Diseases and infections are passed on in different ways. Many, such as colds, influenza or tuberculosis, are passed to other people through the air when infected people sneeze or cough. Some, such as malaria, are passed on to others by mosquitoes. Sexually transmitted infections (STIs) can only be passed on through sexual relationships. Because of this, people find them very embarrassing to deal with. Often they do not want to seek healthcare and so they suffer in silence.
STIs can be uncomfortable and unpleasant, and if left untreated can cause major health problems, including lasting pain, infertility, problems in pregnancy, miscarriage, cancer and death. STIs can also have damaging effects on babies and young children through mother-to-child transmission. Many people are unaware of STIs, or believe they are not at risk. But STIs are a very common type of infection. Even people who have only had one sexual partner can be infected. Often there are no outward signs, so they can be caught from people who look healthy, and it is possible to have an STI and not know it. People are at risk when they have unprotected sex if:
- they or their partner have ever had another sexual partner
- they don’t know their partner’s sexual history
- their partner could have contracted HIV through other means, such as blood transfusion. Some common STIs are described below.
Genital warts are a common STI. They sometimes cause no symptoms, or are so small they can’t be seen. They affect the sexual organs or mouth. Some signs and symptoms are:
- tiny, grey, pink or red swellings in the genital area that grow quickly
- several warts close together
- itching or burning in the genital area
- discomfort, pain or bleeding with sexual intercourse.
Gonorrhoea and chlamydia
Gonorrhoea and chlamydia are easy to cure if treated early but, if not, they can cause infertility in both women and men. For a man, symptoms usually begin two to five days after sex with an infected person, and include:
- discharge from the penis
- pain or burning when passing urine
- pain or swelling of the testicles.
Signs in a woman may not begin for weeks or even months, but include:
- yellow or green discharge from the vagina or anus
- pain or burning when passing urine
- pain in the lower belly
- pain or bleeding during sexual intercourse.
Both men and women may have no signs but can still pass on infection.
HIV is the virus that causes AIDS. There is no cure for HIV. However, it can be controlled by antiretroviral drugs, where these are available. HIV is spread when blood, fluid from the vagina or semen from someone already infected with HIV gets into the body of another person, or through mother-to-child transmission. It is not spread by touching, hugging or kissing someone living with HIV. People living with HIV may look healthy and may have no symptoms. Using a latex condom during sexual intercourse can prevent transmission of the virus.
There is a strong link between HIV and other STIs. HIV is more easily transmitted to or from people who have STIs, particularly if there are open sores on the genitals. STIs can be more severe and difficult or impossible to treat in those who are HIV positive and have a lowered immunity.
Human papillomavirus (HPV) is one of the most common STIs. There are often no symptoms but it can cause cervical cancer and other types of genital cancers in men as well as women. If people have symptoms of other STIs they should be tested for HPV.
Syphilis is an STI that, if left untreated, can cause very serious health problems. A pregnant woman can pass syphilis to her unborn baby, which can cause it to be born too early, deformed, or dead. Syphilis develops in four stages:
- Stage one: A painless sore develops, usually in the genital area. It looks like a pimple, blister, or open sore. The sore will heal without treatment, leaving a thin scar, but this does not mean the infection is cured.
- Stage two: A skin rash develops over the body (especially on the palms of the hands and soles of the feet) four to ten weeks after the initial infection. Other symptoms include a sore throat, mouth sores, swollen joints, weight loss and patchy hair loss.
- Hidden stage: After about a year, the symptoms disappear, though the person may still be contagious.
- Late stage: If syphilis is not detected and treated in the early stages, serious problems can develop, including heart disease, mental illness, blindness, paralysis, and even death.
Compiled by Maggie Sandilands from Where women have no doctor: a health guide for women by A August Burns, Ronnie Lovich, Jane Maxwell and Katharine Shapiro, edited by Sandy Niemann (The Hesperian Foundation).
Prevention and treatment
There are ways to prevent STIs, but these will often depend on how much choice and control people have over sexual decisions. Women in particular may have little influence in decision making. To help prevent STIs, people who are sexually active should:
- Remain with only one partner.
- Use condoms.
- Avoid ‘dry sex’ (using herbs or powders to dry out the vagina). If the vagina is dry or irritated it will tear more easily during sex, making infection more likely.
- Wash the outside of their genitals before and after sex.
- Pass urine after having sex.
Many STIs can be cured by antibiotics if people have access to medical care. Those caused by a virus (such as HIV or HPV) cannot be cured, but they can be treated to relieve symptoms. People who think they may have an STI should:
- seek medical treatment as early as possible
- encourage their sexual partner to get tested and treated as well
- avoid sex or practise safer sex by using a condom until treatment is complete.
Women at risk
Women are more vulnerable to STIs, including HIV, than men, for physical as well as social reasons. Semen stays inside the vagina for a long time after sex, so a virus can easily pass into a woman’s body. Sexual violence, rape, ‘dry sex’, or female genital mutilation all increase the likelihood of tears in the vagina during sex, which increase the risk of infection.
Women often have little control or choice over when and with whom to have sex, or to negotiate using a condom. Poverty can add to this lack of choice, as women may depend economically on a man, or be forced to sell themselves for sex for survival. Lack of education means that women may have no access to information about STIs or how to protect themselves.