STI Awareness: 10 Sexually Transmitted Infections You Probably Don’t Know About

Giardia lamblia, a microbe that can be transmitted sexually. Image: NIH

Gonorrhea and chlamydia go back to antiquity. Syphilis took hold in Europe during the late 15th century. Herpes wasn’t on most people’s radars until the early 1980s, and human papillomavirus (HPV) was relegated to relative obscurity in the popular imagination until the HPV vaccines made their debuts less than a decade ago.


Have you heard of CMV, chancroid, or donovanosis?


But there are still a handful of sexually transmitted infections (STIs) that you might not know about. These include incredibly common infections, as well as those caused by pathogens you might have heard of but probably don’t associate with sexual transmission. They also include infections that are very rare here in Arizona but are much more common in other parts of the world. They all deserve a closer look.

10 Trichomoniasis: What is the most common curable STI? You might guess that it’s chlamydia or gonorrhea, but according to the Centers for Disease Control and Prevention, it’s trichomoniasis (also known as trich, pronounced “trick”). This infection is caused by Trichomonas vaginalis, a single-celled parasite that is actually pretty cute as far as microbes go. What’s not so cute is its propensity to attach to your cells and degrade their surfaces, which on a large scale can produce unpleasant symptoms. Continue reading

STDs 101: An Introduction to Sexually Transmitted Diseases

It’s April, which for Arizonans means a gradual increase in temperature as we head toward summer. But at Planned Parenthood Arizona it also means that it’s time to focus on sexually transmitted diseases (STDs) in observance of STD Awareness Month. While we regularly provide information about sexual health with our monthly STD Awareness series, April is the time of year to fix the spotlight on sexually transmissible microbes and the infections they cause. April is also the time of year when Planned Parenthood Arizona offers coupons for discounted STD screening, so if you’ve been putting it off, now’s the time!

Symptoms of Sexually Transmitted Diseases

First, some basic facts. STDs can be transmitted through all sexual activities — vaginal, anal, or oral sex, as well as activities involving skin-to-skin contact. STDs are most commonly caused by viruses or bacteria, though they can be caused by other agents as well, including animals! Each STD is unique, with unique symptoms, but common symptoms include:

  • rashes, open sores, blisters, or warts in the genital area
  • swelling or tenderness
  • pus, bleeding, odor, or abnormal discharge
  • itching in the genital region
  • burning sensation during urination

It’s best not to focus too closely on symptoms, though – most people with STDs actually don’t experience any symptoms whatsoever! As they say in the biz, “The most common symptom of an STD is … no symptom.” For example, most people with herpes either have no symptoms or have mild symptoms that go unnoticed. Ten percent of males and 80 percent of females with gonorrhea don’t experience symptoms, and most people with chlamydia are asymptomatic. And HIV symptoms usually take a decade to show up. If you are, or have been, sexually active, you can’t assume that the absence of symptoms means you’re in the clear. To know for sure if you have an STD, the best thing you can do is to get yourself tested. Continue reading

STI Awareness: Antibiotic-Resistant Gonorrhea

Under the microscope, Neisseria gonorrhoeae infects larger human cells (click to enlarge). The bacteria resemble tiny pairs of coffee beans. Image: Dr. Norman Jacobs, CDC

Under the microscope, Neisseria gonorrhoeae infects larger human cells (click to enlarge). The bacteria resemble tiny pairs of coffee beans. Image: Dr. Norman Jacobs, CDC

Writing about sexually transmitted infections (STIs), one must walk the line between warning readers of risks and engaging in full-fledged alarmism. So it’s a bit disconcerting that researchers writing in the New England Journal of Medicine last month declared that it’s “time to sound the alarm”: The emergence of completely antibiotic-resistant gonorrhea is becoming more of a realistic threat and less of a theoretical possibility. The bacteria that cause gonorrhea are evolving faster than we can develop effective antibiotics against them, and a return to the era of untreatable gonorrhea could see a rise in the particularly nasty complications that arise from a long-term gonorrheal infection, such as pelvic inflammatory disease and epididymitis.


There are genes that confer resistance to every single antibiotic we use to cure gonorrhea. If they all combine within one organism, we might have a superbug on our hands.


Neisseria gonorrhoeae is a species of tricky bacteria that cause gonorrhea, which can infect the mouth, throat, rectum, urethra, cervix, and even eyes. These bacteria have vexed us for thousands of years, having evolved many strategies for entrenching themselves in our bodies. They can alter the proteins that adorn their surfaces, rendering our immune systems incapable of recognizing them. They can form colonies in which they work together to manipulate our cell surfaces with their retracting appendages until they’re allowed entry inside, where they can surreptitiously multiply.

You’ve probably heard of MRSA, which is pronounced “mersa” and stands for methicillin-resistant Staphylococcus aureus — a strain of bacteria that has acquired resistance to methicillin, as well as pretty much every other antibiotic to boot. MRSA is an example of evolution by natural selection — what didn’t kill its ancestors made them stronger, spawning a drug-resistant strain.

Why are we talking about MRSA in a post about STIs? It’s not just because MRSA has apparently found a way to be transmitted sexually, but also because it helps make the concept of antibiotic-resistant gonorrhea more accessible. It wasn’t until less than a century ago that we finally developed a magic-bullet treatment for gonorrhea, and for a handful of decades it was quickly and easily treated with a dose of penicillin. Enter evolution by natural selection. Continue reading

STI Awareness: Trichomoniasis

Trichomonas vaginalis, normally pear-shaped, flattens itself out after attaching to vaginal epithelial cells, maximizing surface area between parasite and host. The purple rod-shaped organisms are bacteria. Image courtesy of Antonio Pereira-Neves and Marlene Benchimol, Santa Ursula University, Rio de Janeiro, Brazil

Trichomonas vaginalis, normally pear-shaped, flattens itself out after attaching to vaginal epithelial cells, maximizing surface area between parasite and host. The purple rod-shaped organisms are bacteria. Image courtesy of Antonio Pereira-Neves and Marlene Benchimol, Santa Ursula University, Rio de Janeiro, Brazil

Most sexually transmitted infections are caused by viruses or bacteria. STIs caused by viruses include herpes and genital warts, and the viruses that cause them aren’t even technically living organisms – they are pieces of genetic information that are able to infect a host cell. STIs caused by bacteria include gonorrhea and syphilis; bacteria are microscopic, single-celled organisms with relatively simple cell structures.

But some STIs are caused by other types of living organisms. Protozoan organisms are microscopic and unicellular, like bacteria; unlike bacteria, their cell structures more closely resemble that of the so-called “higher” life forms such as animals and plants. While protozoa are considered to be “animal-like,” they are not animals at all – they are single-celled organisms that reproduce asexually. When certain types of protozoans get into your body, they can cause infections – such as trichomoniasis, the most common curable STI among young females (as well as more females over 40 than previously thought). It is estimated that 7.4 million new cases of trichomoniasis occur annually in the United States; worldwide, there are about 170 million cases each year.

Trichomoniasis, colloquially known as trich, is spread by vaginal or anal intercourse, direct vulva-to-vulva contact, and other activities that involve passing secretions from one partner to another (e.g., sharing sex toys or mutual masturbation). Sexually active people can reduce the risk of contracting trichomoniasis by using latex barriers, such as condoms. Continue reading

STI Awareness: Syphilis

Treponema pallidum, the causative agent of syphilis, is seen in this electron micrograph adhering to a surface with the end of its structure. Image: Public Health Image Library, CDC

When syphilis first descended upon Europe, it was seen as a new plague, and anxiety and blame coalesced around this mysterious scourge. Was it a punishment from God? Was it introduced by a hated Other? Was it caused by the stars’ alignment or the presence of “bad air”? The panic it provoked foreshadowed the hysteria that surrounded the emergence of HIV in the 1980s, as syphilitics were discriminated against, feared, or thought to have received punishment for their “unbridled lust.”

We now know that syphilis is not caused by supernatural forces, foreigners, or “bad air,” but rather by a species of spiral-shaped bacteria called Treponema pallidum, which can cause infections in the vagina, anus, urethra, or penis, as well as the lips and mouth. It is mostly spread by sexual contact – vaginal or anal intercourse, as well as oral sex – in which one person comes into contact with a syphilis sore. These sores can be hidden on the cervix or in the vagina, urethra, rectum, or mouth, making it not immediately apparent that one is infected with syphilis. Syphilis can also spread to a fetus during pregnancy. Sexually active people can reduce their risk of contracting syphilis by using latex barrier methods such as condoms or dental dams. Continue reading

STI Awareness: Bacterial Vaginosis and Chancroid

Sexually transmitted infections can be caused by viruses, bacteria, protozoans, and even animals. Bacterial vaginosis and chancroid are both infections caused by bacteria, which means that they can be treated with antibiotics. While bacterial vaginosis only affects people with vaginas, chancroid disproportionately affects people with penises. You can seek diagnosis and treatment for bacterial vaginosis and chancroid at a Planned Parenthood health center, as well as health clinics, private health-care providers, and health departments.

Bacterial vaginosis is caused by an imbalance of bacteria species in the vagina. Image: renjith krishnan / FreeDigitalPhotos.net

Bacterial vaginosis is caused by an imbalance of bacteria species in the vagina. Image: renjith krishnan / FreeDigitalPhotos.net

Bacterial Vaginosis
Bacterial vaginosis seems to be most commonly caused by the bacteria species Gardnerella vaginalis. Scientists aren’t quite sure how this infection is caused, but risk seems to correlate with a change in sexual partners, having multiple sexual partners, douching, or using an intrauterine device; it can also occur in females who have never been sexually active. It is more common in pregnant women. There is no counterpart to this infection in males, although G. vaginalis can be found in their urethras; this raises the possibility that bacterial vaginosis can be sexually transmitted, in which case it could be directly transmitted between two females or indirectly transmitted from one female to another via a male.

Bacterial vaginosis seems to result from an imbalance in the vaginal flora (“flora” is a somewhat fanciful term for the bacteria that live in your body; under normal circumstances they are harmless and even beneficial). Vaginas usually are habitat to a population of bacteria called Lactobacillus, which produce hydrogen peroxide as a byproduct. When the number of Lactobacillus declines, G. vaginalis is able to move in on Lactobacillus’ old territory. The decrease in Lactobacillus and increase in G. vaginalis leads to a rise in the vagina’s pH. The new vaginal environment is less acidic and more alkaline; a vaginal pH of more than 4.5 is one criterion for the diagnosis of bacterial vaginosis. Another symptom includes a vaginal discharge that may smell somewhat fishy. There might also be genital itching or pain during urination. It is also possible not to have symptoms. Continue reading

Can Cranberry Juice Cure Urinary Tract Infections?

Cranberry products have a reputation for fighting urinary tract infections. But is this reputation deserved? Image: FreeDigitalPhotos

An increased urge to urinate. A burning sensation when you do. These are two of the signs of a urinary tract infection (UTI), an incredibly unpleasant condition that can seem to come out of nowhere. Anyone can get a UTI, but among adults they are about 50 times more common in females than in males. Certain microorganisms cause these infections, often when bacteria from feces are introduced into the urinary tract. Although symptoms often clear up without medical intervention, it is very important to seek treatment for a persistent UTI because the infection could spread and become much more serious. (If you are or have been sexually active, it is also important to make sure you don’t actually have a sexually transmitted infection.)

Cranberry products – either as juice (sweetened, unsweetened, or blended with other fruit juices) or capsules – are considered by many to be an effective home remedy for UTIs. While cranberries are a well-known and accessible treatment, the evidence for their efficacy is not very strong. Why, then, are they such a popular treatment? It could be due simply to the placebo effect, an amazing phenomenon in which our expectations help shape our experiences. It could be that symptoms often clear up on their own, but we attribute our improvement to whatever remedies we happened to be trying at the time. It could be that drinking extra fluids (e.g., cranberry juice) helps flush the bacteria from our bodies as we urinate more. Or, it’s possible that cranberries do help clear up UTIs, but we just don’t have solid evidence yet. Continue reading

STI Awareness: Gonorrhea

Neisseria gonorrhoeae, the bacteria species that causes gonorrhea, is pictured here in a photograph taken with a scanning electron microscope. Projecting from the organism’s surface are many pili, powerful appendages that enable the bacteria to adhere to human cells. Image from the National Institute of Biomedical Imaging and Bioengineering.

Neisseria gonorrhoeae, the bacteria species that causes gonorrhea, is pictured here in a photograph taken with a scanning electron microscope. Projecting from the organism’s surface are many pili, powerful appendages that enable the bacteria to adhere to human cells. Image from the National Institute of Biomedical Imaging and Bioengineering.

April is STD Awareness Month, but this blog has sought to increase your awareness of sexually transmitted infections on a monthly basis. So far in 2011 we’ve pointed the spotlight at human papillomavirus, barrier methods, and herpes. This month’s installment will focus on gonorrhea, colloquially known as “the clap,” a common sexually transmitted infection caused by sneaky bacteria called Neisseria gonorrhoeae. It is spread by vaginal, anal, and oral sex, and can infect certain cells in the throat, mouth, rectum, urethra, or cervix. It can also be transmitted manually to infect the eye. If you are sexually active, you can reduce risk of transmission by consistently and correctly using latex barriers such as condoms and dental dams.

Four out of five females infected with gonorrhea do not experience symptoms – males, however, usually do, but they can be mild and therefore easy to overlook. Symptoms can appear within a month, and might include painful or frequent urination, vaginal or penile discharge, painful bowel movements, itching, or sore throat. Additionally, females can experience abdominal pain, fever, irregular menstruation, or bleeding between periods. In pregnant women, untreated gonorrhea infections can lead to complications such as premature labor or stillbirth. The infection can also be passed from mother to infant during delivery.  Continue reading