Diagnosis

Tests

If your sexual history and current signs and symptoms suggest that you have a sexually transmitted disease (STD) or a sexually transmitted infection (STI), laboratory tests can identify the cause and detect coinfections you might also have.

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

Screening

Testing for a disease 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 there are exceptions:

  • Everyone. The one STI screening test suggested for everyone ages 13 to 64 is a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Experts recommend that people at high risk have an HIV test every year.
  • Everyone born between 1945 and 1965. There's a high incidence of hepatitis C in people born between 1945 and 1965. Since the disease often causes no symptoms until it's advanced, experts recommend that everyone in that age group be screened for hepatitis C.
  • Pregnant women. All pregnant women will generally be screened for HIV, hepatitis B, chlamydia and syphilis at their first prenatal visit. Gonorrhea and hepatitis C screening tests are recommended at least once during pregnancy for women at high risk of these infections.
  • Women age 21 and older. The Pap test screens for cervical abnormalities, including inflammation, precancerous changes and cancer, which is often caused by certain strains of human papillomavirus (HPV). Experts recommend that women have a Pap test every three years starting at age 21. After age 30, experts recommend women have an HPV DNA test and a Pap test every five years. A Pap test every three years is also acceptable.
  • 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.

    Some experts recommend repeating the chlamydia test three months after you've had a positive test and been treated. Reinfection by an untreated or undertreated partner is common, so you need the second test to confirm that the infection is cured. You can catch chlamydia multiple times, so get retested if you have a new partner.

    Screening for gonorrhea is also recommended 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 acquiring STIs. 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. If you have HIV, it dramatically raises your risk of catching other STIs. Experts recommend immediate testing for syphilis, gonorrhea, chlamydia and herpes 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 within a year of being diagnosed with HIV, and then again six months later.

  • People who have a new partner. Before having vaginal or anal intercourse with new partners, be sure you've both been tested for STIs. However, routine testing for genital herpes isn't recommended unless you have symptoms.

    It's also possible to be infected with an STI yet still test negative, particularly if you've recently been infected.

Treatment

Sexually transmitted diseases (STDs) or sexually transmitted infections (STIs) caused by bacteria are generally easier to treat. Viral infections can be managed but not always cured. If you are pregnant and have an STI, getting treatment right away can prevent or reduce the risk of your baby becoming infected.

Treatment for STIs usually consists of one of the following, depending on the infection:

  • Antibiotics. Antibiotics, often in a single dose, can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomoniasis. Typically, you'll be treated for gonorrhea and chlamydia at the same time because the two infections often appear together.

    Once you start antibiotic treatment, it's necessary to follow through. If you don't think you'll be able to take medication as prescribed, tell your doctor. A shorter, simpler course of treatment may be available.

    In addition, it's important to abstain from sex until seven days after you've completed antibiotic treatment and any sores have healed. Experts also suggest women be retested in about three months because there's high chance of reinfection.

  • Antiviral drugs. If you have herpes or HIV, you'll be prescribed an antiviral drug. You'll have fewer herpes recurrences if you take daily suppressive therapy with a prescription antiviral drug. However, it's still possible to give your partner herpes.

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

    The sooner you start treatment, the more effective it is. If you take your medications exactly as directed, it's possible to reduce your virus count so low that it can hardly be detected.

If you've had an STI, ask your doctor 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 STI, your sex partners — including your current partners and any other partners you've had over the last three months to one year — need to be informed so that they can get tested. If they're infected, they can then be treated.

Each state has different requirements, but most states require that certain STIs be reported to the local or state health department. Public health departments often employ trained disease intervention specialists who can help notify partners and refer people for treatment.

Official, confidential partner notification can help limit the spread of STIs, particularly for syphilis and HIV. The practice also steers those at risk toward counseling and the right treatment. And since you can contract some STIs more than once, partner notification reduces your risk of getting reinfected.

Coping and support

It can be traumatic to find out you have a sexually transmitted disease (STD) or a sexually transmitted infection (STI). You might be angry if you feel you've been betrayed or ashamed if you might have infected others. At worst, an STI can cause chronic illness and death, even with the best care that's available.

These suggestions may help you cope:

  • 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 remains confidential.
  • Contact your health department. Although they may not have the staff and funds to offer every service, local health departments have STI programs that provide confidential testing, treatment and partner services.

Preparing for your appointment

Most people don't feel comfortable sharing the details of their sexual experiences, but the doctor's office is one place where you have to provide this information so that you can get the right care.

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, exactly, is it 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 not be 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 an STI, it's best to not to be sexually active until you've talked with your doctor. If you do engage in sexual activity before seeing your doctor, be sure to follow safe sex practices, such as using a condom.

Oct. 29, 2019
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  4. Overview of sexually transmitted diseases. Merck Manual Professional Version. http://www.merckmanuals.com/professional/infectious-diseases/sexually-transmitted-diseases-std/overview-of-sexually-transmitted-diseases. Accessed Dec. 6, 2015.
  5. Sexually transmitted infections (STIs). World Health Organization. http://www.who.int/mediacentre/factsheets/fs110/en/. Accessed Dec. 6, 2015.
  6. South-Paul JE, et al. Sexually transmitted diseases. In: Current Diagnosis & Treatment in Family Medicine. 3rd ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://accessmedicine.com. Accessed Dec. 5, 2015.
  7. New guidelines for cervical cancer screening: Patient education fact sheet. The American Congress of Obstetricians and Gynecologists. http://www.acog.org/Patients. Accessed Dec. 6, 2015.
  8. Ghanem KG, et al. Screening for sexually transmitted infections. http://www.uptodate.com/home. Accessed Dec. 4. 2015.
  9. Tintinalli JE, et al. Sexually transmitted diseases. In: Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: The McGraw Hill Companies; 2011. http://www.accessmedicine.com. Accessed Dec. 5, 2015.
  10. Hunter P, et al. Screening and prevention of sexually transmitted infections. Primary Care: Clinics in Office Practice. 2014;41:215.
  11. Preexposure prophylaxis for the prevention of HIV infection in the United States — 2017 update: A clinical practice guideline. Centers for Disease Control and Prevention: US Public Health Service. https://www.cdc.gov/hiv/guidelines/preventing.html. Accessed June 26, 2019.
  12. PrEP: HIV/AIDS. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/basics/prep.html. Accessed June 26, 2019.
  13. FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-second-drug-prevent-hiv-infection-part-ongoing-efforts-end-hiv-epidemic. Accessed Oct. 17, 2019.

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