Sexually transmitted diseases (STDs)

Diagnosis

Diagnosis of an STD starts with your sexual history and current symptoms. If these suggest that you have an STD, your health care professional may do a physical or pelvic exam to look for signs of infection. Some signs of infection are a rash, warts or discharge.

Tests

Lab tests can find the cause of STD symptoms. They can also find sexually transmitted infections without symptoms.

• Blood tests. Blood tests can confirm the diagnosis of HIV or later stages of syphilis.
• Urine samples. Some STDs can be confirmed with a urine sample.
• Fluid samples. If you have open genital sores, your health care professional may test fluid and samples from the sores to diagnose the type of infection.

Screening

Testing for an STD or sexually transmitted infection in someone who doesn't have symptoms is called screening. Most of the time, STI screening is not a routine part of health care.

But when a person's risk for getting an STD changes, a health care professional may suggest screening. The risk level may change when a person is in a new setting with a higher risk, such as a prison or jail. Or it can be based on factors such as if a person has a history of sexually transmitted infections.

Experts recommend STI screening for:

• Almost everyone at least once. Guidelines suggest screening with a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS, for everyone ages 15 to 65. Experts recommend that people at high risk have an HIV test every year.

  National guidelines recommend hepatitis B screening for people age 18 and older at least once, and with a test that includes a few different markers of the virus.

  Guidelines also recommend hepatitis C screening for all adults.

• Pregnant women. All pregnant women will generally be screened for HIV, hepatitis B, chlamydia and syphilis early in the pregnancy.

  Guidelines recommend gonorrhea and hepatitis C screening tests at least once during pregnancy for women at high risk of these infections.

  They also suggest hepatitis B screening at each pregnancy for everyone.

• Women age 21 and older. The Pap test screens for changes in the cells of the cervix, such as swelling an irritation, also called inflammation, precancerous changes and cancer. Cervical cancer is often caused by certain HPV strains.

  Experts recommend that women have a Pap test every three years starting at age 21. After age 30, experts recommend women have an HPV test and a Pap test every five years. Or, women over 30 can have a Pap test alone every three years or an HPV test alone every three years.

• Women under age 25 who are sexually active. Experts recommend that all sexually active women under age 25 be tested for chlamydia infection. The chlamydia test uses a sample of urine or vaginal fluid you can collect yourself.

• Reinfection by an untreated or undertreated partner is common. If you've been treated for a chlamydia infection, you should be retested in about three months. Get retested if you have a new partner.

  Experts also recommend screening for gonorrhea in sexually active women under age 25.

• Men who have sex with men. Compared with other groups, men who have sex with men run a higher risk of getting sexually transmitted infections.

  Many public health groups recommend annual or more-frequent STI screening for these men. Regular tests for HIV, syphilis, chlamydia and gonorrhea are particularly important. Evaluation for hepatitis B also may be recommended.

• People with HIV. Having HIV raises your risk of getting other sexually transmitted diseases. Experts recommend testing for syphilis, gonorrhea, chlamydia and herpes right away after being diagnosed with HIV. They also recommend that people with HIV be screened for hepatitis C.

  Women with HIV may develop aggressive cervical cancer. So experts recommend they have a Pap test at the time of the HIV diagnosis or within a year of becoming sexually active if they are under 21. Then, experts recommend repeating the Pap test every year for three years.

  After three negative tests, women with HIV can get a Pap test every three years.

• People who have a new partner. Before having vaginal or anal sex with new partners, be sure you've both been tested for STDs. However, experts don't recommend routine testing for genital herpes unless you have symptoms.

  It's also possible to be infected with an sexually transmitted infection yet still test negative, which is most common if you've recently been infected.

Treatment

STDs may be treated in different ways based on the causes. Sexually transmitted infections caused by bacteria are generally easier to treat. STI infections caused by viruses can be managed and treated but not always cured.

If you are pregnant and have an STD, getting treatment right away can prevent or lower the risk of your baby becoming infected.

Treatment for sexually transmitted infections usually consists of one of the following, depending on the infection:

• Antibiotics. Antibiotics, often in a single dose, can cure many STIs caused by bacteria or parasites, such as gonorrhea, syphilis, chlamydia and trichomoniasis.

  Once you start antibiotic treatment, you need to finish the prescription. If you don't think you'll be able to take medicine as prescribed, tell your health care professional. A shorter, simpler course of treatment may be available.

  Also, it's important to avoid sexual activity until seven days after you've completed antibiotic treatment and any sores have healed.

  Experts also suggest people diagnosed with chlamydia be retested three months after treatment because there's a high chance of reinfection.

• Antiviral drugs. If you have herpes or HIV, your doctor may prescribe medicine that keeps a viral infection from getting worse, called an antiviral medicine.

  You'll generally have fewer herpes recurrences if you take what's called daily suppressive therapy with a prescription antiviral medicine. But it's still possible to give your partner herpes.

  Antiviral medicines can keep HIV infection in check for many years. But you will still carry the virus and can still spread it, though the risk is lower.

  The sooner you start HIV treatment, the more effective it is. If you take your medicines as directed, it's possible to lower the viral load in the blood so that it can't be found. At that point, you won't spread the virus to sex partners.

If you've had a sexually transmitted infection, ask your health care professional how long after treatment you need to be retested. Getting retested will ensure that the treatment worked and that you haven't been reinfected.

Partner notification and preventive treatment

If tests show that you have an STD, you need to tell your sex partners. Tell your current partners and any other partners you've had over the last three months to one year that you have an sexually transmitted infection. They will need to get tested. If they're infected, they can then be treated.

Each state has different requirements. But most states require that certain STDs be reported to the local or state health department.

Public health departments often staff trained disease intervention specialists. These specialists can help privately tell partners and refer people for treatment.

Official, confidential partner notification can help limit the spread of sexually transmitted infections. This is very important for syphilis and HIV.

It also steers those at risk for STDs to get counseling and treatment. And since you can get some STIs more than once, telling your partners lowers your risk of getting reinfected.

Coping and support

It can be traumatic to find out that you have an STD. You might be angry if you feel you've been betrayed. Or you might feel ashamed if you might have infected others.

And you may be worried — an STI can cause chronic illness and death, even with the best care that's available.

These suggestions may help you cope with having a STD or an STI:

• Hold off placing blame. Don't assume that your partner has been unfaithful to you. One (or both) of you may have been infected by a past partner.
• Be honest with health care workers. Their job is not to judge you, but to provide treatment and stop STIs from spreading. Anything you tell them stays confidential.
• Contact your health department. Local health departments have STD programs that give confidential testing, treatment and partner services. They may not have the staff and funds to offer every service, though.

Preparing for your appointment

The doctor's office is one place where you have to provide details of your sexual experience so that you can get the right care.

If you feel nervous about this topic, think about writing your experiences down. You can share this with your health care professional before or at your appointment.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, vitamins or supplements you're taking.
• Write down questions to ask your doctor.

Some basic questions to ask your doctor include:

• What's the medical name of the infection or infections I have?
• How is the infection transmitted?
• Will it keep me from having children?
• If I get pregnant, could I give it to my baby?
• Is it possible to catch this again?
• Could I have caught this from someone I had sex with only once?
• Could I give this to someone by having sex with that person just once?
• How long have I had it?
• I have other health conditions. How can I best manage them together?
• Should I avoid being sexually active while I'm being treated?
• Does my partner have to go to a doctor to be treated?

What to expect from your doctor

Giving your doctor a complete report of your symptoms and sexual history will help your doctor determine how to best care for you.

Here are some of the things your doctor may ask:

• What symptoms made you decide to come in? How long have you had these symptoms?
• Are you sexually active with men, women or both?
• Do you currently have one sex partner or more than one?
• How long have you been with your current partner or partners?
• Have you ever injected yourself with drugs?
• Have you ever had sex with someone who has injected drugs?
• What do you do to protect yourself from STIs?
• What do you do to prevent pregnancy?
• Has a doctor or nurse ever told you that you have chlamydia, herpes, gonorrhea, syphilis or HIV?
• Have you ever been treated for a genital discharge, genital sores, painful urination or an infection of your sex organs?
• How many sex partners have you had in the past year? In the past two months?
• When was your most recent sexual encounter?

What you can do in the meantime

If you think you might have a sexually transmitted infection, it's best to avoid any sexual activity until you've talked with your doctor.

If you do take part in sexual activity before seeing your doctor, be sure to follow safe sex practices, such as using a condom.