I Think I May Have an STI. What Symptoms Should I Be Looking For?

Sexually transmitted infections (STIs) are different types of contagious infections that are transmitted primarily through sexual contact. Sexual transmission happens when an infected person comes into contact with or exposes a noninfected person.

STIs are transmitted during vaginal, oral or anal sex. They can be bacterial, viral, or parasitic and can cause various diseases. Some of the most common STIs are bacterial vaginosis, HPV and trichomoniasis. An untreated STI can become a sexually transmitted disease (STD) such as chlamydia, genital herpes, gonorrhea or syphilis.

While sexual contact is the most common route of transmission of a sexually transmitted infection, in some cases, that can happen via nonsexual contact. Some STIs can be passed through direct contact, including touching an open sore and then touching another area vulnerable to transmission.

Mother-to-child transmission during childbirth is another way some STIs may spread.

What are the common symptoms of STIs?

STIs can vary in signs and symptoms and sometimes have none, which is why they may go unnoticed until complications occur.

Potential symptoms to watch for include the following:

• Anal bleeding and itching
• Burning during urination
• Discharge from the rectum
• Discharge from the penis
• Fever
• Lower abdominal pain
• Pain during sex
• Rashes in the midsection
• Sores or bumps in the genital, oral or rectal area
• Swollen lymph nodes, particularly in the groin
• Unusual or odorous vaginal discharge
• Vagina bleeding

"Syphilis is a hard one because it can present in so many ways," said Sara Moskowitz, A.P.R.N.-C., a nurse practitioner at NYU Langone's Preston Robert Tisch Center for Men's Health in New York City. "I've had syphilis present with a stomach ache, headache and joint pain. But the classic symptoms would be that it starts with a chancre, which is like a painless ulcer, and that can be found on the genitals or around the anus and in the mouth."

She added that there's also a syphilis rash, which is usually a non-itchy rash that starts on the torso and back and can spread to the arms.

"It's pretty distinct. You start to really notice it when you see the rash on the palms of the hands and the feet," she said.

Herpes typically presents either around the mouth or the anus or on the genital region. It's usually painful, especially during the first outbreak, causing painful red blister bumps. Herpes can be accompanied by a burning sensation.

STI testing and diagnosis

It's challenging for healthcare providers to diagnose an STD or STI based on symptoms alone. They will need to perform tests and examinations. Blood tests and urine samples are common.

If you have open sores, they may test fluid and samples from the sores to make the diagnosis.

"For chlamydia and gonorrhea, for example, you do either a genital swab or a penile swab," said Paul Pavlov, M.D., a family physician at North Bay Family Medical Clinic in Biloxi, Mississippi. "Basically, you stick a cotton swab into the tip of your penis. For things like herpes, you'd do a direct herpes culture, hopefully by lifting the lid off a herpes blister and swabbing the base of it. You have to swab it pretty aggressively to get a good culture. That's the best way to diagnose that."

A visual examination can be done for syphilis if there's a little canker sore in the affected area.

"If it's a viral infection, you can test for viral load," said Renee Trewella, B.S.N., a registered nurse with LHC Group in Baton Rouge, Louisiana. "For human immunodeficiency virus (HIV), an enzyme-linked immunosorbent assay (ELISA) is often done. An ELISA tests the patient's blood sample for antibodies."

Herpes antibodies are generally unreliable.

"The herpes blood test checks for antibodies, and so if you've ever had an outbreak, or even sometimes if you've been exposed, your herpes blood test can come back positive, so it's a pretty poor test," Moskowitz said.

The most accurate way to diagnose herpes is a positive culture from an active lesion.

"If someone comes into the office with symptoms of herpes—like if they have a genital herpes outbreak or herpes around their anus—I can swab those lesions and that's a great test to diagnose herpes," she said.

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When should you seek help for an STI?

Women can go to their primary care provider or their OB-GYN to get checked if they're having any STI symptoms, Trewella said.

"[Men] can go to their primary care physician. And if it's something that needs a specialist, they can be referred to urology or infectious disease, depending on how it's progressed," she said.

Most health departments throughout the United States have an STD/STI clinic. Planned Parenthood clinics offer STD/STI testing, treatment and vaccines.

What happens if an STI goes undiagnosed?

Undiagnosed and untreated STIs can increase your risk of acquiring HIV. An STI can lead to an immune response in the genital area, which may increase the likelihood of HIV development.

Several STDs can cause infertility in men and women. In women, they can cause pelvic inflammatory disease (PID), which sometimes causes infertility by scarring the fallopian tubes.

"Untreated gonorrhea can cause infertility in both men and women," Moskowitz said. "It would just be like the infection spreading to the testicles or ovaries. There's disseminated gonococcal infection, which can cause arthritic symptoms, but it is pretty rare."

Untreated gonorrhea could potentially develop into sepsis if the infection spreads from the genitals or the infected area, Trewella said. Sepsis is the body's extreme response to an infection and is a life-threatening medical emergency that could lead to organ failure, tissue damage and death.

STDs, STIs and Senior Citizens: More than 40 percent of the 54 million people older than 65 in the U.S. remain sexually active. It's vital to educate older adults to ensure they're aware of sexually transmitted infections.

Myths and misconceptions about STIs

"The big common myth from STIs is you can only have it from having sex and that's not the case," Trewella said. "There doesn't have to be penetrative sex to contract an STI. It can be oral. It can be any contact with the area. HIV can pass through breast milk. Transmission does not have to be inclusive to sex."

Take a look at three of the more common myths about STIs.

1. I've been tested for STIs, so my partner does not need to be tested.

If you've been tested and treated for STIs, you may assume your partner need not worry. You may have received effective treatment, but there's no guarantee your partner has taken the same precautions. If your partner needs treatment and doesn't get it, you can be infected again when you next have sex with them.

2. You can contract STIs from a toilet seat.

This is mostly untrue. STDs and STIs are spread through unprotected vaginal, anal or oral sexual activity and by genital contact and sharing sex toys. The viruses that cause bacterial STDs and STIs can't survive outside of your body's mucous membranes for more than a few seconds. However, some infections, such as herpes and hepatitis B, can survive outside the body for several days and still be contagious.

3. You would know if you or someone else had an STD or STI.

Infections such as chlamydia and herpes often have no symptoms. For instance, with herpes, you may have cold sores for a while and then they go away, so you think the infection is gone. Subsequent outbreaks could show no symptoms. With chlamydia, you might not have any symptoms and you can pass along the infection without knowing it.

The only way to know for sure if you've been infected is by visiting a medical professional and taking a test.