1. The How’s and Why’s of STI’s
Melanie J. Davis, EdD, CSE

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About the Author
Melanie Davis, EdD, CSE is a sexuality education consultant and trainer. She teaches lifespan sexuality education programs, presents on college campuses, and works with healthcare providers and their patients.
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-- Free resources & blogs
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How STIs Reach the Body
Bacteria
Can be cured by antibiotics
Bacterial Vaginosis
Chlamydia
Chancroid
Gonorrhea
Syphilis
Fungus
Curable with antifungals
Candida
This is not a complete list of STIs.
Virus
No cure, but symptoms can be treated
Genital Herpes
Hepatitis B
HIV – AIDs
Human Papilloma Virus (HPV)
Parasites
Curable with antimicrobials
Scabies
Lice
Trichomoniasis
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4. The Interrelationship Between HIV and Other STIs
Increased infectiousness
People with HIV or other STIs are more likely to
transmit their infection through sexual contact
Increased susceptibility
People with STI are 2-3x more susceptible
to HIV through sexual contact due to genital ulcers
and increased concentrations of CD4+ cells in
genital secretions
The good news
STI testing and treatment can help prevent the
spread of HIV
Treatment for other STIs reduces HIV shed and
frequency of shed
STI treatment reduces spread of HIV in communities.
Education helps people reduce risky behaviors
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Behaviors
Behaviors and life circumstances can increase or reduce the risk of transmission. Behaviors are affected by cultural, social, and religious values, personal experience, and education.
Increased risk: Reduced risk:
Multiple partners Limited or no partners
Unprotected sex Correct use of barriers
High-risk partners Outercourse & other low-risk activity
Lack of knowledge Increased age upon initiation of sex
Poverty Knowledge about safer sex
Sexual coercion Consensual activities
Having STIs Regular STI tests
Being STI free
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Barriers
Barriers can be used during sexual activity to reduce the transmission of STIs. They restrict access to blood, semen, and vaginal fluids.
Protection is limited to the area of the body that is covered by the barrier.
Male condoms
Female condoms
Dental dams
Gloves
Clothing
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Chlamydia
Organism: Bacteria
Signs: May be no symptoms. Abnormal discharge from penis or vagina, burning or pain during
urination, anal irritation, Itching at urethral opening (male), bleeding between periods (female), painful intercourse and lower abdominal or back pain (female)
Transmission: Unprotected oral, anal, or vaginal sex; from mother to infant during birth
Cure? Yes, with antibiotics. Partners must be notified and treated.
If ignored:  risk of HIV infection, PID, Infertility, ectopic pregnancy, chronic pelvic pain
Risk reduction:
Avoid sexual contact while until treated and re-checked
Be tested for this and other STIs at least annually.
Take all medications as prescribed
The CDC estimates there are about 2.8 million new cases of chlamydia in the United States each year.
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Genital Herpes
Organism: Virus
Signs: Symptoms are rare or mild. Blisters on or near genitals or anus; painful or difficult urination,
genital or anal itching or irritation, swelling or soreness or cuts or sores in groin area, “fever
blisters” of the mouth or lips, flu-like symptoms.
Transmission: Unprotected oral, anal, or vaginal sex. Mother-to-child transmission during vaginal delivery.
Can be transmitted even when symptoms are absent.
Cure? No, but anti-viral medication can prevent and shorten outbreaks. Some medications may lower risk of transmission to another person. Arginine increases risk of herpes breakout; lysine minimizes outbreak. Eating a lot of nuts, sweet potatoes, chocolate, and coconut may lead to an outbreak. Diet can influence your herpes diagnosis by keeping lesions hidden.
If ignored:  HIV infection, recurrent painful genital sores, fatal infections in newborns if untreated during
pregnancy.
Risk reduction:
Abstain from oral, anal and vaginal sex
Consistent, correct use of Latex or polyurethane barriers during sex
Mutually monogamous relationships with an uninfected partner
Regular pelvic exams (women) and STI tests
If having sex with an infected partner, discuss outbreaks and treatment
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Gonorrhea
Organism: Bacteria
Signs: Symptoms may not be present. Abnormal discharge from penis or vagina; burning or pain during
urination, frequent urination, irritation around anus, bleeding, or painful elimination; males: itching
around urethral meatus, soreness or swelling around top of penis, painful or swollen testicles;
women: bleeding between periods, painful intercourse.
Transmission: Unprotected oral, anal, or vaginal sex. Mother-to-child transmission during vaginal delivery.
Cure? Yes, with prescription antibiotics and medications.
If ignored:  HIV infection; infertility; women: PID, chronic pelvic pain, ectopic pregnancy. Can cause
premature delivery, blindness or life-threatening infection in newborns.
Risk reduction:
Abstain from oral, anal and vaginal sex
Consistent, correct use of Latex or polyurethane barriers during sex
Mutually monogamous relationships with an uninfected partner
Early treatment for you and partner (notify other partners)
Regular PAP tests and pelvic exams (women)
Regular health exams and STI tests (men and women)
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Hepatitis B
Organism: Virus attacks the liver.
Signs: About 30% of persons have no signs or symptoms. Symptoms may include jaundice, fatigue,  abdominal pain, loss of appetite, nausea, vomiting, and joint pain.
Transmission: Occurs when blood from an infected person enters the body of an uninfected person.
Unprotected sex with an infected person
Sharing drugs, needles, or "works" when injecting drugs
Needle sticks or sharps exposures on the job
From mother to child during birth
Cure? No, but some cases clear up on their own. Chronic Hepatitis B can be treated with Adefovir dipivoxil,
interferon alfa-2b, pegylated interferon alfa-2a, lamivudine, entecavir, and telbivudine.
If ignored: Can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.
Risk reduction:
Hepatitis B vaccine
Abstain from unprotected oral, anal and vaginal sex
Avoid shared needles and exposure to potentially infected blood
Avoid shared razors, toothbrushes, etc. that may have been contaminated by blood.
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11. HIV – Human Immunodeficiency Virus
Organism: Virus targets CD4+ cells
Signs: In first few weeks after HIV infection, acute retroviral syndrome causes fever,
malaise, lymphadenopathy, skin rash. Can occur without symptoms.
Transmission: Exchange of blood, semen and vaginal secretions during unprotected sex; mother-to-child
transmission during pregnancy and breast feeding; exposure to infected blood during needle
sharing or accidental exposure.
Cure? No, but early treatment can delay (often for years) the development of opportunistic infections
and AIDS.
If ignored:  opportunistic infections,  susceptibility to other STIs, and eventual death related to
complications of AIDS
Risk reduction:
Abstain from unprotected oral, anal and vaginal sex
Consistent, correct use of Latex or polyurethane barriers during sex
Regular tests for STIs and HIV, regular health exams
Avoid shared needles and exposure to potentially infected blood and fluids
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12. HPV – Human Papillomavirus
Organism: Virus
Signs: Symptoms are rare for most strains; others cause genital warts that appear as
small bumps, swellings or cauliflower-like growths on or near genitals, anus or upper thigh.
Transmission: Unprotected oral, anal, or vaginal sex. Mother-to-child transmission during vaginal delivery. Can be transmitted even when symptoms are absent.
Cure? No, but warts can be removed, and medications and minor surgery can be used in cases of pre-cancerous cell changes. Some strains of HPV resolve on their own. The HPV vaccine protects against four HPV types that cause most cervical cancers and genital warts. The vaccine is recommended for females ages 9-26 years.
If ignored: Abnormal PAP tests;  risk for cervical or penile cancer;  HIV infection
Risk reduction:
Abstain from oral, anal and vaginal sex
Consistent, correct use of Latex or polyurethane barriers during sex
Regular PAP tests and pelvic exams (women)
Regular health exams and STI tests (men and women)
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Syphilis
Organism: Bacteria
Signs: May be no symptoms or easily misdiagnosed symptoms. Painless chancre (sore) on genitals,
rectum or mouth lasting up to several weeks; skin rash (usually rough reddish spots on palms
and soles of feet and trunk, flu-like symptoms
Transmission: Unprotected oral, anal, or vaginal sex; mother-to-child during birth
Cure? Yes, with antibiotics. Partners must be notified and treated.
If ignored:  risk of HIV infection; damage to major organs, blood vessels, bones, eyes,
joints; paralysis, blindness, dementia; death
Risk reduction:
Abstain from oral, anal and vaginal sex
Mutually monogamous relationships with an uninfected partner
Consistent, correct use of Latex or polyurethane barriers during sex
Avoid sexual contact with an infected partner until treatment is complete
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Trichomoniasis
Organism: Parasite
Signs: Most men have no symptoms. Women may have yellow-green discharge with strong odor; discomfort during urination; uncomfortable intercourse; irritation or itching around genitals; lower abdominal pain (rare)
Transmission: Unprotected oral, anal, or vaginal sex
Cure? Yes, with antibiotics. Partners must be notified and treated.
If ignored:  risk of HIV infection;  risk of passing HIV to a partner if you have HIV+
Risk reduction:
Abstain from unprotected oral, anal and vaginal sex
Consistent, correct use of Latex or polyurethane barriers during sex
Avoid sexual contact with an infected partner until treatment is complete
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15. Risk Factors for STIs – According to the CDC
High risk for HIV transmission:
Vaginal or anal intercourse without condoms
Intravenous drug use with shared needles (and being a partner of an IV drug user)
Men who have sex with men
High risk for other STIs:
Vaginal, anal or oral intercourse without condoms
Young age upon initiation of sex
Multiple sex partners
Sex partners with multiple partners
Alcohol and drug use that impairs judgment
Having sex for money
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16. 5 Categories of STI Risk Factors -- CDC
Behavior: unprotected sex, multiple partners, substance use.
Demographics: age, sex, ethnicity, marital/relationship status, education, income.
Psychosocial factors: low self esteem, low self efficacy, perceptions of personal risk, future orientation, hopelessness.
Context: sex with partners of unknown status, safer sex negotiation, domestic violence.
Sociocultural factors: social norms, religious beliefs, gender role norms, marginalization, unemployment, poverty, sexism, racism, homophobia, availability of public health care, and political, economic, and health policy;
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Safer sex isn’t just about condoms. It’s about partners feeling safe with each other emotionally, too.
Can you be trusted not to pressure anyone into unsafe or uncomfortable behaviors ?
Can you trust your partner(s) not to pressure you?
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