One in 5 Americans has a sexually transmitted infection, according to the Centers for Disease Control and Prevention (CDC). During Sexually Transmitted Diseases Awareness Week, April 12–17, the CDC encourages discussion, testing and help to remove the stigma surrounding sexually transmitted infections and diseases.

During the early months of the COVID-19 pandemic reports of sexually transmitted infections decreased due to disruptions to health care and sexually transmitted infections testing services, reports the CDC. Reduced access to testing and diagnoses may have led some people to unwittingly spread infection. As clinics reopen, infections rates are again are on rise.

Dr. Abinash Virk, a Mayo Clinic infectious diseases physician, says rates of infection are rising, especially in younger populations.

Watch: Dr. Abinash Virk talks about sexually transmitted infections.

Journalists: Broadcast-quality sound bites with Dr. Virk are available in the downloads at the end of the post. Please courtesy: "Abinash Virk, M.D./Infectious Diseases/Mayo Clinic."

"The biggest concern with these sexually transmitted infections is that they occur in people between 15 and 24 years. That's the biggest age group that continues to have new and emerging infections. But the problem is that many of these infections are without symptoms. That means that people can transmit diseases to their sexual partner if they don't take precautions like wearing a condom or other protection to prevent transmission."

Sexually transmitted infections, including HPV, chlamydia, gonorrhea and syphilis, are transmitted person to person through sexual activity, including vaginal, oral and anal sex. Left untreated, sexually transmitted infections can lead to larger health problems.

"For women, which is the other group that had higher risk of sexually transmitted infections, it also has an impact on reproduction and fertility," says Dr. Virk. "Along with infertility, sexually transmitted diseases may cause HPV-associated cancers, such as cervical cancer in women or penile cancers in men."

There are more than 100 types of HPV. Certain strains of HPV also can contribute to cancers of the genitals, anus, mouth and upper respiratory tract.

"About 42 million people in the U.S. in 2018 were diagnosed with HPV, which can cause cancer," says Dr. Virk. "There's a vaccine for HPV that is very effective in preventing cervical cancer, cancer of the penis, other types of HPV-related cancers."

Treating sexually transmitted infections, especially gonorrhea, is a growing concern due to antibiotic resistance.

"There is emerging resistance, particularly among the gonorrhea bacteria. This has received international attention because there have been cases where the gonorrhea bacteria were completely resistant to antibiotics. We want to prevent that from happening. It's really important again for people to prevent gonorrhea from happening by using condoms and other precautions," Dr. Virk says.

When it comes to sexually transmitted infections, Dr. Virk urges everyone to have conversations with their sexual partners, use condoms and get tested regularly. "It's really important for people to be aware of their own health and to take precautions."

Related posts:

• Mayo Clinic Minute: Why HPV vaccine is important for preteens.
• Infectious Diseases A-Z: Rising STIs in the US.
• Infectious Diseases A–Z: Sexually transmitted infections at a record high.

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date. 

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Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases, are at a record high in the U.S.

Sexually transmitted infections increased for the fifth consecutive year, with nearly 2.5 million combined cases of chlamydia, gonorrhea and syphilis, according to the annual Sexually Transmitted Disease Surveillance Report released by the Centers for Disease Control and Prevention (CDC). Congenital syphilis can result in miscarriage, stillbirth, newborn death, and severe lifelong physical and neurological problems.

Dr. Gregory Poland, director of Mayo Clinic's Vaccine Research Group, says we are in crisis and this is a real issue not only in the U.S., but also around the world. "For instance, somebody who begins to be sexually active today in America will certainly get infected with human papillomavirus," says Dr. Poland. "That virus causes genital warts and about seven different cancers, but the important thing is that while we don't have a cure for HPV, we have a vaccine to prevent that infection."

"Others, like gonorrhea and syphilis, are becoming anti-biotic resistant," says Dr. Poland. "And then there's a whole host of less common sexually transmitted diseases, like HPV, that we have no cure for, but there are a few we can prevent." says Dr. Poland.

Watch: Dr. Poland discusses sexually transmitted infections.

Journalists: Broadcast-quality sound bites with Dr. Poland are in the downloads at the end of this post. Please "Courtesy: Mayo Clinic News Network." 

"These infections can be life-changing," says Dr. Poland. "There are complications to these. Some of them are incurable, and, so, people have to take appropriate precautions and not think that casual sex is without complication or concern."

"When somebody develops an STI they usually don't know it, and, so, they transmit it other people. And it acts like an amplifier through society," says Dr. Poland. For instance, he says women who get an STI can transmit it to their newborn infant. Cases of congenital syphilis — syphilis passed from a mother to her baby during pregnancy — increased 40% from 2017 to 2018, according to the CDC report.

Dr. Poland adds, "This is such a crisis that the CDC is now recommending women up to age 45 be immunized with the HPV vaccine. Before, it was age 26, and we’ve moved it up."

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THIS WEEK'S TOP STORIES
Preventing golf injuries 
Although golf is a low-impact sport, it's associated with a significant number of injuries. Many golfing-related injuries are a result of poor mechanics or overuse. The most commonly injured area is the lower back, followed by the elbow, wrist and hand, and shoulder. Follow these tips to stay in shape on the course.

Nip seasonal allergies in the bud 
Spring means flower buds and blooming trees. And if you're one of the millions of people who have seasonal allergies, spring also means sneezing, congestion, a runny nose and other bothersome symptoms. Seasonal allergies, also called hay fever and allergic rhinitis, can make you miserable. Try these simple strategies to control seasonal allergies.

EXPERT ANSWERS
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A laryngospasm is a spasm of the vocal cords that temporarily makes it difficult to speak or breathe. The cause of vocal cord spasms often is unknown, but conditions such as anxiety and acid reflux may be contributing factors or triggers. Learn more from Dr. Edward Rosenow III, an emeritus Mayo Clinic pulmonologist.

Should I stop taking long-acting beta agonists for asthma? 
Long-acting beta agonists are used on a regular schedule to open narrowed airways and prevent asthma attacks. In some studies, long-acting beta agonists have been linked to life-threatening asthma attacks — a risk that appears to be greatest when there is not also an inhaled corticosteroid in use. The benefits of long-acting beta agonists to control asthma generally outweigh the risks if they're used as recommended. Learn more from Dr. James Li, a Mayo Clinic allergist and immunologist.

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HEALTH TIP OF THE WEEK
Do you have a living will?
Life-threatening situations can happen to anyone, so it's important to have a living will or other advance directive. These documents spell out your preferences regarding medical treatments you would or would not want to keep you alive. You also can outline your preferences for other medical decisions, such as pain management or organ donation. By planning ahead, you can get the medical care you want and save your family from having to make tough decisions in a crisis.

Need practical advice on diet and exercise? Want creative solutions for stress and other lifestyle issues? Discover more healthy lifestyle topics at mayoclinic.org. 

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On the next Mayo Clinic Radio program, Dr. Halena Gazelka, chair of Mayo Clinic's Opioid Stewardship Program, will explain the survey results and share how Mayo Clinic is taking steps to combat the opioid crisis. Also on the program, Dr. Stacey Rizza, an infectious diseases specialist at Mayo Clinic, will discuss the recent rise in sexually transmitted infections. And Dr. Courtney Bennett, a cardiologist at Mayo Clinic, will explain gender discrepancies when it comes to treating heart attacks.

Here's your Mayo Clinic Radio podcast.

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Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (0:58) is in the downloads at the end of the post. Please ‘Courtesy: Mayo Clinic News Network.’ Read the script. 

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Dr. Stacey Rizza, an infectious diseases specialist at Mayo Clinic, says syphilis affects men and women – and can present in various stages.

"Primary syphilis causes an ulcer, and this sometimes isn’t noticed because it’s painless and can be inside the vagina or on the cervix. After a few weeks, two months, they can get secondary syphilis, which is a rash."

It may then progress to latent-stage syphilis and, finally, the most serious stage: tertiary

Pregnant women are not immune to syphilis. Congenital syphilis can lead to miscarriage, stillbirth or infant deaths. That’s why all pregnant women should be screened.

Syphilis is preventable and treatable. Since the 1940s, penicillin has been the best treatment. As for prevention, Dr. Rizza recommends barrier protection during sex – including oral, anal and vaginal sex.

The post Mayo Clinic Minute: Signs and symptoms of syphilis appeared first on Mayo Clinic News Network.

Watch: Dr. Stacy Rizza discusses rise in STIs in the U.S.

Journalists: Broadcast-quality sound bites video are in the downloads. Please ‘Courtesy: Mayo Clinic News Network.’

The populations most affected include people ages 15–24, gay and bisexual men, and pregnant women. "We know that young people between the age of 15 and 24 are about a quarter of the sexually active people in the U.S.; yet, they make up 50 percent of the sexually transmitted infections," says Dr. Rizza. "There’s definitely a disproportionate number of people in that age group who are getting the infections. And we also know that men who have sex men are almost 10 times as likely to get many of the sexually transmitted infections than other groups of people who are sexually active." The cases of congenital syphilis has doubled in the U.S. since 2013.

Dr. Rizza says more education is needed, particularly in targeted areas. "We can use this information to target certain groups and try to educate, try to provide barrier protection, and also to do better screening. Knowing if somebody has a sexually transmitted infection is very important. There’s excellent curative treatment for the majority of the sexually transmitted infections, which not only helps the infected person prevent their complications, but also helps prevent transmission to others."

Treatment

Chlamydia, gonorrhea and syphilis are bacterial infections that are treatable with antibiotics. Dr. Rizza says many times, those infected have no symptoms and remain infected without realizing it. Antibiotic resistance is also an added concern, especially for treating gonorrhea. The CDC says the bacteria that causes gonorrhea has grown resistant to nearly every antibiotic used to treat it.

Left untreated, sexually transmitted infections can have long-term health implications, including infertility for women.

Protection

"The easiest answer is barrier protection during sex, and that’s during oral sex, anal sex, vaginal sex, using condoms, dental dams and any other barrier protection," says Dr. Rizza.  "Abstinence, of course, would also prevent sexually transmitted infections."

Screening for STIs

"Being screened and being asked to be tested if you think you might be at risk, or going in for the universal screening if you’re in a demographic or an age group that should be screened, is very important," says Dr. Rizza. "And in some situations, such as HPV or HIV, male circumcision also decreases the risk of transmission."

"Universal screening means you screen a person for a disease state, and in this situation, we’re talking about infections, no matter what their demographics are," says Dr. Rizza.

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"This is hugely positive for the health of younger and mid-life adults," says Dr. Gregory Poland, director of the Mayo Clinic Vaccine Research Group. "Currently we have no options for prevention of the many cancers as well as genital warts caused by HPV."

"For adults up to age 45 years who may not have been immunized against HPV in adolescence, we now have a safe and effective option to prevent infection and maintain health in sexually active adults," adds Dr. Poland. "From both an individual health and public health perspective this decision by the FDA is a hugely positive game-changer in the strategy to protect the health of Americans."

Watch: Dr. Gregory Poland discusses HPV.

Journalists: Broadcast-quality sound bites are in the downloads at the end of the post. Please ‘Courtesy: Mayo Clinic News Network.’

HPV is a group of related viruses that can spread from intimate skin-to-skin contact, usually through vaginal, anal or oral sex with someone who is infected with the virus.

Dr. Poland says HPV is ubiquitous. Nearly 80 million people in the U.S. have the HPV sexually transmitted infection, and 14 million people in the U.S. are infected a year.

"In today’s world, anyone who is sexually active and who hasn’t been protected is going to get infected with the HPV virus,” says Dr. Poland.

Most people will not be aware of being infected and will not develop symptoms. However, that's not always the case.

"From both an individual health and public health perspective this decision by the FDA is a hugely positive game-changer in the strategy to protect the health of Americans."  - Dr. Gregory Poland, director of the Mayo Clinic Vaccine Research Group.

"This virus causes two major problems: cancers – and there are about seven of them that it causes – and genital warts," says Dr. Poland.

"People are aware of the connection with cervical cancer, but it [HPV] causes vaginal cancer, labial cancer, anal cancer, oral cancer, penile cancer," says Dr. Poland. "These are completely preventable. Imagine completely preventing a cancer by a vaccine. That’s the power of this vaccine."

The HPV vaccine guidelines from the Centers for Disease Control and Prevention currently recommend that children ages 11-12 should receive two doses of the vaccine at least six months apart. This is a change from the previously recommended three-dose series. Adolescents and young adults older than 15 should continue the three-dose series.

Dr. Poland urges parents to have their children vaccinated, "The risk is essentially zero, and the benefit is incalculably large."

Related posts: 

• Mayo Clinic Minute: Protect your child with HPV vaccine
• Mayo Clinic Minute: The rise of HPV-related throat cancer
• Infectious Diseases A-Z: HPV vaccination guidelines to prevent cervical cancer

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Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on the genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores. People can be infected with syphilis and not know it.

Babies born to women who have syphilis can become infected through the placenta or during birth. Most newborns with congenital syphilis have no symptoms, although some experience a rash on the palms of their hands and the soles of their feet. Later symptoms may include deafness, teeth deformities and saddle nose — where the bridge of the nose collapses.

If left untreated, there is an 80 percent chance of a mother passing congenital syphilis to her baby. Penicillin is the only recommended antibiotic for treating pregnant women with syphilis.

Syphilis is a bacterial infection usually spread by sexual contact. The disease starts as a painless sore — typically on your genitals, rectum or mouth. Syphilis spreads from person to person via skin or mucous membrane contact with these sores. People can be infected with syphilis and not know it.

Congenital syphilis is one of various stages of syphilis which include:

• Primary syphilis
• Secondary
• Latent
• Tertiary (late) syphilis

The CDC recommends that all pregnant women be tested for syphilis the first time they initially see see a doctor about their pregnancy. For women at high-risk for syphilis, the CDC also recommends testing early in the third trimester and at delivery.

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ANSWER: Pelvic exams and Pap smears are not necessary in healthy, adolescent girls who are not sexually active and who do not have gynecologic symptoms or other concerns. The recommended age for young women who have not previously needed a Pap smear to begin having the test is 21. Primary care providers, such as those in family medicine or internal medicine, can perform that exam, or a gynecologist can perform the exam.

In the past, many health care providers used to recommend that teens have a Pap smear at 16 or 18. Now, however, the American College of Physicians does not recommend any routine gynecologic exams for teens at low risk of having the HPV or other sexually transmitted infections.

The purpose of a Pap smear — a procedure that collects cells from the cervix — is to check for changes in those cells that could be a sign of cancer and look for the presence of high-risk types of HPV that are known to cause cervical cancer.

HPV is the most common sexually transmitted infection in the U.S. Although most cases of HPV do not cause symptoms or lead to problems, certain strains of the sexually transmitted HPV are considered high risk, and can lead to cancer and potentially be deadly if left untreated. Two strains of the virus cause 70 percent of all cervical cancer. You can greatly reduce your risk of HPV infection and cervical cancer by getting the HPV vaccine. This anti-cancer vaccine most effectively builds immunity when it’s given between ages 9 and 14.

If you are not sexually active as a teen, in most cases there is no need for a Pap smear because your risk of cervical cancer is low, and you have no risk of HPV or other sexually transmitted infections. Once you begin having sex, a Pap smear may be appropriate. But even in many of those situations, Pap testing still may not need to begin until 21.

Traditionally, some health care providers required a pelvic exam — an evaluation of the vulva, vagina, cervix, ovaries, uterus, rectum and pelvis for any abnormalities — before they would prescribe contraceptives. Again, that is no longer the case. A pelvic exam is not needed to obtain birth control. For most healthy women, the first pelvic exam also can wait until 21.

For young women whose medical history puts them in a higher risk category for infection or cancer, a Pap smear or pelvic exam may be recommended at an earlier age. Those risk factors include a weakened immune system due to chemotherapy, organ transplant or long-term corticosteroid use; exposure to the medication diethylstilbestrol, also known as DES, before birth; and HIV infection.

Some symptoms also may trigger a pelvic exam, such as heavy, painful periods; pelvic pain or pressure; abnormal bleeding or discharge; and itching, pain or lesions in the vulva or vagina. In those situations, a pelvic exam may be necessary, but a Pap smear typically is not required.

When it is time to get a pelvic exam and Pap smear, it’s best to work with a health care provider you know and trust. Before the exam, ask your health care provider about what will happen during the exam and what you can expect. Some providers have anatomical models they can use to describe the procedures beforehand, so you can clearly see what will happen. These procedures are important exams, but they need not be a source of anxiety or fear. If you have questions or concerns, talk to your health care provider. — Dr. Sally Ann Pantin, Family Medicine, Mayo Clinic, Jacksonville, Florida

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Watch: The Mayo Clinic Minute

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Mayo Clinic Infectious Diseases Specialist Dr. Stacey Rizza calls the CDC figures alarming.

"High-risk groups for all three generally are about the same," Dr. Rizza says. "We do know that younger people who are sexually active tend to be at a slightly higher risk."

Dr. Rizza says riskier sexual behavior, like having multiple sex partners and not using barrier protection during sex, puts people at risk for sexually transmitted infections (STI). She says it's unclear whether or not the rise of dating apps and younger people having sexual relationships with strangers could also be a contributing factor to the recent rise in STIs in this age group.

"The major risk factor is having [sex] with partners where you don't know their situation and their status for a sexually transmitted infection and people who have multiple sex partners," Dr. Rizza says.

She says the key to slowing the spread of STIs is having people get tested regularly, and educating people on how to prevent them.

"A condom would prevent the spread of all three sexually transmitted infections as well as HIV," Dr. Rizza says.

She also says preventing STIs has becoming increasingly important as multiple strains of sexually transmitted infections have becoming antibiotic-resistant.

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