The K Health Guide to STDs & STIs in Women

What Are STDs/STIs

Sexually Transmitted Diseases (STDs) and Sexually Transmitted Infections (STIs) are infections transmitted through any sexual activity, be it oral, anal, or genital sexual contact, kissing, or sharing sex toys. Almost 20 million cases of STIs are diagnosed each year in the United States, according to the Centers for Disease Control and Prevention. While both men and women in the U.S. are diagnosed with sexually transmitted infections (STIs) in about equal numbers, they are not affected by STIs equally. Women can be more susceptible to some STDs, and are more likely to experience long-term health complications from them if untreated.

What Is the Difference Between STD and STI?

Many people use the terms STD and STI interchangeably, but there is a subtle difference between them. Having an STI means you have contracted an infection that doesn’t cause symptoms and hasn’t developed into a disease. For example, if you have asymptomatic chlamydia or gonorrhea, you have an STI. An STD is an infection that caused symptoms and has developed into a disease. That is, if your chlamydia or gonorrhea creates pelvic inflammatory disease (PID), then you have an STD. What’s the bottom line? An STD is symptomatic, while an STI is not.

STD Symptoms for Women

The most common STD symptoms in women are:

• Vaginal itching
• Vaginal pain
• Unusual vaginal discharge
• Rashes or sores on the body
• Pain or urgency with urination
• Lower abdominal pain

Abnormal vaginal bleeding can also be related to an STD. However, many STIs cause no symptoms at all, which is why it’s so important to get tested. It’s estimated that as many as 1 in 5 Americans has genital herpes, but up to 90% are unaware that they have it. If STDs are left untreated, they can cause fertility problems and increase a woman’s risk of certain types of cancer.

There are other conditions that can cause vaginal itching, burning, and sensitivity that are not STDs. For example, yeast infections cause many of the same symptoms as STDs, but are not sexually transmitted, and are treated differently. To learn more about yeast infections, you can check out Vaginal Yeast Infections and Male Yeast Infections, Skin Yeast Infections and Thrush: Symptoms, Treatment and Diagnosis.

Common STIs that Affect Women

The most common STDs that affect women are, in order of prevalence, HPV (which causes genital warts), Gonorrhea, Chlamydia, Herpes, Trichomoniasis, pubic lice, scabies (ectoparasitic infections)HIV/AIDS. We’ll describe the symptoms, diagnosis, and treatment for each of these and more below.

Human Papillomavirus (HPV) and Genital Warts

HPV is the most common STD in US women. According to the Centers for Disease Control and Prevention, HPV is so widespread that nearly every sexually active person will contract HPV at some point in their lives if unvaccinated against it. There are many types of HPV, which can be contracted through vaginal, anal, and oral sex, or skin-to skin-contact. Many strains of HPV do not cause symptoms and will resolve on their own, but some strains can cause warts on the genitals, mouth, or throat. Other signs of HPV include genital lesions, which can be painless or cause itching, burning, or tenderness, and can cause abnormal Pap Smears.

Several HPV strains can lead to cervical cancer. A Pap smear is a screening test that can help diagnose cervical cancers. There is no cure for HPV infection, but treatment involves monitoring for cervical abnormalities and removal of suspicious lesions. Men and women between the ages of 11 and 45 can be vaccinated against certain strains of HPV, specifically the ones known to cause genital warts and cervical cancers.

Gonorrhea

Gonorrhea is a common bacterial STD. Most people infected with gonorrhea will not experience any symptoms. Those who do have symptoms may notice: unusual genital redness, swelling, or discharge, vaginal itching or burning, and painful urination. If untreated, gonorrhea can lead to infection in the pelvis (in women) and throughout the body, so it’s important for sexually active people to be tested for this disease. To test for gonorrhea, a medical professional will look for bacteria by swabbing the rectum, throat, or cervix, or a urine test can be performed. Gonorrhea is treated with antibiotics.

Chlamydia

Gonorrhea and chlamydia frequently occur together, and like gonorrhea, chlamydia is bacterial and one of the most commonly reported STDs in the U.S. It's spread mostly by vaginal or anal sex, but can be transmitted through oral sex as well. Symptoms are similar to gonorrhea, such as genital redness, swelling, or discharge, vaginal itching or burning, and painful urination. However, most people with chlamydia don’t know they have it – only about 25% of women and 50% of men experience symptoms. Chlamydia is diagnosed through a cervical swab or urine test in women, and a urine test or urethral swab in men. It is treated with antibiotics.

Syphilis

Syphilis is another bacterial STD. It’s symptoms occur in four stages.

1. A painless sore (called an ulcer or chancre) appears that can look like a cut or an ingrown hair. You are most contagious when this is present.
2. A rash on your body. Typically, the rash presents on the palms of your hands or soles of your feet, and does not itch or hurt. This stage can also include hair loss, sore throat, fever, headaches, and white patches in the nose, mouth, and vagina.
3. Sores and rashes usually disappear in the third, or latent, stage. This stage can last years. In this stage, syphilis is not contagious.
4. Only about 15% of people with untreated syphilis will develop the final stage. This stage of syphilis can be fatal as it causes serious issues in different organs like the heart, brain, eyes, ears, and nervous and muscular systems. Some symptoms of this tertiary stage include dementia, vision problems or blindness, trouble controlling muscular movements, and numbness in various parts of the body.

Syphilis can be diagnosed through blood tests, or by evaluating or testing ulcers from the first stage. Syphilis is effectively treated with antibiotics .

Genital and Oral Herpes

Genital herpes is also common, about 1 out of 6 Americans have it. There are two types of herpes - herpes simplex virus-1 (HSV-1), which usually causes sores around the mouth, and herpes simplex virus-2 (HSV-2), which usually causes blisters around the genitals and anus. Herpes is highly contagious through skin-to-skin contact, and easiest to catch when blisters are present.

The main sign of herpes is the lesions, which can hurt or itch. Diagnosis is made by observing the lesions, testing the fluid inside them, or taking a blood test. Because herpes is a virus, medicine can’t cure it, but there are some medications to help manage the symptoms and duration of the outbreak. It’s important to note that herpes can spread from one part of the body to another, so avoid touching the blisters and then another body part, especially the eyes or mouth, and wash your hands right away if they come in contact with a herpes sore.

Trichomoniasis

A parasite causes trichomoniasis, which is transmissible through genital contact. More women than men become infected, though most don’t experience symptoms. The 30% who do have symptoms may notice burning, itching, sore genitals, or smelly, clear, white, yellowish, or greenish discharge. Trichomoniasis is diagnosed through a urine test or vaginal swab, and can be treated with antibiotics.

Pubic Lice and Scabies (ectoparasitic infections)

Ectoparasitic infections are caused by tiny insects, such as lice or mites, that feed off their hosts. They are transmitted by physical contact, and their main symptom is itching. Pubic lice (pediculosis pubis) is caused by the crab louse, Phthirus pubis, commonly referred to as crabs. The lice live on pubic hair and are visible to the naked eye. You can treat pubic lice with a cream rinse containing 1% permethrin, or pyrethrins with piperonyl butoxide, applied to the affected area. Scabies is another ectoparasitic infection caused by the mite Sarcoptes scabiei. These mites can’t be seen with the naked eye, and live on the skin. They cause itching on the genitals and body, which can be accompanied by small bumps. The itching usually starts several weeks after infection, and tends to worsen at night. For treatment, a 5% cream of permethrin is applied to the entire body for 8 to 14 hours, washed off, and applied again one week later. An oral drug, Ivermectin (Stromectol), can also treat scabies, but carries more risk of side effects than the cream. With both lice and scabies, treatment should include a thorough, hot washing of all bedding and clothes.

HIV/AIDS

HIV is the virus that causes Acquired Immune Deficiency Syndrome (AIDS). Possible symptoms include weight loss, digestive issues, fever, vomiting, headache, sore throat, and painful lymph nodes. Since these symptoms can mimic other conditions like the flu and fatigue, it’s important to get tested if there is a risk you have been exposed to HIV. The virus is transmitted through blood, semen, vaginal fluids, and breast milk. The most common means of infection is through sex without a condom, or sharing a needle. HIV/AIDS is diagnosed through a blood test. There is no a cure for HIV, but medication can treat the infection.

STD Testing

STDs are often diagnosed and treated by primary care providers, sexual health clinics like Planned Parenthood, urgent cares, emergency departments, and obstetrician-gynecologists (OB-GYN).

STI Risk Factors

Sexual diseases are the most commonly reported type of infection in America, and about half of sexually active people acquire at least one of them by age 25. While they’re most common in the 25 and under population, sexually active people at any age are susceptible. The risk of contracting an STD increases if you are a woman having sex with men, or a man having sex with men, particularly if you have multiple sex partners. Additional risk factors include having unprotected sex and abuse of alcohol or drugs.

STI Prevention

While refraining from sexual contact is the only sure-fire way to prevent STDs, there are steps you can take to decrease your chances while being sexually active.

• Get tested with a new partner before having sex.

• Have honest and open conversations with potential partners about your sexual histories.

• Use male and/or female condoms for genital intercourse, dental dams for oral sex, latex gloves for manual stimulation.

• Avoid sexual activity with a partner who is symptomatic with an STD.

• Avoid sex when under the influence of alcohol or drugs.

• Get vaccinated against the human papillomavirus (HPV) and hepatitis B (HBV).

• Take a shower after sex. Women can also urinate after sex to reduce the risk of urinary tract infection (UTI).

• Sexually active women should get a Pap smear every three to five years. Sexually active men and wound should be regularly tested for other STDs.

To help stop the spread of STDs, if you’ve been diagnosed with one, let your partner(s) know so they can be tested. Ask your doctor how long to abstain from sex after treatment for the STD.

When to See a Doctor

If you are sexually active and experiencing any symptoms concerning for an STD, see a medical professional for accurate diagnosis and effective treatment. It’s also a good idea to be tested for STDs regularly when you’re sexually active, and before you start having sex with a new partner.