Sexually transmitted infections (STIs) are some of the world’s most widespread diseases.
In Canada, there has been a significant increase in reportable infections passed from one person to another through sexual contact since 2000. People aged 15 to 24 years acquire half of all new STIs, and one in four sexually active adolescent females has an STI.
Two categories of STIs exist – bacterial and viral. Bacterial STIs can be treated and cured, but viral infections usually cannot be cured. In both cases, prevention is always easier than treating an infection once it has occurred.
Chlamydia is the most common reportable STI in Canada and is on the rise. Between 2010 and 2015, rates increased by 17 percent, with most cases occurring in 15- to 29-year-old males and females. Infections can be persistent for many months, as chlamydia often goes undiagnosed because most infections show no symptoms.
When symptoms do arise, they include vaginal discharge, pain with urination and/or with intercourse, abnormal vaginal bleeding and lower abdominal pain in females, and mucous-like penile discharge, testicular pain and pain with urination in males. Chlamydia is treated with antibiotics.
Gonorrhea, the second most common STI reported in Canada, is also increasing. Between 2010 and 2015, rates increased by 65 percent. Bacteria can survive in the vagina, penis, mouth, rectum or eye. As soon as an individual contracts gonorrhea, they risk spreading the bacteria to other parts of the body, which can prolong the treatment period.
Symptoms in females include vaginal discharge, pain with intercourse or urination, lower abdominal pain and abnormal vaginal bleeding; male symptoms include penile discharge, urinary symptoms and testicular pain. Both sexes may also have a sore throat and conjunctivitis associated with gonorrhea. It can be treated with antibiotics, but usually two different classes of antibiotics are needed due to growing antimicrobial resistance.
Syphilis is another bacterial infection on the increase in Canada with an increase of 86 percent from 2010 to 2015. Over 90 percent of cases are seen in males, but rates in females have been increasing over recent years. The highest rates are seen in 20- to 39-year-old males and females, but also significant increases are occurring in those 60 years and older.
After the initial infection, syphilis has an incubation period of between 9 and 90 days before symptoms occur, with an average incubation of 21 days. Each stage of syphilis has unique signs and symptoms. The primary stage is characterized with a single, painless ulcer; the second stage typically shows with a rash on the palms or soles, fever and headache; the tertiary stage results in more serious health problems with neurological and cardiac manifestations. Syphilis can also pass from a pregnant mother to her baby, which can result in stillbirth or serious deformities. Like other bacterial STIs, syphilis is treatable with antibiotics.
Human papillomavirus (HPV) is the most common STI but is not routinely reported. HPV is a name for a group of viruses that affect the skin and mucous membranes, such as the throat, cervix, anus and mouth. Over 100 types of HPV exist; 40 of them can affect the genital areas. Three out of four sexually active people will get HPV at some point in their lives, yet most infected people don’t show any signs or symptoms and can unknowingly pass the virus onto others.
Most of the time, an HPV infection will clear on its own; however, for some, HPV will not go away, and cells infected with the virus can become cancerous. HPV can lead to abnormal cell growth and alteration within the cervix, significantly increasing the risk of cervical cancer, genital warts and anal, penile, mouth or throat cancer.
There is a safe and highly effective vaccine for prevention of HPV. Gardasil-9 protects against nine types of HPV that cause 90 percent of cervical and anal cancers and 90 percent of genital warts. It can be given to previously unvaccinated males and females over nine years of age with no upper age limit.
Genital herpes is caused by HSV-2, one of the two types of the herpes simplex virus (HSV). While herpes is very common (most Canadians have at least one type of HSV in their lifetime), it also carries a lot of stigma that can lead to anxiety, fear and misinformation. HSV is easily transmissible from human to human through direct contact. Transmission of HSV-2 occurs through vaginal, oral or anal sex, while HSV-1 is more commonly transmitted from shared straws, utensils and surfaces.
Genital herpes is a chronic condition with no cure. However, antiviral medications can be used to minimize the severity and duration of symptoms during an outbreak. Suppressive therapy (taking an antiviral drug every day) can also be used to help prevent passing the virus to sexual partners. Condoms offer good protection but don’t completely prevent the spread of herpes because they don’t cover the whole genital area. During an outbreak, individuals should either abstain from sex or avoid skin-to-skin contact in the affected area.
Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). It’s transmitted through contact with infected semen, vaginal secretions, blood and other bodily fluids. HBV is easier to catch than HIV because it can be 100 times more concentrated in an infected person’s blood. HBV infection can lead to serious liver damage that can eventually cause cancer, and the disease can sometimes become chronic. The treatments for hepatitis B can suppress the infection but not cure it. However, a highly effective vaccine against HBV exists.
Similarly, Hepatitis C can also be transmitted through blood and bodily fluids, including through sexual intercourse. Chronic infection with hepatitis C is associated with a wide spectrum of liver disease ranging from minor inflammation to life-threatening, decompensated cirrhosis. New treatment options for Hepatitis C are more effective than in the past.
Other STIs include trichomoniasis, HIV, scabies, pubic lice, molloscum contagiosum and lymphogranuloma venerum.
How to prevent bacterial and viral STIs
The number one thing you can do to prevent STIs is to practice safe sex. Use condoms or another barrier (such as dental dams) to lower the chances of getting or passing an infection. Nonbarrier contraception forms, such as oral contraceptives or intrauterine devices, do nothing to protect people from STIs. Be sure to avoid sexual contact if you or your partners have symptoms of, have been exposed to or are being treated for an STI.
Before having sexual intercourse with a new partner, ensure that both you and your partner are STI-free. See your physician or nurse practitioner for regular STI testing; examination may include a physical, swabs and urine collection.
Finally, ensure you are vaccinated against HPV and Hepatitis B.
Questions about STIs? Be sure to speak with your Copeman family physician or nurse practitioner.