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Sexually Transmitted Infections Q&A

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What's the deal with yeast? I keep getting yeast infections. What can I do to make them stop?

First, make sure it's yeast, since sometimes symptoms that may seem like yeast can be caused by another kind of infection. And if that's what's going on, yeast treatments won't help! To find out, make an appointment with your clinician and get a professional diagnosis.

Yeast infections may be due to chronic skin conditions, the use of certain antibiotics, continuing bacterial imbalances in the vagina, excessive intake of milk or sugary products, blood sugar problems related to diabetes, a yeasty sex partner whose chemistry throws off your bacterial balance, or multiple and/or new sex partners. Then, of course, it might be something else!

Your clinician might suggest an anti-fungal treatment. Some, such as boric acid, are available over the counter. Others require a prescription. All can have side effects, such as irritation. That is why clinicians often alternate therapies for ongoing problems. Check with your clinician for the best treatment for you. Whatever you do, don't douche. That may cause even further irritation.

For further reading, take a look at The V Book — A Doctor's Guide to Complete Vulvovaginal Health, by Dr. Elizabeth G. Stewart (Bantam Books, 2002). For clinical advice and guidance, make an appointment with the Planned Parenthood health center nearest you by calling 1-800-230-PLAN.

I noticed that my partner's ejaculate is lumpy. Does that mean he's got a sexually transmitted infection?

No. The texture of semen varies greatly. It is decided by two qualities - viscosity and coagulation. Viscosity is about thickness and stickiness. Coagulation is the clumping or clogging that controls how much liquefying takes place after ejaculation. Some men have hyperviscous semen. It's very thick and sticky. Some men's semen is highly coagulated. It will not liquefy after ejaculation. And some men have both hyperviscous and hypercoagulated semen. It may appear ropy, stringy, or clumpy.

If you have warts on your hands can you spread them to your partner's genitals?

No. There may be very rare exceptions, but the kinds of warts that appear on the hands are caused by different types of viruses than the warts that appear on the vulva, vagina, cervix, penis, scrotum, rectum, or anus.

The there are more than 100 different types of human papilloma virus (HPV). Some of them cause warts. Some do not. Some of the ones that cause warts develop on the skin of the hands. Some develop on the skin of the feet. Some develop in the areas around the sex organs and may also develop in similarly moist areas of the mouth and throat. Others develop on other parts of the body.

There are between 500,000 and one million new cases of genital warts every year. Very often they fade away by themselves. But they may stay the same, grow in size or number, or recur. They can cause sores and itching, which can increase the risk of HIV infection. They can be removed with topical medication, cryotherapy (freezing off), or electrocautery (burning off). Other treatments — surgery, laser, and interferon injections — are also available but are less common.

What sexually transmitted infections cause cancer? Can you get cancer by having sex with more than one man? Are these infections only transmitted by sexual intercourse?

A variety of cancers can be caused by particular sexually transmitted infections — the human immunodeficiency virus (HIV), the hepatitis viruses B and C (HBV and HCV), and certain types of the human papilloma viruses (HPVs). All of these viruses can be transmitted to women and men and from women and men.

Unprotected vaginal or anal intercourse is a high-risk activity for transmitting HIV, HBV, and the HPVs that can cause cancer of the cervix, vulva, or penis. HIV and HPV are much less likely to be transmitted by oral sex or other forms of sex play. Of these three viruses, HBV is more likely to be transmitted through oral sex and kissing. (HCV is only rarely transmitted sexually.)

A vaccine is now available to protect against HBV.  There is also a single HPV vaccine that can protect against two types of HPV that cause genital warts and the two types of HPV that cause 70 percent of cases of cervical cancer.

I have been with my partner for one year and five months. I was recently diagnosed with genital warts. I need to know how long exactly it takes for genital warts to show up, and whether or not to believe if he has been faithful or not.

The best way to find out whether or not a partner is faithful is to ask. While it is true that studies have shown that about 33 percent of sex partners are likely to lie about having other partners, ongoing communication between partners about their expectations for faithfulness is very important. Finding out that you are infected with a sexually transmitted infection may seem like a clear indication that your partner has had sex with someone else. But this is often not the case.

Genital warts are caused by certain highly contagious, and very common, types of HPV — human papilloma virus. Warts usually develop six weeks to six months after infection. But it may take longer. And very often, people with the types of HPV that cause genital warts have no symptoms. Sometimes, too, the warts are so small that people who are infected can't see them. Also, tiny warts can be hidden, unseen, in the folds of the anus, scrotum, vagina, or vulva.

Genital warts are not only common, they also recur. This means that they may appear for a year, then disappear, then reappear two to six months later. Like other types of HPV, those that cause genital warts can be passed from one person to another at any time during an infection — whether or not there are ever symptoms.

There are many possible scenarios for infection. Partner A may pass the virus to partner B without knowing it. It is then possible for partner B to pass the virus back to partner A, without knowing it. If partner A then develops symptoms, it may seem that partner B was the one who had it first.

It's also possible for partner B to have been infected without knowing it before having contact with partner A. If partner B's infection becomes stronger months later, the infection can be passed to A who may not develop symptoms for months more. So it may seem that partner B became infected during the relationship with partner A, when that is not the case.

And then of course, partner B may have sex with partner C, who is infected and then pass the infection on to partner A.

With the recent news regarding the effectiveness of circumcision in the prevention of the transmission of HIV does Planned Parenthood advocate for young men to get circumcised if they have not been already to promote safer sex?

Recent studies have shown that the circumcision of adult men who live in parts of the developing world where condoms are not easily available can reduce HIV transmission rates by about 50 percent.  Used correctly, however, a condom reduces the risk of HIV transmission by nearly 100 percent.  So condom use is, by far, a superior safer sex strategy.  That is why health authorities, including medical experts associated with Planned Parenthood, are not recommending circumcision as an HIV-prevention strategy for infant boys, adolescents, or adult men who live in more developed countries.  Not only is access to condoms easy and the use of condoms prevalent in more developed countries, but HIV rates are much lower here than they are in the African nations where the studies were done.

Can a virgin get a sexually transmitted infection?

Yes. Virginity has different meanings for different people. Most people around the world believe that a heterosexual virgin is someone, of either gender, who has never had vaginal intercourse. In lesbian and gay communities, of course, virginity is defined in other ways.

Most women and men believe they are preserving their virginity if they have sex play that does not involve vaginal intercourse. But they can still get certain sexually transmitted infections. For example, unprotected anal intercourse is a very high risk activity for all sexually transmitted infections, including HIV. Some of the infections that can be passed through oral sex are gonorrhea, syphilis, herpes, and hepatitis. Even kissing can transmit certain infections, such as herpes and syphilis.

So no matter what kind of sex play people have, they must think about safer sex — the steps they can take to reduce the risk of infection.

Can shaving infected hair get rid of critters like scabies and pubic lice?

No. Shaving, dousing with kerosene, hot baths, and other so-called remedies just won't work. Scabies are mites that belong to the same family as spiders. Pubic lice are tiny insects that look a lot like crabs. Both are transmitted through sexual and intimate contact. They can also be picked up from infested bedding and clothing. Scabies get under the skin. Pubic lice attach their eggs to pubic hair.

Symptoms usually include intense itching. Scabies also appears as small bumps or rashes that look like dirty, small curling lines, especially on the penis, between the fingers, on buttocks, breasts, wrists, thighs, and around the navel.

To get rid of scabies, follow the directions on the package insert of a prescription medication such as Nix, Elimite, or Scabene.  Your clinician may also be able to suggest treatments that are less toxic if the infestation is not severe.  Repeated neck-to-toe applications may be necessary. Everyone who may have been exposed to scabies should be treated at the same time. All bedding, towels, and clothing that may have been exposed should be thoroughly washed or dry cleaned, and the home should be thoroughly vacuumed.

To get rid of pubic lice, follow the directions on the package insert of an over-the-counter medication such as A-200, RID, and InnoGel Plus. (Pregnant and breastfeeding women and infants must use products especially designed for them.) As with scabies, repeated neck-to-toe applications may be necessary. (Many clinicians do recommend trimming back the pubic hair before shampooing to cut down on the number of nits. This can help treatment work faster because fewer nits need to be treated after some have been shaved off.) And everyone who may have been exposed to public lice should be treated at the same time. All bedding, towels, and clothing that may have been exposed should be thoroughly washed or dry cleaned, and the home should be thoroughly vacuumed.

Scabies and pubic lice are highly contagious. Condoms usually don't cover all the areas that are infested so scabies can be transmitted even if condoms are used. The only protection for sexually active people is to limit the number of sex partners. Limiting the number of sex partners can help reduce the possibility of exposure to these infestations.

I was just diagnosed today with HPV. I'm wondering about the HPV vaccine. If someone has HPV already, will the vaccine prevent future outbreaks?

It depends on the type(s) of HPV (human papilloma virus) a person has.

In 2006, the U.S. Food and Drug Administration (FDA) approved a vaccine, Gardasil, that protects against four of the 40 types of HPV that are sexually transmitted. Two of the types, 6 and 11, are the ones that cause 90 percent of the outbreaks of genital warts. The two others, 16 and 18, cause 70 percent of cases of cancer of the cervix. They are also associated with cancers of the vulva, penis, anus, or throat.

Right now, there is no clear evidence that the vaccine will protect an already infected person. Because, however, a person may be infected with one of the HPV types covered by the vaccine but not with another, the vaccine will protect against the HPV type(s) that a person does not already have.

The new vaccine does not offer protection against all the types of HPV that cause cervical cancer. So authorities urge sexually active women who become vaccinated to continue to have regular Pap tests. These tests can detect cervical cancer in its early, treatable stages.

I heard that there is a sexually transmitted infection that can be transmitted by a man to a woman, but not by a woman to a man. Is that true? Can you explain what the name of that is and what causes it?

It's not true, but it can certainly seem that way. You may have heard people talking about trichomoniasis. Men rarely have symptoms, and they usually don't know they are infected. But they can be infected during vaginal intercourse. And they can pass their infections to other partners. They can also re-infect women partners who have been treated.

Trichomoniasis is a common cause of vaginitis. Symptoms, if they occur, include

  • frothy, often unpleasant-smelling discharge
  • itching in and around the vagina
  • blood spotting in the discharge
  • swelling in the groin
  • urinating more often than usual — often with pain and burning

Sometimes women have no symptoms, either. Symptoms, when they happen, often take three to 28 days to develop after exposure. But it can take years before they do develop.

Trichomoniasis is caused by a microscopic one-cell animal — a protozoan that is called a trichomonas. It causes vaginitis for more than seven million women in the United States every year.

Also known as "trich," trichomoniasis is spread through sharing sex toys, mutual masturbation, and vaginal intercourse — if fluids from one partner are passed to the genitals of another. If a woman is diagnosed with trich, her partner(s) should be treated, as well, so that she does not become re-infected. Treatment is successful with oral medication. Using condoms can help reduce the risk of infection and re-infection.

I had molloscum contagiosum about six years ago, and had the growths removed. I never thought twice about it again, and I thought I was cured. Now, I'm worried. Can it recur? Is it an STI you have forever, even if the growths are gone for years?

In general, recurrences of the symptoms of the molluscum contagiosum virus (MCV) become less likely as time goes on. They happen for 15-35 percent of people who develop symptoms. Recurrences usually occur within four years of the initial episode. Although the virus may survive in the body for a longer time, recurrences after four years are unlikely, unless a person's immune system has been impaired. Symptoms and the life course of the infection are greatly extended, for example, among women and men who have HIV or AIDS.

MCV is transmitted by sexual and non-sexual intimate contact. MCV is, in fact, more common among children than it is among adults. Symptoms of sexually transmitted MCV are much less common than symptoms of either herpes or genital warts. They include very small, waxy, round growths in the genital area or on the thighs. There is often a tiny depression in the middle of the growth. Symptoms usually appear between two and 12 weeks after exposure and infection — but it can take longer. Treatment is often not required because the growths may go away by themselves. Treatments for removing growths include the application of chemicals, electrical current, or freezing.

Using condoms can reduce the risk of transmitting MCV, but the virus may "shed" beyond the area protected by the condom.

(Stats on life course, prevalence of infection, and recurrence of symptoms from Holmes, King, et al., (1999). Sexually Transmitted Diseases. New York: McGraw-Hill, 385-389.)

My boyfriend is getting pre-ejaculate fluid when he's at work and doesn't understand what is happening. It is happening without erection. He says the fluid is sometimes yellow. Sometimes it's clear. Is it normal? If not, what's he supposed to do?

It is unusual for an adult, sexually active man to secrete pre-ejaculate without sexual stimulation. But there are different kinds of discharges from the penis that might happen during the day without sexual stimulation. The possibilities include

  • leaking of urine from the bladder because the bladder muscles are weak
  • leaking of urine that is caused by a urinary tract infection
  • discolored discharges that are caused by sexually transmitted infections, such as gonorrhea or chlamydia

Men who have any of these symptoms should visit a health care provider to find out what is causing the secretion. They can visit their own provider, make an appointment with a urologist — a physician who specializes in the health of the urinary tract and male sex organs, or contact the nearest Planned Parenthood health center by calling 1-800-230-PLAN.

People who are diagnosed with sexually transmitted infections should be sure to contact all the partners they may have exposed to infection. The partners of people who have gonorrhea or chlamydia must be treated at the same time in order to protect them and to avoid reinfection. Untreated gonorrhea and chlamydia can have serious health consequences. They can lead to infertility and chronic arthritis in both women and men.

I am a woman and want to know if I can contract HPV by performing oral sex on a woman who has it? A lot of the information available seems to pertain to mostly heterosexual activity.

Yes, it is possible. HPV, the human papilloma virus, can be passed from partner to partner through any intimate skin-to-skin activity. Women who have sex with women, and men who have sex with men, and people who have sex with the other sex are all at risk for becoming infected with HPV and many other sexually transmitted infections. Right now, about 75 percent of sexually active women are infected with HPV. That's why it's so important that we all practice safer sex, whether we are lesbian, gay, bisexual, transgender, straight, or people who don't want to use any of these labels to describe themselves.

Most often, HPV infections resolve on their own. But in some cases they persist. And certain kinds of HPV can lead to cervical cancer. That's why it is very important for women who have sex with women, whether or not they identify as lesbians, to have periodic gynecological visits and Pap tests to detect abnormal growths in the cervix that could lead to cancer. Early detection and treatment save thousands of women's lives every year in the United States.

I'm the manager of a busy town bar and recently one of my staff told me he had been diagnosed with chlamydia. Is it OK for him to continue working with food and drink? Can the chlamydia be passed on to other staff or customers?

You don't need to worry. It's perfectly fine for your staff person to keep doing his job. Chlamydia is a sexually transmitted infection that can be passed from one person to another by sexual contact or from mother to baby during childbirth. It is usually transmitted by vaginal or anal intercourse, and, less commonly, oral sex. Chlamydia is not passed through casual contact. Shaking hands, hugging, kissing, and sharing bathroom facilities or utensils for food and drink will not pass chlamydia or most other sexually transmitted infections.

Chlamydia is a very common sexually transmitted infection. Even though it often has no symptoms, it can cause sterility and disabling arthritis in women and men if left untreated. Antibiotic treatment for chlamydia can be given in one-dose or multiple-dose regimens. People who learn they have chlamydia should be treated as soon as possible. They should also be sure that their sex partners are treated, too, before they have sex again. This will ensure that they don't pass the infection back and forth after one of them is treated. Some health care providers will give clients who have chlamydia medication to take home for their partners.

Is it true that younger men are more at risk of testicular cancer than older men?

Yes, it is true. Young men are most at risk for cancer of the testes — most cases occur in men aged 15–39. Even though testicular cancer rarely occurs (5.4 of every 100,000 U.S. white men and 0.7 of every 100,000 U.S. black men), it is the most common cancer seen among men aged 20–34. Only nine percent of men with testicular cancer are older than 50.

Testicular cancer happens if abnormal cells in one or both of the testicles grow uncontrollably. Certain factors increase the risk of developing testicular cancer:

  • cryptorchidism — having a testicle that did not descend into the scrotum
  • a family history of testicular cancer
  • HIV
  • Klinefelter's syndrome — a genetic condition that causes under-developed testicles and other problems
  • having previously had testicular cancer

Early detection is very important. Treatment is very effective and there is a high cure rate. If untreated or detected late, it can spread to other parts of the body — and it may cause death. That's why men should become familiar with the way their testicles normally look and feel. That way they will be more likely to notice any changes.

Some men use testicular self-exams (TSEs) to check their testicles. If you would like to learn how to do a TSE, your health care provider can teach you. Lumps and other changes are also noticed during activities such as showering or sex play. Most lumps are not cancerous — they may be caused by injury, infection, or other conditions. But report anything unusual to your health care provider as soon as possible.

I'm a woman in college and I'm wondering if I still need to be worried about getting HIV. Isn't it pretty much under control by now?

HIV/AIDS is definitely still a threat — especially among young people and women. According to the United Nations Population Fund a person between the ages of 15 and 24 is infected with HIV every 14 seconds. And 62 percent of people aged 15-24 living with HIV are girls and women.

So, how can you protect yourself against HIV? Aside from abstinence, which is 100 percent effective, using latex or female condoms, or other safer sex strategies such as mutual masturbation, greatly reduce the risk of transmission.

Is it true that some sexually transmitted infections can cause arthritis?

Yes. Chlamydia and gonorrhea can both cause sterility as well as arthritis. It is more likely to occur in men and can be permanently disabling. About 5,000 men a year develop reactive arthritis caused by chlamydia.

Untreated gonorrhea can lead to a condition called disseminated gonococcal infection (DGI). The arthritis caused by DGI can permanently damage the joints of the back, hips, neck, hands, arms, feet, and legs. DGI develops in up to three percent of untreated women and men. Women, especially adolescent women, are three times more likely than men to develop DGI.

About three weeks ago I had a cold sore on my lip and had sex with my boyfriend. He gave me oral sex during that time. Today, my vulva is extremely itchy, red, and irritated. Could my fiancé have picked up my cold sore on his lips and infected me with it sexually?

You will need to be examined by a qualified health care provider to see if you have a sexually transmitted infection or some other condition that is irritating you. But it is possible for infections to follow the route you describe. For example, although herpes virus-1 (HSV-1) is most commonly associated with cold sores around the mouth, it can infect the sex organs. And, while herpes virus 2 (HSV-2) is most commonly associated with infections of the sex organs, it can infect the mouth and throat.

During oral sex — anilingus (on an anus), cunnilingus (on a vulva), or fellatio (on a penis) — the HSV-1 or HSV-2 in a cold sore can be passed directly to the sex organs or anus. It is also possible for the fluid from the "weeping" sore to be passed from mouth to mouth and then to the sex organs where it can start an infection. That's why it's best for people with open herpes sores, oral or genital, to refrain from intimate contact with other people.

If you are diagnosed with herpes, it may be a good idea for your partner to be tested, too. There are medications available today that reduce the number and severity of outbreaks and also reduce the risk of one partner infecting the other. Talk with your health care provider about what options may be best for you.

This column is for informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. If you have a medical problem, please call toll-free 1-800-230-PLAN for an appointment with the Planned Parenthood health center nearest you.

This column is for informational purposes only and is not intended to constitute medical advice, diagnosis, or treatment. If you have a medical problem, please call toll-free 1-800-230-PLAN for an appointment with the Planned Parenthood health center nearest you.
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Sexually Transmitted Infections Q&A