Sexually Transmitted Diseases (STDs) and Sexually Transmitted Infections (STIs)

STD/STI Testing, Diagnosis and Treatment

At Lee Health we offer the following services related to the testing and treatment of the following sexually transmitted diseases (STDs) and sexually transmitted infections (STIs):

Gonorrhea:

Women infected are often asymptomatic

Symptoms may include: 

• vaginal irritation 
• yellow thick discharge
• rectal pain with discharge 
• lower abdominal pain 
• painful intercourse 
• painful and swollen labia 

Treatment:

Intramuscular injection of an antibiotic called ceftriaxone in office 

Prevention and education: 

• limiting number of sexual partners 
• using protection (condoms) at all times 

Chlamydia:

Women are often asymptomatic 

Symptoms may include:

• abnormal yellow thick vaginal/penile discharge 
• painful urination
• lower abdominal pain, 
• vaginal spotting/bleeding after intercourse
• painful/enlarged testicles 

Treatment: 

Antibiotic called Azithromycin taken by mouth 

Prevention and education: 

• limiting number of sexual partners 
• using protection (condoms) at all times

Syphilis

Symptoms

• Primary infection: One or more painless chancre sores lasts for 3-6 weeks. 
• Secondary infection: Without treatment it progresses to the second stage. Symptoms include red and or brown rashes located on hands and feet or other parts of the body. May also experience fever, sore throat, muscle aches, alopecia, tiredness, and malaise. 
• Latent stage: No symptoms or hidden symptoms. 
• Tertiary: Difficulty moving extremities, paralysis, numbness or blindness.

Treatment: 

Penicillin in one-time dose. Treatment cures the disease but will not cure the existing conditions related to disease.

Prevention and education: 

• limiting number of sexual partners 
• using protection (condoms) at all times. 
• Maternal to fetal transmission can result in low birth weight, premature delivery, and stillbirth. If left untreated 
• serious health problems include cataracts, deafness, seizures and death in newborn.

Herpes   

 Symptoms:

• Painful vesicular lesions on the skin and genitals, typically recurrent with the first outbreak being most painful and severe. 
• Lesions last 4-15 days in primary and 7-10 in recurrent outbreaks.  
• Primary (first) outbreaks typically also have flu-like symptoms: fever, fatigue, muscle aches, swollen lymph nodes, swelling of the vulva/labia, vaginal discharge, and painful urination.  

Treatment:

Antiviral medication called acyclovir or valacyclovir is prescribed during outbreaks

Prevention and Education:

• Prevention by using condoms and practicing safe sex 
• Virus is a chronic disease and recurring, with no known cure 
• Inform partners if infection present and abstain from sex until lesions fully healed 
• Pregnancy: Inform provider if history of herpes. 
• If no active lesions, can give birth vaginally. 
• If active lesions present during labor, c-section should be done

Trichomoniasis 

Symptoms:

Women with trichomoniasis may notice

• Itching, burning, redness or soreness of the genitals;
• Discomfort with urination;
• A change in their vaginal discharge (i.e., thin discharge or increased volume) that can be clear, white, yellowish, or greenish with an unusual fishy smell.

Men with trichomoniasis may notice:

• Itching or irritation inside the penis;
• Burning after urination or ejaculation;
• Discharge from the penis.

Treatment: 

• Metronidazole 2gm PO x1 Tinidazole 2gm PO x1 Do NOT drink alcohol while taking these meds.
• Do not drink alcohol for 24 hrs after completing metronidazole and 72 hours after completing tinidazole.
• Sexual partners must be treated All individuals should abstain from sex until both partners treated and asymptomatic

Prevention and education:

• limiting number of sexual partners 
• using protection (condoms) at all times
• Pregnant Women If infected, at risk for premature rupture of membranes, preterm labor and birth, low birth weight

HIV 

Symptoms

• Fever 
• Malaise 
• Rash 
• Myalgias 
• Lymphadenopathy 
• Sore throat 
• Headache    

Treatment:

• Antiretroviral therapy Prevention 
• Pre-exposure prophylaxis (PrEP) (tenofovir disoproxil fumarate 300mg and emtricitabine 200mg) 

Prevention and education:

• limiting number of sexual partners 
• using protection (condoms) at all times
• Incurable virus
• Even if pt does not exhibit symptoms, they are still infectious and will remain so for life

HPV

Symptoms

• Most people have no symptoms and in most cases, HPV goes away on its own and does not cause any health problems. 
• But when HPV does not go away, it can cause health problems like genital warts and cancer.
• Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.   

 Treatment:

• Genital warts can be treated by your healthcare provider or with prescription medication. If left untreated, genital warts may go away, stay the same, or grow in size or number.
• Cervical precancer can be treated. Women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. 
• Other HPV-related cancers are also more treatable when diagnosed and treated early.

Prevention and Education:

• HPV vaccination is recommended at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already.
• limiting number of sexual partners 
• using protection (condoms) at all times

Hepatitis B:     

Not necessarily symptomatic especially in chronic HBV. 

Sudden and Serious Symptoms may include: 

• Fatigue 
• Fever 
• Nausea/vomiting
• Loss of appetite
• Abdominal pain
• Dark urine
• Clay-colored stool 
• Joint pain 
• Jaundice    

Treatment for Hepatitis B 

• Acute infection: supportive treatment
• Chronic infection: treatment w/ antivirals to help prevent liver damage or liver CA

Prevention and education:

• HBV vaccine provides pre- and post-exposure protection (3-dose series) -recommended in infancy (or adolescence if not vaccinated previously) and in adulthood if at high risk

Hepatitis C     

Usually asymptomatic or have mild symptoms which can include: 

• Fever 
• Fatigue 
• Dark urine 
• Clay-colored stool 
• Abdominal pain 
• Loss of appetite 
• N/V 
• Joint pain 
• Jaundice 
• Most people with chronic HCV are asymptomatic or have non-specific symptoms such as chronic fatigue and depression. 
• Can progress to chronic liver disease, mild to severe, including cirrhosis & liver CA.

PID (Pelvic inflammatory disease)  

Some women are asymptomatic 

Some women may exhibit any of the following: 

• Abnormal bleeding
• Dyspareunia (pain w/ intercourse) 
• Vaginal discharge 
• Lower abdominal pain 
• Cervical motion tenderness
• Uterine tenderness 
• Adnexal tenderness 
• Oral temperature >101°F 
• Mucopurulent discharge (common)    

Treatment:

• Antimicrobial tx of likely causative agent that is also effective against N. gonorrhoeae and C. trachomatis 
• Women with mild or moderate PID may be effectively treated with oral or parenteral antimicrobials. 
• Hospitalization may be necessary 

Prevention and Education:

• limiting number of sexual partners 
• using protection (condoms) at all times
• PID is an inflammatory disorder of the upper female reproductive tract 
• It can be caused by a number of different organisms. 
• If left untreated, can lead to infertility
• Pregnant women w/ PID are at increased risk for maternal morbidity and preterm delivery. They should be hospitalized and treated w/ IV antimicrobials.