Eric Evans, MD
Division of Student Health
University of Iowa Hospitals and Clinics

First Published: May 2000
Last Revised: October 2003
Peer Review Status: Internally Peer Reviewed

I am currently practicing in the student health center at The University of Iowa in Iowa City, and I'm pleased to be part of this online chat today and welcome your questions. I should say that my training is as a family physician, and I've been in practice about 13-14 years now, both in academic settings and in private practice. I've been in my current position here at student health at Iowa for the past two years.

How can teenagers avoid contracting an STD?

The absolute surest way is not to be sexually active. If the teenager is sexually active, using condoms with every single act of sexual activity, limiting the total number of partners, or being in a monogamous sexual relationship will limit their risk of contracting an STD. Also, if in a relationship, having open discussion with their sexual partner and agreeing to both get tested before becoming sexually active is a good idea.

Do STDs interfere with fertility?

The short answer is yes. Particularly one of the more common bacterial STDs, Chlamydia, may cause no symptoms in infected patients and can cause impaired fertility or even sterility in women.

How can one tell if they have an STD? Is it always obvious?

It's often not obvious, which is why STDs are such a problem. Several STDs may or may not cause symptoms. Many patients can be infected for example with HPV (human papillomavirus), a virus that can cause warts, but have no symptoms for years. Similarly, chlamydia, a very common bacterial infection, may cause no symptoms at all in women or in men. Sometimes, however, symptoms do occur such as a white or creamy discharge from the penis or the vagina and/or burning with urination.

I was tested for chlamydia yesterday because I had a positive UA Dip for moderate blood and a slight pain while urinating. I am male. Should I be having more symptoms? I am pretty worried now.

As with the previous question, you potentially could be infected with chlamydia and have no symptoms at all. However, the symptoms you describe may be caused by a variety of other causes, not necessarily chlamydia or another STD. You've done the right thing in being checked and hopefully will have more information soon. Until the results of your test return, you probably should not be sexually active, and you might want to notify any of your sexual partners so that they might be tested as well.

I have a burning in my private area...is this something to be concerned about?

Yes, probably. I'm not sure what you mean by your private area, nor am I sure if you're male of female, but I would highly recommend you see a physician to be evaluated and treated if necessary.

Are there any home remedies for STDs?

I'm sure there probably are, but I wouldn't recommend any. STDs in general can be grouped into two broad categories. At least this is one way to think about STDs. The first category is bacterial and essentially curable STDs. These would include infections with chlamydia, trichomonas, gonorrhea, and syphilis, for example. The other broad category would be viral STDs or those caused by viruses and essentially incurable although treatable. These would include infections with viruses such as the herpes virus, HPV (human papillomavirus), hepatitis B, and the HIV virus or the virus that causes AIDS. Back to the question, in my opinion, it's best to seek good medical care and treatment with up-to-date, modern antibacterial or antiviral medications.

Where did STDs originally come from?

I don't know. In my training and my reading, STDs have been around as long as recorded history. One could speculate that they may have evolved somehow from earlier bacterial and viral infections that were present since humans first appeared, but I honestly don't know the answer to that question, nor am I sure anyone does.

Do you always need to have symptoms to be tested for STDs? What are the tests?

No, you don't always have symptoms, and, with certain STDs, at least as many people who are infected do not have symptoms as do have symptoms. To be tested, I would recommend that anyone entering a new sexual relationship probably ought to be tested. Anyone who is worried or might lose sleep because they are worried about an STD probably ought to be tested and certainly anyone with symptoms as we've discussed previously today including burning with urination, sores or tender areas on their genitals, or discharge from the penis or vagina ought to be tested. As far as what the tests are, there are a variety of tests depending upon which STD and to a certain extent what is available to the practitioners in the clinic you may go to. For example, to test for HIV involves either drawing a blood sample which is then sent to a laboratory or collecting saliva or spit from the inside of the patient's mouth and sending that to a laboratory. Other tests involve using sterile swabs much like small Q-tips to collect samples from open sores or from the vagina or tip of the penis.

Is it possible I could have been exposed to syphilis and never suffered any symptoms (am female), and then later in life would develop neurosyphilis?

Often syphilis will cause symptoms but the symptoms may be minor, such as a slight rash that might be attributed to another cause. If you have any concerns that you might have contracted syphilis at an early age and have never been tested, you certainly should see your physician for further evaluation.

I have heard so much about HPV causing cervical cancer in women. What are the dangers for men? How is it treated?

HPV stands for human papillomavirus. It actually is a family of viruses with at least 60 and perhaps more than 70 subtypes of the virus in the family. About one third of this total group of viruses has been shown to be associated with genital infections, and hence is an STD. Incidentally, the other members of this large family of viruses cause warts elsewhere on the body such as plantar warts on the feet or common warts on the hands. However, only the small number of viruses in this family that can infect the genitals can cause the STD, which commonly is referred to as HPV. Of those several viruses of the HPV family causing genital infections, only four types, types 16, 18, 31, and 45, are strongly associated with the development of cancer of the cervix in women. However, most women infected with those four types will not develop cervical cancer, but if infected, it puts a woman at higher risk. In terms of whether or not these or other HPV types might cause cancer of the penis in men, there is still ongoing research to determine this for sure. In terms of treatment, there is no cure for HPV. Once infected, the virus stays in the body for at least several weeks and maybe for your lifetime.

What is the most common STD today?

The most common STD is HPV or the human papillomavirus. The Centers for Disease Control and Prevention (CDC) estimates that around 4 to 6 million new cases of HPV occur each year. The second and third most common STDs are trichomonas with about 4 or 5 million cases newly diagnosed each year and chlamydia with about 3 or 4 million new cases per year.

I know someone who had contracted syphilis and is trying to conceive, but with difficulty. Should she be concerned?

Without knowing the specifics of that patient's case, I would say that anyone with a history of syphilis ought to seek medical care before trying to conceive and should discuss that history with her obstetrician or family doctor providing her care. I am assuming that she was diagnosed and treated for the syphilis in the past.

What is the average life span now with someone with AIDS?

That's a difficult question to answer. It depends on many variables including how early in the course of the HIV infection the patient was diagnosed. It also depends on other illnesses, which the patient may have and is impacted by whether or not the patient is being treated with the current antiviral medications. In general, many people infected with HIV may not develop AIDS for 8-10 years from the time they were first infected, and this period can be extended if they receive the proper care.

Can you have HPV and never have genital warts?

Yes, definitely. Several of the strains of the HPV virus do not cause visible genital warts, and even those that do cause visible warts may be present but not be causing warts at the moment. With sexually active women, the strains of HPV that have been most strongly associated with cervical cancer do not seem to cause visible genital warts. For this reason, any sexually active woman should be sure to get annual pelvic exams that include a Pap smear. The Pap smear can detect early changes in the cells of the cervix caused by HPV. Early diagnosis can then lead to treatment well before any cancer develops.

At one time I broke out in a rash and itch all in my vaginal area. It spread to my boyfriend and went away after two weeks or so. It hasn't showed up again in almost a year. Could this be an STD?

Yes, it could be, and I would recommend both you and your boyfriend be tested for STDs if you have not been already. Certainly there could be other causes as well for rashes in the genital area, for instance, an irritation to a specific brand of condom or to a lubricant you may have been using. Because many STDs can cause initial symptoms, which then go away with time, I would strongly recommend you be tested as well as having your boyfriend retested.

Can HIV be treated and cured, so AIDS will never develop?

To my knowledge, it cannot be cured. Once you are infected with HIV, you will always have the virus in your system. Having said that, many of the current treatment protocols can suppress the virus to nearly undetectable levels. However, in many patients thus treated who then stop taking their medication, the virus seems to come back, indicating that at present the best medications can help to manage and suppress the virus but cannot eliminate it or cure the infection.

Can STDs cause cancer?

The short answer is yes. As we have discussed previously this morning, HPV infection can cause cervical cancer in women if certain strains are present and if left untreated. Another sexually transmitted disease we haven't talked about yet today is hepatitis B. Hepatitis B is a virus that is spread through intercourse that leads to an infection and inflammation of the liver. Certain percentages of people infected with hepatitis B do go on and develop liver cancer. Granted, this is a small percentage, perhaps less than 5 or 10 percent over several years, but it is a cancer that is caused by the sexually transmitted disease hepatitis B. Additionally, HIV infection, which can lead to AIDS, while not directly causing cancers, can make one more susceptible to certain kinds of cancer. For example, Kaposi's sarcoma, which has a much higher incidence in persons infected with HIV.

Is there a new material for condoms, other than latex, that will protect against STDs. I am allergic to latex.

I'm not aware of any new material, but would not be surprised if one were under development. A note of caution, certain animal-skin condoms do not seem to protect against most STDs.

You don't hear much about gonorrhea anymore. Is it still around?

Yes, it's still around, although not as common as some of the STDs we've talked about here today. The annual incidence of new cases of gonorrhea is about 650,000 per year in the United States. Gonorrhea is much more common in younger age groups, particularly 13- to 25-year-olds and is much more common in patients with higher numbers of sexual partners.

What types of STDs can be passed through oral sex?

Good question. Oral sex can lead to gonorrhea of the throat, herpes infections, and has been implicated in the transmission of HIV, although at a much lower rate or lower risk than anal sex or vaginal sex.

Do you see many AIDS cases on the campus where you work?

HIV infection is still relatively uncommon on our campus. I see many, many more cases of chlamydia, HPV, and herpes.

Is bacterial vaginosis considered an STD? If so, what would be the male counterpart?

Bacterial vaginosis is basically an overgrowth of a bacteria not normally found in high numbers in the vagina. Some physicians might consider this a sexually transmitted disease. However, it probably has more to do with other conditions, which may change the environment of the vagina and allow the normal bacteria that live there to grow out of bounds. In short, it is a condition that causes troublesome symptoms and is easily treated with an antibiotic. I don't believe that there is a male counterpart. However, similar or identical symptoms can be caused by trichomonas or other sexually transmitted diseases and so anyone having symptoms ought to be checked also for STDs.

At most college campus clinics, are psychologists available to students once diagnosed with an STD?

I can't answer for other college student health centers, but at our center, and I believe at most large centers, there are psychologists and/or psychiatrists available for psychological support. Most physicians, physician's assistants, or nurse practitioners working in college health centers should be capable of providing counseling and support and referrals when necessary as well.

Is there a relationship between depression and having an STD?

This may be a cart-and-horse situation. Certainly being diagnosed with an STD can be a very stressful event and may lead to increased stress, low mood, and even depression. On the other hand, people who are depressed may engage in behaviors that put them at higher risk for contracting STDs. As far as I'm aware, there is nothing about depression per se that would make one more susceptible or alter one's immune system to make it more susceptible to STDs. But I'm also not aware of research in this area.

I'd like to cover a couple of points and give a couple of recommendations before I sign off. First, one of the greatest obstacles regarding STDs in the United States is the fear we all seem to have about talking about them in the open. I would hope that those of you who signed on today would make a commitment and an effort to talk about STDs with your friends, families, and lovers in the future. Maybe even start today. Secondly, I have a website that is loaded with good, accurate, scientific information about STDs in an easy-to-understand format. The Centers for Disease Control and Prevention (CDC) website is located at www.cdc.gov. Once at the CDC's homepage, you can either do a search or click through buttons on the screen to find the CDC's STD homepage listing information and resources about all STDs.