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FAQ
Sexual Health
Sexually Transmitted Infections (STIs)
Many STIs can be easily cured, but some can be permanent and difficult to manage. Here is a brief rundown of what STIs are and how they can impact people.
Sexually transmitted infections (STIs) refer to a variety of different viruses and bacteria that can be transmitted from one or more partners during sexual activities. There are many different STIs, each of which is a bit different in terms of how it is transmitted, what testing and treatment options are available, and what the best prevention strategy is.
Getting an STI can be a relatively common experience, though that doesn’t mean it can’t impact your physical or mental well-being. Some STIs can be cured through treatment, like chlamydia, gonorrhea and syphilis, while some can only be managed through treatment, such as HIV, HPV and herpes.
If you have an STI and don’t treat it, your risk of becoming HIV-positive increases. If you’re sexually active, it’s important to be tested regularly for HIV and STIs. It is common for STIs to be present without any symptoms, so even if you don’t feel like you have an STI, it’s still important to be tested regularly. If you have an STI, you can pass it to someone else whether or not you are experiencing symptoms.
List of STI’s
STI information for people living with HIV
The impact of getting an STI when already living with HIV is not entirely clear. For many years it was thought that untreated STIs impacted viral load and the likelihood of onward transmission of HIV. However, recent research has called this belief into question.
Certainly, getting an STI while living with HIV has the potential to damage to your health. STIs can progress faster in people living with HIV and can increase the chance of getting serious complications such as cancer or lesions. If unsure, talk to your doctor or a sexual health counsellor about what strategy for preventing STIs is best for you. Also, getting tested for STIs each time you have your viral load checked is a convenient way to stay on top of your sexual health! If you do get an STI, be sure to talk to your doctor to find the best course of treatment, keeping in mind your ongoing HIV treatment.
What are some common STI?
STIs are caused by three broad categories of organisms:
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Bacterial infections (chlamydia, gonorrhea etc.) which are usually cured with antibiotics
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Viral infections (four Hs ) which infections cannot be cured (except for Hep C) but can be managed.
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insects or parasitic microorganisms (lice, scabies and trichomoniasis) which can be treated with topical solutions or antibiotics (trichomoniasis with abx)
1. Chlamydia
What is it?
Chlamydia is a bacterial STI that is very common, especially in people aged 15– 24. Most people who have chlamydia do not have any signs or symptoms. But if it is left untreated, chlamydia can cause serious health problems including infertility, pelvic inflammatory disease, chronic pelvic pain, and can increase the risk of ectopic pregnancy (a pregnancy that occurs outside the uterus).
How do you get it?
You can get chlamydia if you have condomless oral, vaginal and/or anal sex with someone who has the infection. If you are pregnant, it is important to get tested and treated for chlamydia to avoid passing the infection on to the baby during childbirth.
How can you tell if you have it?
You may not know that you have chlamydia since most people do not have symptoms.
If you have chlamydia and you do have symptoms, you might notice:
FOR PEOPLE WITH VAGINAS:
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A change or an increase in discharge from the vagina
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Vaginal itching
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Bleeding between periods
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Pain or bleeding during or after vaginal sex
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Pain in the lower abdomen
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Burning sensation while urinating
FOR PEOPLE WITH PENISES:
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Burning sensation while urinating
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Discharge from the penis
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Burning or itching around the opening of the penis
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Pain in the testicles
How do you get tested?
A urine sample is used to test for chlamydia. If you have a vagina, your healthcare provider may also take samples from your cervix (the opening to the uterus) using a swab. Swabs may also be taken from the throat, anus, or penis. If you are tested for chlamydia, have a discussion with your healthcare provider about which other STI testing should be done. Make sure to also ask about being tested for HIV, because it may not be part of routine STI testing.
How is it treated?
Chlamydia can be cured with antibiotics. If you are prescribed antibiotics it is important that you take your medication as prescribed, even after you start to feel better. Even if you are treated for this infection, you can get it again if you have sex with someone who has the infection and has not been treated or has not finished treatment. A different type of chlamydia can also cause a less common form of STI called lymphogranuloma venerum, also known as LGV or venereal disease. (see details below 1A)
1A. Lymphogranuloma Venereum
What is it?
Lymphogranuloma venereum (LGV) is an STI caused by a certain type of chlamydia bacteria. LGV can infect the:
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Vagina
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Penis
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Cervix (the opening to the uterus)
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Anus
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Mouth
LGV is relatively rare in Canada but cases have been reported, particularly among gay, bisexual and other men who have sex with men. Left untreated, LGV can cause serious health problems such as scarring and deformity to the genitals and rectum (the lower part of the large intestine) that may need surgery. LGV must be treated.
How do you get it?
You can get LGV if you have condomless oral, vaginal and/or anal sex with a person who has the infection.
How can you tell if you have it?
There are usually three stages of LGV infection:
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A painless sore or lump may appear where the bacteria entered your body. The sore may go away without treatment, but the infection is still there and needs to be treated. Having a sore can increase the risk of getting or passing on other infections such as HIV, hepatitis B or hepatitis C.
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In the second stage you may develop swelling of the glands (lymph nodes), flu-like symptoms, discharge from the genital or anal area, and/or rectal pain and bleeding
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If left untreated, at this stage the symptoms can become more severe. You may be able to feel swollen glands behind the ears, under the jaw, in the armpits and in the groin. You may also experience swelling of the genitals or the rectum.
How do you get tested?
LGV is tested by taking samples from the sores using a swab or by doing a urine test. If your glands are swollen, your healthcare provider may also take a sample of liquid from your glands. If you are tested for LGV have a discussion with your healthcare provider about which other STI testing should be done.
How is it treated?
LGV can be cured with antibiotics. It is important that you take all of your medication as directed by your healthcare provider, even if you start to feel better.
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2. Gonorrhea
What is it?
Gonorrhea is a bacterial infection that often occurs at the same time as chlamydia. Gonorrhea is on the rise in Canada and around the world and is becoming increasingly resistant to antibiotics. That means that one day current antibiotics may not work to treat this infection. If left untreated, gonorrhea can cause serious health problems including infertility, pelvic inflammatory disease, chronic pelvic pain, an increased risk of ectopic pregnancy (a pregnancy that occurs outside the uterus), and pain in the testicles.
How do you get it?
You can get gonorrhea if you have condomless oral, vaginal and/or anal sex with someone who has an infection. If you are pregnant, it is important to get tested and treated for gonorrhea to avoid passing the infection on to the baby during childbirth.
How can you tell if you have it?
You can pass on gonorrhea to someone without even knowing that you have it, as you may not have any symptoms. If you have gonorrhea and you do have symptoms, you might notice:
FOR PEOPLE WITH VAGINAS:
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A change or an increase in discharge from the vagina
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Bleeding between periods
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Pain or bleeding during or after vaginal sex
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Pain in the lower abdomen
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Burning sensation while urinating
FOR PEOPLE WITH PENISES:
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Burning sensation while urinating
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Discharge from the penis
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Burning or itching around the opening of the penis
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Pain in the testicles
How do you get tested?
You get tested for gonorrhea with a urine sample. You may also have a swab taken from the throat, cervix, anus or penis. If you are tested for gonorrhea, have a discussion with your healthcare provider about which other STI testing should be done. It is possible to have more than one STI at the same time. Make sure to also ask about being tested for HIV, because it may not be part of routine STI testing.
How is it treated?
It is becoming more and more difficult to treat gonorrhea with existing antibiotics. It is important that you take your medication as prescribed even if you start to feel better. If you have finished your treatment for gonorrhea and still have symptoms, you should go back to your healthcare provider as soon as possible because you may need additional treatment. Many people who have gonorrhea also have chlamydia and are treated for both the number of people with infections at the same time.
3. Syphilis
What is it?
Syphilis is a bacterial infection that is on the rise in Canada. If undetected, during the first two years of infection, you can pass on syphilis, even if you do not have any symptoms. After these two years, you will still have the infection, but you cannot pass it on. If syphilis is left untreated, it can cause serious health problems including damage to the brain, heart and other organs in the body, which can become permanent.
How do you get it?
Syphilis is spread by having condomless vaginal, anal and/or oral sex with someone who has the infection. Syphilis can be passed on to a baby during pregnancy or childbirth. Syphilis in babies can cause serious health problems or death. If you are pregnant, it is important to get tested and treated.
How can you tell if you have it?
Symptoms may include:
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An open sore that does not hurt, called a chancre, on the genitals, anus or throat. The sore will go away even if it is not treated, but you will still have syphilis.
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Some chancres might not be apparent since they are painless. A chancre in the vagina might go unnoticed.
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A body rash and/or feeling like you have the flu. These symptoms will also go away even if they are not treated.
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Swollen glands (lymph nodes) including behind the ears, under the jaw, in the armpits and in the groin. The swelling may feel like small bumps underneath the skin.
How do you get tested?
You get tested for syphilis with a blood test. You may also have a swab taken of your sore(s). Having a chancre can also increase your risk of getting or passing on HIV. It is possible to have more than one infection at the same time. If you are tested for syphilis, have a discussion with your healthcare provider about which other STI testing should be done. Make sure to also ask about being tested for HIV, because it may not be part of routine STI testing.
How is it treated?
Syphilis can be cured with antibiotics. Once you have been treated for syphilis, you will need to go for follow-up blood tests to make sure the infection is gone. It is important that you attend all of the scheduled visits.
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4. Trichomoniasis
What is it?
Trichomoniasis is caused by a parasite and must be treated. If you are pregnant and have trichomoniasis, your baby may be born early or be underweight at birth. You can also pass the infection on to your baby during childbirth.
How do you get it?
Trichomoniasis is most often spread by having condomless vaginal sex with someone who has the infection
How can you tell if you have it?
The infection is most commonly found in the vagina and the opening of the penis (urethra), but most people do not have symptoms. You can pass it on without knowing that you have it.
If you do have symptoms, they may include:
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A change or increase in vaginal discharge
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Vaginal itching
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Pain during vaginal sex
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Burning during urination
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Discharge from the penis
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Burning or itching around the opening of the penis
How do you get tested?
You get tested for trichomoniasis by taking a swab of discharge from the vagina or from the tip of the penis. Trichomoniasis can also increase the risk of getting and passing on HIV. It is possible to have more than one infection at the same time. If you are tested for trichomoniasis, have a discussion with your healthcare provider about which other STI testing should be done.
How is it treated?
Trichomoniasis can be cured with antibiotics. It is important that you take your medication as prescribed, even if you start to feel better. You should not have sex until you have completed treatment. You can get the infection again if you have sex with someone who has trichomoniasis and has not been treated.
5. Herpes Simplex Virus (HSV)
What is it?
Genital herpes is an infection caused by the herpes simplex virus (HSV). The HSV type 1 causes sores around the mouth called “cold sores” and it can also cause sores on the genitals. HSV type 2 usually causes genital herpes.
How do you get it?
Genital herpes is generally passed on through condomless oral, vaginal and/ or anal sex with a partner who has the infection, whether the person has sores or not. You can spread herpes to other parts of your or your partner’s body by touching the sores or fluids from the sores and then touching elsewhere, for example, your eyes, mouth or genitals.
How can you tell if you have it?
Many people who have herpes will not have symptoms and may not know they have it. When you first have an outbreak of herpes, there may be itchiness along with very painful sores and blisters. The sores usually go away on their own, but you will still have the virus. An outbreak may also include painful swollen glands in the groin and flu-like symptoms. These symptoms may last several weeks.
Can it keep coming back?
Herpes can keep coming back. These are called recurrences. There is no way to predict if or how often recurrences will happen. Your healthcare provider can give you information on how to manage the infection, including treatment to control recurrences.
Some common causes of recurrences include:
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Fatigue and stress
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Existing illness
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Overexposure to sun
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Your period
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Pregnancy
How can you prevent passing on the virus?
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If you feel a burning or tingling sensation but have no sores, do not have sex. This is a sign that you may be developing an outbreak and even without the sores, you can pass on the virus.
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You should avoid oral sex when you have a cold sore.
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You should not have sex if you have an outbreak of genital herpes. Wait until several days after the sores are completely healed.
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Proper and consistent use of condoms and/or dental dams can lower your risk of passing on or getting the virus because herpes can be passed even when there aren’t any symptoms.
What can you do if you have a genital herpes outbreak?
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Keep the area clean and dry.
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Avoid using ointments and creams, which can cause the infection to spread.
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Wear cotton underwear.
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Wear loose-fitting clothes.
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After urinating, avoid wiping the area. Pat it dry to avoid spreading the infection.
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If it hurts when you urinate, sit in a tub of warm water or pour warm water over the area while you are urinating
How is it treated?
Genital herpes cannot be cured but it can be managed. There are medications that may help to prevent outbreaks or reduce how long the outbreak lasts. Your healthcare provider may also prescribe medication for pain if your outbreaks are severe and cause discomfort.
How is it prevented?
Since many people with herpes do not have any symptoms, proper use of condoms and/or dental dams on a consistent basis can help prevent herpes, but is not 100% effective as herpes can be present in areas not covered by condoms.
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7. Hepatitis C
What is it?
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). Hepatitis C can lead to severe liver damage and cancer of the liver. There is no vaccine to prevent it.
How do you get it?
Hepatitis C is spread through contact with infected blood. It is most often spread through sharing contaminated drug-use equipment (e.g.: needles, straws, pipes, cookers, etc.) to inject or snort drugs; tattooing, body piercing or acupuncture when unsterile equipment is used; unsterilized medical equipment; and, through blood or cutting rituals. It can also be spread by sharing personal care items like a razor, nail clippers or a toothbrush with a person who has the infection. Sexual transmission of hepatitis C is less common, but it can be transmitted sexually, especially when there is a chance that infected blood is present (such as during menstruation).
How can you tell if you have it?
The majority of people will not develop symptoms and will not know they have the virus. If symptoms do develop it can take two to six months for them to appear. People can pass the virus on without even knowing that they have it.
If you do have symptoms, they may include:
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Tiredness
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Pain in the abdomen
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Dark urine and/or pale stools
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Lack of appetite
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Nausea
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Yellowing of the skin and/or the whites of the eyes (jaundice)
How do you get tested?
A blood test can tell if you have hepatitis C. If you are tested for hepatitis C, have a discussion with your healthcare provider about which other STI testing should be done. It is possible to have more than one blood-borne infection at the same time. This requires specialized treatment and care.
How is it treated?
Some adults with hepatitis C will clear the virus on their own within six months. There are several drug combinations that have been approved by Health Canada to treat hepatitis C and to prevent the progression of liver disease caused by hepatitis C. Even if you clear the virus on your own or with treatment, you can still contract it again. Many people with hepatitis C develop a long-term infection called chronic hepatitis C, which can lead to severe liver damage and liver cancer. Chronic hepatitis C is also treatable and in some cases can be cured.
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6. Hepatitis B
What is it?
Hepatitis B is a virus that can infect the liver and sometimes leads to severe liver damage or cancer of the liver.
How do you get it?
Hepatitis B is spread by having condomless vaginal, anal and/or oral sex with a person who has the infection. It can also be spread through sharing contaminated drug-use equipment (e.g.: needles, straws, pipes, cookers, etc.) to inject or snort drugs; tattooing, body piercing or acupuncture when unsterile equipment is used; unsterilized medical equipment; and, through blood or cutting rituals. While less common, it can also be spread by sharing personal care items like a razor, nail clippers, or a toothbrush with a person who has the infection.
Prevention
You can protect yourself against hepatitis B by getting the hepatitis B vaccine. If you did not receive the vaccine as a child or are unsure, you can still get it as an adult. If you have hepatitis B, your sexual partner(s) should be vaccinated.
How can you tell if you have it?
You may not have any signs or symptoms, so you can pass the virus on without knowing that you have it.
If you do have symptoms, they may include:
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Tiredness
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Pain in the abdomen
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Dark urine and/or pale stools
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Lack of appetite
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Nausea
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Yellowing of the skin and/or the whites of the eyes (jaundice)
How do you get tested?
You get tested for hepatitis B using a blood test. If you are tested for hepatitis B, have a discussion with your healthcare provider about which other STI testing should be done. It is possible to have more than one infection at the same time. This requires specialized treatment and care.
How is it treated?
In most people, the virus will go away on its own within six months, but it can be passed on to others during this time. Once the body fights off the infection, you are protected from ever getting the virus again and cannot pass it on to others. If you think you have been exposed to hepatitis B your healthcare provider may inject you with an antibody (immune globulin) within 12 hours of exposure to the virus. For longer-term protection, you should get the hepatitis B vaccine at the same time. There are some cases where other treatments like antivirals may be recommended. Some people will not respond to treatment and will have hepatitis B for life. As long as they have the virus they can pass it onto others.
8. Human Papillomavirus (HPV)
What is it?
HPV is short for Human papillomavirus. There are about 200 types of HPV that can infect different parts of the body.
Some types of HPV can:
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Cause warts on the penis, scrotum and thighs.
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Cause warts on the inside or outside the vagina, anus, or throat.
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Cause cell changes that can lead to cervical, oral or anal cancers.
You can have more than one type of HPV at a time.
How do you get it?
You can get HPV if you have condomless oral, vaginal and/or anal sex with a person who has the virus. You can also get HPV from other sexual activity involving intimate skin-to-skin contact. You or your partner(s) can still spread the virus even if you do not have any symptoms.
How can you tell if you have it?
Most people do not have symptoms. This is why it is so hard to detect. Depending on the type of HPV you have, you may get warts on your genitals or anus which may look like bumps that can be cauliflower-like or may look like flat white patches. Some warts are very hard to see so you may feel them before you see them. Sometimes HPV doesn’t cause visible warts, but rather abnormalities on Pap tests. Pap tests involve collecting cells from the cervix during an appointment with a healthcare provider, and examining them under a microscope to make sure the cells are healthy.
How do you get tested?
A healthcare provider can usually tell if you have oral or genital warts by doing a visual exam. Regular cervical cancer screening (Pap/HPV test) is important for all people with a cervix who are, or have ever been, sexually active. The cervix is located in the lower, narrow end of the uterus at the end of the vagina. The screening tests can detect abnormal cell changes in the cervix that may cause cancer.
Pap test screening usually begins at age 21 and is repeated periodically after that. There is currently no test to detect high-risk HPV in people with penises.
If you are tested for HPV, have a discussion with your healthcare provider about which other STI testing should be done. The need for additional testing depends on risk factors and should be assessed by a healthcare provider.
HPV Vaccine
Youth aged 9–26 should get their HPV vaccine, but it might also be appropriate for adults older than 26 years of age. Ideally, you should get the vaccine before becoming sexually active and exposed to HPV.
If you are sexually active, you can still benefit from HPV vaccination. Few sexually active people have contracted all types of HPV that are prevented by the vaccine, so you will still get protection by getting the vaccine. The vaccine is not recommended during pregnancy.
Vaccine schedules can vary across provinces and territories. For information on how to get the vaccine where you live, speak to your healthcare provider or local public health unit.
How is it treated?
HPV cannot be cured, but oral or genital warts caused by HPV will often go away without treatment. Your healthcare provider can advise you on how to treat them if they do not go away on their own.
Some ways that oral or genital warts can be removed include:
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Freezing the warts with a very cold liquid called liquid nitrogen.
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Applying an ointment or liquid to destroy the warts.
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In some cases a surgical procedure may be required.
Treatment does not prevent re-infection or recurrence of HPV. You can still get another HPV infection in the future.
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9. Pubic Lice and Scabies
What is it?
Pubic lice are also known as “crabs” because the lice resemble tiny crabs. They are usually found around the genitals in pubic hair. You can get pubic lice from having close contact with someone who has it. Lice can be clear to darker brown in colour. They live by feeding on human blood and lay their eggs at the base of the pubic hair. Their eggs are called nits and can stay alive for up to 10 days. Scabies are tiny bugs or mites that burrow below the surface of the skin and lay eggs. They are not visible to the naked eye.
How do you get it?
Pubic lice and scabies are passed on from one person to another through sexual and non-sexual contact. An example of nonsexual contact is sharing towels or sheets with a person who has pubic lice or scabies. Pubic lice and scabies can live on objects such as clothing, towels, bedding and mattresses for one to two days if they fall off their host.
How can you tell if you have it?
If you have pubic lice or scabies you will feel itchy and may have a rash. For pubic lice, you might see tiny light brown insects or oval, whitish eggs on the hair. Bites can cause a rash or small bluish spots on your skin. For scabies, itching occurs mainly at night and a rash may appear between your fingers, on your wrists, abdomen, ankles, on the bend of your elbows or around your genitals.
How do you get tested?
You can usually tell if you have pubic lice by finding the adult lice or eggs on the hair. If you are not sure if you have pubic lice or scabies, see your healthcare provider. If you have scabies or pubic lice you should discuss with your healthcare provider which other STI testing should be done.
How is it treated?
Pubic lice and scabies are treated with special creams, lotions or shampoos available at the drug store without a prescription. The pharmacist can help you find the right product. You need to follow the directions carefully. Your partners, friends and family may also have lice or scabies and have to be treated too. Infants, those who are pregnant and those who are breastfeeding need a different treatment. Speak to a pharmacist to make sure that you use the safest treatment for you.
Because lice and scabies can live on clothing, towels, bedding and mattresses, you need to:
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Dry clean or machine wash all of your clothing in hot water.
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Wash all bed linen in hot water.
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Store quilts and blankets for one week in sealed airtight plastic bags if you cannot wash them.
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Vacuum everything that has been in contact that you cannot wash (mattress, carpets, etc.)
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10. Mycoplasma Genitalium
Mycoplasma Genitalium is a bacterial infection that is passed through sex and genital contact and can be responsible for inflammation of the urethra (the tube that carries urine from your bladder to the outside), inflammation of the cervix, pelvic inflammatory disease and even infertility.
Usually, a urine sample or swab is taken to test for mycoplasma Genitalium if inflammation is detected. The best current treatment is with antibiotics, but Mycoplasma Genitalium is developing a resistance to some of these drugs, meaning you might need a combination of antibiotics. It is important that you take your medication as prescribed even if you start to feel better. If you have finished your treatment for Mycoplasma Genitalium and still have symptoms, you should go back to your healthcare provider as soon as possible. Re-testing may be necessary to determine whether the infection is gone, or if you need additional or alternate treatment.
11. Molluscum Contagiosum
Molluscum contagiosum is a skin rash that is transmitted during oral, anal and/or vaginal sex, or from towels or clothing from someone who has the infection. The rash can appear on the genitals, or eyes, nose and mouth, and will often go away without treatment, although it can cause scarring.
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