Booklet: Sexually Transmitted Infections

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Organization: Public Health Agency of Canada

Date published: February 2020

Contents

What is an STI?

Sexually transmitted infections, commonly called STI for short, are infections you can get if you have vaginal, oral or anal sex or intimate skin-to-skin contact with someone.

What are some common STI?

Can STI be cured?

There are quite a few STI that can be treated and cured with antibiotics, or a combination of antibiotics. Herpes and HIV can't be cured, but they can be treated effectively. Other STI, such as hepatitis B and HPV can be prevented with vaccines.

However, some STI, including gonorrhea, syphilis and chlamydia are becoming increasingly difficult to treat due to antibiotic resistance. This means these infections may become untreatable someday because antibiotics may no longer work.

What are the long-term effects of an untreated STI?

If left untreated or if treatment isn't completed, STI can persist or recur, and can cause serious health problems.

Long-term effects on your fertility and/or other gynaecological issues (e.g., chlamydia, gonorrhea)

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Make sexual health part of your routine health checkups. Consider whether you want to have sex, practise safer sex, and get tested regularly for STI if you're sexually active.

Long-term effects on your genital area or anus (e.g., HPV, HSV, LGV)

Long-term effects on your health (e.g., HIV, hepatitis, syphilis)

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Birth control, including the pill, intrauterine devices (IUD/IUS) and other contraceptives, help to protect against pregnancy, not STI.

Birth control isn't 100% effective and will only work if used correctly, and consistently.

If you're sexually active, use birth control, make sure you use condoms and/or dental dams, and get tested regularly for STI, including HIV.

Reduce your risk

Can I get an STI without intercourse if we are just fooling around?

Yes, you can get some STI just by intimate skin-to-skin touching or kissing of an infected area.

All kinds of sex, including oral, vaginal and anal intercourse, can transmit infections. They're also contracted through body fluids like blood, semen, saliva, vaginal secretions and breast milk.

It doesn't matter whether you're heterosexual, gay, bisexual, transgender, two-spirit or questioning. STI can be transmitted by anyone.

Drugs and/or alcohol can impair judgement and lead to risky behaviour. When you or your partner are impaired and 'caught up in the moment', you may be more likely to have sex without a condom and take other risks that can increase your exposure to STI and unplanned pregnancy.

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Most STI have no obvious symptoms (or only mild ones), so you may not know if you or your sexual partner has an infection. That's why practising safer sex (always using condoms) and getting tested regularly is so important.

You can choose not to have sex

You might not be ready to have sex if:

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STI rates are the highest among Canadians 25 years or younger. If you choose to have sex, remember to always use condoms and/or dental dams.

What is consent and what is sexual assault?

Consent is when you and your partner feel informed and freely agree to participate in any sexual activity. Your body is yours alone and only you can give your consent.

If one of you is drunk, on drugs, or feels forced, consent has not actually been given. And even if you originally said "yes", you can still change your mind. Saying "no" at any time still means "no." Any type of sexual activity without your consent or your partner's consent is sexual assault.

You may feel pressured to have sex

Pressure to engage in sexual activity can come from many sources, including someone you know well, such as a classmate, friend or partner, someone who has been bullying you (online or in person), or someone you have chatted with or 'met' on a dating site or hookup app.

Sexting is considered a risky sexual activity, even though it isn't physical and won't cause an STI. Sexting usually involves sending sexually explicit pictures and/or texts online. Once those images or words are sent, you have no control over whether or not they will be shared with other people.

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Visit Sex & U for more information on consent, sexual assault and online safety.

If you think you've been sexually assaulted, it's not your fault. Don't hesitate to seek help. Find a sexual assault crisis centre near you.

What should I think about and do before I have sex?

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Hepatitis B and HPV can be prevented by a vaccine.

Condoms and dental dams

Most STI can be prevented by using a condom or dental dam during vaginal, anal or oral sex. You can buy condoms or dental dams at drug stores or health clinics without a prescription. The use of pre-lubricated condoms or added personal lubricants can help prevent the risk of a condom breaking.

Other things to think about:

How to use an external ("male") condom

External condoms are also known as "male" condoms because they cover the penis during sex. There are 3 kinds of external condoms: natural, latex and synthetic. Natural condoms help prevent pregnancy but don't protect against STI. To protect against STI, make sure to use a latex or synthetic condom.

1. Open carefully

Don't use teeth, scissors or a knife to open the condom. Roughly tearing or handling the condom can damage it. If the person handling the condom has long fingernails, be extra careful as they can nick the condom, making it ineffective, putting you at risk of STI or unplanned pregnancy.

2. Place and pinch

Put the condom at the tip of the erect penis and pinch out the air at the top. You can also put condoms on sex toys to make sure they won't transmit STI. If the sex toy is inserted in different partners or openings, the condom should be changed.

3. Roll it on

Unroll the condom right down to the base of the erect penis or sex toy.

4. Afterwards

The condom user should pull out right after ejaculation and while the penis is still hard. Remember to hold the base of the condom when pulling out so that it doesn't come off. Throw the used condom in the garbage and don't reuse it.

Lubricants

It's recommended to use lubricated condoms and, if needed, add a personal lubricant to the outside of the condom to decrease the risk of breaking and to decrease discomfort.

Broken condoms can put you at risk of STI or pregnancy. Only water-based lubricants should be used with latex condoms. Synthetic condoms are fine to use with oil or water-based lubricants.

How to use an internal ("female") condom

Internal condoms are also known as "female" condoms because they're inserted in an opening, such as the vagina. These condoms are larger than "male" condoms and are pre-lubricated. When used properly, they're highly effective at preventing pregnancy and reducing the risk of STI. They are primarily used for vaginal sex, but they can also be used for anal sex. It's not recommended to use a "male" condom and a "female" condom at the same time as it increases the risk of a condom breaking.

1. Open carefully

Don't use teeth, scissors or a knife to open the condom. Roughly tearing or handling the condom can damage it. If the person handling the condom has long fingernails, be extra careful as they can nick the condom, making it ineffective, putting you at risk of STI or unplanned pregnancy.

2. Placement

The outer ring covers the area around the opening of the vagina or anus. The inner ring is used for insertion and to help hold the condom in place during intercourse. Hold the condom at the closed end, squat, sit or lie comfortably and then slide the inner ring inside. Gently push the inner ring up as far as it will go, with the outer ring remaining on the outside. Guide the penis or sex toy to make sure it's entering inside the condom, not next to it.

3. Afterwards

To remove the condom, twist the outer ring gently and pull the condom out. Throw the used condom in the garbage and don't reuse it.

Lubricants

"Female" condoms usually come pre-lubricated or with a small package of lubricant. If you need additional lubricant, make sure you know what kind of condom you're using first.

For polyurethane condoms, oil-based lubricant products can be used. For latex condoms, use a lubricant made of water, glycol or silicone. The use of the proper lubricant will help avoid breakage and discomfort.

How to use a dental dam

Dental dams are latex or polyurethane sheets that are used as a barrier between the mouth and vagina, penis, or anus during oral sex. They're rectangles of about 10 inches by 6 inches and are available online and at some health clinics, specialty sex shops and drug stores without a prescription. You can also easily make a homemade dental dam.

1. Open carefully

Unfold the dam and check for holes or damage that could make it less effective.

2. Placement of the dental dam

Put the dam flat across the vaginal or anal area before any oral contact. One partner needs to hold it in place.

3. Afterwards

Fold the dam up and throw it in the garbage, and don't reuse it.

Lubricants

A water-based personal lubricant may be used directly on vaginal or anal areas before putting the dam in place and can help hold the dam in place.

DIY

You can make a dental dam from an unlubricated condom by rolling it out, cutting off the top and the ring, and then cutting along the length to create a rectangle.

STI symptoms and treatments

Syphilis

What is it?

Syphilis is a bacterial infection that's on the rise in Canada. If undetected, during the first 2 years of infection, you can pass on syphilis, even if you don't have any symptoms. After these 2 years, you will still have the infection, but you can't 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're pregnant, it's important to get tested and treated.

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The number of people with syphilis is increasing. While it's more common among men, syphilis is increasingly affecting women.

Syphilis won't go away on its own if left untreated.

How can you tell if you have it?

Symptoms may include:

If you have syphilis

You should notify your sexual partner(s) so that they can be tested and treated, if needed, and avoid exposing others. If you're uncomfortable notifying your partner(s), ask your health care provider or local public health unit for assistance.

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's possible to have more than one infection at the same time. If you're tested for syphilis, have a discussion with your health care 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've been treated for syphilis, you will need to go for follow-up blood tests to make sure the infection is gone. It's important that you attend all of the scheduled visits.

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're pregnant, it's 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:

For people with penises:

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Condoms can help prevent the spread of gonorrhea during anal or vaginal sex, and condoms or dental dams can be used for protection during oral sex.

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're tested for gonorrhea, have a discussion with your health care provider about which other STI testing should be done. It's 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's becoming more and more difficult to treat gonorrhea with existing antibiotics. It's important that you take your medication as prescribed even if you start to feel better. If you've finished your treatment for gonorrhea and still have symptoms, you should go back to your health care provider as soon as possible because you may need additional treatment.

Many people who have gonorrhea also have chlamydia and are treated for both infections at the same time.

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The number of people with gonorrhea has doubled in the past 10 years with over 75 new cases reported in Canada every day.

If you have gonorrhea

You should notify your sexual partner(s) so that they can be tested and treated, if needed, and avoid exposing others. If you're uncomfortable notifying your partner(s), ask your health care provider or local public health unit for assistance.

Chlamydia

What is it?

Chlamydia is a bacterial STI that is very common, especially in people aged 15 to 24. Most people who have chlamydia don't have any signs or symptoms. But if it's left untreated, chlamydia can cause serious health problems, including infertility, pelvic inflammatory disease and chronic pelvic pain. It can also 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're pregnant, it's important to get tested and treated for chlamydia to avoid passing the infection on to the baby during childbirth.

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Certain STI such as chlamydia, gonorrhea and syphilis often have no symptoms at all. If you're getting tested for one, you should get tested for others. Make sure to also ask about being tested for HIV because it may not be part of routine STI testing.

How can you tell if you have it?

You may not know that you have chlamydia, since most people don't have symptoms.

If you have chlamydia and you do have symptoms, you might notice:

For people with vaginas:

For people with penises:

How do you get tested?

A urine sample is used to test for chlamydia. If you have a vagina, your health care 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're tested for chlamydia, have a discussion with your health care 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.

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There are over 340 cases of chlamydia reported in Canada every day.

How is it treated?

Chlamydia can be cured with antibiotics. If you're prescribed antibiotics, it's important that you take your medication as prescribed, even after you start to feel better. Even if you're treated for this infection, you can get it again if you have sex with someone who has the infection and hasn't been treated or hasn't 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.

If you have chlamydia

You should notify your sexual partner(s) so that they can be tested and treated, if needed, and avoid exposing others. The test and treatment are simple and can cure the infection. If you're uncomfortable notifying your partner(s), ask your health care provider or local public health unit for assistance.

Lymphogranuloma venereum

What is it?

Lymphogranuloma venereum (LGV) is an STI caused by a certain type of chlamydia bacteria. LGV can infect the:

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 3 stages of LGV infection:

  1. 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.
  2. 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.
  3. 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 health care provider may also take a sample of liquid from your glands. If you're tested for LGV, have a discussion with your health care provider about which other STI testing should be done.

How is it treated?

LGV can be cured with antibiotics. It's important that you take all of your medication as directed by your health care provider, even if you start to feel better.

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Proper use of condoms and/or dental dams on a consistent basis can prevent LGV.

If you have LGV

You should notify your sexual partner(s) so that they can be tested and treated, if needed, and avoid exposing others. If you're uncomfortable notifying your partner, ask your health care provider or local public health unit for assistance.

Human immunodeficiency virus (HIV)

What is it?

Human immunodeficiency virus (HIV) is a virus that attacks the body's immune system. HIV may lead to acquired immune deficiency syndrome (AIDS) if it's left untreated.

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Approximately 7 Canadians are newly diagnosed with HIV in Canada every day.

How do you get it?

HIV is spread by having condomless vaginal, anal and/or oral sex with someone who has the infection, by coming in contact with infected blood or blood products, and by sharing needles or other drug equipment (syringes, cookers, water, filters, etc.) with someone who has HIV.

If you're pregnant or thinking about getting pregnant, get tested for HIV. If you're HIV-positive, with proper treatment and care before and during pregnancy, you can have a healthy baby. In Canada, formula feeding is recommended to mothers who have HIV to prevent transmission to the baby.

HIV can't be passed on through hugging, kissing or casual contact like shaking hands or giving someone a high-five or pat on the back.

If you're HIV-positive and being treated with antiretroviral medication that suppresses the virus to undetectable levels, there's effectively no risk in transmitting HIV sexually to your partner(s).

There are situations where taking pre-exposure prophylaxis (PrEP) can help to prevent you from getting HIV. Your health care provider can help you decide whether PrEP is appropriate for you. PrEP doesn't protect against other STI so be sure to use condoms to prevent transmission of other STI.

If you think you've been exposed to HIV through contact with blood, breast milk, vaginal or anal secretions, post-exposure prophylaxis (PEP) can reduce the risk of contracting HIV. PEP needs to be started within 72 hours of exposure for maximum effect and requires consultation with a health care provider.

Because HIV weakens the immune system, it can be easier for someone with HIV to contract other STI as well. Having an STI that causes sores, such as herpes or syphilis, increases the risk of getting HIV or passing HIV to a partner.

If you have HIV, the best way to protect yourself and your partner is to take your medication to achieve and maintain an undetectable viral load, and to use condoms consistently for protection against other STI.

How can you tell if you have it?

Some people present no symptoms for many years, whereas other people may develop mild flu-like symptoms 2 to 4 weeks after contracting HIV.

Common early symptoms can include:

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Proper use of condoms and/or dental dams on a consistent basis can prevent HIV. You can also use PrEP to prevent the transmission of HIV if you're more likely to be exposed to HIV.

How do you get tested?

HIV is diagnosed using a blood test. HIV will show up in a blood test approximately 3 to 4 weeks after you've contracted the infection, so it's important to be retested if the window between testing and exposure to HIV is really short.

However, if you know you've been exposed to HIV, you can seek medical attention prior to a blood test. A health care professional may recommend you start post-exposure prophylaxis (PEP) medication immediately.

If you're tested for HIV, have a discussion with your health care provider about which other STI testing should be done. It's possible to have more than one infection at the same time. This requires specialized treatment and care.

It's important that you follow up for your test results and any treatment you might need.

How is it treated?

There's no cure for HIV, but it can be managed with antiretroviral medications and medical supervision.

Antiretroviral medications help lower the amount of virus in your body, keep your immune system healthy, and, in this way, help you fight off other infections.

If you're HIV-positive, you can live a longer and healthier life if you start treatment early. You can also prevent sexual transmission of HIV to your partner if you're on treatment and have an undetectable viral load.

If you're diagnosed with HIV

You must notify your sexual partner(s) so that they can be tested and treated. If you're uncomfortable notifying your partner(s), ask your health care provider or local public health unit for assistance. Resources are available on CATIE's website if you have questions about your obligations to disclose your status.

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 didn't 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.

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If you're pregnant, you can pass hepatitis B to the baby during childbirth, so it's important to get tested. Let your health care provider know if you have hepatitis B.

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:

How do you get tested?

You get tested for hepatitis B using a blood test. If you're tested for hepatitis B, have a discussion with your health care provider about which other STI testing should be done. It's possible to have more than one infection at the same time. This requires specialized treatment and care.

If you have hepatitis B

You should notify your sexual partner(s) and household members so that they can get vaccinated to protect themselves. If you're uncomfortable notifying your partner(s), ask your health care provider or local public health unit for assistance.

How is it treated?

In most people, the virus will go away on its own within 6 months, but it can be passed on to others during this time. Once the body fights off the infection, you're protected from ever getting the virus again and can't pass it on to others.

If you think you've been exposed to hepatitis B, your health care 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 won't respond to treatment and will have hepatitis B for life. As long as they have the virus, they can pass it onto others.

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's no vaccine to prevent it.

How do you get it?

Hepatitis C is spread through contact with infected blood. It's 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's a chance that infected blood is present (such as during menstruation).

How can you tell if you have it?

The majority of people won't develop symptoms and won't know they have the virus. If symptoms do develop, it can take 2 to 6 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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Hepatitis C can be passed on to a baby during pregnancy or childbirth, so it's important to tell your health care provider if you have hepatitis C or ask if you should be tested.

How do you get tested?

A blood test can tell if you have hepatitis C. If you're tested for hepatitis C, have a discussion with your health care provider about which other STI testing should be done. It's 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 6 months. There are several drug combinations that have been approved by Health Canada to treat hepatitis C and to prevent 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.

If you have hepatitis C

You should notify your drug-use partner(s) and sexual or intimate partner(s) so that they can be tested and treated. If you have chronic hepatitis C, talk to your health care provider or local public health unit about long-term treatment.

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 cause:

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 don't have any symptoms.

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Vaccination is up to 90% effective at preventing the HPV types responsible for most genital warts and HPV-related cancers.

How can you tell if you have it?

Most people don't have symptoms. This is why it's 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 health care provider, and examining them under a microscope to make sure the cells are healthy.

HPV vaccine

Youth aged 9 to 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're 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 isn't 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 health care provider or local public health unit.

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Everyone should make sure they've been vaccinated against HPV if they are, or are planning to be, sexually active.

How do you get tested?

A health care 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's currently no test to detect high-risk HPV in people with penises.

If you're tested for HPV, have a discussion with your health care provider about which other STI testing should be done. The need for additional testing depends on risk factors and should be assessed by a health care provider.

How is it treated?

HPV can't be cured, but oral or genital warts caused by HPV will often go away without treatment. Your health care provider can advise you on how to treat them if they don't go away on their own. Some ways that oral or genital warts can be removed include:

Treatment doesn't prevent re-infection or recurrence of HPV. You can still get another HPV infection in the future.

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HPV can cause cancer of the cervix, vulva, vagina, penis, anus, mouth and throat.

HPV vaccination is the best way to prevent genital warts and cervical cancer. Condoms will reduce the risk of transmission but aren't 100% effective because HPV can live in areas not covered by condoms.

Genital herpes

What is it?

Genital herpes is an infection caused by the herpes simplex virus (HSV). 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.

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500 million people worldwide are estimated to have the herpes simplex virus genital infection.

How can you tell if you have it?

Many people who have herpes won't 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.

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If you're pregnant, you can pass the virus on to your baby during pregnancy or childbirth. Tell your health care provider if you have herpes. They can give you medications to reduce the risk of your baby getting herpes.

Can it keep coming back?

Herpes can keep coming back. These are called recurrences. There's no way to predict if or how often recurrences will happen. Your health care provider can give you information on how to manage the infection, including treatment to control recurrences. Some common causes of recurrences include:

How can you prevent passing on the virus?

How do you get tested?

Genital herpes is most often tested by taking a swab from a herpes sore. If you don't have sores when you visit your health care provider, you may have to delay testing. If you're tested for genital herpes, have a discussion with your health care provider about which other STI testing should be done.

What can you do if you have a genital herpes outbreak?

How is it treated?

Genital herpes can't be cured but it can be managed. There are medications that may help to prevent outbreaks or reduce how long the outbreak lasts. Your health care provider may also prescribe medication for pain if your outbreaks are severe and cause discomfort.

How is it prevented?

Since many people with herpes don't have any symptoms, proper use of condoms and/or dental dams on a consistent basis can help prevent herpes, but isn't 100% effective as herpes can be present in areas not covered by condoms.

If you have herpes

You should notify your sexual partner(s) so that they can practise safer sex with you. If they have contracted the virus, they can be treated, and avoid passing it on to others. If they don't have herpes, they can choose to use condoms and avoid sex during outbreaks to lessen (but not eliminate) their chance of contraction. If you're uncomfortable notifying your partner(s), ask your health care provider or local public health unit for assistance.

Pubic lice and scabies

What is it?

Pubic lice are also known as "crabs" because the lice resemble tiny crabs. They're usually found around the genitals in the 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're 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 non-sexual 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 1 to 2 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're not sure if you have pubic lice or scabies, see your health care provider. If you have scabies or pubic lice, you should discuss with your health care provider which other STI testing should be done.

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The best way to protect against STI is to not have sex. If you're having any type of sex, the best way to protect yourself against STI is to use condoms and/or dental dams consistently and correctly.

How is it treated?

Pubic lice and scabies are treated with special creams, lotions or shampoos available at the drugstore 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:

Trichomoniasis

What is it?

Trichomoniasis is caused by a parasite and must be treated. If you're 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.

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10% to 50% of people who have trichomoniasis have no symptoms.

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 don't 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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If left untreated or if treatment isn't completed, an STI can recur and spread to sexual partners as well.

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's possible to have more than one infection at the same time. If you're tested for trichomoniasis, have a discussion with your health care provider about which other STI testing should be done.

How is it treated?

Trichomoniasis can be cured with antibiotics. It's important that you take your medication as prescribed, even if you start to feel better. You shouldn't have sex until you have completed treatment. You can get the infection again if you have sex with someone who has trichomoniasis and hasn't been treated.

If you have trichomoniasis

You should notify your sexual partner(s) so that they can be tested, get treated, if needed, and avoid exposing others. If you're uncomfortable notifying your partner(s), ask your health care provider or local public health unit for assistance.

Other, less common STI

Mycoplasma genitalium

Mycoplasma genitalium is a bacterial infection that's 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's important that you take your medication as prescribed, even if you start to feel better. If you've finished your treatment for mycoplasma genitalium and still have symptoms, you should go back to your health care 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.

Molluscum contagiosum

Molluscum contagiosum is a skin rash that's 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.

Symptom map

For people with vaginas

It's important to remember that many STI often have no symptoms. Get tested regularly and before each new sexual partner.

Figure 1. Symptoms map for people with vaginas
figure 1
Figure 1: Text description
  • Sore throat: HIV
  • Swollen glands (lymph nodes): Syphilis / LGV / HIV
  • Body rash: Syphilis / pubic lice / scabies
  • Flu-like symptoms: Syphilis / HIV / genital herpes / LGV
  • Headache: HIV
  • Fatigue: HBV / HCV / HIV
  • Fever: HIV
  • Yellow skin/whites of your eyes: HBV / HCV
  • Pain in your lower abdomen: Chlamydia / gonorrhea / HBV / HCV
  • Lack of appetite: HBV / HCV
  • Nausea: HBV / HCV / HIV
  • Itchy skin: Genital herpes / pubic lice / scabies
  • Itchy and painful blisters on skin/sores: Genital herpes
  • Abnormal pap test: HPV
  • Light brown insects or white eggs in the pubic hair, bluish marks on skin: Pubic lice
  • Rectal pain and bleeding: Chlamydia / gonorrhea / LGV
  • Discharge from anal area: Chlamydia / gonorrhea / LGV
  • Dark urine or pale stools: HBV / HCV
  • Open sores or chancres on genitals, anus or mouth / throat: HSV / LGV / syphilis
  • Warts on inside or outside the vagina and anus: HPV
  • Painful swollen glands (lymph nodes): Genital herpes / LGV / syphilis / HIV
  • A change or increase in discharge from vagina: Chlamydia / gonorrhea / trichomoniasis / LGV
  • Vaginal itching: Chlamydia / trichomoniasis
  • Bleeding between periods: Chlamydia / gonorrhea
  • Pain or bleeding during or after vaginal sex: Chlamydia / gonorrhea / trichomoniasis
  • Burning during urination: Chlamydia / gonorrhea / trichomoniasis

For people with penises

It's important to remember that many STI often have no symptoms. Get tested regularly and before each new sexual partner.

Figure 2. Symptoms map for people with penises
figure 2
Figure 2: Text description
  • Sore throat: HIV
  • Swollen glands (lymph nodes): Syphilis / LGV / HIV
  • Body rash: Syphilis / pubic lice / scabies
  • Flu-like symptoms: Syphilis / HIV / genital herpes / LGV
  • Headache: HIV
  • Fatigue: HBV / HCV / HIV
  • Fever: HIV
  • Yellow skin/whites of your eyes: HBV / HCV
  • Pain in your abdomen: HBV / HCV
  • Lack of appetite: HBV / HCV
  • Nausea: HBV / HCV / HIV
  • Itchy skin: Genital herpes / pubic lice / scabies
  • Pain in your testicles: Chlamydia / gonorrhea
  • Warts on penis, scrotum and thighs: HPV
  • Itchy and painful blisters on skin/sores: Genital herpes
  • Light brown insects or white eggs in the pubic hair, bluish marks on skin: Pubic lice
  • Rectal pain and bleeding: Chlamydia / gonorrhea / LGV
  • Dark urine or pale stools: HBV and HCV
  • Discharge from anal area: Chlamydia / gonorrhea / LGV
  • Open sores or chancres on genitals, anus or mouth / throat: LGV / HSV / syphilis
  • Painful swollen glands (lymph nodes): Genital herpes / HIV / LGV / syphilis
  • Burning during urination: Chlamydia / gonorrhea / trichomoniasis
  • Discharge from penis: Chlamydia / gonorrhea / trichomoniasis / LGV
  • Burning or itching around the opening of penis: Chlamydia / gonorrhea / trichomoniasis

Get tested

When should I go and get tested?

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If you and your partner both get tested and don't have STI, you're only protected as long as you remain in a relationship with this same partner. When in doubt, talk to your partner about safer sex and testing, and use a condom and/or dental dam.

What do I need to know about the testing process?

No matter your sex assigned at birth, gender identity, expression or sexual orientation, if you feel more comfortable with someone else in the room during your examination, tell your health care provider. Everything you discuss with your health care provider is confidential.

They can't discuss things with anyone unless they:

Positive test results for chlamydia, gonorrhea, syphilis, hepatitis B, hepatitis C and HIV are reported to your local public health department. However, your personal information isn't given out to the health department or anyone else, and no one will know you have the infection except you, your health care provider and public health nurse. A nurse may contact you to offer to help with telling your current and past partners that they need to be tested.

What should I expect during my appointment?

The health care provider will ask you many questions about your sexual activity. They may ask you to undress from the waist down and will give you a drape to cover yourself. They may do some or all of the following:

How do I tell my partner(s) I have an STI?

If you have an STI, it's important that your sexual partner(s) be tested as well to make sure the infection doesn't spread further. There are many ways to tell your partner(s) that they need to get tested for STI.

There are programs and tools to help you tell your partner(s) anonymously that they need to get tested.

Contact your local public health department for more information.

Quick facts on safer sex

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You matter. Your choices matter. You decide what is right for you.

Websites to visit

Where to go for help

If you have questions or want to be tested for STI, you can go to your health care provider, clinics offering anonymous testing, sexual health clinic or local public health unit.

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