July 9, 2020

What to know about sexually transmitted infections (STIs)

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Common sexually transmitted diseases sometimes cause no symptoms but can lead to bigger problems.

At Vanderbilt Health Walk-In Clinics, nurse practitioners treat a wide range of conditions and symptoms, including sexually transmitted infections (STIs — sometimes called STDs, or sexually transmitted diseases). The good news is that there are ways to prevent these infections, and some can be successfully treated. Here, Candice Lewis, FNP, one of our Walk-In providers, answers questions about STIs that prompt people to visit the clinics.

Question: What are the most common STIs that you see at our clinics?

Answer: The most common we see and diagnose are chlamydia, gonorrhea and genital herpes.

Question: What other common ones are out there?

Answer: The other STIs that we will test for are trichomonas, syphilis, hepatitis B, hepatitis C and human immunodeficiency virus (HIV).

Chlamydia

Question: What are the signs of a chlamydia infection?

Answer: Unfortunately, chlamydia is often asymptomatic, meaning you won’t have symptoms, especially in men. For women, symptoms that can be seen are vaginal pain, or discolored vaginal discharge. For men, they can see a penile discharge, or painful urination. Men can also develop something called epididymitis, which is swelling and pain around the testicles. But up to 70% of people diagnosed with chlamydia are asymptomatic.  So it’s very common to see this, and have it passed to other people before someone realizes they have it.

Question: Where does chlamydia come from?

Answer: It is a bacteria. It’s one that we will detect with either a urine specimen or a vaginal or urethral swab. It is treated with antibiotics. The reason we want to catch this and treat it: It can cause problems in pregnancy. It can cause things like pelvic inflammatory disease that can result in infertility.

Question: Will any of these STIs go away if you leave them untreated?

Answer: There is some data that suggests chlamydia can resolve without treatment. However, the risk of not treating this infection is that you could instead end up with complications such as pelvic inflammatory disease. Positive tests for any STI should always be treated, to decrease the risk of complications or that the infection will spread.

Question: How can someone prevent chlamydia?

Answer: The main preventive measures are going to be pretty similar with any of these STDs: Abstinence from sexual activity, reducing the number of sexual partners, and/or condoms.

Question: What else should people be aware of about chlamydia?

Answer: It can also infect your eye, your throat or your rectum. Those areas of infection are rare.

Gonorrhea

Question: You said another common STI the clinic staff often treats is gonorrhea. What are the symptoms of a gonorrhea infection?

Answer: For women, the main things are vaginal burning or vaginal itching, and a discolored discharge. Gonorrhea is much more likely than chlamydia to cause pelvic inflammatory disease. The fallopian tubes can also become infected, and it can be very painful. It can cause fever and infertility. For men, burning with urination is the only symptom. But this is another infection that can be asymptomatic.

Question: Is gonorrhea also caused by a bacteria?

Answer: It is. It’s diagnosed the same as the chlamydia, with either a urine specimen or a swab. It is treated with an antibiotic, but typically we treat it with a (one-time) injection of an antibiotic.

For gonorrhea, you’re more likely to end up with other problems like pelvic inflammatory disease. For it to go away, you definitely need to have it treated.

Genital herpes

Question: What about genital herpes. That is caused by a virus, right?

Answer: It is viral.

Question: What are the symptoms of genital herpes infection?

Answer: The symptoms are painful ulcers, ulcerated lesions anywhere in the genital or rectal area. If someone is able to see them, they’re usually just like little shallow open sores. Usually people come in because it is very painful.

Unfortunately, you can carry the virus for years before you ever have your first outbreak. So it’s possible to carry it and pass it without realizing you have it.

Question: What triggers these sores to erupt?

Answer: It can be something that happens to decrease your immune response, like being sick. Or being pregnant. Or it could be something like an injury. So sometimes you’ll see someone that nicks themselves shaving (in the pubic area), and that will bring on that outbreak.

Question: How long can the herpes virus linger in your system without showing symptoms? If you are diagnosed with it, is there a way to tell how long you’ve had it, or where you got it from?

Answer: There is not.

Question: How can one prevent genital herpes? Is it again a matter of abstinence or condom use?

Answer: That’s going to be pretty much the answer across the board: abstinence, condoms or restricting the number of sex partners. To reduce exposure to these bacteria and viruses, reduce the number of people you’re exposed to.

Question: How is genital herpes treated?

Answer: It is treated with an antiviral medication. That will help shorten the course of the outbreak. But there is no way to make the herpes go away forever. Some people will end up on a daily preventive medication to help control the outbreaks. But that is one that stays with you.

Question: We’re talking about genital herpes. Are there other types?

Answer: The other form of herpes is what we call oral-labial. But that would be like a cold sore or fever blisters. And those are just another form of that same virus, (but it) tends to live on the mouth, on the lips, and is passed by contact as well — oftentimes, kissing, sharing drinks or utensils. We will often see the oral-labial herpes spread to the genital area through oral sex. So it can cross from one area to the other.

Question: Are they the same virus, or like a cousin to each other?

Answer: They are very similar — herpes simplex one (oral) and herpes simplex two (genital).

Question: But not every sore or irritation in the mouth is from a herpes virus, right?

Answer: Right.

Rates are increasing

Question: You said chlamydia, gonorrhea and genital herpes are the most common STIs seen in our walk-in clinics. Are the infection rates you see for these STIs typical of Middle Tennessee or does the Nashville area have a lower or higher infection rate than the rest of the state or country?

Answer: Unfortunately, we have seen the rates of all of these increase over the last five years. But that seems very, very much typical for Middle Tennessee, the state of Tennessee and the entire U.S. as well. Tennessee statistics are in line with what the rest of the U.S. is seeing.

The most common age group for STI diagnoses is 20 to 24 years old, college-age. We have a lot of college students in the Nashville area.

Question: Who is most at risk for picking up one of these infections?

Answer: People who are not being careful: multiple partners, no protection. People who have sex for money, people who have sex for drugs, men who have sex with men. There are certain demographics that are at higher risk for things like HIV and syphilis. Also, having HIV puts you more at risk for having another sexually transmitted infection — gonorrhea or herpes or any of these others.

Question: What can you tell people to make them feel more comfortable having a discussion with a doctor about these symptoms or diagnoses?

Answer: We need for them to be honest. If they’re withholding information, it’s like trying to put a puzzle together, but we’re missing pieces. So we really need the patient to be very honest and straightforward. To give them some comfort, I’d point out that we’re not judging them. We’re just there to try to help them.

Vanderbilt Health operates a variety of walk-in clinics in Middle Tennessee, including some with Williamson Medical Center, to take care of everything from sprains and sport injuries to flu shots, fevers, coughs and rashes. Search locations and learn more about the conditions treated there.