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STI & Sexual Health Toolkit

Sexually Transmitted Infections

      • Females:
        1. Unusual vaginal discharge
        2. Cervicitis
        3. Burning sensation when urinating
        4. Lower abdominal pain
        5. Pain during intercourse, bleeding between menstrual periods
        6. May present with no symptoms
      • Males:
        1. Discharge from penis
        2. Burning sensation when urinating
        3. Burning, itching, or irritation around the opening of the penis
        4. Pain/swelling in the testicles (associated with epididymitis)
        5. May present with no symptoms
      • Chlamydia testing can be as simple as peeing in a cup. Sometimes the test is done by gently rubbing your genitals with a cotton swab, to take cell samples from your urethra, vagina, cervix, or anus. The samples are tested for chlamydia bacteria. Your doctor may also be able to see chlamydia symptoms, like discharge on your cervix, during an exam. Because chlamydia has similar symptoms to gonorrhea, another common STI, providers often test for both gonorrhea and chlamydia at the same time.
      • Chlamydia tests include:
        1. A urine test. A sample of your urine is analyzed in the laboratory for presence of this infection.
        2. A swab. For women, your doctor takes a swab of the discharge from your cervix for culture or antigen testing for chlamydia. This can be done during a routine Pap test.
    • CDC Fact Sheet
    • Treatment & Care

    • Gonorrhea is a common bacterial infection that’s easily cured with antibiotic medicine. It’s sexually transmitted, and most people with gonorrhea don’t have symptoms.

      • Urethral Symptoms:
        1. Thick, purulent penile discharge (usually white, greenish or yellow).
        2. Dysuria, frequency.
        3. Redness or swelling of the urethral meatus.
        4. Tenderness or swelling of the testicles with or without complaints of pain.
        5. Tingling in the tip of the penis or itching along the length of the urethra.
        6. No symptoms present in 5-20% of cases
      • Cervical Symptoms:
        1. Green or yellow-green discharge.
        2. Irritation of the vulva.
        3. Low back pain.
        4. Lower abdominal pain.
        5. Pain or swelling of the labia.
        6. *50-80% may be asymptomatic for the first few weeks.
      • Rectal (anal) Symptoms:
        1. May have irritation, burning or itching around the anus.
        2. Pain with bowel movement.
        3. Mucous discharge, blood or pus in feces.
        4. *May have few noticeable symptoms.
      • Pharyngeal (throat) Symptoms:
        1. May complain of sore throat.
        2. Yellow or greenish exudates from the pharynx.
        3. May have low-grade fever.
      • Getting tested is the only way to find out if you have gonorrhea. People who have sex should get tested regularly. Gonorrhea tests are generally quick and painless. Most of the time, a healthcare provider will use a urine sample to diagnose gonorrhea. However, if you have had oral and/or anal sex, your healthcare provider may use swabs to collect samples from your throat and/or rectum. Because gonorrhea has similar symptoms to chlamydia, another common STI, doctors often test for both gonorrhea and chlamydia at the same time.
    • CDC Fact Sheet
    • Treatment & Care
      • Transmission of hepatitis A virus can occur from any sexual activity with an infected person and is not limited to fecal-oral contact. People who are sexually active are considered at risk for hepatitis A if they are MSM, live with or are having sex with an infected person, or inject drugs. Vaccination is the most effective means of preventing hepatitis A transmission among people at risk for infection.
        • Most adults with hepatitis A have symptoms, including fatigue, low appetite, stomach pain, nausea, and jaundice (yellow skin or eyes, dark urine, light-colored bowel movements). Most children less than 6 years of age do not have symptoms.
        • Most people who get hepatitis A feel sick for several weeks, but they usually recover completely and do not have lasting liver damage. In rare cases, hepatitis A can cause liver failure and death; this is more common in people older than 50 years and in people with other liver diseases.
        1. Children need 2 doses of hepatitis A vaccine:
          1. First dose: 12 through 23 months of age
          2. Second dose: at least 6 months after the first dose
        2. Older children and adolescents 2 through 18 years of age who were not vaccinated previously should be vaccinated.
        3. Adults who were not vaccinated previously and want to be protected against hepatitis A can also get the vaccine.
        4. Hepatitis A vaccine is also recommended for the following people:
          1. International travelers
          2. Men who have sexual contact with other men
          3. People who use injection or non-injection drugs
          4. People who have occupational risk for infection
          5. People who anticipate close contact with an international adoptee
          6. People experiencing homelessness
          7. People with HIV
          8. People with chronic liver disease
      • CDC Fact Sheet
      • Hepatitis B can be transmitted through sexual activity. Unvaccinated adults who have multiple sex partners, along with sex partners of people with chronic hepatitis B infection, are at increased risk for transmission. Injection-drug use and sexual contact are other common modes of hepatitis B transmission in the United States. Among adults seeking treatment in STI clinics, as many as 10%–40% have evidence of past or current hepatitis B virus infection. Many of these infections could have been prevented through universal vaccination during delivery of STI prevention or treatment services.
        • Not all people with acute HBV infection have symptoms. Symptoms can range from asymptomatic or mild disease to, rarely, fulminant hepatitis. The presence of signs and symptoms varies by age. Infants, children under 5 years old, and immunosuppressed adults with acute HBV infection are typically asymptomatic. People less than 30 years old are less likely to be symptomatic compared with persons aged 30 years and older. When present, signs and symptoms of acute HBV infections can include:
          1. fever
          2. fatigue
          3. loss of appetite
          4. nausea
          5. vomiting
          6. abdominal pain
          7. dark urine
          8. clay-colored stool
          9. joint pain
          10. jaundice
        • Certain adults who are sexually active should be vaccinated against hepatitis B.
        • CDC and the Advisory Committee on Immunization Practices (ACIP) recommend hepatitis B vaccination for:
          1. sexually active people with more than one sex partner during the previous 6 months;
          2. people seeking evaluation or treatment for a sexually transmitted disease;
          3. sex partners of people with hepatitis B; and
          4. men who have sex with men (MSM).
      • CDC Fact Sheet
      • Although not common, hepatitis C can be transmitted through sexual activity. There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially sharing needles or other equipment to inject drugs. CDC recommends one-time hepatitis C testing of all adults (18 years and older) and regular testing for people with risk factors.
        • People with newly acquired HCV infection usually are asymptomatic or have mild symptoms that are unlikely to prompt a visit to a health-care professional. When symptoms do occur, they can include:
          1. Fever
          2. Fatigue
          3. Dark urine
          4. Clay-colored stool
          5. Abdominal pain
          6. Loss of appetite
          7. Nausea
          8. Vomiting
          9. Joint pain
          10. Jaundice
        • Routine periodic testing is recommended for people with ongoing risk factors, while risk factors persist, including those who currently inject drugs and share needles, syringes, or other drug preparation equipment, along with people who have certain medical conditions (e.g., people who ever received maintenance hemodialysis).
      • CDC Fact Sheet
    • Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2).
      • Most people have flu-like symptoms within 2 to 4 weeks after infection. Symptoms may last for a few days or several weeks.
    • CDC Fact Sheet
    • HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). There is currently no effective cure. Once people get HIV, they have it for life. But with proper medical care, HIV can be controlled. People with HIV who get effective HIV treatment can live long, healthy lives and protect their partners.
      • Most people have flu-like symptoms within 2 to 4 weeks after infection. Symptoms may last for a few days or several weeks.
        • HIV symptoms
        1. Stage 1 – Acute HIV Infection
          1. People have a large amount of HIV in their blood and are very contagious.
          2. Many people have flu-like symptoms.
          3. If you have flu-like symptoms and think you may have been exposed to HIV, get tested.
        2. Stage 2 – Chronic HIV Infection
          1. This stage is also called asymptomatic HIV infection or clinical latency.
          2. HIV is still active and continues to reproduce in the body.
          3. People may not have any symptoms or get sick during this phase but can transmit HIV.
          4. People who take HIV treatment as prescribed may never move into Stage 3 (AIDS).
          5. Without HIV treatment, this stage may last a decade or longer, or may progress faster. At the end of this stage, the amount of HIV in the blood (viral load) goes up and the person may move into Stage 3 (AIDS).
        3. Stage 3 – AIDS
          1. The most severe stage of HIV infection.
          2. People with AIDS can have a high viral load and may easily transmit HIV to others.
          3. People with AIDS have badly damaged immune systems. They can get an increasing number of opportunistic infections or other serious illnesses.
          4. Without HIV treatment, people with AIDS typically survive about three years.
        1. Should I get tested for HIV?
          1. CDC recommends that everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine health care. For people with certain risk factors, CDC recommends getting tested at least once a year.
          2. People with certain risk factors should get tested more often. You should get tested at least once a year if:
            1. You’re a man who has had sex with another man.
            2. You’ve had anal or vaginal sex with someone who has HIV.
            3. You’ve had more than one sex partner since your last HIV test.
            4. You’ve shared needles, syringes, or other drug injection equipment (for example, cookers).
            5. You’ve exchanged sex for drugs or money.
            6. You’ve been diagnosed with or treated for another sexually transmitted disease.
            7. You’ve been diagnosed with or treated for hepatitis or tuberculosis (TB).
            8. You’ve had sex with someone who has done anything listed above or with someone whose sexual history you don’t know.
        2. Where can I get tested?
          1. You can get an HIV test at many places:
            1. Your health care provider's office.
            2. Health clinics or community health centers.
            3. STI or sexual health clinics.
            4. Your local health department.
            5. Family planning clinics.
            6. VA medical centers.
            7. Substance abuse prevention or treatment programs.
            8. Pharmacies.
            9. At Kalamazoo County HCS, HIV tests are free and confidential for anyone 12 and older. HCS offers complete screening and counseling for STI & HIV risk reduction and pre- and post-counseling for HIV testing. For more information, click here.
          2. For more information on HIV testing click here.
        1. How can I prevent getting HIV from sex?
          1. Choose Sexual Activities With Little to No Risk
          2. Use Condoms the Right Way Every Time You Have Sex
          3. Take PrEP
          4. Decide Not to Have Sex
          5. Get Tested and Treated for Other STIs
          6. If Your Partner Has HIV, Encourage Your Partner to Get and Stay in Treatment
        2. How can I prevent getting HIV from injection drug use?
          1. Never Share Needles, Syringes, or Other Drug Injection Equipment
          2. Take PrEP
          3. Don’t Have Sex When You’re High on Drugs
          4. If You Do Share Needles, Syringes, or Other Drug Injection Equipment, Use Bleach to Clean Them
          5. Decide Not to Inject Drugs
        3. Learn more about the benefits of HIV treatment as prevention.
        4. Pre-Exposure Prophylaxis (PrEP)
          1. PrEP is medicine taken to prevent getting HIV. PrEP is highly effective for preventing HIV when taken as prescribed.
          2. PrEP reduces the risk of getting HIV from sex by about 99%.
          3. PrEP reduces the risk of getting HIV from injection drug use by at least 74%.
          4. PrEP is less effective when not taken as prescribed. Since PrEP only protects against HIV, condom use is still important for the protection against other STIs. Condom use is also important to help prevent HIV if PrEP is not taken as prescribed.
          5. For more information about PrEP here.
        5. Post-Exposure Prophylaxis (PEP)
          1. PEP is the use of antiretroviral drugs after a single high-risk event to stop HIV seroconversion. PEP must be started as soon as possible to be effective—and always within 72 hours of a possible exposure.
          2. PEP 101 Fact Sheet
    • CDC Fact Sheet
    • Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. HPV vaccines can prevent some of the health effects HPV causes.
      • HPV does not usually cause any symptoms. Sometimes the virus can cause painless growths or lumps around your vagina, penis or anus (genital warts).
      • There is no test to find out a person’s “HPV status.” There are HPV tests that can screen for cervical cancer. Healthcare providers only use these tests for screening women aged 30 years and older. HPV tests are not recommended to screen men, adolescents, or women under the age of 30 years.
      • CDC recommends HPV vaccination at age 11 or 12 years (or can start at age 9 years) and for everyone through age 26 years, if not vaccinated already. For more information about the HPV vaccine click here.
    • CDC Fact Sheet
    • Pelvic inflammatory disease is an infection of a woman’s reproductive organs. It is a complication often caused by some STIs, like chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID.
      1. Pain in the lower abdomen.
      2. Fever.
      3. An unusual discharge from your vagina, with a bad odor.
      4. Pain when you have sexual intercourse.
      5. Bleeding between periods.
      1. Be examined by your doctor if you notice any of these symptoms.
      2. Promptly see a doctor if you think you or your sex partner(s) have or were exposed to an STI.
      3. Promptly see a doctor if you have any genital symptoms such as an unusual sore, a smelly discharge, burning when peeing, or bleeding between periods.
      4. Get a test for chlamydia and gonorrhea every year if you are sexually active and younger than 25 years of age.
      5. Have an honest and open talk with your health care provider if you are sexually active and ask whether you should be tested for other STIs.
      1. Primary Stage:
        1. During the first (primary) stage of syphilis, you may notice a single sore or multiple sores. The sore is the location where syphilis entered your body. These sores usually occur in, on, or around the: penis; vagina; anus; rectum; and lips or in the mouth.
        2. Sores are usually (but not always) firm, round, and painless. Because the sore is painless, you may not notice it. The sore usually lasts 3 to 6 weeks and heals regardless of whether you receive treatment. Even after the sore goes away, you must still receive treatment. This will stop your infection from moving to the secondary stage.
      2. Secondary Stage:
        1. During the secondary stage, you may have skin rashes and/or sores in your mouth, vagina, or anus. This stage usually starts with a rash on one or more areas of your body. The rash can show up when your primary sore is healing or several weeks after the sore has healed. The rash can be on the palms of your hands and/or the bottoms of your feet and look
          1. rough;
          2. red; or
          3. reddish-brown
        2. The rash usually won’t itch, and it is sometimes so faint that you won’t notice it. Other symptoms may include:
          1. fever;
          2. swollen lymph glands;
          3. sore throat;
          4. patchy hair loss;
          5. headaches;
          6. weight loss;
          7. muscle aches; and
          8. fatigue (feeling very tired).
        3. The symptoms from this stage will go away whether you receive treatment. Without the right treatment, your infection will move to the latent and possibly tertiary stages of syphilis.
      3. Latent Stage:
        1. The latent stage of syphilis is a period when there are no visible signs or symptoms. Without treatment, you can continue to have syphilis in your body for years.
      4. Tertiary Stage

        1. Most people with untreated syphilis do not develop tertiary syphilis. However, when it does happen, it can affect many different organ systems. These include the heart and blood vessels, and the brain and nervous system. Tertiary syphilis is very serious and would occur 10–30 years after your infection began. In tertiary syphilis, the disease damages your internal organs and can result in death. A healthcare provider can usually diagnose tertiary syphilis with the help of multiple tests.

      • Most of the time, healthcare providers will use a blood test to test for syphilis. Some will diagnose syphilis by testing fluid from a syphilis sore. Having syphilis once does not protect you from getting it again. Even after successful treatment, you can get syphilis again. Only laboratory tests can confirm whether you have syphilis. Follow-up testing by your healthcare provider is necessary to make sure your treatment was successful.
    • CDC Fact Sheet
      • Neurosyphilis, Ocular Syphilis, and Otosyphilis
      • Without treatment, syphilis can spread to the brain and nervous system (neurosyphilis), the eye (ocular syphilis), or the ear (otosyphilis). This can happen during any of the stages described above.
        1. Signs and symptoms of neurosyphilis can include:
          1. severe headache;
          2. muscle weakness and/or trouble with muscle movements; and
          3. changes to your mental state (trouble focusing, confusion, personality change) and/or dementia (problems with memory, thinking, and/or decision making).
        2. Signs and symptoms of ocular syphilis can include:
          1. eye pain and/or redness; and
          2. changes in your vision or even blindness.
        3. Signs and symptoms of otosyphilis can include:
          1. hearing loss;
          2. ringing, buzzing, roaring, or hissing in the ears (“tinnitus”); and
          3. dizziness or vertigo (feeling like you or your surroundings are moving or spinning).
      1. Most people who have trichomoniasis do not have any symptoms. About 70% of people with the infection do not have any signs or symptoms. When trich does cause symptoms, they can range from mild irritation to severe inflammation. Some people get symptoms within 5 to 28 days after getting the infection. Others do not develop symptoms until much later. Symptoms can come and go.
      2. Men with trich may notice:
        1. Itching or irritation inside the penis;
        2. Burning after peeing or ejaculating; and
        3. Discharge from the penis.
      3. Women with trich may notice:
        1. Itching, burning, redness or soreness of the genitals;
        2. Discomfort when peeing; and
        3. A clear, white, yellowish, or greenish vaginal discharge (i.e., thin discharge or increased volume) with a fishy smell.
      4. Having trich can make sex feel unpleasant. Without treatment, the infection can last for months or even years.
      • It is not possible to diagnose trich based on symptoms alone. Your healthcare provider can examine you and a laboratory test will confirm the diagnosis.
      1. Trich can increase the risk of getting or spreading other sexually transmitted infections. For example, trich can cause genital inflammation, making it easier to get HIV, or pass it to a sex partner.
      2. Pregnant people with trich are more likely to have their babies early. Also, their babies are more likely to have a low birth weight (less than 5.5 pounds).
    • Trichomoniasis a common, treatable, sexually transmitted infection (STI).