Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What are sexually transmitted infections?

Sexually transmitted infections (STIs) are infections you can get by having sex with someone who has an infection. Having intercourse usually passes on these infections, but they can also be passed on through other types of sex, such as oral sex. Viruses or bacteria can cause STIs. Some of the most common STIs and their symptoms are listed below.

Types of STIs

Caused by bacteria

Chlamydia. No symptoms may occur at first or at all, especially in women. Later symptoms for women may include itching around the vagina, a yellow, odorless discharge from the vagina, pain during sex, and needing to urinate often or having pain when urinating. Women may also have bleeding between periods or dull pain in the pelvic area. Symptoms for men may include pain or burning when urinating and a watery, milky-colored discharge from the penis.

Gonorrhea (or "GC"). Men may have a thick, yellow discharge from the penis and pain when urinating or may have no symptoms. The opening of the penis may be sore. Gonorrhea doesn't cause symptoms in most women. When symptoms do occur, women may have white, green or yellow discharge from the vagina, pain when urinating, spotting between periods, or heavy bleeding during periods. Sometimes fever and abdominal pain occur. Gonorrhea can cause sore throats in people who have oral sex or can cause pain in the anus in people who have anal sex.

Syphilis. Early signs include a chancre (a painless, red sore). The sores may appear where you were touched during sex, including your genitals, anus, tongue and throat. The glands near the chancre may swell. A few months later, you may have a fever, sore throat, and headache, not feel hungry or have joint pain. A scaly rash may appear on the palms of your hands and the soles of your feet. After these symptoms pass, you may not have any symptoms for a number of years. When the symptoms return, the infections can affect the brain, spinal cord, and skin and bone.

Caused by viruses

Hepatitis B. Symptoms may include muscle aches, fever, tiredness, loss of appetite, headache and dizziness. As the disease worsens, you may have dark urine, loose, light-coloured stools, yellow eyes and skin, and tenderness in the liver area (just below the ribs on the right side). Hepatitis B can be fatal if it leads to liver failure or liver cancer.

Herpes. Symptoms start with tingling or itching around your genitals. Small blisters may form in the area and then pop open. When this happens, you might feel burning, especially when urinating. The sores then turn to scabs. During the first outbreak, you might have swollen glands, fever and body aches. But some people don't have such obvious symptoms. Outbreaks may occur for the rest of your life, but usually become less frequent and less painful with time.

Human immunodeficiency virus (HIV). HIV is the virus that causes AIDS (acquired immunodeficiency syndrome). It weakens your body's ability to fight off disease. As your body's immune system weakens, illnesses begin to develop until you can no longer fight them off. Symptoms may take years to develop and may include unusual infections, unexplained fatigue, night sweats and weight loss.

Human papillomavirus (HPV). HPV may cause a growth of soft, flesh-coloured warts around the genital area or on the cervix. The warts are painless, but may be bothersome because of the way they look. Sometimes the virus causes warts that can't be seen by the naked eye. There is a link between some types of HPV and cancer of the cervix; this is why Pap smears are so important.

Am I at risk for having an STI?

If you've ever had sex, you may be at risk for having an STI. You're at higher risk if you have had many sex partners, have had sex with someone who has had many partners or have had sex without using condoms.

Should I be checked for STIs?

See your doctor if you're at risk for having an STI or if you have any concerns about whether you have one. Most STIs can cause further problems if not treated.

Chlamydia can lead to pelvic inflammatory disease (PID) in women (a disease that can cause women not to be able to have children) and epididymitis in men (painful swelling of the tubes that carry sperm from the testicles).

Gonorrhea can lead to arthritis and PID. HPV (the virus that cause venereal warts) can lead to cancer of the cervix or penis, and syphilis can lead to paralysis, mental problems, heart damage, blindness and death.

Most STIs can be diagnosed through an exam by your doctor, a culture of the secretions from your vagina or penis, a blood test or a urine test, depending on the type of infection.

Can STIs be prevented?

Yes. But the only way to be sure to prevent STIs is by not having sex. You can lower your risk by only having sex with someone who isn't having sex with anyone else and who doesn't have an STI, and by always using condoms.

To help prevent the spread of STIs:

	Know your sex partner. Tell your sex partner if you have an STI and ask your partner if he or she has one. Talk about whether you've both been tested, which STIs you've been tested for and whether you should be tested.
	Look for signs of an STI in your sex partner. For example, look for sores around the penis or vagina, or for any of the symptoms listed. But remember that STIs don't always have symptoms.
	Limit the number of sex partners you have.
	Always use a condom when having sex, including oral and anal sex
	Use the spermicide (sperm-killer) nonoxynol-9 along with condoms. Nonoxynol-9 may help kill some of the germs that lead to STIs.
	Avoid sex when you're being treated for an STI.
	Don't douche. Douching may spread infections higher into the womb, perhaps raising your risk of PID.
	Wash your genitals with soap and water and urinate soon after you have sex. This may help clean away some germs before they have a chance to infect you.
	Have regular Pap smears.
	Have your shots for Hepatitis A and B.
	See your doctor regularly.

How safe are condoms?

Latex condoms can be effective in reducing your risk of getting an STI. Be sure to use them correctly (see diagram), use them every time you have sex, and use them during all types of sex, including vaginal, anal and oral sex. For oral sex with a woman, you can use a condom split lengthwise to place between her body and her partner's mouth. Condoms aren't foolproof and can't protect you from coming in contact with some sores, such as those that can occur with herpes, or warts, which can occur with HPV infections.

Use only water-based lubricants (some examples are Gyne-Moistrin, K-Y Jelly, Replens) with condoms. Oil-based lubricants, such as petroleum jelly (an example is Vaseline), baby oil or lotions, cause the rubber in condoms to break down. If a condom sticks to itself, it's damaged and should be thrown away. Coloured and flavoured condoms don't work as well.

How to use a condom

	Use a latex condom. Condoms made of animal skin may not protect against tiny viruses, which may be able to pass through the porous skin.
	Put the condom on before any contact is made.
	Unroll the condom over an erect penis. The unrolled ring should be on the outside. Leave about a half-inch of space in the tip so semen can collect there. Squeeze the tip to get the air out. Unroll the condom to the base of the penis. See the diagram to see how it should look after it's on.
	Use the sperm-killer nonoxynol-9 to improve how well condoms protect you. It works best when put into the vagina or anus, rather than just on the condom.
	Pull out after ejaculating ("coming") and before the penis gets soft. To pull out, hold the rim of the condom at the base of the penis to make sure it doesn't slip off.
	Don't reuse condoms.

Can STIs be treated?

STIs that are caused by bacteria can be treated with antibiotics. Those that are caused by viruses can't be cured at this time. However, much can be done to treat the symptoms viruses cause and limit how far they spread.

PDF Version

Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.