An STI Diagnosis Can Be Devastating—But Is It Worse For Women?
Key Points
- A new study indicated that women who contract STIs experience a significantly greater loss of quality-adjusted life years compared to men.
- Women who engage in receptive sex may be more vulnerable due to micro-abrasions and the potential for bacterial infection.
- Untreated STIs can have both short- and long-term consequences for mental health, including stress, anxiety, depression and diminished self-worth.
Whether a urinary tract infection (UTI) or a sexually transmitted infection (STI), any infection of the reproductive tract or surrounding areas can affect a person's overall health and quality of life.
While this applies to all genders, it's particularly true for a sexually transmitted infection women, according to a new study.
What did the researchers find?
Women who experience gonorrhea, chlamydia or trichomoniasis lose significantly more quality-adjusted life years (QALYs) than men, according to an April 2023 study.
The researchers used a probability-tree model to estimate the average number of QALYs people in the United States lost due to each of these three infections in 2018, according to the study. They evaluated years lost per infection incident and at the population level by sex and age group.
At the population level, chlamydia contributed to the most quality-adjusted life years lost (1,541 in males and 111,872 in females), according to the study.
Gonorrhea contributed to 989 QALYs lost among males and 111,872 among females, and trichomoniasis was responsible for about 386 QALYs lost in males and 4,576 in females.
The quality-adjusted life years lost per incident were likewise substantially higher among women than men across all age groups and infections.
These findings are most likely so high because these infections can all have substantial reproductive health consequences, with chlamydia being the most impactful, researchers said. One of the main contributors to total lifetime QALYs lost in women was chronic pelvic pain from chlamydia and gonorrhea, followed by symptomatic trichomoniasis. In men, urethritis had the most pronounced effect.
Why are females more likely to get STIs?
Any sexually active person can contract an STI. Their risk depends on various factors, including their anatomy, overall health, underlying conditions, medications, type of sexual activity and other factors, said Sandra Guerra, M.D., M.P.H., the chief medical officer for Texas Health Action in San Antonio.
However, people who have receptive sex—such as anal and vaginal sex—may be more likely to acquire STIs than their partners, according to Rosalyn Plotzker, M.D., M.P.H., an assistant professor in the University of California, San Francisco Department of Epidemiology and Biostatistics.
"During receptive sex, tiny micro-abrasions occur along the mucosa [lining] of the rectum or vagina along with the resulting local inflammation," she said. "These can make it easier for bacteria to infect cells. What's more, after sex, ejaculate can remain in the canal, allowing more time/bacterial volume for the cells to become infected."
Is thrush an STI?
Thrush, or a yeast infection, isn't classified as an STI but can be triggered by sex, according to the Office on Women's Health.
A person with a yeast infection can pass the infection to another person through anal, oral or vaginal sex. Like UTIs, thrush is much more likely to occur in females.
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When do STI symptoms start?
Pending the specific sexually transmitted infection, symptoms may start to appear days, weeks or months after infection, according to the North Dakota Department of Health. In some cases, as with the sexually transmitted diseases chlamydia and gonorrhea, and also some strains of human papillomavirus (HPV), females often don't exhibit symptoms. And if they do, they take longer to do so, according to the Centers for Disease Control and Prevention (CDC).
In part, that's because males present scant urethral discharge that's unusual or otherwise noticeable, according to Plotzker. For women, some amount of vaginal discharge is common, although discharge quantity and quality can vary significantly from one person to another and at different stages of the menstrual cycle.
Factors such as stress, medications and underlying health conditions can impact discharge, Guerra said. That can make it exceedingly difficult to discern what's "normal" and what's a symptom of an STI.
"When a patient's infection goes unnoticed, it might take longer for them to get tested, diagnosed and treated," Plotzker said. "That prolongation allows more time for the bacteria to spread from the lower reproductive tract to the upper tract—the uterus, fallopian tubes and ovaries. This increases the potential for PID [pelvic inflammatory disease], infertility and chronic pelvic pain."
How do STIs affect females differently?
Sexually transmitted diseases, when untreated, can cause several short- and long-term effects. However, consequences tend to be more severe and persistent for women.
Men can have discomfort, pain and abnormal discharge, Plotzker said. Sperm quality may diminish during an active infection but returns to normal after treatment.
"Women may also experience discomfort, pain, and discharge as well as more severe issues such as pelvic inflammatory disease, chronic pelvic pain and permanent infertility," Guerra said.
While anyone with a sexually transmitted infection could experience mental health effects such as stress, anxiety and depression, these tend to be more pronounced and unceasing in women. In part, that's because they often shoulder the burden of reproductive health concerns, including long-term consequences of untreated STIs, according to Rhiannon John, a New York City sexologist who works at Bedbible, a sex toy review site.
"Often, individuals diagnosed with an STI are incorrectly assumed to have various behavioral characteristics when in reality, people impacted by any infection are simply people," Guerra said.
These assumptions can have an amplified effect on women, who may be blamed or blame themselves if they experience complications, such as trouble conceiving, preterm birth, low birth weight or transmission to a newborn, Guerra added.
"The stigma associated with infections is another factor that affects people of all genders, causing shame, scrutiny, emotional distress, diminished self-worth and isolation," said Jenelle Pierce, C.S.E., board president at The STI Project and spokesperson for Positive Singles, who is based in Asheville, North Carolina.
STDs, STIs and Senior Citizens: More than 40 percent of the 54 million people over 65 in the U.S. remain sexually active. It's vital to educate older adults to ensure they're aware of sexually transmitted infections.
Pierce noted the stigma may disproportionately impact women due to societal constructs, misconceptions, and the shame associated with women's sexual health, sexuality and bodies.
"Women encounter unique factors contributing to this distress, such as the pressure to remain silent about their sexual health, double-bind [conflicting] media messages, reproductive healthcare limitations, sex-related federal regulations and the objectification of young women," she said. "These gender-specific themes exacerbate the emotional toll of an STI diagnosis, leading women to perceive it as evidence of personal failure or falling short of societal norms. Consequently, adverse mental effects diminish a woman's overall quality of life, impacting her mental and physical well-being."
Does an STI go away on its own?
Most sexually transmitted infections are treatable, but many, such as herpes, HIV and hepatitis B, are incurable, and very few resolve spontaneously, according to Planned Parenthood. Proper treatment is crucial to prevent disease transmission and diminish the risk of flare-ups and severe, potentially life-altering consequences, from infertility to cancer or even death.
That's why screening and testing are crucial.
The frequency with which someone should be tested depends on a few different factors, but the CDC provides recommendations by gender and STI.
Recognize the difference between screening and testing. Screenings are appropriate when you don't have symptoms but think you are at risk, Guerra noted. Most people should be screened regularly for conditions such as syphilis, chlamydia, gonorrhea and HIV at least once a year, per the CDC.
There's no HPV test for penises—though an anus can be tested in the same way a cervix is tested—but Planned Parenthood recommends women between 25 and 65 years old should be tested every five years.
A doctor can provide individualized recommendations based on your specific situation and health history, she added.
Does a well-woman exam include STI testing?
The specifics of a routine gynecological visit—known as a well-woman exam—vary by practice but usually include breast cancer screening, pelvic exams, Pap smears and birth control consultations, according to Planned Parenthood.
Tests for sexually transmitted infections typically aren't automatically included, but these visits are perfect opportunities to request them.
Does urgent care do STI testing?
Most urgent care facilities provide STI testing, as do primary care providers. At-home STD tests are available online and at sexual health clinics and pharmacies.
How can you have a better quality of life while living with an STI?
The direct and indirect consequences of a sexually transmitted infection can, directly and indirectly, affect a person's health and well-being, Pierce noted.
Direct consequences can include inflammation, pain, anxiety, depression and sleep disturbances. Indirectly, an STI diagnosis can diminish a person's likelihood of accessing treatment and preventive services. Also, their interest in self-care measures—such as exercise and healthy eating—can also diminish, which can further exacerbate existing issues and raise their risk to others.
Misinformation Makes STIs and STDs Worse: Sex and sexually transmitted infections (STIs) are surrounded by a centuries-long history of stigma that to this day negatively impacts our reproductive and overall health. Taking precautions is key, but that relies on you knowing the right facts first.
If a sexually transmitted infection has affected your quality of life, you're not alone. STIs are extremely common, which is why doctors screen and test for them, even in people with no symptoms, Plotzker said.
"Most sexually active individuals will contract an STI at some point. It's a shared experience that does not define or diminish your worth," Pierce said. "Instead of allowing this diagnosis to overshadow your identity, it's time to reclaim your narrative and become your own best advocate."
The following strategies can help you educate yourself so you get the treatment and care you need and deserve:
- Disregard sources contributing to shame or negativity about yourself or your body and embrace those empowering you.
- Educate yourself about the STU you have, including how it can be transmitted, symptoms, treatment options and potential long-term effects.
- Find a care team with whom you're comfortable discussing your sexual and reproductive health needs.
- Learn how to prevent future infections, including regular screening and testing, using protection and asking new partners to get tested.
- Practice self-compassion and prioritize your health and well-being.
- Recognize your diagnosis is just part of your lived experience, not a reflection of your value or a measure of your failures.
- Seek emotional support from trusted loved ones and peers, including people with similar experiences.
The bottom line
A diagnosis of a sexually transmitted infection can be devastating, but it doesn't have to ruin your life or relationships.
"Many of us have experienced a sunburn after being at the beach. A sunburn is painful but will heal over time, and we do not usually carry guilt or shame from getting a sunburn," Guerra said. "Eventually, once the sunburn heals, we go out and enjoy the sun again. Perhaps we wear more sunscreen, stay out for less time, or wear different clothes, but we still enjoy our time in the sun.
"By taking precautions during intimacy, people can find ways to enjoy sex again."
If you think you have an STI or you're at risk of infection, then screening or testing is the first step to preserving your short- and long-term health and well-being. With proper treatment, most infections are highly manageable. Talk to your healthcare provider and make an appointment.
