STIs, or STDs (sexually transmitted diseases), affect women differently than men. Because the vagina is moist and has a thin lining, it's easier for a woman to get an STI than it is for a man to get one. Also, a woman is less likely to have symptoms of common STIs — such as chlamydia and gonorrhea — compared with a man. That means that a woman could have an STI and not know it.

Untreated STIs can lead to pelvic inflammatory disease, which can result in ectopic pregnancy and infertility, making it difficult, even impossible for a woman to have a baby. A woman who is pregnant can pass an STI to her baby. Genital herpes, syphilis, and HIV can be passed to babies during pregnancy and delivery.

A woman who has an STI is also more likely to get HIV, the virus that causes AIDS. STIs that cause sores — such as genital herpes, syphilis, and chancroid — can make it easier for HIV to enter the body.

That said, there are steps a woman can take to avoid STIs. First, a woman can abstain from sex or limit her number of sex partners. The surest way to keep from getting any STI is to not have vaginal, oral, or anal sex. If abstinence is not the right choice, having sex with only one person who has agreed to have sex only with you can lower your risk of infection.

To help avoid STIs, a woman can use condoms every time she has sexual contact, from the very start to the very end of each sex act, and with every sex partner. A woman needs to know how to use condoms correctly. Condoms can protect you from STIs only if you use them correctly. Check out the How to Use Condoms page for tips and step-by-step instructions.

Furthermore, women should find a trusted doctor with whom they talk openly about sexual health. Doctors are there to help with any and all health problems, so don't feel embarrassed about talking sexual health.

A woman needs to get regular health care. Ask your doctor if you should be tested for STIs and/or vaccinated for HPV and Hepatitis B. Testing for and vaccinating against STIs is simple and can often be done during your checkup.

If you use birth control, talk to your doctor about your STI risk. Some methods of birth control, like pills, shots, implants, intrauterine devices (IUDs), and diaphragms, will not protect you from STIs. If you use one of these methods, be sure to also use a condom every time you have sex.

Chlamydia is an infection caused by bacteria. It is the most commonly reported sexually transmitted disease (STD) in the United States.

How is it spread?

Women get chlamydia through vaginal, oral, or anal sexual contact with an infected person.

What are signs of chlamydia in women?

75% of infected women and 50% of infected men have no signs. Signs in women include:

• Increased or unusual vaginal discharge
• Burning with urination
• Pain in the back or abdomen
• Nausea
• Fever
• Discomfort during sex
• Bleeding between periods
• Rectal pain, bleeding, or discharge
• Sore throat

Most women with chlamydia do not show any signs of infection.

How do you know if you have chlamydia?

The only way to know if you have chlamydia is by a medical exam. Most women with chlamydia do not have any signs of infection. See your health care provider to be tested for chlamydia each year if you:

• Are age 25 or younger and are sexually active
• Are older than 25 with new or multiple sex partners
• Do not practice safe sex
• Are having sex with someone who might be having sex with others
• Are pregnant

How is it treated?

Chlamydia can be treated and cured with antibiotics. Always finish antibiotic treatment, even if signs of chlamydia go away. Do not have sex until after treatment and signs of it are gone. See your health care provider if your signs do not go away after finishing treatment.

What can happen if you have chlamydia for a long time?

• Problems getting pregnant
• Pregnancy outside of the uterus
• Swelling in the anus
• Eye and joint redness and pain
• More likely to get HIV from a partner who is infected with HIV

If you have chlamydia

• Always finish all antibiotic treatment.
• Do not have sex with someone who has chlamydia or has not finished treatment (to prevent re-infection).
• Tell current and recent sex partners of the infection so they can get checked.
• Know that it can raise the risk of getting and spreading HIV.

How can you avoid chlamydia?

• Avoid sexual contact.
• Have safer sex:
  • Reduce the number of sexual partners.
  • Condoms, when used correctly, can reduce the risk of getting chlamydia. Each time you have sex use a condom (male or female type):
    • Before vaginal sex
    • Before anal sex
    • Before oral sex
  • Have sex with only one partner who does not have sex with others and does not have chlamydia.
• Know that other forms of birth control do not protect against chlamydia.

What about pregnancy?

All pregnant women should be tested for chlamydia. If you are pregnant and have chlamydia, you should discuss your pregnancy and infection with your health care provider. Pregnant women with chlamydia can have early births or babies with eye and lung infections.

Pregnant women with chlamydia can pass it to their babies during childbirth.

Genital herpes is a sexually transmitted disease (STD) caused by herpes simplex viruses. Many people with herpes have no signs of infection and do not know they have it.

There are 2 herpes simplex viruses that can cause infection

• One causes most genital herpes.
• The other virus can also cause genital herpes but more often causes blisters of the mouth and lips (e.g., cold sores or fever blisters).

The U.S. Centers for Disease Control and Prevention (CDC) states that about 1 out of 6 people ages 14 to 49 have genital herpes.

Women are more easily infected with herpes than men.

How is it spread?

The herpes virus is spread by skin-to-skin contact with a person who has the herpes virus:

• Most often, from herpes sores or blisters
• Less often, from normal looking skin where the virus first entered the body
• During vaginal, anal, or oral sexual contact, or skin-to-skin contact. This may happen even without visible sores.
• The herpes virus enters the body through the:
  • Lining of the mouth
  • Labia
  • Vagina
  • Regular skin that has small cracks or cuts

People with a weak immune system can get a herpes infection more easily. A weak immune system is caused by some diseases (e.g., cancer, HIV/AIDS) and by some medicines used to treat serious diseases.

People who don't know they have herpes can still spread the virus to others.

What are signs of genital herpes in women?

Women who have the herpes virus may have no outbreaks or signs of infection. Many do not know they have the virus. Once you are infected, the virus stays in your nerve cells for life. When the virus is not active, there is no sign of infection. When the virus becomes active, a herpes outbreak occurs. Some women may not have any outbreaks or may have only one outbreak, while others may have multiple outbreaks.

First Outbreak

The first herpes outbreak often occurs within the 2 weeks after contracting the virus from an infected person. The first signs may include:

• Itching, tingling, or burning feeling in the vaginal or anal area
• Flu-like symptoms, including fever
• Swollen glands
• Pain in the legs, buttocks, or vaginal area
• A change in vaginal discharge
• Headache
• Painful or difficult urination
• A feeling of pressure in the area below the stomach

After a few days, painful sores, blisters, or ulcers may develop where the virus entered the body. These areas include:

• The vaginal or anal area
• The mouth
• Inside the vagina
• On the cervix
• In the urinary tract
• On the buttocks or thighs
• On other parts of your body where the virus has entered

Sometimes the first outbreak will not occur until months or years after infection.

Other Outbreaks

After the first outbreak, you may have more outbreaks. For most, these outbreaks occur less often over time. The signs of herpes infection are usually milder than during the first outbreak, and they go away faster.

For people with a weak immune system, outbreaks can be severe and long-lasting.

See your health care provider to be tested if you have signs of herpes.

How do you know if you have genital herpes?

The only way to know if you have genital herpes is by a medical exam. Your health care provider can examine you and test for it. Lab samples are taken from a sore, blister, or blood. Your health care provider may ask to test you for other infections at the same time.

Tell current and most recent sex partners of your herpes infection.

How is it treated?

Genital herpes can be treated, but it cannot be cured. Anti-viral medicines can make outbreaks:

• Shorter
• Less severe
• Less frequent

Living with genital herpes causes some people to:

• Feel embarrassed or ashamed
• Worry about infecting a sexual partner
• Worry that having herpes will affect relationships with sexual partners
• Avoid dating or sexual relationships

Most people with herpes are able to live with the virus and manage their outbreaks. Talking to trusted health care providers and friends can help. Your health care provider can talk to you about medicines that treat outbreaks and about ways to reduce the chance of passing the virus on to a sexual partner.

Medicines can help lower the chance that you will pass the virus to others.

If you have genital herpes, during outbreaks you should

• Keep the infected area clean and dry.
• Avoid touching the sores or blisters.
• Clean hands after contact with the infected area.
• Avoid skin-to-skin contact from the time you first notice signs of herpes until the sores have healed.

For more on how to clean hands, see Clean Hands.

How can you avoid genital herpes?

Most women get genital herpes through sexual contact with a person who has herpes sores. You can get the virus without having sex. To avoid infection:

• Avoid skin-to-skin and sexual contact.
• Have safer sex:
  • Reduce the number of sexual partners.
  • Condoms, when used correctly, can reduce the risk of getting genital herpes. Each time you have sex use a condom (male or female type):
    • Before vaginal sex
    • Before anal sex
    • Before oral sex
  • Have sex with only one partner who does not have sex with others and does not have herpes.
• Know that other forms of birth control do not protect against herpes infection.

What about pregnancy?

A pregnant woman who has genital herpes can pass the virus to her baby. A baby born with herpes might:

• Be born early
• Have brain, skin, or eye problems
• Not survive

If you are pregnant, you should tell your health care provider if you have herpes. If you show any signs of herpes during pregnancy, tell your provider. Pregnancy can be managed safely if your health care provider knows about your herpes. Medicines can help babies born with herpes if they are treated right away.

Genital warts are caused by low-risk types of human papillomavirus (HPV). These viruses may not cause warts in everyone.

How are they spread?

Women can get genital warts from sexual contact with someone who has HPV. Genital warts are spread by skin-to-skin contact, usually from contact with the warts. It can be spread by vaginal, anal, oral, or handgenital sexual contact. Genital warts will spread HPV while visible, and after recent treatment. Long-term sexual partners usually have the same type of wart-causing HPV.

What are signs of genital warts in women?

Genital warts can grow anywhere in the genital area:

• In the vagina
• Around the vaginal opening
• On the cervix (the opening to the womb)
• On the groin
• In or around the anus
• In the mouth or throat (rare)

Genital warts:

• Can be any size – from so small they can't be seen, to big clusters and lumps
• Can be smooth with a "mosaic" pattern or bumpy like a cauliflower
• Are soft, moist and flesh-colored
• Can cause itching, burning or pain

Not all HPV infections cause genital warts. HPV infections often do not have any signs that you can see or feel. Some HPV infections can be more serious, see HPV.

Even if you can't see any genital warts, you could still have an HPV infection.

How do you know if you have genital warts?

Genital warts can be detected by:

• Yourself
• A sexual partner
• A health care provider

The only way to confirm HPV infection is if your health care provider does an HPV test.

How is it treated?

See your health care provider to discuss treatment. Even when genital warts are treated, the HPV infection may remain. Warts may also return after treatment. Over-the-counter treatments for other types of warts should not be used. Treatments for genital warts include:

• Watch and wait to see if the warts stay the same, get bigger, or go away
• Medicines applied directly to the warts. These can include prescribed creams.
• Burning off the warts
• Freezing off the warts
• Cutting the warts out
• Using special lights or lasers to destroy the warts.

What can happen if you have genital warts for a long time?

The immune system fights HPV infection. The types of HPV that cause genital warts do not cause cancer. Without any treatment, genital warts may:

• Go away
• Remain unchanged
• Increase in size or number

If you have genital warts

• Discuss treatment for genital warts with your health care provider.
• Know that it you may never know when you got HPV or who gave it to you.
• Know that partners that have been together for a while often share the same HPV types, even if both have no symptoms.

Condoms may not fully protect against HPV since HPV can infect areas not covered by a condom.

How can you avoid genital warts?

• Get vaccinated against HPV.
  • Certain types of HPV vaccines protect against the low-risk HPV that causes 90% of genital warts.
  • HPV vaccine is safe for all females 9 to 26 years old.
  • The Centers for Disease Control and Prevention (CDC) recommends all 11-12 year old girls get the HPV vaccine.
• Avoid sexual contact.
• Have safer sex:
  • Reduce the number of sexual partners.
  • Condoms, when used correctly, can reduce the risk of getting HPV. But, condoms may not cover all infected areas. Each time you have sex use a condom (male or female type):
    • Before vaginal sex
    • Before anal sex
    • Before oral sex
  • Have sex with only one partner who does not have sex with others and does not have HPV.
• Know that other forms of birth control do not protect against HPV.

What about pregnancy?

Genital warts rarely cause problems during pregnancy and birth. Most women who no longer have visible genital warts do not have problems with pregnancy or birth. If you are pregnant, you should discuss treatment options with your health care provider as the warts may:

• Grow larger and bleed
• Make it difficult to urinate if growing in the urinary tract (rare)
• Make the vagina less elastic during birth if the warts are in the vagina (rare)
• Cause a need for a cesarean section (C-section) birth if the warts block the birth canal (rare)
• Be passed to the baby during birth (rare)

Gonorrhea is an infection spread by bacteria. Also known as "the clap" or "the drip", it affects both women and men. Women can get it in moist, warm areas such as the vagina, reproductive organs, anus, mouth, throat, and eyes.

How is it spread?

Women get gonorrhea from sexual contact with someone who is infected. Anyone who has gonorrhea can spread it to others. Gonorrhea can be spread through oral, vaginal, and sexual contact between:

• Men and women
• Women and women
• Men and men

What are signs of gonorrhea in women?

Some women and men can have gonorrhea without any signs. For women, signs include:

• Painful or burning urination
• Increased vaginal discharge
• Bleeding between periods or after sex
• Vaginal itching and irritation
• Discomfort or pain during sex
• Urgent or increased need to urinate
• Anal discharge, pain, bleeding or itching
• Fever, abdominal pain, rashes, and swelling or pain in joints over time
• Sore throat
• Red or itchy eyes
• Eye discharge

See your health care provider to be tested if you have signs of gonorrhea.

Women can get or spread HIV more easily if they have gonorrhea.

How do you know if you have gonorrhea?

The only way to know if you have gonorrhea is by a medical exam. Your health care provider can examine you and test for it. Lab samples may be taken from the vagina, bladder, bowels, throat, urine, or eyes. Your health care provider may ask to test you for other infections at the same time. See your health care provider to be tested for gonorrhea each year if you:

• Are age 25 or younger and are sexually active
• Are older than 25 with new or multiple sex partners
• Do not practice safe sex
• Are having sex with someone who might be having sex with others
• Are pregnant

Get tested for gonorrhea if your sex partner has it.

How is it treated?

Gonorrhea can be treated and cured with antibiotics. Always finish antibiotic treatment, even if signs of gonorrhea go away. Do not have sex until after treatment and signs of it are gone. See your health care provider if your signs do not go away after finishing treatment.

What can happen if you have gonorrhea for a long time?

Some women have no signs of gonorrhea until they are very sick and have permanent damage to their health. If untreated, gonorrhea can cause severe problems that include:

• Problems getting pregnant
• Pregnancy outside of the uterus
• Pain and infections in the abdomen
• The spread of gonorrhea to the blood, heart and joints

Tell current and most recent sex partners of the infection.

If you have gonorrhea

• Always finish all antibiotic treatment.
• Do not have sex with someone who has gonorrhea or has not finished treatment (to prevent re-infection).
• Tell current and recent sex partners of the infection so they can get checked.
• Know that it can raise the risk of getting and spreading HIV.

How can you avoid gonorrhea?

• Avoid sexual contact.
• Have safer sex:
  • Reduce the number of sexual partners.
  • Condoms, when used correctly, can reduce the risk of getting gonorrhea. Each time you have sex use a condom (male or female type):
    • Before vaginal sex
    • Before anal sex
    • Before oral sex
  • Have sex with only one partner who does not have sex with others and does not have gonorrhea.
• Know that other forms of birth control do not protect against gonorrhea.

What about pregnancy?

Gonorrhea can cause miscarriages or early labor in pregnant women. If you are pregnant and have gonorrhea, you can pass the infection to your baby during birth. Your baby can have:

• Blindness
• Joint infections
• Blood infections

All pregnant women should be tested for gonorrhea. If treated, most problems in pregnancy and birth can be avoided.

Mothers who have gonorrhea can spread it to their own newborn babies.

HIV stands for human immunodeficiency virus. HIV is a virus that attacks and weakens the immune system. The immune system is the body's defense against infections.

If you are infected with HIV, you are said to be "HIV positive." Over time as HIV weakens your immune system, you are more likely to get other infections. The late stage of HIV infection is known as acquired immune deficiency syndrome (AIDS).

How is it spread?

Each year in the United States about 40,000 people get infected with HIV. The HIV virus is found only in certain body fluids:

• Blood
• Vaginal fluid
• Semen
• Breast milk

HIV is NOT spread by:

• Tears
• Sweat
• Feces
• Urine

Contact with infected body fluids can spread HIV. HIV is mostly spread by:

• Sexual contact:
  • Vaginal and anal sex
  • Sharing unclean sex toys
  • Oral sex, very rarely
  • Body fluids with HIV can enter tiny breaks or rips in the linings of the vagina, vulva, rectum, or mouth. Rips and tears in these areas can be common and often unnoticed.
• Needle sharing:
  • Used or unclean needles
  • During illegal drug use
• Breastfeeding:
  • HIV can be spread to babies and others who drink breast milk from a woman who is HIV positive.
• Pregnancy and birth:
  • HIV-positive women can spread the virus to their babies during pregnancy and birth.

HIV is rarely spread from a blood transfusion because:

• All donated blood is tested and screened for HIV.
• Blood and blood products that test positive for HIV are safely destroyed. None are used for transfusions.
• There is no risk of getting HIV when donating or giving blood.

VA offers HIV testing and treatment to all enrolled Veterans.

What are signs of HIV?

Most people with HIV will not show signs of HIV until years after infection. People who have been recently infected with HIV may have:

• Fever
• Chills
• Night sweats
• Headache
• Sore throat
• Swollen lymph nodes, usually on the neck
• Tiredness
• Rash
• Sores or infections in the mouth
• Body aches

You can't tell if a person is HIV infected by looking at them.

How do you know if you have HIV?

The only way to know you have HIV is by getting an HIV test. Routine HIV testing is recommended for all adults. HIV tests are offered by health care providers in doctor's offices, hospitals, local public health departments, and in community clinics. Most HIV tests use either blood or saliva. HIV tests are very accurate but may not show HIV from a recent infection. It is important to always discuss your test result and retesting with your test provider.

How is it treated?

There is no cure for HIV. But there are very effective treatments that help your body fight HIV. Your health care provider can help you decide when to start treatment and which medicines to take. Treatment is lifelong and can:

• Reduce the amount of virus in your body
• Reduce the spread of HIV to others
• Help most people with HIV live longer and healthier lives

The sooner you know if you have HIV, the sooner your provider can know if you need treatment.

What can happen if you have HIV for a long time?

If HIV infection is not diagnosed and treated, it can progress into AIDS. AIDS stands for acquired immune deficiency syndrome. AIDS is the late stage of HIV infection. When you have AIDS, the virus has severely weakened your immune system. If HIV is not treated, other life-threatening infections can occur. The only way to know if you have AIDS is through a medical exam and testing by your health care provider. Common signs of AIDS are:

• Rapid weight loss
• Fevers
• Night sweats
• Extreme tiredness
• Swelling of the lymph nodes in the armpits, groin, or neck which doesn't go away
• Diarrhea that lasts for more than a week
• Sores of the mouth, anus, or genitals
• Infections such as pneumonia, tuberculosis, and certain cancers
• Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
• Depression
• Memory loss and other brain or nerve problems

If you have HIV

• See a health care provider regularly.
• If on treatment, be sure to take medicines as prescribed.
• Tell current and recent sex partners that you have HIV.
• Avoid spreading HIV to others by:
  • Using condoms during all sexual contact
  • Not sharing used or unclean needles and sex toys
  • Not breastfeeding

How can you avoid HIV?

The best ways to avoid HIV are:

• Avoiding sexual contact.
• Using condoms during all sexual contact.
• Not using or injecting illegal drugs. If you do use injection drugs, use a new sterile needle and clean drug equipment each time you prepare and inject drugs.

Other ways to reduce the risk of getting HIV include:

• Reducing the number of sex partners.
• Have sex with only one partner who does not have sex with others and does not have HIV.
• Knowing that douching or washing the vagina or anus after sex will not prevent HIV.
• Knowing that other forms of birth control do not protect against HIV.
• Not reusing or sharing needles, or drug equipment (works). If unused (new) needles and sterile drug equipment are not used, then all of it should be boiled in water or disinfected with a bleach solution, then rinsed with water before each use.

Ask your sex partners to test for HIV and other STDs.

What about pregnancy?

A woman who has HIV can pass the virus to her baby during:

• Pregnancy
• Birth
• Breastfeeding

A woman with HIV who is not treated for HIV during pregnancy or labor has a 25% chance (1 in 4) of giving the virus to her baby. If the mother is treated, the chance of passing the virus to the baby is less than 2% (fewer than 2 out of 100 times). Babies born to HIV-positive mothers should be treated with anti-HIV drugs after birth.

If you are pregnant or want to get pregnant, you should:

• Get tested for HIV.
• Have your sexual partner tested.
• Discuss your HIV status with your health care provider.
• Talk to your health care provider about starting HIV treatment if you are HIV-positive.
• Take steps to avoid HIV by:
  • Having safe sex. Each time you have sex use a condom.
  • Not injecting illegal drugs.
• Not breastfeeding your infant if you have HIV.

If you are pregnant and HIV-positive, you should talk to your health care provider about starting treatment with anti-HIV drugs to prevent passing HIV to your baby.

Human papillomavirus or HPV is the most common viral sexually transmitted disease (STD) in the United States. According to the Centers for Disease Control and Prevention (CDC), at least one out of every two sexually active people will have HPV at some point in their life.

There are over 100 known types of HPV

About 40 types can infect female and male genital areas. Genital HPV are grouped into two types:

• Low-risk types of HPV can cause genital warts or may be completely harmless.
• High-risk types of HPV increase the chances for some types of cancer, like cervical cancer.

How is it spread?

HPV is spread by skin-to-skin contact. Women get HPV from sexual contact with someone who has it. HPV can be spread by vaginal, anal, oral or handgenital sexual contact. Someone who is infected but has no visible signs can still spread HPV to others. People can be infected with more than one type of HPV. Long-term sexual partners with HPV often have the same HPV types.

Most sexually active men and women get genital HPV at some time in their lives.

There is an increased risk of genital HPV infection if you:

• Become sexually active at an earlier age
• Have multiple sexual partners
• Smoke
• Have an immune system that does not work well due to a medical condition (e.g., cancer, HIV/AIDS) or from a medicine that weakens the immune system

What are signs of HPV in women?

Most HPV infections have no signs that can been seen or felt. You can have HPV even if years have passed since you had sexual contact with an infected person. You may never know which sexual partner gave you HPV. HPV infection may cause:

• Genital warts (infection with low-risk viruses)
• Cancer (infection with high-risk viruses)
  • Cervical cancer (more common)
  • Cancers of the vagina, vulva, anus, throat, tongue or tonsils (less common)

How do you know if you have HPV?

Most women with HPV have no signs of infection. Since most HPV infections go away on their own within two years, many women never know they had an infection. Some HPV infections cause genital warts that can be seen or felt. The only way to know if you have HPV is to ask your health care provider to do an HPV test. Your health care provider may also examine you for other infections.

High-risk types of HPV infection can cause cervical cancer. To detect changes in the cervix caused by HPV, all women should get regular Pap tests. You should talk to your health care provider about when to start, how often, and when to stop having Pap tests.

Pap tests:

• Screen for cervical cancer and changes in the cervix that might turn into cancer
• Are done by a health care provider who collects a cell sample from the cervix with a small brush
• Can find abnormal cells on the cervix caused by HPV
• Can be done with an HPV test if:
  • You are age 30 or older.
  • You have had an abnormal Pap test result. This will show if HPV caused the changes.
• Should be done within three years of first sexual contact or starting at age 21
• Are important, as treating pre-cancer changes on the cervix can prevent cervical cancer

All women, aged 21 and older, should have regular Pap tests.

How is it treated?

Although genital HPV infections are very common, most show no signs and go away without treatment within a few years. If HPV does not go away, treatments are different for low risk HPV and high-risk HPV:

• Low-Risk HPV (Genital warts) – Even when genital warts are treated, HPV infection may remain. Warts can also come back after treatment. Over-the-counter treatments for other types of warts should not be used. Treatments for genital warts include:
  • Watch and wait to see if the warts stay the same, get bigger, or go away
  • Medicines put directly on the warts
  • Burning off the warts
  • Freezing off the warts
  • Cutting the warts out
  • Using special lights or lasers to destroy the warts
• High-Risk HPV – Pap tests can find pre-cancer changes in the cervix and other abnormal cells. Removing the abnormal cells is the best way to prevent cervical cancer.
  • Abnormal cells can be surgically removed without removing the uterus or damaging the cervix. After, women can still have normal pregnancies.

What can happen if you have HPV for a long time?

Certain types of low-risk HPV can cause genital warts. Without treatment genital warts may:

• Go away
• Remain unchanged
• Increase in size or number

High-risk HPV can cause abnormal cells in the cervix and cancer if not treated. Almost all cervical cancers are thought to be caused by HPV infections. While there are often no signs of early cervical cancer, some signs may include:

• Increased vaginal discharge, which may be pale, watery, pink, brown, bloody, or foul-smelling
• Abnormal vaginal bleeding between menstrual periods, after sex, douching or a pelvic exam
• Longer or heavier menstrual periods
• Bleeding after menopause
• Pelvic pain
• Pain during sex

If you have high-risk HPV the risk of cervical cancer is further increased if you:

• Smoke
• Have had more than three children
• Have used a birth control pill for more than five years
• Have a family history of cervical cancer
• Have limited access to medical testing and care
• Have a suppressed immune system

Almost all cervical cancers are caused by high-risk HPV infection.

If you have HPV

• Get regular Pap tests.
• Discuss treatment and follow-up care with your health care provider.
• Know that partners that have been together for a while often share the same HPV types, even if both have no symptoms.

How can you avoid HPV?

• Get vaccinated against HPV.
  • HPV vaccines can protect against 70% of cervical cancers.
  • One type of HPV vaccine can protect against the low-risk HPV that causes 90% of genital warts.
  • HPV vaccine is recommended for all females 9 to 26 years old.
  • The Centers for Disease Control and Prevention (CDC) recommends all 11-12 year old girls and boys get the HPV vaccine.
• Avoid sexual contact.
• Have safer sex:
  • Reduce the number of sexual partners.
  • Condoms, when used correctly, can reduce the risk of getting HPV. But, condoms may not cover all infected areas. Each time you have sex use a condom (male or female type):
    • Before vaginal sex
    • Before anal sex
    • Before oral sex
  • Have sex with only one partner who does not have sex with others and does not have HPV.
• Know that other forms of birth control do not protect against HPV.

Condoms may not fully protect against HPV since HPV can infect areas not covered by a condom.

What about pregnancy?

Genital warts rarely cause problems during pregnancy and birth. Most women who no longer have visible genital warts do not have problems with pregnancy or birth. If you are pregnant, you should discuss treatment options with your health care provider as the warts may:

• Grow larger and bleed
• Make it difficult to urinate if growing in the urinary tract (rare)
• Make the vagina less elastic during birth if the warts are in the vagina (rare)
• Cause a need for a cesarean section (C-section) birth if the warts block the birth canal (rare)
• Be passed on to the baby during birth (rare)

If you are pregnant and have a HPV infection and an abnormal Pap test, you should discuss your pregnancy with your health care provider.

Syphilis is a sexually transmitted disease (STD) caused by bacteria. It has often been called "the great imitator" as so many of the signs andsymptoms are like those from other infections.

How is it spread?

Women get syphilis from sexual contact with someonewho has it. Anyone who has it can spread it to others.Sometimes sores or infection may not be visible andthe person may not know that they have it. Syphilis canbe spread between:

• Men and women
• Women and women
• Men and men

Contact with a syphilis sore can spread the infection. Itcan get into your body through the vagina, anus, mouthand throat, or broken skin. Pregnant women can passthe infection to their babies before they are born.

What are signs of syphilis in women?

There are four stages of syphilis. Each is definedby how long the person has had it. Signs vary ineach stage.

1. Primary Stage: The first sign of syphilis is often asmall, round, firm sore. These appear at the placewhere it entered the body such as the vulva, vagina,tongue, or lips. These signs may be inside thevagina. Most do not cause pain. There can also bemore than one sore. Signs of syphilis often go awayin about 3 to 6 weeks even without treatment.If not treated in this stage, it will progress into theother stages.
2. Secondary Stage: This stage can start with a rashover one or more areas of the body. These appearmostly on the palms of the hands and the bottoms ofthe feet. Other signs may be:
   • Sore throat
   • Swollen glands
   • Fever
   • Hair loss in patches
   • Head and muscle aches
   • Weight loss
   • Tiredness
   If not treated in this stage, signs will still go away.However, the syphilis bacteria are still in the body.The infection will progress into the latent stage.
3. Latent Stage: This stage is also called the hiddenstage. It can last many years. Syphilis remains in thebody with no signs of infection. After 10 to 20 yearswithout treatment, syphilis can progress to the latestage.
4. Late Stage: Syphilis in this stage can cause:
   • Numbness
   • Problems with blood vessels
   • Damage to bones and joints
   • Difficulty walking
   • Blindness
   • Paralysis
   • Brain damage
   • Dementia
   • Heart disease
   • Death

How do you know if you have syphilis?

Your health care provider can examine and test you forsyphilis. Blood or fluid from a sore can be tested.

How is it treated?

Syphilis can be cured with antibiotics in all stages of thedisease. Always finish antibiotic treatment. Do not havesex until after treatment and all signs are gone. Seeyour health care provider if your signs do not go awayafter finishing treatment. Some damage to your bodycaused by the disease may remain.

If you have syphilis

• Always finish all antibiotic treatment.
• Do not have sex with someone who has syphilis or has not finished treatment (to prevent re-infection).
• Tell current and recent sex partners of the infection so they can get checked.
• Know that it can raise the risk of getting and spreading HIV.
• Get tested again after 6 and 12 months. Only a health care provider can tell you when you no longer have it.

How can you avoid syphilis?

• Avoid sexual contact.
• Have safer sex:
  • Reduce the number of sexual partners.
  • Condoms, when used correctly, can reduce the risk of getting syphilis. Each time you have sex use a condom (male or female type):
    • Before vaginal sex
    • Before anal sex
    • Before oral sex
  • Have sex with only one partner who does not have sex with others and does not have syphilis.
• Know that other forms of birth control do not protect against syphilis.

For more information, see Safer Sex.

What about pregnancy?

All pregnant women should be tested for syphilis.If you are pregnant and have syphilis, you can passthe infection to your baby during pregnancy or birth.Syphilis during pregnancy can cause:

• Babies with skin sores, blood, liver and other problems
• Miscarriage
• Early birth
• A baby born dead
• A baby that dies soon after birth

Pregnant women and babies born to infected mothers must be treated to avoid problems.

Trichomoniasis is an infection caused by a tiny parasite. It affects both men and women. It is also known as "trich".

How is it spread?

Women get trichomoniasis from sexual contact with someone who has it. Anyone who has it can spread it to others. It can be spread between:

• Men and women
• Women and women
• Men and men

Most infected men have no signs of trichomoniasis. Anyone who has "trich" can spread it even if they have no signs of it.

What are signs of trichomoniasis in women?

Some women can have "trich" without having signs. Others have signs that include:

• Increased vaginal discharge that can be foamy, yellow, or yellow-green
• Strong vaginal odor
• Vaginal itching and irritation
• Discomfort during sex or urination

See your health care provider to be tested if you have signs of "trich".

How do you know if you have trichomoniasis?

The only way to know if you have trichomoniasis is by a medical exam. Your health care provider can use a simple vaginal swab to test for it. Your provider may also ask to test you for other infections at the same time. See your health care provider to be tested for trichomoniasis each year if you:

• Are age 25 or younger and are sexually active
• Are older than 25 with new or multiple sex partners
• Do not practice safe sex
• Are having sex with someone who might be having sex with others
• Are pregnant

How is it treated?

Trichomoniasis can be treated and cured with prescription pills. Always finish treatment. Do not have sex until after treatment and all signs are gone. See your health care provider if your signs do not go away after finishing treatment.

If you have trichomoniasis:

• Always finish all treatment.
• Do not have sex with someone who has trichomoniasis or has not finished treatment (to prevent re-infection).
• Tell current and recent sex partners of the infection so they can get checked.
• Know that it can raise the risk of getting and spreading HIV.

How can you avoid trichomoniasis?

• Avoid sexual contact.
• Have safer sex:
  • Reduce the number of sexual partners.
  • Condoms, when used correctly, can reduce the risk of getting trichomoniasis. Each time you have sex use a condom (male or female type):
    • Before vaginal sex
    • Before anal sex
    • Before oral sex
  • Have sex with only one partner who does not have sex with others and does not have trichomoniasis.
• Know that other forms of birth control do not protect against trichomoniasis.

What about pregnancy?

Trichomoniasis, if not treated, can increase the risk of low birth weight babies or early birth. Tell your health care provider if you have any signs of "trich" so you can be tested. Discuss treatment options with your health care provider.

CDC Recommends Chlamydia and Gonorrhea Screening of All Sexually Active Women Under 25

Chlamydia and gonorrhea are important preventable causes of pelvic inflammatory disease (PID) and infertility. Untreated, about 10-15% of women with chlamydia will develop PID. Chlamydia can also cause fallopian tube infection without any symptoms. PID and “silent” infection in the upper genital tract may cause permanent damage to the fallopian tubes, uterus, and surrounding tissues, which can lead to infertility.

• In the United States, an estimated 4 million new chlamydia infections and 1.6 million new cases of gonorrhea infections occurred in 2018 alone.*
• Most women infected with chlamydia or gonorrhea have no symptoms.

CDC recommends annual chlamydia and gonorrhea screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.

* Chlamydia and gonorrhea are the first and second most commonly reported bacterial sexually transmitted infections in the United States. In 2019, a total of 1,808,703 cases of chlamydia and 616,392 cases of gonorrhea were reported to CDC from 50 states and the District of Columbia. The number of reported cases is lower than the estimated total number because infected people are often unaware of, and do not seek treatment for, their infections and because screening for chlamydia is still not routine in many clinical settings.

It might be hard to talk to a partner about getting tested for sexually transmitted infections (STIs), also called sexually transmitted diseases (STDs) — but it’s important to have the conversation. Chances are your partner will be glad you brought it up.

Talk before you have sex.

You can say:

• “Let’s get tested before we have sex. That way we can look out for each other."
• “Many people who have an STI don't know it. Why take a chance when we can know for sure?”

There are other things you may want to talk to a sex partner about. For example:

• Sexual history — like what type of protection you usually use (for example, condoms or dental dams) or the last time you got tested for STIs (including HIV)
• Risk factors — like whether you’ve had sex without a condom or used drugs with needles

Share the facts.

You can say:

• “Most STIs are easy to treat. And when they’re treated early, STIs are less likely to cause long-term health problems.”
• “STI tests are quick, simple, and usually painless. For example, rapid HIV tests can provide results from just a swab inside the mouth in only 20 minutes."
• "If you want to get tested at home, you can get an HIV home test or self-testing kits for other STIs."
• "If you don't feel comfortable talking about STIs with your regular doctor, you can get tested at a clinic instead."

Show that you care.

You can say:

• “I really care about you. I want to make sure we're both healthy.”
• “I've been tested for STIs, including HIV. Are you willing to do that, too?”
• “Let’s get tested together.”

Agree to stay safe.

You can say:

• “If we’re going to have sex, using condoms is a good way to protect us both from STIs. Let’s use condoms every time we have sex.”
• “We can enjoy sex more if we know it’s safe.”

Sexually transmitted infections (STIs) are also called sexually transmitted diseases, or STDs. STIs are usually spread by having vaginal, oral, or anal sex. More than 9 million women in the United States are diagnosed with an STI each year. Women often have more serious health problems from STIs than men, including infertility.

What is a sexually transmitted infection (STI)?

An STI is an infection passed from one person to another person through sexual contact. An infection is when a bacteria, virus, or parasite enters and grows in or on your body. STIs are also called sexually transmitted diseases, or STDs.

Some STIs can be cured and some STIs cannot be cured. For those STIs that cannot be cured, there are medicines to manage the symptoms.

Who gets STIs?

Nearly 20 million people in the United States get an STI each year. These infections affect women and men of all backgrounds and economic levels. But half of all new infections are among young people 15 to 24 years old.

How do STIs affect women?

Women often have more serious health problems from STIs than men:

• Chlamydia and gonorrhea, left untreated, raise the risk of chronic pelvic pain and life-threatening ectopic pregnancy. Chlamydia and gonorrhea also can cause infertility.
• Untreated syphilis in pregnant women results in infant death up to 40% of the time.
• Women have a higher risk than men of getting an STI during unprotected vaginal sex. Unprotected anal sex puts women at even more risk for getting an STI than unprotected vaginal sex.

How do you get STIs?

STIs are spread in the following ways:

• Having unprotected (without a condom) vaginal, oral, or anal sex with someone who has an STI. It can be difficult to tell if someone has an STI. STIs can be spread even if there are no signs or symptoms.
• During genital touching. It is possible to get some STIs, such as syphilis and herpes, without having sex.
• Through sexual contact between women who have sex only with other women
• From a pregnant or breastfeeding woman to her baby

Can STIs cause health problems?

Yes. Each STI causes different health problems for women. Certain types of untreated STIs can cause or lead to:

• Problems getting pregnant or permanent infertility
• Problems during pregnancy and health problems for the unborn baby
• Infection in other parts of the body
• Organ damage
• Certain types of cancer, such as cervical cancer
• Death

Having certain types of STIs makes it easier for you to get HIV (another STI) if you come into contact with it.

What are the symptoms of STIs?

Many STIs have only mild symptoms or no symptoms at all. When women have symptoms, they may be mistaken for something else, such as a urinary tract infection or yeast infection. Get tested so that you can be treated for the correct infection.

How do I get tested for STIs?

Ask your doctor or nurse about getting tested for STIs. Your doctor or nurse can tell you what test(s) you may need and how they are done. Testing for STIs is also called STI screening.

STI testing can include:

• Pelvic and physical exam. Your doctor looks for signs of infection, such as warts, rashes, or discharge.
• Blood test. A nurse will draw some blood to test for an STI.
• Urine test. You urinate (pee) into a cup. The urine is then tested for an STI.
• Fluid or tissue sample. Your doctor or nurse uses a cotton swab to take fluid or discharge from an infected place on your body. The fluid is looked at under a microscope or sent to a lab for testing.

Find a clinic near you where you can get tested for STIs.

Does a Pap test screen for STIs?

No. Pap testing is mainly used to look for cell changes that could be cancer or precancer. However, your doctor may test you for HPV in addition to doing the Pap test if you are older than 30.

If you want to be tested for STIs, you must ask your doctor or nurse.

Do I need to get tested for STIs?

If you are sexually active, talk to your doctor or nurse about STI testing. Which tests you will need and how often you need to get them will depend on you and your partner's sexual history.

You may feel embarrassed or that your sex life is too personal to share with your doctor or nurse. But being open and honest is the only way your doctor can help take care of you. Find out what screening tests you may need. Then talk to your doctor or nurse about what tests make sense for you.

How can I get free or low-cost STI testing?

Under the Affordable Care Act, most health insurance plans must cover the cost of STI screening or counseling at no cost to you.

• If you have insurance, check with your insurance provider to find out what's included in your plan.
• If you don't have insurance, find free or reduced cost testing and treatment for STIs.
• If you have Medicare, find out how which STI tests are covered and how often.
• If you have Medicaid, the benefits covered are different in each state, but certain benefits must be covered by every Medicaid program. Check with your state's program to find out what's covered.

For information about other services covered by the Affordable Care Act, visit HealthCare.gov.

How are STIs treated?

For some STIs, treatment may involve taking medicine by mouth or getting a shot. For other STIs that can't be cured, like herpes or HIV and AIDS, medicines can help reduce the symptoms.

If I have an STI, does my partner have it too?

Maybe. If the tests show that you have an STI, your doctor might want your partner to come in for testing. Or the doctor may give you a medicine to take home for your partner.

The STI may have spread to you or your partner from a former sex partner. This is why it is important to get tested after each new sex partner. Also, if you test positive for certain STIs (HIV, syphilis, or gonorrhea), some cities and states require you (or your doctor) to tell any past or current sex partners.

Do medicines sold over the Internet prevent or treat STIs?

No. Only use medicines prescribed or suggested by your doctor.

Some drugs sold over the Internet claim to prevent or treat STIs. And some of these sites claim their medicines work better than the medicines your doctor prescribes. But in most cases this is not true, and no one knows how safe these products are or even what is in them.

Buying prescription and over-the-counter drugs on the Internet means you may not know exactly what you're getting. An illegal Internet pharmacy may try to sell you unapproved drugs, drugs with the wrong active ingredient, drugs with too much or too little of the active ingredient, or drugs with dangerous ingredients.

How can I prevent an STI?

The best way to prevent an STI is to not have vaginal, oral, or anal sex.

If you do have sex, lower your risk of getting an STI with the following steps:

• Get vaccinated. There are vaccines to protect against HPV and hepatitis B.
• Use condoms. Condoms are the best way to prevent STIs when you have sex. Because a man does not need to ejaculate (come) to give or get some STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
• Get tested. Be sure you and your partner are tested for STIs. Talk to each other about the test results before you have sex.
• Be monogamous. Having sex with just one partner can lower your risk for STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
• Limit your number of sex partners. Your risk of getting STIs goes up with the number of partners you have.
• Do not douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting STIs.
• Do not abuse alcohol or drugs. Drinking too much alcohol or using drugs increases risky behavior and may put you at risk of sexual assault and possible exposure to STIs.

The steps work best when used together. No single step can protect you from every single type of STI.

What research is being done on STIs and women?

Research on STIs is a public health priority. Research is focused on prevention, diagnosis, and treatment.

• Researchers are looking at ways to prevent STIs with vaccines and microbicides. A microbicide is a gel or a cream that can be applied inside the vagina or anus to protect against STIs, including HIV.
• Scientists are working on vaccines to prevent HIV and herpes infections.
• Many women do not show any signs or have any symptoms for certain STIs, or have very mild symptoms that can be mistaken for other things. Researchers are studying the reasons why many STIs have no symptoms, which can delay diagnosis.