7 days, (Metronidazole), taken by mouth. However, Trichomonas can be reacquired easily so it is important that you and your partner(s) be treated together.

Name: Human Papilloma Virus (HPV) a.k.a. Genital Warts

How it’s transmitted: Direct skin contact with the warts or genital-to-genital contact

Signs and symptoms:

• Genital warts can appear anywhere from a few weeks to a few months after you are exposed to HPV. The warts might look like small bumps. Sometimes they are fleshy and look like small cauliflowers. They can get bigger over time. Your health care provider can usually tell if you have genital warts by looking at them. They can itch during sex, and cause bleeding in the vagina or rectum.

In women:

• The warts usually show up on the vulva (outer area of the vagina), the anus and area between (perineum)

In Men:

• The warts grow around the head of the penis.

Damage it can cause if left untreated:

• If the warts aren’t treated they can grow to the point where it blocks the vaginal, rectal and urethral openings. The warts grow even faster in an infected woman is pregnant.

Treatment:

• There is no cure for the HPV infection. Even though the infection clears up, you can still be infected with HPV. The warts can be removed by: Burning them with an electric needle or a laser, freezing by liquid nitrogen, or cutting them out.

Name: Pubic Lice a.k.a Crabs

How it’s transmitted:

• Direct contact with some one who has the lice. Sharing a towel, bed linens with an infested person (if the lice have been there for less than 2 days)

Signs and symptoms:

• Moderate to severe itching in your crotch/genital area, especially where there is hair. It’s usually worse at night, when the lice dig into hair follicles. The saliva the louse releases when it bites you causes the itching. The bites may be bluish, but the area they’re in will be red and scaly. The lice can’t transmit any diseases, but the constant scratching can make your skin raw leaving it open to infection.
• A magnifying glass makes the lice more easily visible, and will show the small egg sacs or "nits" that are attached to the pubic hairs, usually at the base. In many cases, adult lice may only be seen in the seams of clothing.
• Adult crabs are visible to the naked eye but because of their gray, white or brown color are difficult to see as they can easily blend in with their surroundings. Under a magnifying glass you can see that the pubic lice have six legs, their two front legs are very large and look like the pincher claws of a crab.

Damage it can cause if left untreated:

• If the infestation gets really bad, the crabs can even spread to the eyelashes. The lice may cause an eye infection, especially in kids. Eyelashes will need to be checked with a high-powered lens. Bites may get infected from continual scratching.

Treatment:

• Any lice killing shampoo such as Kwellada® or Nix®.

Note: If you’re 12 and under or pregnant, these products aren’t for you. You’ll need to ask your doctor or pharmacists for a safer alternative.

After shampooing, use a fine-tooth comb to get out all the eggs.

For pre-caution against re-infestation, use the shampoo/rinse again after 7 days.

Also you have to do a thorough cleaning of you living space. Wash/Dry Clean all sheets, towels, and clothes. Other clothing can be placed in a closed/sealed plastic bag for a month. Thoroughly clean your bathroom.

All sexual partners and persons you share your home with need to be informed, so they can take precautionary measure to prevent further spread of the lice.