Sexually transmitted diseases (STDs), also called sexually transmitted infections (STIs), are very common, with around 25 million new diagnoses made yearly in the United States. Young people, ages 15-24 years of age, appear to be the most prevalent group to acquire and spread STDs, accounting for about half of newly diagnosed cases in 2018 per the Centers for Disease Control (CDC). Notably, 1 in 5 people in the United Stated have had an STD.
Oral, vaginal and anal sexual encounters are the methods of transmission and these infections vary greatly in their symptoms, severity, curability and prognosis. Treatment has improved over the years and some lifelong conditions now do not preclude a good quality of life. However, some of these diseases can be quite quiet in terms of initial symptoms, and screening tests, or tests to check if a disease is present even when symptoms are not, are a critical way to help reduce transmission and consequences of these infections.
Bacterial Vaginosis, not categorized itself as a sexually transmitted disease, is a condition named for alterations in the normal balance of bacteria in the vagina, which can lead to an increased risk for susceptibility to STDs, as well as preterm labor. A fishy odor may be noted after vaginal intercourse, and pain, itching and burning in this area or during urination, as well as thin, grey-white vaginal discharge, are among associated complaints. Although many cases of bacterial vaginosis clear on their own, antibiotic treatment may be needed at times. Currently, there is no recommendation for routine screening for BV.
Two of the most predominant, but easily treatable STDs, include chlamydia and gonorrhea. Both can spread through oral, vaginal or anal sex. Though either condition may be asymptomatic, some suspicious findings include abnormal vaginal or penile discharge, burning while urinating and pain or swelling of the testicles. Chlamydia and gonorrhea can also reoccur if infectious sex continues, despite prior treatment. Also, having these infections increases a woman’s risk to develop pelvic inflammatory disease (PID), which is damage to the internal reproductive organs, making future fertility a challenge. If infected during pregnancy, risk for miscarriage, preterm labor, low birth weight or an infection in the fluid surrounding the fetus, called chorioamnionitis, increases. Newborns of untreated mothers may also suffer postnatal complications such as eye infections and pneumonia. Pregnant women < 25 years of age, or older pregnant women at increased risk of exposure to gonorrhea or chlamydia, are typically screened at their first prenatal visit. Similarly, it is recommended to screen all sexually active women < 25 years of age, yearly, for gonorrhea and chlamydia, and older women who have multiple sexual partners. All sexually active gay or bisexual men, should also be screened at least yearly, but more often depending on frequency of new sexual encounters/multiple partners. Testing for these diseases can be as simple as a urine sample ordered by a virtual physician, however it is prudent to discuss symptoms and history to determine the best course of screening.
According to the CDC, every 1 out of 6 people in the United States has herpes simplex virus (HSV) infection, oftentimes without knowing it. HSV can be divided into HSV 1, more commonly known as oral herpes, and HSV 2, known as genital herpes. Although designated as such, either can occur orally or genitally. Many people are infected with HSV 1 in their childhood, through non sexual mediated contact with infected saliva. Oral herpes results in cold sores or fever blisters, around the lip and mouth area. Genital herpes, likewise, can demonstrate sores throughout the genital region of infected individuals. Lack of active sores however does not negate infectious activity and the disease can still spread through unprotected oral, vaginal and anal routes. There is no curative treatment for HSV and the virus can go into a dormant phase where no symptoms occur for years, though patients are at risk for recurrent outbreaks, where an antiviral medication may be prescribed. Devastating effects can occur if left untreated during pregnancy, including life-threatening infection to the newborn. If there is history of infection or active infection at the time of labor, a Cesarean section may be indicated. The United States Preventive Services Task Force does not recommend routine screening for HSV in asymptomatic sexually active adolescents or adults, including pregnant women.
Syphilis is a bacterial infection spread through sexual contact, and is divided into distinct phases, first beginning as painless mouth/oral, genital or anal sore(s) several days to several months after initial exposure. This sore or sores will resolve after a few weeks, even without medication. Then a body rash develops, sometimes with swollen lymph nodes, general fatigue and a fever, later. There can be a long period of “latency”, or no symptoms, followed by the last stage classified by neurological, ocular and cardiac symptoms. This is a curable condition, but can cause life-long consequences if untreated, including dementia and blindness, and can lead to death. Screening is indicated for sexually active individuals on a yearly basis, but more often such as every 3-6 months for high risk features, such as multiple partners. This can be performed through a blood test, which may be ordered through a virtual physician’s visit.
Although there are other methods of transmission, typically hepatitis B may be acquired through the sexually transmitted routes mentioned above. Hepatitis C is less commonly sexually transmitted, but spreads through exposure of infected blood, such as in activities like sharing needles in illicit IV drug abuse. Both conditions, though incited by different viruses, have the same impact on the liver and symptoms can overlap, with fever, fatigue, yellowing of the eyes and skin, abdominal pain and changes in urine color. With the exception of individuals living in extremely low prevalence areas, it is recommended that hepatitis C screening be given to a person at least once after the age of 18 years. Additionally, although hepatitis B is a vaccine preventable illness, the USPSTF recommends screening by blood test, those individuals at high risk such as those who inject drugs or share needles, men who have sex with men and immunocompromised patients, such as those with HIV, as well as those living in areas with a 2% or higher prevalence of the hepatitis B surface antigen, regardless of vaccination status. This is especially important given that hepatitis B is a chronic illness that will need lifelong treatment and both viruses present a higher susceptibility to liver cancer.
HIV, or human immunodeficiency virus, eventually progresses to acquired immunodeficiency syndrome (AIDS). Fortunately, through screening and early detection, appropriate prophylactic and supportive agents can be provided to help maintain CD4 counts and stable immune status in order to prevent, or at least slow, this advancement. It is generally recommended that adolescents beginning at 13 years, through adulthood, into the 60s, be screened via blood test, at least once as part of routine health maintenance. For those in higher risk categories, such as individuals with multiple sexual partners, men who have sex with men and those who share needles, screening may be advised yearly or with more frequent intervals depending on individual circumstances. Once again, this is a blood test that may be ordered through a virtual doctor visit.
While prevention of any illness is optimal through regular visits with a physician, screening tests have proven to be useful in early detection of otherwise asymptomatic diseases, allowing for quicker treatment. In particular, sexually transmitted diseases are relatively easy to screen for through blood or urine samples. If you have questions or concerns regarding your need to be screened for these conditions, it is quite simple to schedule a virtual visit with one of our physicians at My Virtual Physician, and we can help determine which testing is right for you. In addition, depending on the results, oftentimes follow up guidance or medication can also be provided! Schedule a visit today!