A sexually transmitted infection occurs when a bacteria, virus or other organism is transmitted from one person to another during vaginal, anal or oral sex. When that infecting organism -- also called a pathogen -- causes symptoms, it's known as a sexually transmitted disease. Depending on the pathogen, symptoms can appear within several days or even several weeks from the time of contact. Some infections cause symptoms that, if left untreated, can persist for months. You can also have genital sores and not have STI symptoms.
Prevention, diagnosis and prompt treatment is essential for overall good sexual health.
STIs, for the most part, are preventable, yet they remain a significant public health problem in the United States, as well as in other parts of the world. Rates of STIs have significantly increased over the past few years and are a tremendous financial burden to the U.S. health care system, costing as much as $16 billion annually.
Despite the seemingly harmless effects of these infections, they can cause serious complications such as infertility in women, fetal and newborn infections, and cervical cancer. Certain infectious organisms -- namely, herpes simplex type 2 (HSV II), gonorrhea and syphilis -- can facilitate the transmission of human immunodeficiency virus.
If you are sexually active and don't use barriers such as condoms for protection against getting or transmitting infections, get tested early and often.
Why Does Having an STI Put Me at Risk for HIV?
The same decisions that lead to unsafe sex practices which increase your risk for STIs also put you at risk for HIV. These include having multiple sex partners or having sex with people you don't know and whose sexual history you don't know. Social media, hook-up apps and increased global travel allow people to meet anonymously for sex. And having sex while under the influence of alcohol or drugs can lower your inhibitions, leading to risky sex practices. In addition, STIs cause genital sores on the penis, anus or vagina, and can damage the skin and mucosa (lining) of the vagina or anus, which allows for easier transmission of HIV.
What's Next in Emerging Infections Can Lead to Serious Diseases
Emerging infectious diseases is defined as infectious diseases that have newly appeared in a population or that have existed but are rapidly increasing in incidence. Mycoplasma genitalium (MG) is a serious emerging sexually transmitted organism; it's one of the smallest bacterium but causes one of the most troublesome STIs in both men and women. Newer medical diagnostic techniques have made it easier to detect and identify MG as an important cause of non-gonococcal urethritis (NGU) in men and mucopurulent cervicitis (i.e., thick, yellow to green discharge), pelvic inflammatory disease (PID) and abnormal vaginal discharge in females. MG infects an estimated 1% to 2% of people and is especially common in adolescents and young adults.
MG infection is often asymptomatic; it can also behave like other infections such as gonorrhea. Persistent asymptomatic infection can cause ongoing inflammation of the urethra in men and the cervix in women. Because it can cause PID in the female reproductive system, it has been associated with infertility, miscarriage, premature birth and stillbirths.
Infection with this organism scares me and causes great angst among many clinicians. MG's growing resistance to the antibiotics azithromycin and doxycycline are leaving doctors with limited options when treatment with these medications fail. As it becomes more resistant, it will become more prevalent, and more people will unknowingly transmit the infection.
Let me repeat: If you're sexually active, get tested early and often!
And Then There's Gonorrhea, the Gift that Keeps on Giving
In 2018, according to the Centers for Disease Control and Prevention, 1 in 5 individuals had an STI. Gonorrhea (GC) is fifth on the CDC's list of STI prevalence, but the number of cases has sharply increased by 63% in the past four years. GC is my No. 1 nemesis! If I could wipe if off the face of the earth, I would.
Gonorrhea is rapidly becoming more and more resistant to all of the antibiotics used to treat it. GC is both more difficult to treat and more easily transmitted during sexual contact than other common STIs. In January 2021, the CDC changed its guidelines for treating GC due to increased treatment failure and increasing antibiotic-resistance. The use of azithromycin has been discontinued and ceftriaxone is now used at a double dose. If left untreated, GC can cause serious complications in women, including PID and infections in newborns.
Do I need to say it again? If you are sexually active, get tested early and often.
How to Avoid STIs? Let Me Count the Ways
1. Talk about sex in simple, easily understandable language with your children, your sexual partners -- and anyone who will listen. Clear, open communication is crucial in preventing the spread of STIs.
2. Make sure you practice safe sex. Safe sex is only safe when you practice it every time you do it. Using a condom, male or female, is extremely effective in preventing the transmission and acquisition of STIs, including HIV.
3. Get tested for STIs early and often. Even if you don't have symptoms, get tested. Asymptomatic infections are common, and you can unknowingly transmit untreated infections to others.
4. Don't drink or use drugs when you're in an unsafe environment or unfamiliar with the people with whom you're sharing that space. It's difficult to make good choices and practice safe sex if you're impaired by drugs or alcohol. And a person under the influence of drugs and/or alcohol is more likely to have sex with someone they may not choose if they were sober.
Michelle Denise Collins-Ogle, MD, FAAP, AAHIVS, is a Clinical Infectious Disease Specialist and certified HIV Specialist in the Bronx at Children's Hospital at Montefiore. Dr. Ogle has committed the majority of her career to providing comprehensive medical care to infants, children, adolescents and adults living with HIV / AIDS. She has a special interest and training in providing comprehensive gender affirming care for transgender pediatric and adolescents including those with HIV. She also provides prevention, diagnosis and treatment of sexually transmitted infections and HIV in high risk adolescents. Dr. Ogle is currently the Adolescent Provider for sexual health services at the Oval Center in the Bronx, where she also provides comprehensive medical care for adolescents and young adults living with HIV/AIDS.
Dr. Collins Ogle recently served as the pediatric liaison for the Pediatric Infectious Disease Society and the HIV Medicine Association, Co-Chairman of the Steering Committee for the Ryan White Medical Provider's Coalition which advocates and Lobbies legislators on the state and federal level to protect funding for HIV/AIDS medical care programs. She also proudly served as a member of the Presidential Advisory Council on HIV/AIDS during the Obama Administration.