Sexually transmitted infection
|Sexually transmitted infection|
|Synonyms||Sexually transmitted diseases (STD), venereal diseases (VD)|
|"Syphilis is a dangerous disease, but it can be cured." Poster encouraging treatment. Published between 1936 and 1938.|
|Symptoms||None, vaginal discharge, penile discharge, ulcers on or around the genitals, pelvic pain|
|Causes||Infections commonly spread by sex|
|Prevention||Not having sex, vaccinations, condoms|
|Frequency||1.1 billion (STIs other than HIV/AIDS, 2015)|
|Deaths||108,000 (STIs other than HIV/AIDS, 2015)|
Sexually transmitted infections (STI), also referred to as sexually transmitted diseases (STD) and venereal diseases (VD), are infections that are commonly spread by sexual activity, especially vaginal intercourse, anal sex and oral sex. Many times STIs initially do not cause symptoms. This results in a greater risk of passing the disease on to others. Symptoms and signs of disease may include vaginal discharge, penile discharge, ulcers on or around the genitals, and pelvic pain. STIs can be transmitted to an infant before or during childbirth and may result in poor outcomes for the baby. Some STIs may cause problems with the ability to get pregnant.
More than 30 different bacteria, viruses, and parasites can be transmitted through sexual activity. Bacterial STIs include chlamydia, gonorrhea, and syphilis. Viral STIs include genital herpes, HIV/AIDS, and genital warts. Parasitic STIs include trichomoniasis. While usually spread by sex, some STIs can be spread by non-sexual contact with donor tissue, blood, breastfeeding, or during childbirth. STI diagnostic tests are usually easily available in the developed world, but this is often not the case in the developing world.
The most effective way of preventing STIs is by not having sex. Some vaccinations may also decrease the risk of certain infections including hepatitis B and some types of HPV. Safer sex practices such as use of condoms, having a smaller number of sexual partners, and being in a relationship where each person only has sex with the other also decreases the risk. Circumcision in males may be effective to prevent some infections. Most STIs are treatable or curable. During school, comprehensive sex education may also be useful. Of the most common infections, syphilis, gonorrhea, chlamydia, trichomoniasis are curable, while herpes, hepatitis B, HIV/AIDS, and HPV are treatable but not curable. Resistance to certain antibiotics is developing among some organisms such as gonorrhea.
In 2015, about 1.1 billion people had STIs other than HIV/AIDS. About 500 million were infected with either syphilis, gonorrhea, chlamydia or trichomoniasis. At least an additional 530 million people have genital herpes and 290 million women have human papillomavirus. STIs other than HIV resulted in 108,000 deaths in 2015. In the United States there were 19 million new cases of sexually transmitted infections in 2010. Historical documentation of STIs date back to at least the Ebers papyrus around 1550 BC and the Old Testament. There is often shame and stigma associated with these infections. The term sexually transmitted infection is generally preferred over sexually transmitted disease or venereal disease, as it includes those who do not have symptomatic disease.
- 1 Classification
- 2 Signs and symptoms
- 3 Cause
- 4 Pathophysiology
- 5 Prevention
- 6 Screening
- 7 Diagnosis
- 8 Management
- 9 Epidemiology
- 10 History
- 11 Other names or slang terms
- 12 Plants
- 13 References
- 14 Further reading
- 15 External links
Until the 1990s, STIs were commonly known as venereal diseases, the word venereal being derived from the Latin word venereus, and meaning relating to sexual intercourse or desire, ultimately derived from Venus, the Roman goddess of love. STIs have been euphemistically referred to as "blood diseases" and "social diseases" in the past.
The World Health Organization (WHO) has recommended the more inclusive term sexually transmitted infection since 1999. Public health officials originally introduced the term sexually transmitted infection, which clinicians are increasingly using alongside the term sexually transmitted disease in order to distinguish it from the former.
Signs and symptoms
Not all STIs are symptomatic, and symptoms may not appear immediately after infection. In some instances a disease can be carried with no symptoms, which leaves a greater risk of passing the disease on to others. Depending on the disease, some untreated STIs can lead to infertility, chronic pain or even death.
A sexually transmitted infection present in a pregnant woman may be passed on to the infant before or after birth.
|Risk per unprotected sexual act with an infected person|
|Performing oral sex on a man|
|Performing oral sex on a woman|
|Receiving oral sex—man|
|Receiving oral sex—woman|
- Chancroid (Haemophilus ducreyi)
- Chlamydia (Chlamydia trachomatis)
- Gonorrhea (Neisseria gonorrhoeae), colloquially known as "the clap"
- Granuloma inguinale or (Klebsiella granulomatis)
- Mycoplasma genitalium
- Mycoplasma hominis
- Syphilis (Treponema pallidum)
- Ureaplasma infection
- Candidiasis (yeast infection)
- Viral hepatitis (Hepatitis B virus)—saliva, venereal fluids.
(Note: Hepatitis A and Hepatitis E are transmitted via the fecal-oral route; Hepatitis C is rarely sexually transmittable, and the route of transmission of Hepatitis D (only if infected with B) is uncertain, but may include sexual transmission.)
- Herpes simplex (Herpes simplex virus 1, 2) skin and mucosal, transmissible with or without visible blisters
- HIV (Human Immunodeficiency Virus)—venereal fluids, semen, breast milk, blood
- HPV (Human Papillomavirus)—skin and mucosal contact. 'High risk' types of HPV cause almost all cervical cancers, as well as some anal, penile, and vulvar cancer. Some other types of HPV cause genital warts.
- Molluscum contagiosum (molluscum contagiosum virus MCV)—close contact
- Crab louse, colloquially known as "crabs" or "pubic lice" (Pthirus pubis) The infestation and accompanying inflammation is Pediculosis pubis
- Scabies (Sarcoptes scabiei)
- Trichomoniasis (Trichomonas vaginalis), colloquially known as "trich"
Sexually transmitted infections include:
- Chlamydia is a sexually transmitted infection caused by the bacterium Chlamydia trachomatis. In women, symptoms may include abnormal vaginal discharge, burning during urination, and bleeding in between periods, although most women do not experience any symptoms. Symptoms in men include pain when urinating, and abnormal discharge from their penis. If left untreated in both men and women, Chlamydia can infect the urinary tract and potentially lead to pelvic inflammatory disease (PID). PID can cause serious problems during pregnancy and even has the potential to cause infertility. It can cause a woman to have a potentially deadly ectopic pregnancy, in which the egg implants outside of the uterus. However, Chlamydia can be cured with antibiotics.
- The two most common forms of herpes are caused by infection with herpes simplex virus (HSV). HSV-1 is typically acquired orally and causes cold sores, HSV-2 is usually acquired during sexual contact and affects the genitals, however either strain may affect either site. Some people are asymptomatic or have very mild symptoms. Those that do experience symptoms usually notice them 2 to 20 days after exposure which last 2 to 4 weeks. Symptoms can include small fluid-filled blisters, headaches, backaches, itching or tingling sensations in the genital or anal area, pain during urination, Flu like symptoms, swollen glands, or fever. Herpes is spread through skin contact with a person infected with the virus. The virus affects the areas where it entered the body. This can occur through kissing, vaginal intercourse, oral sex or anal sex. The virus is most infectious during times when there are visible symptoms, however those who are asymptomatic can still spread the virus through skin contact. The initial infection and symptoms are usually the most severe because the body does not have any antibodies built up. After the primary attack, one might have recurring attacks that are milder or might not even have future attacks. There is no cure for the disease but there are antiviral medications that treat its symptoms and lower the risk of transmission (Valtrex). Although HSV-1 is typically the "oral" version of the virus, and HSV-2 is typically the "genital" version of the virus, a person with HSV-1 orally CAN transmit that virus to their partner genitally. The virus, either type, will settle into a nerve bundle either at the top of the spine, producing the "oral" outbreak, or a second nerve bundle at the base of the spine, producing the genital outbreak.
- The human papillomavirus (HPV) is the most common STI in the United States. There are more than 40 different strands of HPV and many do not cause any health problems. In 90% of cases the body’s immune system clears the infection naturally within 2 years. Some cases may not be cleared and can lead to genital warts (bumps around the genitals that can be small or large, raised or flat, or shaped like cauliflower) or cervical cancer and other HPV related cancers. Symptoms might not show up until advanced stages. It is important for women to get pap smears in order to check for and treat cancers. There are also two vaccines available for women (Cervarix and Gardasil) that protect against the types of HPV that cause cervical cancer. HPV can be passed through genital-to-genital contact as well as during oral sex. It is important to remember that the infected partner might not have any symptoms.
- Gonorrhea is caused by bacterium that lives on moist mucous membranes in the urethra, vagina, rectum, mouth, throat, and eyes. The infection can spread through contact with the penis, vagina, mouth or anus. Symptoms of gonorrhea usually appear 2 to 5 days after contact with an infected partner however, some men might not notice symptoms for up to a month. Symptoms in men include burning and pain while urinating, increased urinary frequency, discharge from the penis (white, green, or yellow in color), red or swollen urethra, swollen or tender testicles, or sore throat. Symptoms in women may include vaginal discharge, burning or itching while urinating, painful sexual intercourse, severe pain in lower abdomen (if infection spreads to fallopian tubes), or fever (if infection spreads to fallopian tubes); however, many women do not show any symptoms. There are some antibiotic resistant strains for Gonorrhea but most cases can be cured with antibiotics.
- Syphilis is an STI caused by a bacterium. Untreated, it can lead to complications and death. Clinical manifestations of syphilis include the ulceration of the uro-genital tract, mouth or rectum; if left untreated the symptoms worsen. In recent years, the prevalence of syphilis has declined in Western Europe, but it has increased in Eastern Europe (former Soviet states). A high incidence of syphilis can be found in places such as Cameroon, Cambodia, Papua New Guinea. Syphilis infections are increasing in the United States.
- Trichomoniasis is a common STI that is caused by infection with a protozoan parasite called Trichomonas vaginalis. Trichomoniasis affects both women and men, but symptoms are more common in women. Most patients are treated with an antibiotic called metronidazole, which is very effective.
- HIV (human immunodeficiency virus) damages the body's immune system, which interferes with its ability to fight off disease-causing agents. The virus kills CD4 cells, which are white blood cells that help fight off various infections. HIV is carried in body fluids, and is spread by sexual activity. It can also be spread by contact with infected blood, breast feeding, childbirth, and from mother to child during pregnancy. When HIV is at its most advanced stage, an individual is said to have AIDS (acquired immunodeficiency syndrome). There are different stages of the progression of and HIV infection. The stages include primary infection, asymptomatic infection, symptomatic infection, and AIDS. In the primary infection stage, an individual will have flu like symptoms (headache, fatigue, fever, muscle aches) for about 2 weeks. In the asymptomatic stage, symptoms usually disappear, and the patient can remain asymptomatic for years. When HIV progresses to the symptomatic stage, the immune system is weakened, and has a low cell count of CD4+ T Cells. When the HIV infection becomes life-threatening, it is called AIDS. People with AIDS fall prey to opportunistic infections and die as a result. When the disease was first discovered in the 1980s, those who had AIDS were not likely to live longer than a few years. There are now antiretroviral drugs (ARVs) available to treat HIV infections. There is no known cure for HIV or AIDS but the drugs help suppress the virus. By suppressing the amount of virus in the body, people can lead longer and healthier lives. Even though their virus levels may be low they can still spread the virus to others.
Viruses in semen
Twenty-seven different viruses have been identified in semen. Information on whether or not transmission occurs or whether the viruses cause disease is uncertain. Some of these microbes are known to be sexually transmitted. Those found in semen are listed by the CDC.
Microbes known to be sexually transmissible (but not generally considered STDs/STIs) include:
- Marburg virus – Virus in semen for seven weeks after clinical recovery.
- HTLV (both types 1 and 2) – Sexually transmissible, consumption of breast milk breastfeeding, and once mistaken as a HIV, risk of leukemia.
Many STIs are (more easily) transmitted through the mucous membranes of the penis, vulva, rectum, urinary tract and (less often—depending on type of infection) the mouth, throat, respiratory tract and eyes. The visible membrane covering the head of the penis is a mucous membrane, though it produces no mucus (similar to the lips of the mouth). Mucous membranes differ from skin in that they allow certain pathogens into the body. The amount of contact with infective sources which causes infection varies with each pathogen but in all cases a disease may result from even light contact from fluid carriers like venereal fluids onto a mucous membranes.
Some STIs such as HIV can be transmitted from mother to child either during pregnancy or breastfeeding.
Healthcare professionals suggest safer sex, such as the use of condoms, as a reliable way of decreasing the risk of contracting sexually transmitted diseases during sexual activity, but safer sex cannot be considered to provide complete protection from an STI. The transfer of and exposure to bodily fluids, such as blood transfusions and other blood products, sharing injection needles, needle-stick injuries (when medical staff are inadvertently jabbed or pricked with needles during medical procedures), sharing tattoo needles, and childbirth are other avenues of transmission. These different means put certain groups, such as medical workers, and haemophiliacs and drug users, particularly at risk.
It is possible to be an asymptomatic carrier of sexually transmitted diseases. In particular, sexually transmitted diseases in women often cause the serious condition of pelvic inflammatory disease.
The most effective way to prevent sexual transmission of STIs is to avoid contact of body parts or fluids which can lead to transfer with an infected partner. Not all sexual activities involve contact: cybersex, phonesex or masturbation from a distance are methods of avoiding contact. Proper use of condoms reduces contact and risk. Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom.
Both partners can get tested for STIs before initiating sexual contact, or before resuming contact if a partner engaged in contact with someone else. Many infections are not detectable immediately after exposure, so enough time must be allowed between possible exposures and testing for the tests to be accurate. Certain STIs, particularly certain persistent viruses like HPV, may be impossible to detect with current medical procedures.[medical citation needed]
Some treatment facilities utilize in-home test kits and have the person return the test for follow-up. Other facilities strongly encourage that those previously infected return to ensure that the infection has been eliminated. Novel strategies to foster re-testing have been the use of text messaging and email as reminders. These types of reminders are now used in addition to phone calls and letters. After obtaining a sexual history, a healthcare provider can encourage risk reduction by providing prevention counseling. Prevention counseling is most effective if provided in a nonjudgmental and empathetic manner appropriate to the person's culture, language, gender, sexual orientation, age, and developmental level. Prevention counseling for STIs is usually offered to all sexually active adolescents and to all adults who have received a diagnosis, have had an STI in the past year, or have multiple sex partners.
USPSTF recommends high-intensity behavioral counseling for all sexually active adolescents and for adults at increased risk for STIs. Such interactive counseling, which can be resource intensive, is directed at a person's risk, the situations in which risk occurs, and the use of personalized goal-setting strategies.
Vaccines are available that protect against some viral STIs, such as Hepatitis A, Hepatitis B, and some types of HPV. Vaccination before initiation of sexual contact is advised to assure maximal protection. The development of vaccines to protect against gonorrhea is ongoing.
In the case of HIV, sexual transmission routes almost always involve the penis, as HIV cannot spread through unbroken skin; therefore, properly shielding the penis with a properly worn condom from the vagina or anus effectively stops HIV transmission. An infected fluid to broken skin borne direct transmission of HIV would not be considered "sexually transmitted", but can still theoretically occur during sexual contact. This can be avoided simply by not engaging in sexual contact when presenting open, bleeding wounds.
Other STIs, even viral infections, can be prevented with the use of latex, polyurethane or polyisoprene condoms as a barrier. Some microorganisms and viruses are small enough to pass through the pores in natural skin condoms, but are still too large to pass through latex or synthetic condoms.
Proper male condom usage entails:
- Not putting the condom on too tight at the tip by leaving 1.5 centimetres (0.6 in) room for ejaculation. Putting the condom on snug can and often leads to failure.
- Wearing a condom too loose can defeat the barrier
- Avoiding inverting or spilling a condom once worn, whether it has ejaculate in it or not
- If a user attempts to unroll the condom, but realizes they have it on the wrong side, then this condom may not be effective
- Being careful with the condom if handling it with long nails
- Avoiding the use of oil-based lubricants (or anything with oil in it) with latex condoms, as oil can eat holes into them
- Using flavored condoms for oral sex only, as the sugar in the flavoring can lead to yeast infections if used to penetrate
In order to best protect oneself and the partner from STIs, the old condom and its contents are be assumed to be infectious. Therefore, the old condom must be properly disposed of. A new condom is used for each act of intercourse, as multiple usage increases the chance of breakage, defeating the effectiveness as a barrier.
Specific age groups, persons who participate in risky sexual behavior, or those have certain health conditions may require screening. The CDC recommends that sexually active women under the age of 25 and those over 25 at risk should be screened for chlamydia and gonorrhea yearly. Appropriate times for screening are during regular pelvic examinations and preconception evaluations. Nucleic acid amplification tests are the recommended method of diagnosis for gonorrhea and chlamydia. This can be done on either urine in both men and women, vaginal or cervical swabs in women, or urethral swabs in men. Screening can be performed:
- to assess the presence of infection and prevent tubal infertility in women
- during the initial evaluation before infertility treatment
- to identify HIV infection
- for men who have sex with men
- for those who may have been exposed to hepatitis C
- for HCV
Testing may be for a single infection, or consist of a number of tests for a range of STIs, including tests for syphilis, trichomonas, gonorrhea, chlamydia, herpes, hepatitis and HIV. No procedure tests for all infectious agents.
STI tests may be used for a number of reasons:
- as a diagnostic test to determine the cause of symptoms or illness
- as a screening test to detect asymptomatic or presymptomatic infections
- as a check that prospective sexual partners are free of disease before they engage in sex without safer sex precautions (for example, when starting a long term mutually monogamous sexual relationship, in fluid bonding, or for procreation).
- as a check prior to or during pregnancy, to prevent harm to the baby
- as a check after birth, to check that the baby has not caught an STI from the mother
- to prevent the use of infected donated blood or organs
- as part of the process of contact tracing from a known infected individual
- as part of mass epidemiological surveillance
Early identification and treatment results in less chance to spread disease, and for some conditions may improve the outcomes of treatment. There is often a window period after initial infection during which an STI test will be negative. During this period, the infection may be transmissible. The duration of this period varies depending on the infection and the test. Diagnosis may also be delayed by reluctance of the infected person to seek a medical professional. One report indicated that people turn to the Internet rather than to a medical professional for information on STIs to a higher degree than for other sexual problems.
In the case of rape, the person can be treated prophylacticly with antibiotics.
An option for treating partners of patients (index cases) diagnosed with chlamydia or gonorrhea is patient-delivered partner therapy, which is the clinical practice of treating the sex partners of index cases by providing prescriptions or medications to the patient to take to his/her partner without the health care provider first examining the partner.[needs update]
In 2008, it was estimated that 500 million people were infected with either syphilis, gonorrhea, chlamydia or trichomoniasis. At least an additional 530 million people have genital herpes and 290 million women have human papillomavirus. STIs other than HIV resulted in 142,000 deaths in 2013. In the United States there were 19 million new cases of sexually transmitted infections in 2010.
In 2010, 19 million new cases of sexually transmitted infections occurred in women in the United States. A 2008 CDC study found that 25–40% of U.S. teenage girls has a sexually transmitted disease.
AIDS is among the leading causes of death in present-day Sub-Saharan Africa. HIV/AIDS is transmitted primarily via unprotected sexual intercourse. More than 1.1 million persons are living with HIV/AIDS in the United States, and it disproportionately impacts African Americans. Hepatitis B is also considered a sexually transmitted disease because it can be spread through sexual contact. The highest rates are found in Asia and Africa and lower rates are in the Americas and Europe. Approximately two billion people worldwide have been infected with the hepatitis B virus.
The first well-recorded European outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops besieging Naples in the Italian War of 1494–98. The disease may have originated from the Columbian Exchange. From Naples, the disease swept across Europe, killing more than five million people. As Jared Diamond describes it, "[W]hen syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months," rendering it far more fatal than it is today. Diamond concludes,"[B]y 1546, the disease had evolved into the disease with the symptoms so well known to us today." Gonorrhoeae is recorded at least up to 700 years ago and associated with a district in Paris formerly known as "Le Clapiers". This is where the prostitutes were to be found at that time.
Prior to the invention of modern medicines, sexually transmitted diseases were generally incurable, and treatment was limited to treating the symptoms of the disease. The first voluntary hospital for venereal diseases was founded in 1746 at London Lock Hospital. Treatment was not always voluntary: in the second half of the 19th century, the Contagious Diseases Acts were used to arrest suspected prostitutes. In 1924, a number of states concluded the Brussels Agreement, whereby states agreed to provide free or low-cost medical treatment at ports for merchant seamen with venereal diseases.
The first effective treatment for a sexually transmitted disease was salvarsan, a treatment for syphilis. With the discovery of antibiotics, a large number of sexually transmitted diseases became easily curable, and this, combined with effective public health campaigns against STDs, led to a public perception during the 1960s and 1970s that they have ceased to be a serious medical threat.
During this period, the importance of contact tracing in treating STIs was recognized. By tracing the sexual partners of infected individuals, testing them for infection, treating the infected and tracing their contacts in turn, STI clinics could effectively suppress infections in the general population.
In the 1980s, first genital herpes and then AIDS emerged into the public consciousness as sexually transmitted diseases that could not be cured by modern medicine. AIDS in particular has a long asymptomatic period—during which time HIV (the human immunodeficiency virus, which causes AIDS) can replicate and the disease can be transmitted to others—followed by a symptomatic period, which leads rapidly to death unless treated. HIV/AIDS entered the United States from Haiti in about 1969. Recognition that AIDS threatened a global pandemic led to public information campaigns and the development of treatments that allow AIDS to be managed by suppressing the replication of HIV for as long as possible. Contact tracing continues to be an important measure, even when diseases are incurable, as it helps to contain infection.
Other names or slang terms
In the 1996 sexual harassment case filed against Mitsubishi Motor Manufacturing of America by the Equal Employment Opportunity Commission (EEOC), a number of male employees referred to sexually transmitted infections as “souvenirs”.
- Microbotryum violaceum is an STI in a plant caused by a smut fungus and infects the plant species Silene latifolia. This smut fungus is spread by pollinators, where pollen is the male gamete in plants, which is why M. violaceum is referred to as an STI. It also sterilizes the plants that it infects, regardless of sex.
- "Sexually transmitted infections (STIs) Fact sheet N°110". who.int. November 2013. Archived from the original on 25 November 2014. Retrieved 30 November 2014.
- "How You Can Prevent Sexually Transmitted Diseases". cdc.gov. Centers for Disease Control and Prevention. 31 May 2016. Archived from the original on 9 December 2014. Retrieved 13 December 2017. This article incorporates public domain material from websites or documents of the Centers for Disease Control and Prevention.
- GBD 2015 Disease and Injury Incidence and Prevalence, Collaborators. (8 October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC . PMID 27733282.
- GBD 2015 Mortality and Causes of Death, Collaborators. (8 October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC . PMID 27733281.
- "Sexually transmitted infections". womenshealth.gov. Retrieved 2017-12-08. This article incorporates text from this source, which is in the public domain.
- Murray PR, Rosenthal KS, Pfaller MA (2013). Medical microbiology (7th ed.). St. Louis, Mo.: Mosby. p. 418. ISBN 9780323086929. Archived from the original on 2015-12-01.
- Goering, Richard V. (2012). Mims' medical microbiology (5th ed.). Edinburgh: Saunders. p. 245. ISBN 9780723436010.
- "Preventing Mother-to-Child Transmission of HIV". HIV.gov. Retrieved 2017-12-08.
- International technical guidance on sexuality education: An evidence-informed approach (PDF). Paris: UNESCO. 2018. p. 28. ISBN 978-92-3-100259-5.
- Centers for Disease Control Prevention (2012). "Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: Oral cephalosporins no longer a recommended treatment for gonococcal infections". Morbidity and Mortality Weekly Report. 61 (31): 590–4. PMID 22874837.
- "STD Trends in the United States: 2010 National Data for Gonorrhea, Chlamydia, and Syphilis". Centers for Disease Control and Prevention. Archived from the original on 9 September 2012. Retrieved 15 September 2012.
- Gerd Gross, Stephen K. Tyring (2011). Sexually transmitted infections and sexually transmitted diseases. Heidelbergh: Springer Verlag. p. 20. ISBN 9783642146633. Archived from the original on 2015-09-24.
- Organization, World Health (2003). Guidelines for the management of sexually transmitted infections (PDF). Geneva: World Health Organization. p. vi. ISBN 9241546263. Archived (PDF) from the original on 2014-12-08.
- "Venereal". dictionary.reference.com. Archived from the original on June 3, 2013. Retrieved June 18, 2013.
- Keith Allan; Kate Burridge (6 June 1991). Euphemism & dysphemism: language used as shield and weapon. Oxford University Press. p. 192. ISBN 978-0-19-506622-7.
- K. Madhav Naidu. "Epidemiology and Management". Community Health Nursing. Gyan Publishing House (2010). p. 248.
- "Male STI check-up video". Channel 4. 2008. Archived from the original on 2009-01-23. Retrieved 2009-01-22.
- Hoffman, Barbara (2012). Williams gynecology. New York: McGraw-Hill Medical. ISBN 9780071716727.[page needed]
- Kennedy, Caitlin E; Yeh, Ping T; Pandey, Shristi; Betran, Ana P; Narasimhan, Manjulaa (2017). "Elective cesarean section for women living with HIV". AIDS. 31 (11): 1579–91. doi:10.1097/QAD.0000000000001535. PMC . PMID 28481770.
- Edwards, S; Carne, C (1998). "Oral sex and transmission of non-viral STIs". Sexually Transmitted Infections. 74 (2): 95–100. doi:10.1136/sti.74.2.95. PMC . PMID 9634339.
- Maura Gillisons (2007). "HPV Infection Linked to Throat Cancers". Johns Hopkins Medicine. Archived from the original on 2013-09-06.
- Hoare A (2010). models of HIV epidemics in Australia and Southeast Asia Archived 2012-04-19 at the Wayback Machine.
- Australasian contact tracing manual. Specific infections where contact tracing is generally recommended Archived 2011-03-01 at the Wayback Machine.
- Varghese, Beena; Maher, Julie E; Peterman, Thomas A; Branson, Bernard M; Steketee, Richard W (2002). "Reducing the Risk of Sexual HIV Transmission". Sexually Transmitted Diseases. 29 (1): 38–43. doi:10.1097/00007435-200201000-00007. PMID 11773877.
- Holmes, King K; Johnson, David W; Trostle, Henry J (1970). "An Estimate of the Risk of Men Acquiring Gonorrhea by Sexual Contact with Infected Females1". American Journal of Epidemiology. 91 (2): 170–4. doi:10.1093/oxfordjournals.aje.a121125. PMID 5416250.
- Mahiane, Séverin-Guy; Legeai, Camille; Taljaard, Dirk; Latouche, Aurélien; Puren, Adrian; Peillon, Aurélie; Bretagnolle, Jean; Lissouba, Pascale; Nguéma, Eugène-Patrice Ndong; Gassiat, Elisabeth; Auvert, Bertran (January 2009). "Transmission probabilities of HIV and herpes simplex virus type 2, effect of male circumcision and interaction: a longitudinal study in a township of South Africa". AIDS. 23 (3): 377–383. doi:10.1097/QAD.0b013e32831c5497. PMC . PMID 19198042.
- Burchell, Ann N; Richardson, Harriet; Mahmud, Salaheddin M; Trottier, Helen; Tellier, Pierre P; Hanley, James; Coutlée, François; Franco, Eduardo L (2006). "Modeling the Sexual Transmissibility of Human Papillomavirus Infection using Stochastic Computer Simulation and Empirical Data from a Cohort Study of Young Women in Montreal, Canada". American Journal of Epidemiology. 163 (6): 534–43. doi:10.1093/aje/kwj077. PMID 16421235.
- Platt, R; Rice, P. A; McCormack, W. M (1983). "Risk of acquiring gonorrhea and prevalence of abnormal adnexal findings among women recently exposed to gonorrhea". JAMA. 250 (23): 3205–9. doi:10.1001/jama.250.23.3205. PMID 6417362.
- Department of Public Health, City & County of San Francisco (2011).STD Risks Chart Archived 2011-08-16 at the Wayback Machine.
- Jin, Fengyi; Jansson, James; Law, Matthew; Prestage, Garrett P; Zablotska, Iryna; Imrie, John CG; Kippax, Susan C; Kaldor, John M; Grulich, Andrew E; Wilson, David P (2010). "Per-contact probability of HIV transmission in homosexual men in Sydney in the era of HAART". AIDS. 24 (6): 907–13. doi:10.1097/QAD.0b013e3283372d90. PMC . PMID 20139750.
- Bryan C (2011)INFECTIOUS DISEASE CHAPTER EIGHT SEXUALLY TRANSMITTED DISEASES Archived 2014-06-24 at the Wayback Machine.
- Richard Pearson (2007). "Pinworm Infection". Merck Manual Home Health Handbook. Archived from the original on 2013-10-31.
- Caini, Saverio; Gandini, Sara; Dudas, Maria; Bremer, Viviane; Severi, Ettore; Gherasim, Alin (2014). "Sexually transmitted infections and prostate cancer risk: A systematic review and meta-analysis". Cancer Epidemiology. 38 (4): 329–38. doi:10.1016/j.canep.2014.06.002. PMID 24986642.
- Ljubin-Sternak, Sunčanica; Meštrović, Tomislav (2014). "Chlamydia trachomatisand Genital Mycoplasmas: Pathogens with an Impact on Human Reproductive Health". Journal of Pathogens. 2014: 183167. doi:10.1155/2014/183167. PMC . PMID 25614838.
- Schlicht, M. J; Lovrich, S. D; Sartin, J. S; Karpinsky, P; Callister, S. M; Agger, W. A (2004). "High Prevalence of Genital Mycoplasmas among Sexually Active Young Adults with Urethritis or Cervicitis Symptoms in La Crosse, Wisconsin". Journal of Clinical Microbiology. 42 (10): 4636–40. doi:10.1128/JCM.42.10.4636-4640.2004. PMC . PMID 15472322.
- McIver, C. J; Rismanto, N; Smith, C; Naing, Z. W; Rayner, B; Lusk, M. J; Konecny, P; White, P. A; Rawlinson, W. D (2009). "Multiplex PCR Testing Detection of Higher-than-Expected Rates of Cervical Mycoplasma, Ureaplasma, and Trichomonas and Viral Agent Infections in Sexually Active Australian Women". Journal of Clinical Microbiology. 47 (5): 1358–63. doi:10.1128/JCM.01873-08. PMC . PMID 19261782.
- "Mycoplasma Infections". WebMD. Archived from the original on 2017-07-30. Retrieved 2017-06-29.
- "Diseases Characterized by Urethritis and Cervicitis - 2015 STD Treatment Guidelines". www.cdc.gov. Retrieved 8 December 2017.
- Lis, Rebecca; Rowhani-Rahbar, Ali; Manhart, Lisa E (2015). "Mycoplasma genitalium Infection and Female Reproductive Tract Disease: A Meta-analysis". Clinical Infectious Diseases. 61 (3): 418–26. doi:10.1093/cid/civ312. PMID 25900174.
- Wiesenfeld, Harold C; Manhart, Lisa E (2017). "Mycoplasma genitalium in Women: Current Knowledge and Research Priorities for This Recently Emerged Pathogen". The Journal of Infectious Diseases. 216 (suppl_2): S389–S395. doi:10.1093/infdis/jix198. PMID 28838078.
- Clark, Natalie; Tal, Reshef; Sharma, Harsha; Segars, James (2014). "Microbiota and Pelvic Inflammatory Disease". Seminars in Reproductive Medicine. 32 (1): 43–9. doi:10.1055/s-0033-1361822. PMC . PMID 24390920.
- Larsen, Bryan; Hwang, Joseph (2010). "Mycoplasma,Ureaplasma, and Adverse Pregnancy Outcomes: A Fresh Look". Infectious Diseases in Obstetrics and Gynecology. 2010: 1. doi:10.1155/2010/521921. PMC . PMID 20706675.
- "Giardia, Epidemiology & Risk Factors". Center For Disease Control. July 13, 2012. Archived from the original on May 2, 2015. Retrieved 2015-07-03.
- "Hepatitis A, Division of Viral Hepatitis". Center For Disease Control. May 31, 2015. Archived from the original on July 4, 2015. Retrieved 2015-07-03.
- "Shigella Infections among Gay & Bisexual Men". Center For Disease Control. April 23, 2015. Archived from the original on July 4, 2015. Retrieved 2015-07-03.
- Ljubin-Sternak, Sunčanica; Meštrović, Tomislav (2014). "Chlamydia trachomatisand Genital Mycoplasmas: Pathogens with an Impact on Human Reproductive Health". Journal of Pathogens. 2014: 183167. doi:10.1155/2014/183167. PMC . PMID 25614838.
- Zarei, Omid; Rezania, Simin; Mousavi, Atefeh (2013). "Mycoplasma genitalium and Cancer: A Brief Review". Asian Pacific Journal of Cancer Prevention. 14 (6): 3425–8. doi:10.7314/APJCP.2013.14.6.3425. PMID 23886122.
- McGowin, Chris L; Anderson-Smits, Colin (2011). "Mycoplasma genitalium: An Emerging Cause of Sexually Transmitted Disease in Women". PLoS Pathogens. 7 (5): e1001324. doi:10.1371/journal.ppat.1001324. PMC . PMID 21637847.
- Weinstein, Scott A; Stiles, Bradley G (2014). "Recent perspectives in the diagnosis and evidence-based treatment of Mycoplasma genitalium". Expert Review of Anti-infective Therapy. 10 (4): 487–99. doi:10.1586/eri.12.20. PMID 22512757.
- Taylor-Robinson, D (1996). "Infections Due to Species of Mycoplasma and Ureaplasma: An Update". Clinical Infectious Diseases. 23 (4): 671–82; quiz 683–4. doi:10.1093/clinids/23.4.671. JSTOR 4459713. PMID 8909826.
- Centers for Disease Control Prevention; Workowski, K. A; Berman, S. M (2006). "Sexually transmitted diseases treatment guidelines, 2006". Morbidity and Mortality Weekly Report. 55 (RR-11): 1–94. PMID 16888612.
- Wu J, Chen C, Sheen I, Lee S, Tzeng H, Choo K (1995). "Evidence of transmission of hepatitis D virus to spouses from sequence analysis of the viral genome". Hepatology. 22 (6): 1656–60. doi:10.1002/hep.1840220607. PMID 7489970.
- Farci P (2003). "Delta hepatitis: an update". J Hepatol. 39 (Suppl 1): S212–9. doi:10.1016/S0168-8278(03)00331-3. PMID 14708706.
- Shukla N, Poles M (2004). "Hepatitis B virus infection: co-infection with hepatitis C virus, hepatitis D virus, and human immunodeficiency virus". Clin Liver Dis. 8 (2): 445–60, viii. doi:10.1016/j.cld.2004.02.005. PMID 15481349.
- Baussano, Iacopo; Lazzarato, Fulvio; Brisson, Marc; Franceschi, Silvia. "Human Papillomavirus Vaccination at a Time of Changing Sexual Behavior". Centers for Disease Control and Prevention, Emerging Infectious Diseases. 22 (1): 18–23. doi:10.3201/eid2201.150791.
- Williams gynecology. Hoffman, Barbara L., Williams, J. Whitridge (John Whitridge), 1866-1931. (2nd ed.). New York: McGraw-Hill Medical. 2012. ISBN 9780071716727. OCLC 779244257.
- Prevention, CDC - Centers for Disease Control and. "CDC - Lice". www.cdc.gov. Retrieved 2017-12-04. This article incorporates text from this source, which is in the public domain.
- Prevention, CDC - Centers for Disease Control and. "Lice: Pubic". www.cdc.gov. Retrieved 2017-12-04. This article incorporates text from this source, which is in the public domain.
- King, B. (2009). Human Sexuality Today (Sixth ed.). Upper Saddle River: Pearson Education, Inc.
- "Chlamydia Infections: MedlinePlus". Nlm.nih.gov. Archived from the original on 2013-07-02. Retrieved 2013-06-30.
- "The Basics of Genital Herpes". Archived from the original on 2014-09-22.
- "Herpes". Avert.org. Archived from the original on 2013-07-04. Retrieved 2013-06-30.
- "Human Papillomavirus (HPV) | Overview". FamilyDoctor.org. 2010-12-01. Archived from the original on 2013-07-03. Retrieved 2013-06-30.
- "STD Facts - Human papillomavirus (HPV)". Cdc.gov. Archived from the original on 2013-06-28. Retrieved 2013-06-30.
- MedlinePlus Encyclopedia Gonorrhea
- "STD Facts –Syphilis". Cdc.gov. Archived from the original on 2013-02-11. Retrieved 2013-02-18.
- "Syphilis". Who.int. Archived from the original on 2006-10-30. Retrieved 2013-02-18.
- Clement, Meredith E; Okeke, N. Lance; Hicks, Charles B (2014). "Treatment of Syphilis". JAMA. 312 (18): 1905–17. doi:10.1001/jama.2014.13259. PMID 25387188.
- "STD Facts – Trichomoniasis". Cdc.gov. Archived from the original on 2013-02-19. Retrieved 2013-02-18.
- "Trichomoniasis: MedlinePlus". Nlm.nih.gov. Archived from the original on 2013-03-02. Retrieved 2013-02-18.
- "Trichomoniasis – NHS Choices". Nhs.uk. 27 February 2012. Archived from the original on 11 February 2013. Retrieved 2013-02-18.
- "Hiv/Aids". Mayo Clinic.com. 2012-08-11. Archived from the original on 2013-07-03. Retrieved 2013-06-30.
- "AIDS". Avert.org. Archived from the original on 2013-07-04. Retrieved 2013-06-30.
- "HIV/AIDS Treatment". Niaid.nih.gov. 2009-06-03. Archived from the original on 2013-07-03. Retrieved 2013-06-30.
- Salam, Alex P; Horby, Peter W (2017). "The Breadth of Viruses in Human Semen". Emerging Infectious Diseases. 23 (11): 1922–1924. doi:10.3201/eid2311.171049. PMC . PMID 29048276.
- "Marburg virus disease: origins, reservoirs, transmission and guidelines,". ((Great Britain)) GOV.UK. 5 September 2014. Archived from the original on 5 July 2015. Retrieved 2015-07-03.
- Verdonck, Kristien; González, Elsa; Van Dooren, Sonia; Vandamme, Anne-Mieke; Vanham, Guido; Gotuzzo, Eduardo (2007). "Human T-lymphotropic virus 1: Recent knowledge about an ancient infection". The Lancet Infectious Diseases. 7 (4): 266–81. doi:10.1016/S1473-3099(07)70081-6. PMID 17376384.
- K. Madhav Naidu. Community Health Nursing, Gen Next Publications, 2009, p.248
- "How You Can Prevent Sexually Transmitted Diseases". Centers for Disease Control and Prevention. 31 March 2016. Retrieved 13 December 2017.
- Villhauer, Tanya (2005-05-20). "Condoms Preventing HPV?". University of Iowa Student Health Service/Health Iowa. Archived from the original on 14 March 2010. Retrieved 2009-07-26.
- Desai, Monica; Woodhall, Sarah C; Nardone, Anthony; Burns, Fiona; Mercey, Danielle; Gilson, Richard (2015). "Active recall to increase HIV and STI testing: A systematic review". Sexually Transmitted Infections. 91 (5): 314–23. doi:10.1136/sextrans-2014-051930. PMID 25759476.
- Workowski, K. A; Bolan, G. A; Centers for Disease Control Prevention (2015). "Sexually transmitted diseases treatment guidelines, 2015". Morbidity and Mortality Weekly Report. 64 (RR-03): 1–137. PMID 26042815.
- "Men Who Have Sex with Men | Populations and Settings | Division of Viral Hepatitis | CDC". www.cdc.gov. 31 May 2015. Retrieved 2017-12-13.
- Baarda, Benjamin I; Sikora, Aleksandra E (2015). "Proteomics of Neisseria gonorrhoeae: The treasure hunt for countermeasures against an old disease". Frontiers in Microbiology. 6: 1190. doi:10.3389/fmicb.2015.01190. PMC . PMID 26579097.
- Wilkinson, David; Ramjee, Gita; Tholandi, Maya; Rutherford, George W (2002). "Nonoxynol-9 for preventing vaginal acquisition of sexually transmitted infections by women from men". Cochrane Database of Systematic Reviews (4): CD003939. doi:10.1002/14651858.CD003939. PMID 12519623.
- Williams, M. Healthy Choices for Fertility Control. CreateSpace, Scotts Valley, CA, 2009. ISBN 1-4486-6472-1[page needed]
- Gavin, L; Moskosky, S; Carter, M; Curtis, K; Glass, E; Godfrey, E; Marcell, A; Mautone-Smith, N; Pazol, K; Tepper, N; Zapata, L; Centers for Disease Control Prevention (2014). "Providing quality family planning services: Recommendations of CDC and the U.S. Office of Population Affairs". MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports. 63 (RR-04): 1–54. PMID 24759690.
- "Screening for Chlamydia and Gonorrhea: U.S. Preventive Services Task Force Recommendation Statement". USPSTF. Archived from the original on 9 October 2011. Retrieved 29 April 2014.
- Quilliam, Susan (2011). "'The Cringe Report': Why patients don't dare ask questions, and what we can do about that". Journal of Family Planning and Reproductive Health Care. 37 (2): 110–2. doi:10.1136/jfprhc.2011.0060. PMID 21454267.
- McInerny, Thomas K. (2017). Textbook of Pediatric Care - 2nd Edition. American Academy of Pediatrics. ISBN 978-1-58110-966-5. STAT!Ref Online Electronic Medical Library[permanent dead link][subscription required]
- Expedited Partner Therapy in the Management of Sexually Transmitted Diseases (2 February 2006) Archived 2 November 2009 at the Wayback Machine. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE. Centers for Disease Control and Prevention National Center for HIV, STD, and TB Prevention
- "WHO Disease and injury country estimates". World Health Organization. 2004. Archived from the original on 2009-11-11. Retrieved Nov 11, 2009.
- GBD 2013 Mortality and Causes of Death, Collaborators (17 December 2014). "Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013". Lancet. 385 (9963): 117–71. doi:10.1016/S0140-6736(14)61682-2. PMC . PMID 25530442.
- "Sex Infections Found in Quarter of Teenage Girls Archived 2017-06-26 at the Wayback Machine.". The New York Times. March 12, 2008.
- "CDC study says at least 1 in 4 teen girls has a sexually transmitted disease; HPV most common Archived 2010-04-20 at the Wayback Machine.". The Oklahoman. March 11, 2008.
- UNAIDS, WHO (December 2007). "2007 AIDS epidemic update" (PDF). Archived from the original (PDF) on 2008-05-27. Retrieved 2008-03-12.
- "HIV in the United States: At A Glance Archived 2014-07-13 at the Wayback Machine.". Centers for Disease Control and Prevention.
- "AIDS In Black America: A Public Health Crisis Archived 2015-07-11 at the Wayback Machine.". NPR. July 5, 2012.
- "Hepatitis: Type B (caused by hepatitis B virus) Archived 2010-05-23 at the Wayback Machine.". Minnesota Department of Health.
- "Hepatitis B Archived 2010-03-15 at the Wayback Machine.". U.S. Food and Drug Administration.
- "World Hepatitis Day 2012". WHO. 2012. Archived from the original on 2012-10-23.
- Oriel, J.D. (1994). The Scars of Venus: A History of Venereology. London: Springer-Verlag. ISBN 3-540-19844-X.
- Harper, Kristin N; Ocampo, Paolo S; Steiner, Bret M; George, Robert W; Silverman, Michael S; Bolotin, Shelly; Pillay, Allan; Saunders, Nigel J; Armelagos, George J (2008). "On the Origin of the Treponematoses: A Phylogenetic Approach". PLoS Neglected Tropical Diseases. 2 (1): e148. doi:10.1371/journal.pntd.0000148. PMC . PMID 18235852. Lay summary – Live Science (January 15, 2008).
- CBC News Staff (January 2008). "Study traces origins of syphilis in Europe to New World". Archived from the original on 2013-10-17. Retrieved 2014-02-21.
- Diamond, Jared (1997). Guns, Germs and Steel. New York: W.W. Norton. p. 210. ISBN 84-8306-667-X.
- Archives in London and the M25 area (AIM25 Archived 2006-04-10 at the Wayback Machine.) London Lock Hospital records
- Gilbert, M. T. P; Rambaut, A; Wlasiuk, G; Spira, T. J; Pitchenik, A. E; Worobey, M (2007). "The emergence of HIV/AIDS in the Americas and beyond". Proceedings of the National Academy of Sciences. 104 (47): 18566–70. Bibcode:2007PNAS..10418566G. doi:10.1073/pnas.0705329104. PMC . PMID 17978186.
- "Equal Employment Opportunity Commission v. Mitsubishi Motor Manufacturing of America Inc." Archived 2016-03-04 at the Wayback Machine., Adam J. Conti, LLC, Filing 96-1192, September 15, 1997
- Kaltz, Oliver; Shykoff, Jacqui A (2001). "Male and female Silene latifolia plants differ in per-contact risk of infection by a sexually transmitted disease". Journal of Ecology. 89 (1): 99–109. doi:10.1046/j.1365-2745.2001.00527.x. JSTOR 3072122.
- Workowski, K. A; Berman, S; Centers for Disease Control Prevention (2010). "Sexually transmitted diseases treatment guidelines, 2010". Morbidity and Mortality Weekly Report. 59 (RR-12): 1–110. PMID 21160459.
- Aral, Sevgi O (2008). Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases. : Springer Singapore Pte. Limited. ISBN 978-0-387-85768-8
- Faro, Sebastian (2003). Sexually transmitted diseases in women. Lippincott Williams & Wilkins. ISBN 0-397-51303-8
- Ford, Carol A; Elizabeth Shimer Bowers (2009). Living with Sexually Transmitted Diseases. Facts On File. ISBN 978-0-8160-7672-7
- Sehgal, Virendra N (2003). Sexually Transmitted Diseases (4th ed.). Jaypee Bros. Medical Publishers. ISBN 81-8061-105-1
- Shoquist, Jennifer; Diane Stafford (2003). The encyclopedia of sexually transmitted diseases. Facts On File. ISBN 0-8160-4881-9
- Sexually transmitted infection at Curlie (based on DMOZ)
- CDC Sexually Transmitted Diseases Treatment Guidelines, 2010
- STD photo library at Dermnet
- UNFPA: Breaking the Cycle of Sexually Transmitted Infections at UNFPA
- STDs In Color: Sexually Transmitted Disease Facts and Photos
- : Sexually transmitted diseases in the U.S.