Understanding Sexually Transmitted Infections

Home , Ejaculation, Side Effects (Bass book)

Second Edition

Administered by Table of contents

Introduction...... page 1

Anatomy...... page 2

Chlamydia...... page 3 Bacterial Gonorrhea...... page 4

Syphilis...... page 5

Genital Herpes...... page 6 Viral Hepatitis B...... page 7

HIV (Human Immunodeficiency Virus)...... page 8

HPV (Human Papillomavirus)...... page 9

Pubic Lice & Scabies...... page 10 Parasitic Trichomoniasis...... page 11

Fungal Candidiasis (Yeast Infection)...... page 12

Bacterial Vaginosis (BV)...... page 12

Diagnosing Sexually Transmitted Infections...... page 13

Barrier Methods ...... page 14

Treatment Summary

• Bacterial ...... page 15

• Viral...... page 16

• Parasitic & Fungal...... page 17 Introduction Sexually Transmitted Infections

Toward effective prevention, diagnosis and treatment

Building awareness Informing your partner Bacterial In Canada and around the world, the trend is clear: Partner notification is critical to prevent further spread of STIs and prevent Chlamydia sexually transmitted infections (STIs) are on the rise. complications. It can be difficult to talk with a sexual partner about Gonorrhea Syphilis One of the primary defenses in the fight against STIs health problems, especially when they involve sexual health or a sexually is awareness. With the right information, individuals transmitted infection. However, it is important for anyone who suspects can make informed choices and better protect they’ve become infected or tests positive for an STI to ensure that current Viral themselves and their partners. and previous partners are made aware so they can seek medical attention Genital Herpes and treatment if needed. Hepatitis B An important reference HIV (Human Immunodeficiency Virus) Support is available This booklet is designed to optimize sexual HPV (Human Papillomavirus) health through STI prevention, testing/screening, If infected individuals are uncomfortable informing partners themselves, diagnosis, and timely treatment. they may ask their health-care professional to contact their partner(s) for them. This is done confidentially, meaning the patient’s name is never Parasitic A quick reference guide for health professionals, revealed to notified partners. Pubic Lice/Scabies counsellors and educators, it provides details Trichomoniasis of specific infections including infection Precautions characteristics, means of transmission, signs and Once an infection is detected, it is recommended that infected individuals symptoms, and methods for testing/screening, Fungal and their sexual partner(s) abstain from sexual activity until treatment is Candidiasis (Yeast Infection) treatment, management and prevention. complete (for treatable STIs), symptoms have subsided, and the infection Every case is different is cured (for curable STIs, confirmed through follow-up testing, as appropriate). Partners should consult a health professional for direction on Bacterial Vaginosis (BV) Many STIs are asymptomatic. Often, the only way to when sexual relations can be resumed. In the case of viral STIs, a health- detect an infection is through screening. care professional can offer safer-sex and risk-reduction tips to prevent Individuals who suspect they may have been transmission. Testing Methods infected should be encouraged to seek medical Condoms are important to reduce the risk of transmission, even if other attention immediately, rather than waiting for the methods of birth control are being used to prevent pregnancy. Prevention onset of visible symptoms. Treatment

page 1 page 2 Anatomy Female and Male Reproductive Systems

Fallopian tube

Ovaries Seminal vesicles

Uterus Vas deferens

Prostate gland Cervix Penis

Vagina Fallopian tube Epididymis Ovary Uterus Testicles

Clitoris Cervix

Urethra Rectum

Vagina © sexualityandu.ca Bacterial Chlamydia

An often-asymptomatic infection that can lead to reproductive complications

What is it? What are the Considerations and Chlamydia possible complications • The most common bacterial sexually signs and symptoms? Clear or milky urethral discharge may be a transmitted infection • Many infected individuals have no • Chlamydia is often associated with symptom of chlamydia in men. • Greatest number of infections found symptoms. other undetected or untreated in people 15 to 24 years old • Symptoms may occur from two to infections. • Can affect the cervix, urethra, and six weeks after initial exposure to the • Individuals infected with chlamydia occasionally the rectum, throat, and bacteria. are at increased risk of contracting and eyes transmitting HIV. Female How is chlamydia • Vaginal discharge Female transmitted? • Painful urination • Infection spreading to the uterus and Fallopian tubes (pelvic inflammatory • Chlamydia can be spread through • Lower abdominal pain unprotected oral, vaginal or anal sex disease) with an infected partner. • Vaginal bleeding after intercourse or • Risk of ectopic pregnancy between menstrual periods • Penetration and ejaculation are not • Infertility • Pain during intercourse © sexualityandu.ca required for transmission. • Chronic pelvic pain • Eye or rectal infection (rarely) • It can be passed from an infected • Rashes, sores and joint pain Although chlamydia is usually asymptomatic mother to her infant during birth, Male in women, it may present with inflammation causing lung and/or eye infections. Male of the cervix. • Clear, watery or milky urethral • Inflammation of the testicles, prostate discharge and scrotum • Itchy urethra • Rashes, sores and joint pain • Painful urination • Infertility (in rare cases) • Testicular pain • Eye or rectal infection (rarely)

page 3 page 4 Bacterial Gonorrhea

An often-asymptomatic infection that can lead to reproductive complications

What is it? What are the Considerations and Gonorrhea • The second most common bacterial STI signs and symptoms? possible complications Yellowish-greenish discharge from the • Two-thirds of reported cases in Canada Female • Gonorrhea is often associated with penis may develop in men within two to are in men other undetected or untreated seven days of infection. Women are most often asymptomatic. infections. • Most common in individuals 15 to 29 Those that do exhibit symptoms may years old experience: • Individuals infected with gonorrhea are at increased risk of contracting and • Can affect the cervix, urethra, rectum, • Increased vaginal discharge throat, and occasionally the eyes transmitting HIV. • Painful urination • Often occurs as a co-infection with Female • Lower abdominal pain chlamydia • Infection spreading to the uterus and • Vaginal bleeding after intercourse or Fallopian tubes (pelvic inflammatory How is gonorrhea between menstrual periods disease) transmitted? • Pain during intercourse • Chronic pelvic pain • Gonorrhea can be spread through • Rectal pain, discharge or itching • Infertility unprotected oral, vaginal or anal sex © sexualityandu.ca with an infected partner. Male • Risk of ectopic pregnancy • Penetration and ejaculation are not Most men develop symptoms within • Systemic gonococcal infection Infected women who develop required for transmission. two to seven days of infection: Male symptoms may notice an increase in • It can be passed from an infected • Thick, yellowish-green discharge from vaginal discharge. mother to her infant during birth, penis • Inflammation of the testicles causing an eye infection. • Painful urination • Rashes, sores and joint pain • Testicular pain or swelling • Infertility (in rare cases) • Rectal pain, discharge or itching • Systemic gonococcal infection

A staged STI once considered rare in Canada, sometimes called the great imitator

What is it? Secondary syphilis Congenital syphilis Syphilis • An infection sometimes called the great A person may develop a range of symptoms Congenital syphilis can be a life- The first sign of syphilis in men is often imitator because signs and symptoms from two to 24 weeks after exposure, most threatening infection for infants. A a small, painless sore (chancre) on the mirror those of some common medical commonly: pregnant mother who has syphilis penis. conditions • A general feeling of being unwell can spread the infection through • Progresses in stages the placenta to the unborn child. To • A rash anywhere on the body and can decrease the risk of the unborn child • Infectious in the first year after include the palms of the hands or soles of becoming infected, the pregnant contraction the feet mother should be treated with How is syphilis transmitted? • Patchy hair loss antibiotics as early as possible. • Through oral, vaginal or anal sex with an • Flat, smooth warts in the genital area (not Considerations and infected partner the same as those caused by HPV) possible complications • Through direct contact with bacteria Early latent syphilis • Syphilis increases the risk of contained in syphilitic sores or rashes Is asymptomatic, but for the first year transmitting or becoming infected • In rare cases, from sharing unclean after infection lesions or rashes of with HIV. needles or receiving a blood transfusion secondary syphilis can recur and the • Response to treatment must be • From an infected mother to her fetus, infection can be transmitted. monitored by blood testing over © sexualityandu.ca time to ensure effectiveness, which can result in fetal death or Late latent syphilis congenital syphilis (causing birth defects) especially in HIV-infected The chancre sore appears where the Late latent syphilis is the stage diagnosed individuals. bacteria entered the body. What are the signs and a year or more after infection. Late latent • In individuals with HIV co-infection, symptoms of syphilis? syphilis is asymptomatic and non- symptoms may be modified. A infectious. longer course of treatment and Primary syphilis Tertiary syphilis closer follow-up post-treatment may • Three days to three months after exposure, be required. infected individuals develop small painless Untreated syphilis may lead to tertiary syphilis, which can damage: • Early syphilis can be associated with sores called a chancre. infection of the nervous system • The sore appears where the bacteria • The cardiovascular system (heart and blood (neurosyphilis) which requires entered the body (e.g. external genitalia, on vessels) urgent referral. the cervix, in the vagina, under the foreskin, • The neurological system (dementia, loss of • Partner notification is important; in the anus, mouth or throat). sensitivity) infected individuals should seek • The chancre is painless and can be missed • Other major organs of the body guidance from their health-care easily; while it heals on its own without professional. Complications of tertiary syphilis may lead © sexualityandu.ca treatment, the infection remains. to death. page 5 page 6 Viral Genital Herpes

A very common viral infection that can cause genital and anal sores

What is it? What are the Atypical signs and Genital herpes • Herpes simplex virus (two types: HSV-1 traditionally signs and symptoms? symptoms (without lesions) During a herpes outbreak, blister- associated with cold sores, and HSV-2, traditionally • Symptoms may emerge two to 21 days • Genital pain, urethritis, aseptic meningitis associated with anogenital herpes) like sores often occur, surrounded after initial infection; usually after six. or cervicitis. by redness and inflammation. • May cause a single outbreak or recurrences over time • Not all infected people develop Considerations and Recurrences may be triggered by: symptoms. possible complications • The menstrual cycle in women During an outbreak: • Increased risk of transmitting or becoming • Emotional stress • Painful sores (external or internal) infected with HIV • Illness (especially fever) • Inflammation and redness • Avoid sexual activity from the start of • Sexual intercourse • Fever burning/tingling symptoms until all lesions have completely healed. It is important • Surgery • Muscular pain to note that this is not the only risky time. • Exposure to sun (including tanning beds) • Tender lymph nodes Transmission of the infection can take • Use of certain medications Primary Occurrence place at any time. • Pay attention to personal hygiene to avoid How is genital herpes Patients often present with multiple lesions, pain, fever, lymphadenopathy, fomite transmission. © sexualityandu.ca transmitted? and possible urinary retention. • Be aware of the potential for recurrences; • Through oral, vaginal or anal sex with an infected A primary outbreak resolves in 17 days watch for signs and symptoms as they may Herpes sores may develop on partner for men and 23 days for women on not be obvious. the vulva. • By receiving oral sex from a partner with a history of average. • Condoms and drug therapy can reduce cold sores Subsequent Recurrences but not eliminate the risk of transmission. • Through asymptomatic shedding. Because shedding Subsequent Recurrences resolve in 17 • Though chronic in nature, herpes is a occurs internally, it is almost impossible to tell when days for men and 7 days for women on manageable infection. Counselling may be this is happening. Therefore, it is almost impossible average. useful to help with relationship issues. to tell when a person is contagious. As a result the • Advise your health-care professional of majority of transmission occurs during this period. • Symptoms are more localized, with one or more lesions only. your history of infection; precautions can • From an infected woman to her infant during be taken during pregnancy and delivery to pregnancy or birth • Prior to an outbreak, the infected person minimize risk of transmission to the baby. may feel a tingling or burning sensation • Less commonly through fomite transmission — • Asymptomatic shedding can be where the virus first entered the skin © sexualityandu.ca contact with contaminated objects such as towels or, in the case of a recurrence, where managed by suppressive antivirals which Condoms have limited effectiveness at preventing there were lesions. Signs and symptoms also decrease the risk of transmission infection as they do not cover the entire genital area. could recur in multiple locations at once considerably. over the body. Viral Hepatitis B

A vaccine-preventable viral infection that affects the liver

What is it? What are the Considerations and Hepatitis B • A virus found in blood and body fluids signs and symptoms? possible complications including the vaginal secretions, In up to 50% of people, there are no • All sexual and household contacts semen, breast milk and saliva of outward signs of infection. of people with hepatitis B should be infected individuals Up to eight weeks after exposure to the advised to be vaccinated to prevent • Most infected people (90%) naturally virus, some people experience flu-like infection. produce antibodies to fight the symptoms including: • Chronic hepatitis B can lead to severe disease, but some develop chronic • Tiredness liver damage including cirrhosis hepatitis B; they carry the virus all their (scarring of the liver) and cancer. lives and are infectious for life • Nausea and vomiting • Individuals who develop chronic • Chronic infection can significantly • Decreased appetite hepatitis B infection require liver damage the liver • A rash function monitoring and may benefit from treatment with an interferon or • Most common in developing countries • Joint pain an antiviral medication. • Yellowing of the eyes and skin (in rare How is hepatitis B • Babies born to mothers with hepatitis cases) transmitted? B are at a high risk of becoming • Through oral, vaginal or anal sex with chronic carriers. They should an infected partner receive an injection of antibodies © sexualityandu.ca immediately after birth, followed • Through exposure to infected blood by the vaccine. With the use of or blood products (e.g. injection drug People with chronic hepatitis B are at passive antibody and vaccine there use with shared equipment, accidental risk of suffering progressive liver disease is an extremely low risk of vertical exposure, needlestick) and liver cancer. transmission. • Occasionally from contact with shared household items (such as toothbrushes or razors) • During childbirth (transmission from mother to infant)

page 7 page 8 Viral HIV (Human Immunodeficiency Virus)

A virus that attacks the body’s immune system, leaving infected individuals unable to ward off other illnesses

What is it? What are the Considerations and HIV • Virus that destroys cells critical to a person’s immune signs and symptoms? possible complications system, robbing the body of its ability to fight other Two to four weeks after exposure, When diagnosed early, a large proportion An individual who is diagnosed with HIV infections and illnesses some infected individuals may of the population with HIV infection can requires regular medical consultation. • AIDS stands for “Acquired Immunodeficiency experience mild flu-like symptoms go on to lead a relatively normal life and Syndrome”. A person with HIV infection is considered that last a few weeks then disappear. have an almost normal life expectancy to have AIDS when the number of CD4 cells in their For most people, symptoms don’t through managed treatments. blood drops below a certain number or if they emerge until years after exposure. In Canada, it is estimated that about a develop an “AIDS defining illness.” Once the immune system is quarter of people with HIV do not know weakened, the following may they are infected and risk transmitting the How is HIV transmitted? develop: virus to others. When the body fluids of an infected person (blood, • Frequent fever or sweats Partner notification is important; infected semen, pre-semen, vaginal secretions, breast milk) individuals should seek guidance from enter the blood stream of another individual— • Joint or muscle pain their health-care professional. specifically from: • Persistent skin rashes Examples of AIDS defining illnesses are: • Unprotected oral, vaginal or anal sex with an infected • Swollen glands partner • Infections: pneumocytis jiroveci • Sore throat (previously known as PCP), • Use of contaminated sex toys • Fatigue or lack of energy cytomegalovirus (CMV) causing loss of • Shared needles or other drug equipment (i.e. water, vision, candidiasis (esophageal, lungs, © sexualityandu.ca • Headaches cookers, crack pipes) bronchial, vaginal), mycobacterium • HIV-infected blood or blood products • Rapid, unexplained weight loss avium complex, mycobaterium HIV destroys cells critical to the immune tuberculosis system, leaving carriers susceptible to • Transmission during pregnancy, childbirth or • Nausea, vomiting, or diarrhea other infections. breastfeeding (transmission from mother to child) A blood test to check for HIV • Cancers: cervical, anal, kaposi sarcoma and lymphoma • Increased transmission risks with Acute HIV infections. antibodies is the only way to detect HIV infection. It may take up to • Increased frequency or severity of • Increased risk of HIV acquistion/transmission when three months for an infection to herpes outbreaks co-infected with Hep.C or any other STI be detectable. An individual may • Conditions affecting the brain including need to retest at a later date if • HIV cannot be transmitted by mosquitoes or other toxoplasmosis insects that have made contact with infected blood, recommended by their health-care nor can it be transmitted through saliva, sweat, tears, professional. • Chronic intestinal disturbances urine or feces of infected individuals, unless blood is AIDS can take many years to develop in present. a person with HIV. The average length of time from HIV infection to AIDS is © sexualityandu.ca about 10 years. There is no cure for HIV. Viral

HPV (Human Papillomavirus)

A very common viral infection that can cause anogenital warts and cancer

What is it? What are the Considerations and HPV • One of the most common sexually signs and symptoms? possible complications Men with HPV may develop warts on the transmitted infections • Many individuals infected with low-risk • Genital wart recurrences—common penis—small, flesh-coloured growths • There are over 100 types of HPV; 40 can types have no symptoms (do not develop even with treatment cauliflower-like in appearance. cause anogenital infection visible warts or lesions). • Cervical, vulvar, vaginal, anal, penile • It is estimated that 75% of the sexually • In some people, anogenital warts develop and other cancers active adult population will have at least within one to eight months on the vulva, • Obstruction of the urethra or vaginal one HPV infection during their lifetime cervix, penis, scrotum, anus or in the opening urethra. These can be small, soft, flesh- • Low-risk HPV types cause anogenital • Depression and sexual dysfunction in warts and other benign lesions coloured growths, with a cauliflower-like appearance. chronic cases • High-risk HPV types can cause 99% of • Specialist referral is required for cervical dysplasia and cancers. • The size and number of warts may change over time; eventually most will clear. atypical and/or non-healing warts • HPV has been linked to other types of • During pregnancy, warts may increase • Counselling may be useful to help cancers including cancer of the vagina, with relationship issues that may vulva, anus, penis, and head and neck in size and number then regress/resolve after delivery. arise from the complex nature of the (e.g. eye, mouth, throat and skin) infection • HPV infection is most commonly detected • Vaccination is available to prevent © sexualityandu.ca infection with certain types of HPV through an abnormal Pap smear. • Most HPV infections clear on their own Other symptoms without medical intervention within one may include: Genital warts may appear on the vulva to two years within one to eight months of infection. • Itchiness How is HPV transmitted? • Discomfort during intercourse • Through oral, vaginal or anal sex with an • Bleeding with intercourse infected partner • Other sexual activity with intimate contact (genital rubbing or activity causing friction) • To an infant during delivery (rare)

page 9 page 10 Parasitic Pubic Lice & Scabies

Infections caused by parasitic infestations

What are pubic lice? What are scabies? Considerations and Pubic lice (Crabs) • Tiny crab-like insects that nest in pubic • Parasitic mites that burrow below the possible complications The insects bite their host to feed on hair; also found in chest, armpit and surface of the skin • Persistent scratching of irritated blood. facial hair, eyebrows and eyelashes • Eggs laid under the skin hatch; larvae skin can cause a secondary bacterial • Adult insects bite and feed on the move to new areas and spread infection infection. blood of their host and lay small eggs • Mites prefer warm zones (folds of skin on • All household contacts and recent (nits) that attach to the shaft of the hair elbows, wrists, buttocks, knees, armpits, sexual partners within the past month shoulder blades, waist, breasts and penis, should be treated to prevent re- between the fingers and under nails) infestation. • Clothes, bedding and other possible How are pubic lice How are scabies transmitted? contaminated items should be washed transmitted? • Through close contact—sexual or non- or drycleaned, or bagged for three • Transmission occurs primarily during sexual days to one week. Items that cannot intimate sexual and non-sexual • Scabies can live for three days on the be washed or bagged should be contact. bedding, towels and clothes of an vacuumed. • Pubic lice can live for one to two days infected individual. These items can be a • For scabies, severe infections are © sexualityandu.ca in the bedding, towels and clothes of source of transmission. commonly seen in people with an infected individual. These items can compromised immune systems: be a source of transmission. the skin can become scaly or Scabies (Mites) crusty, requiring more complex and What are the What are the aggressive treatment. Parasitic mites burrow below the skin’s signs and symptoms? signs and symptoms? surface. Pubic lice and nits are small and can be Within three to four weeks of infestation: difficult to spot. Infected individuals • Intense itchiness, especially at nighttime may experience: • Reddish rash • Skin irritation and inflammation accompanied by itchiness and redness • With recurrences, the same symptoms occur but more rapidly (within hours to • Small blue spots on the skin where lice days of a re-infestation) have bitten • Louse feces (fine black particles) in the infected person’s undergarments

A sexually transmitted parasitic infection commonly referred to as trich

What is it? What are the Considerations and Trichomoniasis An infection caused by Trichomonas signs and symptoms? possible complications Half of infected women develop vaginalis, a microscopic, single-celled Female • Trichomoniasis infections can symptoms, including yellowish-green organism that can be found in the increase the risk of acquiring and frothy vaginal discharge. urethra, bladder, vagina, cervix, or About half of infected women show transmitting HIV. under the foreskin. signs of infection including: • Trich may occur in conjunction How is trichomoniasis • off-white or yellowish-green frothy with other STIs such as gonorrhea, vaginal discharge transmitted? chlamydia, syphilis, HIV and hepatitis B. • sore or itchy vagina • Through unprotected sexual activity, • In pregnancy, trichomoniasis including mutual masturbation and • pain during intercourse or urination infection may increase the risk of pre- sharing of sex toys term delivery and low birth weight. Male • Trichomoniasis, candidiasis, and Trichomoniasis infections tend to be bacterial vaginosis are three major asymptomatic in men. When symptoms causes of vulvovaginitis (infection or occur, they can include: inflammation of the vulva or vagina). • irritation or redness at the urethral opening © sexualityandu.ca • burning during urination or ejaculation

page 11 page 12 Fungal Candidiasis (Yeast Infection) Bacterial Vaginosis (BV)

A common fungal infection caused by overgrowth The most common vaginal infection in of the naturally occurring yeast Candida women of reproductive age What is it? • Thick white, clumpy discharge resembling cottage cheese What is it? • 75% of women develop vaginal candidiasis at least • Burning of the external genitalia on urination • Bacterial vaginosis (BV) is the most common lower genital tract once in their lifetime. • Pain with intercourse due to vaginal dryness and irritation disorder in both non-pregnant and pregnant women. It is caused • Candida can also affect the mouth, esophagus, skin of the vulva by the imbalance of bacteria in the vagina. or blood. • While BV is more common in women who are sexually active and is Male • Yeast is normally found in a woman’s vagina. When associated with sexual activity, it is not generally considered an STI. the fungus begins to grow in excess, it may develop Men with an infection of the penis may develop balanitis • Increases the chances of contracting an STI. into candidiasis. (inflammation of the head of the penis) and may experience: How is BV transmitted? Causes of overgrowth include: • Itching • Red dots on the tip of the penis • BV is not transmitted sexually, but is more common among women • Pregnancy who have unprotected sexual activity including sharing of sex toys. • Dry peeling skin • Recent or current use of antibiotics and certain other • More common among women with multiple partners. prescription medications • Burning on urination (occasionally) • BV cannot be transmitted through toilet seats or swimming pools. • Sexual activity Considerations and possible complications • Poorly controlled diabetes • Yeast infections can increase the risk of acquiring and What are the signs and symptoms? • A weakened immune system transmitting HIV. Not all infected people develop signs or symptoms. In cases where they do appear, the most common are: • Genital moisture retention caused by tight-fitting • Candidiasis may be confused with bacterial vaginosis. • Vaginal discharge clothing • Candidiasis, trichomoniasis and bacterial vaginosis • Malodour. (Odour may be increased after intercourse.) How is a yeast infection transmitted? are three major causes of vulvovaginitis (infection or inflammation of the vulva or vagina). While a yeast infection can be transmitted sexually, it Considerations and possible complications is not generally considered an STI. • BV has been associated with women who smoke, use vaginal Men sometimes develop signs of a yeast infection on douches and are sexually active. the head (glans) of the penis after having intercourse • BV can occur in virginal women. with a woman with vaginal candidiasis. (She may have no symptoms.) Candidiasis • During pregnancy and delivery, BV can increase the risk of complications. What are the signs and symptoms? Women with • Bacterial vaginosis, trichomoniasis and candidiasis are three major candidiasis may causes of vulvovaginitis (infection or inflammation of the vulva or Female experience swelling vagina). Women with vaginal candidiasis may experience: in the vulva or vagina accompanied by Physical examination, vaginal culture or • Vaginal itching discharge resembling Testing/Screening wet preparation • Swollen or red vulva and vagina cottage cheese. Can be treated with oral or vaginal Treatment antibiotics (metronidazole or clindamycin). © sexualityandu.ca Testing/Screening Diagnosing Sexually Transmitted Infections

Decreasing the risks The main methods of Bacterial Early identification and treatment of testing/screening are: Chlamydia Swab from the infected area; urine sample for men; urine sample for women where available, when a pelvic exam is an STI can help decrease the possibility 1. Swab from the urethra, cervix, not done or indicated of complications, both for an infected vagina, penis, anus or throat individual and their sexual partner(s). Gonorrhea Swab from the infected area or a urine sample in 2. Urine test This is especially true for women, as cases where a swab is not an option undetected and untreated infections 3. Blood test can lead to pelvic inflammatory Syphilis Blood test and/or swab from the sore Approaches differ by infection and disease, ectopic pregnancy, chronic gender, and vary across the country. pelvic pain and even infertility. Viral When to get tested Swab Genital herpes Swab from sore(s) and/or blood test (currently not widely available for this STI) • Individuals who suspect they may Cervical and urethral have contracted an STI should ask samples may be HPV* Physical exam for visible warts. Pap test to detect abnormal their health-care professional for collected for testing. cells in the cervix guidance about when to get tested. Hepatitis B Blood test Recommendations vary by type of infection. HIV Blood test • Regardless of symptoms, at-risk individuals should be screened Parasitic regularly. Trichomoniasis Physical examination and vaginal swab • Visible symptoms should not be Lice(Crabs)/Scabies(Mites) Examination of skin and hair the only reason for testing, as many infections are asymptomatic. If Urine test Fungal symptoms are not present or a person For testing of certain is infectious before symptoms appear, STIs, a urine sample Yeast infection Physical examination and vaginal swab the infection can be unknowingly may be requested. passed on to others. * Individuals infected with high-risk HPV types usually have no noticeable symptoms even though the virus may be causing changes at a cellular level. Currently, cervical cancer screening (primarily the Pap • At the start of any new sexual Blood test smear) is used to detect cellular changes in the cervix that may progress to cancer if not found early relationship, it is a good idea for and treated if necessary. In some regions, HPV DNA testing is available and used in conjunction with both partners to get assessed and For testing of some the Pap test in cervical cancer screening. screened for infections. STIs, a blood sample • Suspicion or diagnosis of an STI is required. should prompt testing for other STIs if not already done. All images © sexualityandu.ca

page 13 page 14 Prevention Barrier Methods

Preventative approaches are important to decrease the transmission of STIs

Blocking transmission Female condom Cutting a condom to make Male condom Proper use of barrier methods is critical. A female condom is a polyurethane a dental dam A male condom prevents the exchange Barrier methods are very effective sheath worn inside the vagina during of fluids during intercourse. in the prevention of many sexually sexual intercourse. It has two rings—an transmitted infections (STIs). inner one at the closed end, used to 1 insert the condom and hold it in place Male and female condoms made of behind the pubic bone; and an outer latex and polyurethane offer the best ring that remains outside the vagina. protection. It should not be used with a male Note: Latex and polyurethane condoms condom. may not fully protect against herpes Use of the female condom has been and HPV, as the viruses can be found in reported for anal sex. Condom areas not covered by a condom. manufacturers do not recommend Dental dams are an effective option for such use and little evidence exists to © sexualityandu.ca oral sex. support its efficacy. Dental dam 2 Male condom © sexualityandu.ca A male condom is a sheath placed A dental dam is a thin square of latex on an erect penis to prevent the that can be used as a shield during oral exchange of fluids between partners sex. The dam is placed over a woman’s Female condom during intercourse or oral sex. Latex vulva, acting as a barrier between her condoms offer protection against the genitals and her partner’s mouth. They The female condom is inserted into the transmission of many STIs. Polyurethane can also be used as a barrier when oral vagina prior to entry by the penis. condoms are also highly effective, but sex is performed on a partner’s anus. are more prone to breakage. Condoms Dams are for sale in some pharmacies © sexualityandu.ca made from sheep membrane are not and sexual-health clinics, but can also effective barriers to STIs. be made using a condom or a latex glove. Simply unroll the condom, cut 3 off the tip and base and cut down the length of the tube. Then unroll the condom into a rectangular sheet.

Chlamydia Gonorrhea Syphilis

Uncomplicated genital infections Uncomplicated gonorrhea is People infected with syphilis are can be treated with antibiotics treated with antibiotics. Gonorrhea typically treated with injectable taken as a single dose or over the bacteria are becoming more resistant to some penicillin. Other antibiotics can be used in some course of one week. medications, requiring follow-up for treated cases, but close monitoring is required. infections. Complicated chlamydial infections (i.e. PID, Sexual partners must be notified so they may neonatal, epididymitis) usually require a Complicated gonorrhea infections (i.e. PID, seek medical attention. longer course of treatment and may require neonatal, disseminated) usually require a hospitalization for treatment with IV antibiotics. longer course of treatment and may require • For primary syphilis: partners from three hospitalization for treatment with IV antibiotics. months prior to the onset of symptoms Sexual partner(s) who have had contact with an infected person within 60 days of diagnosis Patients treated for gonorrhea should also be • For secondary syphilis: partners from six require testing and treatment. treated for chlamydia unless concurrent test months prior to the onset of symptoms results for chalmydia are available and negative. Abstinence from unprotected sexual • For early latent syphilis: partners from one intercourse until treatment is complete (seven Sexual partner(s) who have had contact with year prior to the diagnosis days after a single dose treatment, or until all an infected person within 60 days of diagnosis Response to treatment needs to be monitored. the medication is finished for a multiple dose require testing and treatment. Therefore, follow-up is required. treatment) is essential. Abstinence from unprotected sexual Anyone treated for chlamydia should be re- intercourse until treatment is complete (seven tested six months afterwards. days after a single dose treatment, or until all the medication is finished for a multiple dose treatment) is essential. Anyone treated for gonorrhea should be re- tested six months afterwards.

EXCEPTIONS Pregnant and lactating women with STIs may require different forms of treatment to prevent harm to their fetus or newborn.

page 15 page 16 Treatment Viral STIs

Genital Herpes Hepatitis B HIV (Human Immunodeficiency Virus)

Antiviral medications—acyclovir, There is no cure for hepatitis B, but No cure exists for HIV/AIDS. famciclovir and valacyclovir—to be a vaccine to prevent the infection is Treatments are continually evolving, started as early as possible following the onset available. helping people living with HIV/AIDS of symptoms. Suppressive therapy can be control the virus and its symptoms. considered for patients with frequent outbreaks Most individuals recover fully within about six (six or more times per year). months. Anti-retroviral therapy (ART) helps slow the progression of the infection Other considerations for management during Individuals who are acutely infected with and can help the immune system an outbreak: hepatitis B should abstain from sexual activity restore itself. until their partner(s) have been screened and • Pain relievers and laxatives immunized if needed. Household contacts Though available HIV medications have should also be screened and immunized if lengthened the average time from infection to • Hospitalization, should urine retention needed. progression to AIDS, there are significant side become a problem effects that may affect quality of life. People If an individual is exposed, an injection of on ART need to be monitored closely by a antibodies may be given (up to seven days after specialist for their response to treatment and a needlestick injury and up to 14 days after side effects. HPV (Human Papillomavirus) sexual contact), followed by the hepatitis B vaccine to help prevent infection. Individuals diagnosed with HIV should inform There is currently no cure for women sexual partners of their status. Failure to Infants born to infected mothers should receive disclose may have legal implications. and men infected with the virus. an injection of antibodies immediately after Vaccination is available to prevent birth followed by the vaccine within 12 hours. certain types of HPV. Individuals with acute infections usually do not Depending on their size, number and location, need antiviral medications. genital warts can be treated using several different options, for example: strong acids Those who develop chronic hepatitis B require and chemicals, topical cream, liquid nitrogen, monitoring of their liver function and may electric currents or laser therapy. benefit from treatment with interferon or an antiviral medication. Although partner notification is not required, patients are encouraged to notify their partners that they have had genital warts or an abnormal Pap smear.

EXCEPTIONS Pregnant and lactating women with STIs may require different forms of treatment to prevent harm to their fetus or newborn. Treatment Parasitic & Fungal STIs

Trichomoniasis Scabies Candidiasis (Yeast Infection)

Treated with medication, usually Creams and lotions are available Several over-the-counter antifungal metronidazole. (No alcohol can be to treat scabies. These are typically tablets, creams, ointments and consumed during treatment and for 24 hours applied and washed off in a specified amount suppositories are available. These are inserted following the completion of treatment.) of time. into the vagina for a period of one to seven days. They can also be applied externally to the Sexual partner(s) should be treated with Clothes and bedding must be washed in hot vulva or penis. metronidazole even if they do not have water or drycleaned, and mattresses should be symptoms. Testing is usually not recommended vacuumed or, depending on the size, items may In certain circumstances, oral medications are for male partners. be placed in a sealed plastic bag for three days prescribed by a health-care professional. to one week. For problematic recurrent infections, All household contacts and sexual partners maintenance therapy may be recommended. within the month prior to infection should Pubic Lice be treated. Itching may continue for several Some medications used to treat yeast infections weeks, so medication may be recommended. are harmful if used in pregnancy. All pregnant The affected area should be washed Repeat treatment recommendations should be women should seek medical advice prior to and a lice-killing cream, lotion or followed closely. using any over-the-counter product. shampoo used (can be obtained Sexual partners do not need to be notified or directly at a pharmacy). Itchiness may last for clinically evaluated unless they have symptoms. several weeks after treatment, which may be controlled with medication. Repeat treatment recommendations should be followed closely. Sexual partner(s) within the last month should be treated. Clothes and bedding must be washed in hot water or drycleaned, and mattresses should be vacuumed or, depending on the size, items may be placed in a sealed plastic bag for one week.

EXCEPTIONS Pregnant and lactating women with STIs may require different forms of treatment to prevent harm to their fetus or newborn.

page 17 Contact the sexualityandu.ca order desk at (800) 561-2416 ext. 375 For additional information, visit: or order material online at www.sexualityandu.ca. sexualityandu.ca Canada’s leading website on sexual health Administered by the Society of Obstetricians and Gynaecologists of Canada www.sexualityandu.ca Public Health Agency of Canada In-depth information on chronic and infectious diseases www.phac-aspc.gc.ca/std-mts Canadian Federation for Sexual Health Information about sexual and reproductive health and rights across Canada www.cfsh.ca Content based on the Canadian Guidelines on Sexually Transmitted Infections 2010 Edition www.publichealth.gc.ca/sti Administered by 780 Echo Drive Ottawa, Ontario K1S 5R7 Tel: (800) 561-2416 or (613) 730-4192 Fax: (613) 730-4314 www.sogc.org

Cette ressource est disponible en français. Copyright © 2011 - Society of Obstetricians and Gynaecologists of Canada. None of the contents may be reproduced or transmitted in any form or by any means without prior written consent of the SOGC. Published in Canada in March 2011.