Sexually Transmitted Diseases in Females

Introduction

Sexually transmitted diseases (STDs) are bacterial, viral, and parasitic infections that are spread by sexual activity.  Females, youths, and people of minority groups have the highest incidence of sexually transmitted diseases.  Sexually transmitted diseases may or may not produce symptoms, but they can have severe consequences for women, developing babies during pregnancy, and breast feeding infants.  Some sexually transmitted diseases are curable.  Others are not, and may result in infertility or even death.  It is important to prevent the spread of STDs and to receive prompt diagnosis and treatment if you suspect that you have been exposed to one.

Anatomy

The internal female reproductive system includes the ovaries, fallopian tubes, uterus, cervix, and vagina.  The ovaries are two small organs that produce eggs (ova) and hormones.  Two fallopian tubes extend from near the ovaries to the uterus.  The fallopian tubes transport the mature eggs to the uterus (womb).

The uterus is a pear-shaped organ where a baby grows in during pregnancy.  The lining of the uterus undergoes cyclic changes to facilitate and maintain pregnancy.  If a pregnancy does not occur, the uterine lining is shed each month during menstruation.

The cervix is an opening that joins the uterus to the vagina.  The vagina is a muscular passageway that extends from the cervix to the outside of the body.  The vagina has several functions.  Menstrual blood leaves the uterus and travels through the vagina during a female’s period.  A baby moves from the uterus and through the vagina during childbirth.  The male’s penis is inserted into the vagina during sexual intercourse, at which time sperm may travel from the vagina, through the cervix and enter the uterus and fallopian tubes to fertilize an egg.

The external female genitalia are referred to as the vulva or pudendum.  The mons pubis and outer labia major are covered with hair in the mature female.  The labia major and labia minor are two pairs of skin flaps that surround the vaginal and urethra openings.  The urethra opening is located in front of the vaginal opening in the vestibule.  The urethra carries urine from the bladder to outside of the body.  The clitoris is located where the front folds of the labia join.  The clitoris is a small sensory organ that responds to sexual stimulation. 

Causes

STDs are caused by bacterial, viral, or parasitic infections that are spread from person to person during sexual activity.  STDs can be spread through oral, anal, or vaginal sex.  They may be spread regardless of if penetration occurs or not.  STDs may be spread between female and male, female and female, or male and male sexual contact.  There are over 25 types of infectious organisms that cause STDs.

The United States has the highest rate of STDs in the industrialized world, according to the American Social Health Association.  Women, youth, and people of minority groups are more likely to become infected and experience more serious medical complications.  STDs are more easily passed from men to women, which accounts for the higher incidence in women.  Sexually active youths have the highest rate of STDs than any other age group in the United States.

Symptoms

There are many different types of STDs, and they can produce a variety of different symptoms.  STDs may produce different symptoms in males and females or not produce any symptoms at all.  Some of the most common STDs for women are listed below, including symptoms, complications, and treatments specifically for women:

Chlamydia

Chlamydia can affect the urethra, rectum, throat, vagina, and cervix in women.  Symptoms include burning with urination, vaginal discharge or bleeding, abdominal pain, and pain during sexual intercourse.  Chlamydia can lead to blindness and eye, lymph node, and respiratory infections.  It can spread to the uterus and fallopian tubes and cause pelvic inflammatory disease, infertility, or ectopic pregnancy.  Chlamydia may also not cause any symptoms.  Chlamydia is usually treated successfully with antibiotic medications.  Both sexual partners should be treated to stop spreading the disease to each other.

Genital Herpes (HSV-2)

Genital herpes can affect the labia, vagina, cervix, anus, mouth, and inner thighs in women.  Genital herpes causes repeated outbreaks of small blisters on the genitals, rectum, or areas of nearby skin.  You may experience tingling, burning, or itching before the blisters appear.  Your skin may appear red and then blister.  The blisters are filled with clear fluid.  When the blisters break, painful sores can result.  Symptoms may also include severe headache, fever, muscle aches, feeling tired, and loss of appetite.  You may experience vaginal discharge and painful urination.  Complications may cause brain or spinal cord infection.

The infection can spread to a newborn during passage through the birth canal and cause serious complications or death.  If you are pregnant, inform your doctor that you have genital herpes so that necessary steps may be taken to ensure the health of your baby.

There is no cure for genital herpes; however, your doctor can prescribe medication to help ease your symptoms.  You may spread genital herpes even when you do not have an active outbreak.  If you have a severe headache associated with an outbreak or your behavior severely changes you should seek medical attention.  Female or male latex condoms should be used correctly and consistently.  Animal membrane condoms should be avoided, as the virus can go through them.

Genital Warts (HPV)

Genital warts are caused by infection with the human papilloma virus (HPV).  In females, HPV can cause warts on the vulva, urethra, vagina, cervix, and anus area.  Visible warts look like raised flesh-colored growths that appear individually or in clusters.  The growths may grow large and have a “cauliflower-like” appearance.  Your doctor may detect warts in the vagina or on the cervix; they are flatter in appearance.  You may experience itching, increased vaginal discharge, and abnormal vaginal bleeding after sexual intercourse.  Some women may not have symptoms.

Infection with certain strains of the HPV virus can cause cervical cancer and vulvar cancer.  You should receive a Pap smear every 6 months to check for cervical cancer if you or your partner has genital warts.  A new vaccine called Gardasil is available to prevent infection from the four types of HPV that cause genital warts and cervical cancer in younger women. 

A doctor must professionally remove genital warts.  Female and male condoms may help prevent the spread of genital warts, but may not fully protect you.  HPV can be transmitted even when there are no visible symptoms.

Gonorrhea (“The Clap”)

Gonorrhea is a bacterial infection that is spread through any type of sexual contact with an infected person.  The bacteria thrive in warm moist areas and can grow in the fallopian tubes, uterus, cervix, urethra, vagina, and eyes.  You may experience a thick green-yellow colored vaginal discharge, vaginal itching or burning, increased urination, and burning or pain while urinating.  You may have bleeding between your menstrual periods.  You may have a fever or sore throat.  Sexual intercourse may feel painful.  You may have severe pain in your lower abdomen if the infection spreads to your fallopian tubes. 

Complications from gonorrhea are pelvic inflammatory disease (PID), tubal scarring that prevents pregnancy, sterility, vulvovaginitis, and painful sexual intercourse.  Gonorrhea is treated with antibiotic medication.  Your partner should be treated as well.  Female or male condoms can lower your risk of contracting gonorrhea.

Hepatitis B (HBV) and Hepatitis C (HCV)

People with multiple sex partners, people with sexually transmitted diseases, people who participate in oral/anal sex, and men who have sex with men have a higher risk of contracting hepatitis B and C.  Hepatitis B is caused by infection from the hepatitis B virus (HBV), and hepatitis C is caused by infection from the hepatitis C virus (HCV).  HBV and HCV are categorized as blood-borne viruses because they are transmitted from an infected person to a non-infected person in blood or body fluids that contain blood, such as semen and saliva.  A mother can transmit hepatitis B and C to her baby during childbirth. Sharing needles for IV drug use can also spread these diseases.

Some people with hepatitis B and many people with hepatitis C do not experience symptoms.  Both forms of hepatitis produce similar symptoms including abdominal pain, loss of appetite, nausea, and vomiting.  You may feel tired all of the time.  Your skin may itch and you may develop jaundice, a yellowing of the skin and eyes.  The color of your urine may change and become as dark as cola or tea.  The color of your stools may change and become gray or clay colored. 

Chronic forms of these diseases can result in life-threatening medical complications and death.  In some cases, medications can slow progression of the disease.  A liver transplant is the only treatment for liver failure.  There is a vaccine to prevent Hepatitis B.  There is not a vaccine to prevent Hepatitis C, and there is not a cure for Hepatitis C. Using a condom may reduce the risk of hepatitis transmission.  If you are with multiple partners, get checked and receive prompt treatment for sexually transmitted diseases.  If you are pregnant, inform your doctor if you are at risk for hepatitis.

HIV and AIDS
 
The human immunodeficiency virus (HIV) infection is a viral infection that gradually destroys the immune system and progresses to acquired immune deficiency syndrome (AIDS).  HIV can be transmitted in blood, semen, and vaginal secretions during oral, vaginal, and anal sex.  A pregnant mother can transmit HIV to her developing baby during pregnancy.  A nursing mother can transmit HIV to her baby in her milk during breast-feeding.  Sharing needles for IV drug use can also spread HIV and AIDS.

Initially, most people with HIV experience flu-like symptoms, although some people do not.  People with HIV may not have symptoms for many years, but may transmit HIV to others during their symptom-free period.  As HIV suppresses the immune system, life-threatening infections such as pneumonia or cancers develop.  For the majority of people who do not receive treatment, HIV results in AIDS, the final stage and death.  There are however, a very small percentage of people that appear to develop AIDS more slowly or not at all.

There is no cure for HIV or AIDS.  Although there is no cure, there are medications that can help people with HIV and AIDS live healthier for longer periods of time.  Infections are treated as they occur.  You can reduce your chance of getting HIV by avoiding contact with the blood, semen, or vaginal fluid of an infected person.  Latex condoms may help reduce the spread of HIV.  Do not use condoms with nonoxynol-9, a chemical to help prevent pregnancy, which actually may increase the chance of HIV transmission.

Pelvic Inflammatory Disease (PID)

The bacteria that cause sexually transmitted diseases, such as Chlamydia, gonorrhea, or mycoplasma cause most cases of PID.  PID infects the lining of the uterus, fallopian tubes, or ovaries.  Common symptoms include abnormal colored or smelling vaginal discharge, abdominal pain, and fever.  You may experience bleeding between periods, pain during sexual intercourse, increased menstrual cramps, and painful or frequent urination.  You may stop getting your period.  Some people may not experience any symptoms.  PID can lead to infertility, ectopic pregnancy, and long-term pelvic pain. 

PID is treated with antibiotic medication.  Severe PID may require intravenous (IV) antibiotics, hospitalization, or surgery.  You may prevent PID by using condoms, getting checked and receiving treatment for STD, and having your partner checked and treated for STD.

Pubic Lice (“Crabs”)

Pubic lice are small six-legged creatures that infect and lay eggs in pubic hair.  They cause moderate to severe itching in areas with pubic hair.  The itching may be worse at night.  You may develop a bluish-gray colored skin rash from constant scratching.  Pubic lice are treated with a prescription wash.  Your partner should be treated as well.  You should treat or dispose of your affected clothes or linens, as they may transmit the lice.

Syphilis

Bacteria cause syphilis and the infection has several stages.  The first stage causes painless crater-like sores on the labia, cervix, anal area, or mouth.  The sore may leave a slightly depressed scar. Some people that do not have primary stage syphilis treated develop second stage syphilis.  Second stage syphilis can cause headache, rashes, fever, joint pain, hair loss, and flu-like symptoms.  There may be no visible symptoms while the bacteria multiply during second stage syphilis.  Tertiary syphilis, the final stage, can cause dangerous brain, nervous system, heart, skin, and bone infections. 

Primary and secondary syphilis are extremely contagious.  Syphilis can be cured with prompt antibiotic treatment.  Late stage syphilis may not respond to medication and can lead to disability and death.  Pregnant mothers can pass syphilis on to their developing babies during pregnancy.  Babies with congenital syphilis can develop a variety of conditions and serious medical disorders.  All pregnant women should be screened for syphilis.  Female or male condoms can help reduce the spread of syphilis.

Trichomoniasis (“Trich”)

Trichomoniasis is a parasite that is transmitted by penis to vagina or vulva to vulva contact with an infected person.  You may develop a heavy, frothy, foamy, foul smelling, green-white or yellow colored vaginal discharge.  Your vaginal area or inner thighs may itch.  Your labia may be swollen.  Sexual intercourse may be uncomfortable.

Trichomoniasis is curable with antibiotic medication.  Your partner should be treated as well.  Long-term infections can cause cell changes on the cervix.  You should receive Pap smear testing 3 to 6 months after treatment.  

Diagnosis

You should contact your doctor if you experience STD symptoms.  You should be tested for STDs if you suspect that you may have been exposed to STDs.  You should be tested for STDs if you have been in a monogamous relationship, but learn that your partner has had sexual contact with another person.  If you are at risk for contracting STDs, you should be tested on a regular basis, even if you do not have symptoms.  Your doctor can help you determine a testing schedule.  A pelvic examination, vaginal cultures, blood tests, mouth swabbing, urine tests, or specific STD tests can help your doctor diagnose STD.

Treatment

The type of treatment that you receive depends on the type of STD that you have.  Please refer to the “Symptoms” section of this article for disease specific treatment information.  Overall, viral STDs, such as herpes, HIV, Hepatitis B, and Hepatitis C can be treated, but there is no cure for viral STDs.  Bacterial STDs, such as gonorrhea and Chlamydia can be cured, and early treatment is important to reduce complications and transmission to others.

Prevention

Abstinence, not having sexual contact with another person, is the leading way to prevent STDs. Couples considering sexual relations should be tested for STDs before having sexual contact.  It is helpful to have a monogamous relationship, meaning you and your partner only have sexual contact with each other.  Stay sober.  Using drugs and alcohol increases the likelihood of participating in high-risk sex.

Consistent and correct use of male and female condoms can help prevent the spread of STDs, although it is not a guarantee.  Condoms may not prevent some types of infections, and certain types of condoms may be more effective for preventing specific STDs.  For more information, please refer to the “Symptoms” section of this article.

A vaccine is available to prevent the four types of HPV that cause cervical cancer, but it does not protect against all types of the virus that causes genital warts.  You should still use prevention methods to prevent HPV even if you have been vaccinated.  The vaccine is not effective for women that already have HPV, and the vaccine does not cure cervical cancer.  There is a vaccine to prevent hepatitis B, but not hepatitis C. 

If you have a STD, let your potential sexual partner know.  You can mutually agree on condom use and low-risk sexual activity.  You should also know your partner’s sexual, STD, and IV drug use history.  Again, you and your partner should both be tested for STDs before having sexual contact.  If you develop a STD, it is important to let your former partners know that they should get tested as well.  By doing so, you can help stop the spread of STDs.

Contact your doctor if you suspect you have or were ever exposed to a STD.  Let your doctor know if you are pregnant.  It is very important to receive prompt diagnosis and treatment.

Am I at Risk

STDs are spread from an infected person to another person during oral, vaginal, or anal sexual contact.  Female or male condoms can help reduce the spread of certain STDs, but not all types of STDs.  People considering having sexual relations should be tested for STDs before having sexual contact with another person.

_____ The highest incidence of STDs occurs in people that are between the ages of 15 and 24.
_____ Women experience a higher rate of STDs than men.
_____ People of minority groups have higher rates of STDs. The rates are the highest among African-Americans and Mexican-Americans.
_____ Sexual activity at a young age is associated with an increased risk for getting STDs.
_____ People that have sexual contact with many different partners have an increased risk for contracting a STD. Sexual contact includes any type of intimate activity, not just sexual intercourse.
_____ Having unprotected sex, sex without condoms, increases the risk of getting a STD.
_____ You are at risk for contracting a STD if you do not know if your partner has one or not. Some people may have a STD and may not know it because they may not have symptoms; however, they may still transmit the disease. It is important that people considering having sexual contact receive female gynecological or male genital examinations specifically for STDs before having sexual contact.
_____ Participating in anal intercourse increases your risk for getting a STD.
_____ Your risk for STD is greater if your partner is an IV drug user.
_____ If you have a STD, you may be more vulnerable to infection with other types of STDs.
____ Using drugs or alcohol in a situation where sex might occur increases the risk of participating in high-risk sex and increases your chance of contracting a STD.

Complications

STDs can result in serious complications for women and their babies, during and after pregnancy.  Some STDs can lead to death.  Please review the “Symptoms” section of this article for disease specific information.

Advancements

Researchers are studying other vaccines to prevent STDs.  Researchers are working on methods to cure STDs.  Public health campaigns are focusing on non-stigmatizing, educational information to impact society.