Understanding Sexually Transmitted Infections 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 © sexualityandu.ca © sexualityandu.ca Bladder 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) © sexualityandu.ca 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 © sexualityandu.ca BACTERIAL Syphilis 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