1. What are sexually transmitted diseases (STDs)?
2. Are sexually transmitted infections (STIs) different from sexually transmitted diseases (STDs)?
3. How common are STDs?
4. What is the relationship between STDs and HIV?
5. Why can it be hard to notice if I have an STD?
6. What are the symptoms of common STDs?
7. What should I do if I think I might have an STD?
8. Why is knowing whether I have an STD important if I am pregnant or planning to become pregnant?
9. How can I avoid getting an STD?
10. Where can I get more information on STDs?

1. What are sexually transmitted diseases (STDs)?

Sexually transmitted diseases are diseases that can be passed from person to person through sexual contact. Depending on the STD, sexual contact that causes transmission can include penis-vagina penetration, oral sex, anal sex, and/or mutual masturbation (touching someone else’s genitals and then touching yours). Some of these diseases can be transmitted by exchange of sexual fluids such as semen or vaginal discharge. Others are usually transmitted by open sores or warts of an infected person coming into contact with the skin of an uninfected person. Occasionally, STDs can be transmitted in non-sexual ways, such as through casual contact, by sharing needles, or from an infected mother to her baby during pregnancy or delivery.

There are many different kinds of STDs: some are easily cured with simple drugs, some take multiple kinds of treatments and drugs to cure, and some can only be treated and not cured. It is important to understand STDs to be able to protect yourself from future infection, to be able to recognize the symptoms of STDs, and to be able to seek treatment if you think you might have an STD.

2. Are sexually transmitted infections (STIs) different from sexually transmitted diseases (STDs)?

Sometimes the terms STI and STD are used interchangeably. This can be confusing and not always accurate, so it helps first to understand the difference between infection and disease. Infection simply means that a germ – virus, bacteria, or parasite – that can cause disease or sickness is present inside a person’s body. An infected person does not necessarily have any symptoms or signs that the virus or bacteria is actually hurting their body (they do not necessarily feel sick). A disease means that the infection is actually causing the infected person to feel sick, or to notice something is wrong. For this reason, the term STI – which refers to infection with any germ that can cause an STD, even if the infected person has no symptoms – is a much broader term than STD.

The term STD refers only to infections that are causing symptoms or problems. Because most of the time, people don’t know they are infected with an STI until they start showing symptoms of disease, the AIDS Resource Center uses the term STD, even though the term STI is also appropriate in many cases.

Depending on the STI, a person may or may not still be able to spread the infection if no signs of disease are present. For example, a person is much more likely to spread herpes infection when blisters are present (STD) than when they are absent (STI). However, a person can spread HIV infection (STI) at any time, even if they haven’t developed symptoms of AIDS (STD).

3. How common are STDs?

In sub-Saharan Africa, 65 million new cases of curable STDs occur among adults every year (WHO 1998). It is estimated that for every 1,000 people in sub-Saharan Africa, 254 people become infected with a curable STD each year. It is estimated that for women ages 15-44, STDs (excluding HIV) are the second most common cause of healthy life lost, after the risks of death and infirmity associated with childbearing.

4. What is the relationship between STDs and HIV?

A person who has an STD is much more likely than someone without an STD to become infected with HIV if they have unprotected sex (sex without a condom) with an HIV-infected person. This is especially true for people infected with an STD that causes genital ulcerations (cuts/open sores on the vagina or penis, or nearby areas). Cuts and open sores provide an easy route for HIV to enter the bloodstream. STDs that can cause genital ulcerations include herpes, syphilis, chancre, gonorrhea, trichomoniasis, and scabies.

5. Why can it be hard to notice if I have an STD?

Most people with STDs have no symptoms. When symptoms are present, they are often hard to recognize because they can be confused with non-sexual diseases. This is especially true for women. This is why it is good to have routine check-ups if you are sexually active, especially if you have had multiple sexual partners (even if you used a condom every time).
However, there are some symptoms to look for if you think you might have an STD.
In women, the most common symptoms of an STD are:

• unusual or bad-smelling vaginal discharge,
• severe itching or burning in the genital area,
• unusual bleeding,
• pelvic pain,
• pain during sex,
• rashes on the genitals,
• open sores or warts on the genital area, and/or
• recurrent urinary tract infections.

In men, the most common symptoms of an STD are:

• pain when urinating,
• open sores or warts on the genital area,
• rashes on the genitals,
• discharge from the penis, and/or
• pain in the scrotum/testicles.

However, in both men and women, STDs can cause symptoms in other parts of the body besides the genitals and bladder, including:

• discharge from the anus,
• swelling of the groin,
• jaundice (yellowing of the skin and whites of the eyes),
• arthritis,
• oral thrush (white tongue),
• sores or bumps in and around the mouth, and
• generalized rashes.

In general, if you:

• notice any sores or warts on or near your genitals,
• have a rash in your genital area,
• have severe itching of your genitals, or
• notice unusual or bad-smelling discharge from your penis or vagina,

Early treatment increases your chances of being cured, if a cure is possible. If a cure is not possible, early treatment improves your ability to prevent negative consequences of infection, including infection with other STDs.

6. What are the symptoms of common STDs?

Specific causes and symptoms associated with some of the more common STDs are described below. However, in general, if you experience any of the symptoms listed in the previous section, visit your clinic or hospital for a check-up.

Chancre – Chancre, caused by bacteria, results in one or more ulcer(s) (open sores) on the genitals within a week after exposure, as well as swollen lymph nodes on one or both sides of the groin. Sometimes the lymph nodes swell and form an abscess. The condition can be extremely painful, but can easily be treated with antibiotics.

Chlamydia – Chlamydial infections often have no symptoms, and may occur alongside other STDs, such as gonorrhea. However, chlamydia can sometimes cause pain when urinating in both men and women, as well as abnormal discharge from the tip of the penis or the vagina. Chlamydia can also cause pelvic inflammatory disease (including chronic pain in the abdomen and abnormal menstruation) in women, which can be very painful and can lead to inability to bear children. Chlamydia can be easily treated with antimicrobial drugs, but both partners should be treated to avoid re-infection.

Gonorrhea – Gonorrhea, also called “the clap,” is a very common STD, and frequently occurs as co-infection with chlamydia. Men with gonorrhea often experience discharge from the end of their penis, and feel pain when urinating. In women, gonorrhea has no symptoms in almost 70% of cases, but some women experience unusual vaginal discharge, or have pain when urinating and have to urinate more often than normal. Occasionally, gonorrheal infection can spread through the body and cause sores like pimples on many different parts of the body including hands, back, legs, and shoulders, as well as cause a rash or arthritis-like symptoms. Treatment is simple: gonorrhea is easy to cure with antibiotics, but both partners need to be treated or re-infection will occur.

Genital warts (or HPV) – Genital warts are caused by a virus called the human papilloma virus. The virus is extremely contagious: genital warts are one of the most common STDs. Warts can affect the penis or anal area in men, and the outer areas of the vagina, the anal area, and even the surface of the cervix and inner walls of the vagina in women. Genital warts are often painless and can be hard to see, however, they sometimes grow in number or size. They usually look like raised bumps or growths with a rough, uneven surface. Genital warts on the cervix tend to be flat, and can be hard to feel or notice. If left untreated over many years, HPV of the cervix can lead to cervical cancer. HPV infection of the cervix can be detected by having routine Pap smears every year or two. HPV infection cannot be cured, but warts can be removed with medical treatment (even though they often come back). If you have all your HPV warts removed, you are much less likely to infect your partner.

Herpes – Herpes is caused by a virus, and unfortunately, there is no cure. Herpes causes multiple painful open sores on the penis or nearby areas (scrotum, anus, buttocks, or thighs) in men, or on the vulva and cervix, or nearby areas (anus, buttocks, or thighs) in women. Herpes sores tend to happen in outbreaks – a person might have multiple sores for a while, but they go away in 3 to 4 weeks, and come back a few months later. Outbreaks can happen at any time, but are encouraged by stress, poor nutrition, other illnesses, or physical weakness. When a person has herpes sores, he or she is much more likely to infect someone else if he or she has sex (or other intimate contact) with them. If a person has no sores, it is possible but not as likely that their sex partner will become infected. Sex with a condom when you are not experiencing a herpes outbreak is the best way to protect your sexual partner if you have herpes infection. If you have herpes sores, a condom is not effective in preventing transmission of herpes infection. While some medications are under development that can reduce the frequency of outbreaks, they are unfortunately hard to find in Ethiopia.

HIV – Even though HIV can be transmitted in non-sexual ways, it is spread primarily through sexual activity in Ethiopia, and so it is considered an STI. When HIV has weakened the immune system so much that a person gets sick with other diseases easily, the person is said to have AIDS (considered an STD). HIV infection usually has no symptoms, but if you think you could have been exposed to the HIV virus (you had sex, especially unprotected sex, with a person who has HIV or AIDS, or who died from AIDS or unknown causes), you can increase your chances of living a long and healthy life by getting tested for HIV before symptoms of AIDS appear.

Symptoms of AIDS can vary greatly. Usually, a person who has AIDS has a very weak immune system, and so they often get unusual diseases (called opportunistic infections) that an ordinary healthy person would not get. These diseases include untreatable yeast infections, rare cancers, rare pneumonias, active tuberculosis disease, and other chronic viral infections. People with AIDS often lose a lot of weight rapidly and for no apparent reason. Most opportunistic infections can be treated successfully, especially if they are treated early before the body gets too weak to handle strong medicines. For this reason, knowing your HIV status can do a lot to prolong your life by helping you change your behaviors, whether or not you have the virus. You can find out your HIV status for around 10 birr at places called voluntary counseling and testing (VCT) sites. If you still have questions about HIV and AIDS, click here to read a list of FAQ’s about HIV and AIDS.

Scabies – Scabies is caused by a mite, a small creature that lives in the skin around the genitals. It causes severe itching, especially during the night. Symptoms appear 2-6 weeks after contact with another person who has scabies. The infestation causes a rash on the fingers, wrists, and (in males) the penis, as well as blisters on these areas as well as elbows, armpits, (in females) breasts, abdomen, (in males) scrotum, buttocks, and/or thighs. Bathing frequently helps to reduce the bites and itching, but treatment with malathion or permethrin can kill the mites.

Syphilis – Almost 1/3 of the world’s new syphilis cases each year occur in sub-Saharan Africa, making it one of the most common, and potentially most deadly, STDs in Africa. People infected with syphilis have symptoms early after infection, when the disease can be easily treated with penicillin or other common drugs. However, the longer a person has had syphilis, the harder it is to treat.

Nine to Ninty days after a person is infected with syphilis, a person develops a single, round, open sore on the penis, vagina, or nearby area. It is usually painless, and heals in 3 to 10 weeks. Because it is painless and can sometimes occur in hard-to-see places (such as the cervix, underside of the penis, and inside the rectum, many people with syphilis never notice this stage. Four to eight weeks after the first open sore appears, many more appear (either as individual sores or a generalized rash) anywhere on the body.

Syphilis eventually enters a long inactive, or latent, phase where no symptoms are noticed. After the latent phase, very serious symptoms appear, including blindness, insanity, paralysis, convulsions, and joint pain. At this point, syphilis is much harder to treat, and symptoms may not be reversible.

Pregnant women are often tested for syphilis, as syphilis can be passed to the baby while the mother is pregnant, and can cause deformities, sores, blindness, and bone development problems in the baby.

Trichomoniasis – Trichomoniasis is caused by a parasite that lives in the tissue lining the vagina, penis, prostate, and semen ducts. In women, infection often causes a bad-smelling vaginal discharge, and sometimes itching, swelling, pain during sex, and pain while urinating. Still, some women may have no symptoms. In men, infection rarely causes any symptoms, though occasionally they may experience pain while urinating. Trichomoniasis is easily treated with a medicine called metronidazole, but both partners must be treated to prevent recurrence of the infection.

7. What should I do if I think I might have an STD?

If you have any of the symptoms described above, or you suspect you could have been exposed to an STD, it’s important to get medical help.

People who think they might have an STD often feel scared or embarrassed. It is normal to feel this way, but it is important to keep your feelings from getting in the way of seeking medical help. Untreated STDs usually get worse, making you even more scared and embarrassed. Some STDs can make you very sick or even kill you. If you have an untreated STD, you can infect anyone else you have sex with.

If you are worried people might find out you are getting tested or treated for an STD, many clinics and hospitals provide anonymous testing, and even free treatment if you have an STD.
If you think or know you have an STD, it is important to consider changing your sexual behavior. Because some STDs, like herpes and HPV, cannot always be prevented with condoms, you may consider abstinence (not having sex) as an option. You may also wish to take precautions with your sexual partner(s). This means talking to them about your sexual history and any infections you have, encouraging them to seek diagnosis and treatment if it is possible they have an STD, encouraging faithfulness to one another, and using a condom.

If you find out you have an STD, it is important to:

• avoid sex while being treated;
• follow the full treatment regimen prescribed by your doctor; and
• tell recent sexual partners, so they can seek treatment themselves if they are infected, and avoid infecting others.

8. Why is knowing whether I have an STD important if I am pregnant or planning to become pregnant?

Many STDs can be passed from a mother to her baby either while she is pregnant (syphilis) or while the baby is passing through the birth canal during delivery (chlamydia, gonorrhea, herpes, and others). The consequences of STD infection in infants can be extremely serious and lifelong, including blindness, deformity, brain damage, deafness, pneumonia, and even fetal or infant death.

With medicines and appropriate medical care, it is easy to prevent the transmission of STDs from the mother to her child. This is why it is important for women planning to have children, or who are already pregnant, to seek testing and treatment for STDs if they could have been exposed.

9. How can I avoid getting an STD?

The best way to avoid getting an STD is by abstaining from (not having) sex. This includes oral, vaginal, and anal sex. Some STDs, like herpes and HPV, cannot always be prevented with condoms, so not having sex protects you from this risk.

If you are a teenager, delaying having sex until your twenties can reduce your risk of getting an STD. The younger you are when you start having sex, the more likely you are to get an STD. Also, the more sexual partners you have in a lifetime, the greater your risk.

If you are sexually active, take precautions with your sexual partner(s). This means talking honestly about your sexual experiences in the past and your faithfulness in the present, and going to a clinic (separately or together) to make sure neither of you have an STD, even if you have no symptoms. Staying faithful to one another once you know you are both uninfected is the second best way to avoid getting an STD.

If abstinence or being faithful to one uninfected partner is not possible for you, consider using a condom every time you have sex. While condoms are not 100% effective in preventing the transmission of STDs, they help reduce your risk of getting almost all STDs. Especially when having sex with a new partner, have regular check-ups to screen for STDs. Additional ways to reduce your risk include avoiding sex during a woman’s menstrual period, avoiding douching (for women), avoiding anal sex without a condom, and learning to recognize symptoms early.

10. Where can I get more information on STDs?

Helpful information on STDs is available by clicking on the STD/STI links on the Links page. You can also visit the AIDS Resource Center next to London Café on Bole Road, which has many different books, articles, posters, and videos about STDs to help you learn more about these diseases and their treatment on your own. You can also ask your doctor or health care provider any questions you may have about STDs and their prevention and treatment.