Sexually Transmitted Infections 43

Sexually Transmitted 

Infections

You probably have heard of sexually transmitted infections 

(STIs)—also called sexually transmitted diseases, or STDs. But 

if you are like many women, you might not know that much 

about how STIs could impact your health. You might not think 

you need to worry about STIs. Yet STIs are a major public 

health concern in the United States, where an estimated 19 

million new infections occur each year. STIs affect people of 

all backgrounds and economic levels. And women have more 

frequent and more serious complications from STIs than men. 

Thankfully, most STIs are preventable. Taking a few protective 

steps can lower your risk of getting an STI. 

What is a sexually transmitted 

infection (STI)?

A sexually transmitted infection 

(STI) is an infection you can get by 

having intimate sexual contact with 

someone who already has the infection. 

STIs can be caused by viruses, bacteria, 

and parasites. Many STIs have mild or 

no symptoms. So you can have an STI 

and not even know it. Most STIs can be 

found by simple tests, but routine testing 

is not widespread. So many cases of STIs 

go undiagnosed and untreated, which 

can lead to serious health problems—

particularly for women.
44 The Healthy Woman: A Complete Guide for All Ages

One partner can expose you to many diseases. You are at risk of 

getting all of the STIs that your partner’s past and present partners 

have had.

STIs are easily passed through 

intimate sexual contact

STIs are spread during vaginal or anal 

intercourse, oral sex, and genital touching. It is possible to get some STIs without having intercourse. Here are some 

other reasons STIs spread so easily:

l	 You can’t tell if a person has an STI by 

the way he or she looks. 

l	 Talking about sex is awkward for some 

people. They may not bring up safe sex 

or STIs with their partners.

l	 Many STIs have no or only mild 

symptoms. So many people don’t know 

that they have an STI or that they are 

putting their partners at risk.

l If you have unprotected sex, you may 

be exposed to the STIs that your partner’s past and present partners have 

had. This is true even if you have been 

sexually active with only one person.

l	 Myths and false beliefs about STIs put 

people at risk of getting and passing 

on STIs. 

TRUE statements about STIs:

You CAN get an STI without having intercourse.

You CANNOT get HIV from sitting on toilet seats.

Birth control pills DO NOT protect from STIs.

YOU
Sexually Transmitted Infections 45

STIs: Dangerous to women

Both men and women get STIs. But 

women have more frequent and more 

serious complications from STIs than 

men. Overall, untreated STIs can cause 

cancer, infertility, pregnancy problems, 

and other health problems in women. 

Women also need to be concerned about 

STIs for these reasons:

l	 Mild symptoms can be mistaken for 

“nothing” or something else, such as a 

urinary tract infection or vaginal yeast 

infection.

l	 A woman’s ability to protect herself 

from STIs depends on whether she is 

able to get her partner to use a condom. Women who don’t feel they can 

choose to use a condom are at greater 

risk of getting STIs because they may 

feel forced to take part in unsafe sexual 

practices. This is true for women in 

relationships and for women who are 

victims of sexual assault.

l	 Some STIs increase a woman’s risk of 

getting HIV/AIDS and other STIs 

because they irritate the vagina. Some 

cause open sores. This makes it easier 

for semen or vaginal fluid carrying 

HIV or other STIs to get inside a 

woman’s body.

l	 Having prior STIs raises a woman’s 

risk of future STIs. The reasons for 

this are complex and include biological, behavioral, and social issues.

l	 Silent and harmful STIs, such as chlamydia, affect young women at higher 

rates.

l	 Women of color have STIs at higher 

rates than other women. In 2005, 

the rate of reported chlamydia was 

7 times greater in black women and 

almost 5 times greater in American 

Indian/Alaska Native women than in 

white women. These differences might 

reflect limited access to quality health 

care, higher rates of poverty, and other 

health issues among these women.

Will I get an STI?

The answer depends on whether you 

take steps to reduce your risks. Keep 

in mind that more than half of Americans will have an STI at some point in 

their lifetime.
46 The Healthy Woman: A Complete Guide for All Ages

Learning more: Types of STIs

More than 25 infections are known to be passed through sexual contact. The STIs 

discussed here are among the most common and dangerous to women. 

Types of STIs

Bacterial 

vaginosis (BV)

How you get it Symptoms How to find out if 

you have it

BV is the most common vaginal infection in 

women of childbearing 

age. With BV, the normal 

balance of bacteria in 

the vagina is changed 

so that there are more 

“harmful” bacteria and 

fewer “good” bacteria. 

Antibiotics are used to 

treat and cure BV.

Not much is known 

about how women get 

BV. Any woman can get 

BV. But BV rarely occurs 

in women who have 

never had vaginal sex. 

Having BV can increase 

a woman’s risk of getting 

an STI, including HIV. 

These things put you 

more at risk for BV:

•	 Having a new or many

sex partners

•	 Douching

•	 Using an intrauterine

device (IUD) for birth

control 

•	 Not using a condom

You cannot get BV from 

such objects as toilet 

seats, bedding, or swimming pools.

Most women have no 

symptoms. Women with 

symptoms may have:

•	 Vaginal itching

•	 Pain when urinating

•	 Discharge with a fishy

odor

Your doctor will test a 

sample of fluid from your

vagina. Your doctor also 

may be able to see signs 

of BV, like a grayish-white 

discharge, during an 

exam.

Chlamydia How you get it Symptoms How to find out if 

you have it

Chlamydia is the most 

frequently reported STI 

caused by bacteria. It 

is a “silent” disease 

because 75 percent of 

infected women and at 

least half of infected 

men have no symptoms. 

Severe complications 

can result from untreated chlamydia. Antibiotics 

are used to treat and 

cure chlamydia.

Women and men can get 

chlamydia by having vaginal, anal, or oral sex with 

an infected person. 

An infected mother can 

also pass chlamydia to 

her baby during childbirth.

Most women have no 

symptoms. If symptoms 

do occur, they usually appear within 1 to 3 weeks 

of exposure. Symptoms, 

if any, include:

•	 Abnormal vaginal

discharge

•	 “Burning” when

passing urine

•	 Bleeding between

periods

•	 Lower abdominal pain

•	 Low back pain

•	 Nausea

•	 Fever

•	 Pain during sex

Your doctor can tell if you 

have chlamydia by testing your urine or by testing a swab sample taken 

from the infected site, 

such as the cervix.
Sexually Transmitted Infections 47

Types of STIs

Genital herpes How you get it Symptoms How to find out if 

you have it

Genital herpes is caused 

by the herpes simplex 

viruses type 1 (HSV-1)

and type 2 (HSV-2). Most

genital herpes is caused 

by HSV-2.

About 1 in 4 women in 

the United States have

had HSV-2 infection. 

The virus will stay in 

the body forever. But 

outbreaks, for people 

who have them, tend to 

be less severe and occur less often over time. 

Also, antiviral therapy 

can shorten outbreaks 

and make them less severe, or keep them from 

happening.

Genital herpes is spread 

through genital-to-genital 

or genital-to-oral contact. 

It spreads most easily 

when an infected person 

has open sores. But you 

also can get herpes from 

an infected person who 

has no symptoms. You 

do not need to have intercourse to get herpes.

You cannot get herpes 

from objects such as 

toilet seats, bathtubs, or 

towels.

Most people have mild or 

no symptoms. For people

who have “outbreaks,” 

the symptoms are clear: 

•	 Small red bumps,

blisters, or open sores 

show up where the virus entered the body, 

such as the penis, 

vagina, or mouth

•	 Vaginal discharge

•	 Fever

•	 Headache

•	 Muscle aches

•	 Pain when passing

urine

•	 Itching, burning, or

swollen glands in the 

genital area

•	 Pain in legs, buttocks,

or genital area

•	 Symptoms may go

away and then come 

back. Sores heal after 

2 to 4 weeks.

Your doctor can tell you if 

you have genital herpes 

by looking at the sores 

and by taking a sample 

from the sore for lab 

testing.

It can be hard to tell if 

you have herpes without 

symptoms. Blood tests 

can help detect herpes when there are no 

symptoms or between 

outbreaks.
48 The Healthy Woman: A Complete Guide for All Ages

Types of STIs

Gonorrhea How you get it Symptoms How to find out if 

you have it

Gonorrhea is caused by 

a type of bacteria that 

thrives in warm, moist 

areas of the reproductive 

tract. It also can grow in 

the mouth, throat, eyes, 

and anus.

Most women who have 

gonorrhea have no symptoms. Untreated gonorrhea can lead to serious 

health problems.

Antibiotics are used to 

cure gonorrhea. But gonorrhea has become more 

and more resistant to 

antibiotics, which means 

the drugs do not work 

as well or at all. Still, it’s 

important to get tested 

and treated by a doctor.

You can get gonorrhea 

through contact with an 

infected vagina, penis, 

anus, or mouth. It is 

spread through semen 

and vaginal fluid during

unprotected sexual contact with a person who 

has it. Touching infected 

sex organs, and then 

touching your eyes can 

cause an eye infection.

An infected pregnant 

woman can pass gonorrhea to her baby during 

vaginal delivery.

You cannot get gonorrhea from shaking hands 

or sitting on toilet seats.

Most women have no 

symptoms. When a woman does have symptoms, 

they most often appear 

within 10 days of becoming infected. Symptoms 

can include:

•	 Pain or burning while

passing urine

•	 Yellowish and sometimes bloody vaginal 

discharge

•	 Bleeding between

periods

•	 Pain during sex

•	 Heavy bleeding during

periods

These signs can be 

mistaken for a urinary 

tract infection or another 

vaginal infection.

Gonorrhea that affects 

the anus might cause 

discharge, soreness, 

bleeding, itching, or painful bowel movements. 

Infections in the throat 

could cause a sore 

throat. With eye infection, symptoms may include redness, itching, or 

discharge from the eye.

Your doctor can tell if you 

have gonorrhea by testing your urine or by testing a swab sample taken 

from the infected site, 

such as the cervix.
Sexually Transmitted Infections 49

Types of STIs

Hepatitis B How you get it Symptoms How to find out if 

you have it

Hepatitis B (HBV) is one

type of viral hepatitis. 

With hepatitis, the liver 

does not work well.

In most people, HBV gets 

better on its own. Longlasting hepatitis (chronic)

can lead to scarring of 

the liver, liver failure, and 

liver cancer. Chronic HBV 

can be suppressed with 

some antiviral drugs. But 

these drugs don’t work 

for all people.

Vaccines are available 

for hepatitis A and B.

HBV is spread by exposure to an infected 

person’s blood. This 

can happen by having 

vaginal, anal, or oral sex 

with someone who is 

infected. It also can be 

passed from an infected 

mother to her baby during vaginal childbirth or 

through sharing needles 

with an infected person. 

You also can get HBV by 

sharing personal items, 

such as razors or toothbrushes, with an infected 

person.

You cannot get hepatits 

through casual contact, 

such as shaking hands, 

hugging, or kissing.

Some people with viral 

hepatitis have no signs 

of infection. Others might 

have:

•	 Low-grade fever

•	 Headache

•	 Muscle aches

•	 Tiredness

•	 Loss of appetite

•	 Nausea

•	 Vomiting

•	 Diarrhea

•	 Dark-colored urine

and pale bowel movements

•	 Jaundice

Your doctor can tell if 

you have viral hepatitis 

through blood tests and 

a medical exam.

HIV/AIDS

For complete information, see the HIV/AIDS chapter on page 139.

Pubic lice How you get it Symptoms How to find out if 

you have it

Also called “crabs,” 

pubic lice are parasites 

found in the genital area 

on pubic hair and sometimes on other coarse 

body hairs. Pubic lice

are common. They are 

different from head lice. 

Special shampoos and 

medicines are used to 

kill pubic lice.

Pubic lice usually are

spread through sexual 

contact. Intercourse 

does not need to occur. Rarely, pubic lice 

are spread through 

contact with an infected 

person’s sheets, towels, 

or clothes.

Pubic lice CANNOT be

spread by sitting on a 

toilet seat. Animals do 

not get or spread pubic 

lice.

Symptoms of pubic lice 

include:

•	 Itching in the genital

area

•	 Visible nits (lice eggs)

or crawling lice (which 

look like crabs when 

viewed with a magnifying glass)

Doctors can tell if a 

person has pubic lice by 

looking closely at the pubic hair for nits or young 

or adult lice.
50 The Healthy Woman: A Complete Guide for All Ages

Types of STIs

Human 

papillomavirus 

(HPV) and genital 

warts

How you get it Symptoms How to find out if 

you have it

There are more than 

100 types of HPV, 30

of which are passed 

through sexual contact. 

The types of HPV that

infect the genital area 

are called genital HPV.

HPV is very common.

Most sexually active people will have it at some 

point in their lives.

Some types of genital 

HPV are “high risk,”

which means they put a 

woman at greater risk of 

getting cervical cancer. 

“High risk” does not have 

to do with the risk of getting HPV. Low-risk types

of HPV do not cause cervical cancer. But low-risk 

types of HPV may cause

genital warts.

There is no treatment or 

cure for HPV. But a new 

HPV vaccine protects 

women against some 

HPV types that cause 

cancer or warts. (See 

page 134 for more information.)

Genital HPV is passed by

skin-to-skin and genital 

contact, mainly during 

vaginal and anal intercourse. It might also be 

possible to pass it during 

oral sex.

HPV usually has no

symptoms. 

Both low-risk and highrisk types of HPV can

cause growths on the 

cervix and vagina. These 

often are invisible.

Low-risk types of HPV

can cause genital warts. 

Warts can form weeks, 

months, or years after 

sexual contact with a 

person who has genital 

HPV. They can grow

inside and around the 

outside of the vagina, 

on the vulva and cervix, 

groin, and in or around 

the anus. Warts can be 

raised or flat, alone or in

groups, small or large, 

and sometimes they are 

shaped like a cauliflower.

High-risk types of HPV

may cause cervical 

changes that, if not 

treated, may progress 

into cervical cancer.

A Pap test can find

changes on the cervix 

that are caused by HPV

infection. Women who 

have had the HPV vaccine still need to have a 

regular Pap test.

An HPV test, which is a

DNA test that detects 

high-risk types of HPV,

may be done for women 

who are older than 30 

or for women who are 

younger than 30 who 

have abnormal Pap test

results. An abnormal 

Pap test result does not

mean for sure that a 

woman has HPV or cervical cancer. Follow-up

tests are needed to confirm any diagnosis.

Having genital warts is 

another way a doctor can 

tell if a person has an 

HPV infection.
Sexually Transmitted Infections 51

Types of STIs

Syphilis How you get it Symptoms How to find out if 

you have it

Syphilis is caused by 

a type of bacteria. It 

progresses in stages. 

Without treatment, the 

infection will continue to 

progress, possibly leading to death.

Syphilis can be cured 

with an antibiotic. 

Penicillin is the preferred

drug to treat syphilis at 

all stages. Doctors can 

use other medicines for 

people who cannot take 

penicillin.

Syphilis is spread 

during vaginal, anal, or 

oral sex through contact 

with an open sore or contact with a skin rash of 

an infected person. The 

bacteria can enter the 

body through the penis, 

anus, vagina, mouth, or 

through broken skin. It 

can be spread during the 

first two stages of the

disease.

An infected pregnant 

woman also can pass 

syphilis to her baby during pregnancy and childbirth.

Syphilis is not spread by 

contact with toilet seats, 

doorknobs, swimming 

pools, hot tubs, bathtubs, shared clothing, or 

shared food and drinks.

In the primary stage, 

a single, painless sore 

appears about 10 to 90 

days after infection. It 

can appear in the genital 

area, tongue, lips, or 

other parts of the body. 

The sore will heal with or 

without treatment. 

The secondary stage 

starts 3 to 6 weeks after 

the sore appears. Symptoms can include:

•	 Skin rash with rough,

red or reddish-brown 

spots both on the 

hands and feet that 

usually does not itch 

and clears on its own

•	 Fever

•	 Sore throat and swollen glands

•	 Patchy hair loss

•	 Headaches and muscle aches

•	 Weight loss

•	 Tiredness

In the latent stage, 

symptoms go away, but 

can come back. When 

symptoms come back, 

the infection can be 

passed to others. People

without treatment may or 

may not move to the late 

stage.

In the late stage, the infection spreads and can 

cause damage throughout the body. Some 

people may die.

A doctor can tell if a 

person has syphilis in a 

number of ways:

•	 Recognizing the signs

and symptoms and 

confirming with tests

•	 Looking at the fluid

from a sore or swollen 

lymph node under a 

microscope

•	 Testing the patient’s

blood in the lab
52 The Healthy Woman: A Complete Guide for All Ages

Types of STIs

Trichomoniasis How you get it Symptoms How to find out if 

you have it

This infection, also called 

“trich,” is caused by a 

parasite. It usually is 

passed through sexual 

contact. But it also can 

be picked up from contact with damp, moist 

objects.

Antibiotics are used 

to treat and cure 

trichomoniasis.

The parasite can be 

passed though penisin-vagina intercourse or 

vulva-to-vulva contact 

with an infected partner. 

Women can get the disease from infected men 

or women.

It also can be passed if 

the genital area comes 

in contact with damp 

towels, wet clothing, toilet seats, or other moist 

objects where the parasites are present.

Many women do not have 

symptoms. Symptoms, 

which usually appear 5 to 

28 days after exposure, 

can include:

•	 Yellow, green, or gray

vaginal discharge 

(often foamy) with a

strong odor

•	 Discomfort during sex

or when passing urine

•	 Itching and discomfort

in the genital area

•	 Lower stomach pain

(rarely)

A doctor will do a pelvic 

exam and lab test to tell 

if a person has trichomoniasis. The doctor sometimes can see small, red 

sores inside the vagina 

or on the cervix. The doctor also will take a fluid

sample from the vagina 

and look for the parasite 

under a microscope or 

send the sample to a lab 

for testing, or use other 

lab tests.

If you have any symptoms of an STI, 

stop having sex and contact your 

doctor right away.

Treating STIs

The treatment depends on the type of 

STI. For some STIs, treatment may involve using medicine or getting a shot. 

For STIs that cannot be cured, like 

genital herpes, treatment can ease symptoms. During treatment, follow all of 

your doctor’s orders and avoid sex during 

treatment or an outbreak. And be sure 

to finish all the medicine your doctor 

gives you, even if your symptoms go away. 

With most STIs, your sexual partner(s) 

should be treated, too. This can keep you 

from getting the STI again or your partner from passing it to other people. Remember, the sooner an STI is found, the 

easier it is to treat and the less likely you 

will have health complications.

How untreated STIs can affect your 

health

You might be too shy to talk to your 

doctor about your risk of STIs or any 

symptoms you might be having. But not 

talking to your doctor could be far worse 

than any embarrassment you might feel. 

Untreated STIs can cause severe health 

problems for women, such as pelvic inflammatory disease, infertility, ectopic 

pregnancy, widespread infection to other 

parts of the body, cancer, organ damage, 

and even death.

STIs and pregnancy

STIs can cause many of the same health 

problems for pregnant women as for 

women who are not pregnant. Moreover, 

STIs during pregnancy can cause early 

labor, cause the water to break early, and 

cause infection in the uterus after the 

birth. STIs also can cause problems for 

the unborn baby. Some STIs can cross 

the placenta and infect the baby while 
Sexually Transmitted Infections 53

What is pelvic inflammatory disease (PID)?

Pelvic inflammatory disease, or PID, is a broad term used to describe an infection of

a woman’s pelvic organs. Many types of bacteria can cause PID. Often, PID is a complication of untreated STIs—mainly chlamydia and gonorrhea. Damage from PID can

cause a woman to become infertile (not able to become pregnant). In fact, about 1

in every 5 women with PID becomes infertile. PID also can cause chronic pelvic pain

and ectopic pregnancy (pregnancy in the fallopian tube, which can be life threatening). It can be hard to tell if a woman has PID because there are no specific tests for

PID and she might have mild or no symptoms. Women who have symptoms might

have:

•	pain in the lower belly area

•	fever

•	unusual vaginal discharge, which may smell bad

•	pain during sex

•	bleeding between periods

•	pain during pelvic exam

A doctor will ask about symptoms and can perform a pelvic exam and tests to tell if 

a woman has PID. Once found, PID can be cured with antibiotics. But any damage

already done to a woman’s reproductive organs before treatment cannot be reversed. 

So early treatment of PID is important. A woman should see her doctor right away if

she thinks she might have an STI or PID.

it is in the uterus. Others can be passed 

from a pregnant woman to the baby during delivery. The harmful effects to babies 

range from low birth weight, to chronic 

liver disease, to stillbirth. Some of these 

problems can be prevented if the mother 

has routine prenatal care, which includes 

screening tests for STIs at various points 

during the pregnancy. Other problems 

can be treated if the infection is found at 

birth or within a few days after birth.

STIs and breastfeeding mothers

Some STIs can be passed to your baby 

through breastfeeding. And some medicines used to treat STIs can pass to your 

baby through your breast milk. Talk to 

your doctor about whether you should 

breastfeed if you have an STI. (See page 

199 of the Breastfeeding chapter for more 

information.)

How to protect yourself from STIs

Even though STIs pass easily from person to person, there are steps you can 

take to lower your risk of getting an STI. 

The following steps work best when used 

together—no single strategy can protect 

you from every single type of STI. 
54 The Healthy Woman: A Complete Guide for All Ages

l	 Don’t have sex. The surest way to avoid 

getting any STI is to practice abstinence, which means not having vaginal, oral, or anal sex. Keep in mind that 

some STIs, such as genital herpes, can 

be spread without having intercourse.

l	 Be faithful. Having sex with one 

uninfected partner who only has sex 

with you will keep you safe from STIs. 

Both partners must be faithful all 

the time to avoid STI exposure. This 

means that you have sex only with 

each other and no one else. The fewer 

sex partners you have, the lower your 

risk of being exposed to an STI. 

l	 Use condoms correctly and EVERY 

time you have sex. Use condoms for 

all types of sexual contact, even if penetration does not take place. Condoms 

work by keeping blood, a man’s semen, 

and a woman’s vaginal fluid—all of 

which can carry STIs—from passing from one person to another. Use 

protection from the very beginning to 

How to Use Condoms Correctly 

Both male and female condoms are highly protective when used correctly. But don’t 

use them both at the same time! They do not stay in place when used together. Read 

the instructions and practice a few times before using condoms for the first time.

Also, follow these guidelines: 

Male condom

Use male condoms made of latex, or polyurethane if you or your partner is allergic 

to latex. “Natural” or “lambskin” condoms 

don’t protect against STIs. Use male condoms for vaginal, anal, or oral sex.

•	Keep male condoms in a cool, dry place.

Storing condoms where it can get hot, 

such as in the car or your wallet, can 

cause them to break or tear.

•	Check the wrapper for tears and to make

sure the condom is not too old to use. 

Carefully open the wrapper—don’t use 

your teeth or fingernails. Make sure the condom looks okay to use. Don’t use a

condom that’s gummy, brittle, discolored, or has even a tiny hole.

•	Put on the condom as soon as the penis is erect, but before it touches the vagina,

mouth, or anus.

•	Use only lubricants made with water (such as, K-Y JellyTM, AstroglideTM, AquaLubeTM,

glycerine). Oil-based lubricants, such as VaselineTM, can weaken the condom. The

lubricant is put on the outside of the condom. It helps to keep the condom from 

tearing. Don’t regularly use lubricants with spermicide called nonoxynol-9 (N-9),

which might make it easier for an STI—including HIV—to get into your body.
Sexually Transmitted Infections 55

•	After sex, pull out the penis while it is still erect, holding the condom firmly at the

base of the penis so it does not slip off.

•	Use a new condom if you want to have sex again or in a different way.

Female condom

The female condom (RealityTM) is made of the

plastic polyurethane. It has a ring on each 

end. The inside ring holds the condom in 

place inside the vagina. The outer ring stays 

outside the vagina so it covers the labia. Use

female condoms for vaginal sex if your partner can’t or won’t use a male condom.

•	Check the wrapper for tears and to make

sure the condom is not too old to use. 

Open the wrapper carefully—don’t use your 

teeth or fingernails. Make sure the condom

looks okay to use.

•	Put the condom into the vagina up to 8

hours before having sex, but before the 

penis touches the vagina. The condom cannot disappear inside your body.

•	It is okay to use water or oil-based lubricants. The lubricant is put on the inside 

and outside of the condom.

•	After sex, remove the condom before standing up. Grasp the outside ring and twist

the condom to trap in fluid and gently remove.

•	Use a new condom if you want to have sex again or in a different way.

the very end of each sex act, and with 

every sex partner. And be prepared: 

Don’t rely on your partner to have 

protection.

l	 Know that certain birth control 

methods—and other methods—don’t 

protect against STIs. Birth control 

methods including the pill, shots, implants, intrauterine devices (IUDs), 

diaphragms, and spermicides will not 

protect you from STIs. They only can 

help keep you from getting pregnant. 

Still, many women who use these 

forms of birth control don’t use condoms. If you use one of these birth 

control methods, make sure to also 

use a condom with every sex act. Also, 

don’t use contraceptives that contain 

the spermicide nonoxynol-9 (N-9). N9 can irritate the vagina, which might 

make it easier for an STI—including 

HIV—to get into your body. Keep in 

mind that women who are unable to 

become pregnant can get STIs.
56 The Healthy Woman: A Complete Guide for All Ages

You might have heard of other ways 

to keep from getting STIs—such as 

washing genitals before sex, passing 

urine after sex, douching after sex, or 

washing the genital area with vinegar 

after sex. These methods DO NOT 

prevent the spread of STIs.

l	 Talk with your sex partner(s) about 

using condoms before having sex.

This way, you can set the ground rules 

and avoid misunderstandings during a moment of passion. Hopefully, 

you and your partner will agree to use 

condoms all the time. But know this: 

You can control their use by making it 

clear that you will not have any type 

of sex at any time without a condom. 

Remember, it’s your body, and it’s up 

to you to make sure you are protected.

l	 Don’t assume you’re at low risk 

for STIs if you have sex only with 

women. Some common STIs are 

spread easily by skin-to-skin contact. 

Also, most women who have sex with 

women have had sex with men, too. So 

a woman can get an STI from a male 

partner, and then pass it to a female 

partner.

l	 Don’t abuse drugs or alcohol. Heavy 

drinking and drug use can put you 

at greater risk of STIs. Drinking too 

much and using drugs are linked to 

sexual risk-taking, such as having sex 

with more than one partner and not 

using condoms. Drug users who share 

needles risk exposure to blood-borne 

infections that also can be passed 

sexually, such as HIV and hepatitis B. 

Drinking too much alcohol or using 

drugs puts you at risk of sexual assault 

and possible exposure to an STI. 

l	 Get tested for STIs. If either you or 

your partner has had other sexual partners in the past, get tested for STIs 

before becoming sexually active. Don’t 

wait for your doctor to ask you about 

getting tested—ask your doctor! Many 

tests for STIs can be done at the same 

time as your regular pelvic exam. 

l	 Have regular checkups and pelvic 

exams—even if you think you’re 

healthy. During the checkup, your 

doctor will ask you a lot of questions 

about your lifestyle, including your sex 

life. This might seem too personal to 

share. But answering honestly is the 

only way your doctor is sure to give 

you the care you need. Your doctor 

might also do a Pap test to check for 

signs of cancer in your cervix. Ask your 

doctor how often you need a Pap test. 

Also, ask your doctor if the HPV vaccine is right for you. (See page 134 for 

more information.)
Sexually Transmitted Infections 57

After diagnosis: What to do if you 

have an STI

Finding out that you have an STI might 

be difficult to face, especially if the 

source of your STI is an unfaithful partner or if it cannot be cured. For many, 

coping with the emotional side of having 

an STI is more difficult than managing 

the physical effects. But once you know 

what you are up against, you can start 

treatment right away and take steps to 

keep you and your partner(s) healthy. 

Let partners know

Although you might not want to tell 

anybody about your STI, informing all

your sexual partner(s) is the only way to 

stop the STI from getting passed to others or possibly reinfecting you. If your 

partner has other partners, they should 

be notified too. There are a few ways to 

do this:

1. Tell your partner(s) yourself and urge 

your partner(s) to get treated for the 

STI. For gonorrhea or chlamydial infection, you might be able to give your 

partner the needed medicine without 

him seeing a doctor. This is called expedited partner therapy (EPT). EPT 

is a last-resort option for partner(s) 

who won’t or can’t see a doctor. EPT is 

not possible in all states. If your partner is unwilling to seek treatment, ask 

your doctor if EPT is possible where 

you live.

2. Ask your doctor or the clinic where 

you were diagnosed to notify your 

sexual partner(s) anonymously. That 

means they won’t disclose your name.

3. Tell your main partner, but ask that 

your medical provider inform all other 

or past partners.

4. Ask your doctor for help if you fear 

that notifying your partner(s) might 

lead to a violent or abusive reaction.

Follow treatment orders

Different STIs are treated differently. 

Follow your doctor’s orders and finish any medicine you are given to cure 

or manage the infection. Even if your 

symptoms go away, you still need to finish all the medicine. Your doctor also will 

instruct you to not have sex until you and 

your partner(s) have finished treatment 

and until symptoms, such as sores, have 

completely cleared. You might also need 

to get a follow-up test after treatment to 

make sure the infection is cured. Doing 

these things is the only way to be sure 

your STI is treated and won’t be passed 

to other people.
58 The Healthy Woman: A Complete Guide for All Ages

Be responsible sexually

Whether you are in a long-term relationship or involved with somebody new, 

it’s up to you to act responsibly when 

it comes to your and your partner’s(s’) 

sexual health. This means:

l	 talking honestly about your having 

an STI, so that your current or fuFrequently Asked Questions About the HPV Vaccine

I’ve never heard of the HPV vaccine. What is it?

Many women don’t know about the HPV vaccine and

question whether it is something they need. That’s 

because the HPV vaccine came out in 2006. It is

the first vaccine to prevent cervical cancer and other

diseases caused by certain types of genital human 

papillomavirus (HPV). The vaccine protects women

against four HPV types, which together cause 70

percent of cervical cancers and 90 percent of genital 

warts. It does not treat existing HPV infections. The

vaccine is given through a series of three shots over 

a 6-month period. Getting the vaccine is important, 

because more than half of sexually active women and men are infected with HPV at

some point in their lives. 

Who should get this vaccine?

It is recommended for 11- to 12-year-old girls, and it can be given to girls as young as 

9—an age when most girls are not yet sexually active. It is also recommended for 13- 

to 26-year-old females who have not yet received or completed the vaccine series. 

How long does vaccine protection last?

So far, we know that protection from HPV lasts at least 5 years in women who have

been vaccinated. 

I’m older than 26. Why isn’t the vaccine recommended for me—or for men?

So far, the vaccine has been widely tested only in 9- to 26-year-old females. Research 

is just beginning to look at whether the vaccine also is safe and effective in women 

older than 26. Researchers also are working to find out if the vaccine will prevent HPV

in men and boys. 

I’m pregnant. Should I get the HPV vaccine?

Pregnant women should not get the HPV vaccine until after the baby is born. There is

not enough research to know how the vaccine might affect pregnant women and their 

unborn babies.

After I get the HPV vaccine, do I still need to be screened for cervical cancer?

Yes. There are three reasons why. First, the vaccine does not protect against all HPV

types that cause cancer. Second, women who don’t get all the vaccine doses (or at 

the right time) might not be fully protected. Third, women may not fully benefit from

the vaccine if they got it after acquiring one or more of the four HPV types.
Sexually Transmitted Infections 59

ture partner(s) can make an informed 

choice whether or not to be intimate 

with you

l	 abstaining from sexual contact during 

treatment or when you have symptoms, such as warts or sores

Take care of your emotions

If you recently found out that you have 

an STI, you might feel like you’re the 

only one or that you’re now “different” 

from other people. You might feel embarrassed, a sense of “dirtiness,” shame, 

or guilt. These feelings might keep you 

from wanting to seek treatment or telling your partner(s). You also might worry 

about getting better or that an STI will 

keep you from having a long-lasting 

romantic relationship in the future. Rest 

assured that these feelings are normal at 

first and will lessen over time. The following tips might also help you to adjust 

to the diagnosis:

l	 Learning the facts about the STI will 

help put your situation in perspective 

and give you a sense of greater control 

over your health and well-being.

l	 Talking to a trusted friend or loved 

one will ease stress.

l	 Connecting with a support group can 

help you to feel less alone and to see 

how others have dealt with similar 

situations in a positive way.

Keep in mind that stigma is behind 

many of the negative feelings that surround STIs. If you are living with an 

STI, try not to become a victim of stigma yourself. The more you know about 

STIs, the better control you will have 

over your sexual health. At the same 

time, knowing more can make it easier to 

talk about STIs with a loved one. n
60 The Healthy Woman: A Complete Guide for All Ages

One Woman’s Story

Don’t let three 

letters define you.

At the start of my sophomore year, I couldn’t have been more prepared to take on the year. I spent the summer interning and training for a race with my sister. I felt accomplished and healthy. But my first test of the year changed everything.

My yearly Pap showed abnormal cells, so we ran an HPV test, which confirmed that I have

human papillomavirus (HPV). The next step was to see a gynecologist and have a colposcopy.

I was sure I would die from cervical cancer. If not, stress would do me in. I spent hours 

with the nurse practitioner, getting medical leave for doctor’s appointments, worrying 

about how to cover the cost of procedures and doctor’s visits, and coping with possibly 

spreading HPV to my boyfriend.

At some point, my sister sent a card with 

a few encouraging words. “Don’t let three 

letters define you,” she wrote. Her words

helped me through the most difficult parts.

Telling my mom I wasn’t sure how I got HPV

was extremely hard. I was disappointed in 

myself, and it felt even worse that my mom 

might be too. Telling friends, who used to 

know everything about me, that I had a 

doctor’s appointment without elaborating or talking with my boyfriend about how HPV impacts him were the most challenging moments in those relationships.

This year I’ve had two Pap tests, two colposcopies, and an undying sense of guilt for

bringing this on my family and boyfriend. I feel guilty because I knew how to prevent STIs. 

I can only be reassured knowing that when cell changes are monitored, cervical cancer 

is rare. I can’t go back and change the past, but I can prevent this from getting worse. I 

choose what defines me, and this is not it.

Kathleen

Toms River, New Jersey
Sexually Transmitted Infections 61

For More Information...

Office on Women’s Health, HHS

200 Independence Ave SW, Room 712E

Washington, DC 20201

Web site: www.womenshealth.gov/faq/

stdsgen.htm

Phone number: (800) 994-9662,

(888) 220-5446 TDD

Division of STD Prevention, CDC

1600 Clifton Rd NE

Atlanta, GA 30333

Web site: www.cdc.gov/std

Phone number: (800) 232-4636,

(888) 232-6348 TTY

American College of Obstetricians and 

Gynecologists

409 12th St SW, PO Box 96920

Washington, DC 20090-6920

Web site: www.acog.org

Phone number: (202) 863-2518 Resource

Center

American Social Health Association

PO Box 13827

Research Triangle Park, NC 27709

Web site: www.ashastd.org

Phone number: (800) 227-8922 STI

Hotline

CDC National Prevention Information 

Network

PO Box 6003

Rockville, MD 20849-6003

Web site: www.cdcnpin.org 

Phone number: (800) 458-5231

Planned Parenthood Federation of 

America

434 W 33rd St

New York, NY 10001

Web site: www.plannedparenthood.org

Phone number: (800) 230-7526