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Sexually Transmitted Infections

What are sexually transmitted infections (STIs)?

While STIs are usually passed between people during sex, STIs do so in one of two ways: through contact with infected body fluids and through contact with infected areas on the skin. View the Common STIs section to find out more details about how specific STIs are transmitted.

  • STIs and body fluids- When people have sex, the exchange of body fluids like cum and pre-cum, vaginal secretions, and blood can be a route for STIs living in these fluids to to pass from one person to another. Some STIs, like HIV, can be transmitted through any of these fluids while others can only be transmitted through some of them.
  • STIs and skin-to-skin contact- Some STIs are transmitted when a person comes into contact with sores, rashes and skin around the site where their partner got an STI. While an STI may be more likely to be passed on if there is an obvious sore or rash, some STIs can still be transmitted when a sore has healed.

How can I reduce my risk of getting an STI?

Condoms are the best way to reduce risk of STIs when you’re having sex because they prevent the exchange of body fluids during sex and provide partial coverage of areas where a person might have STI related sores. Keep in mind that condoms can’t always prevent STIs if they break, are used incorrectly, or if they don’t cover all of an affected area. Getting tested for STIs helps to keep you informed about what risks you and your partners might have. If one of your partners has an STI, explore activities with less risk of transmitting an STI until they’ve have received treatment or any infectious sores or outbreaks have passed. You can also get vaccinated for some STIs. There are vaccines for Hepatitis A, Hepatitis B and several strains of HPV (which causes genital warts). If you’re not sure if you’ve been vaccinated, ask your doctor to check your medical history.

How do I know if I have an STI?

Most sexually transmitted infections have a variety of different possible symptoms and show up differently in different people. While you may have noticeable symptoms from STIs like itching, painful urination, opens sores or rashes, many people don’t have noticeable symptoms from STIs they have. If you don’t have initial symptoms from an STI you can still transmit it to your sexual partners and the STI you have can still create health problems for you later. The best way to know if you have an STI is to get regularly tested. There are sexual health clinics across Ontario that offer free testing for HIV and other STIs.

How can I get tested for STIs?

There are sexual health clinics across Ontario that offer free testing for HIV and other STIs. Services at clinics can be accessed if you don’t have a regular doctor or a health card. Sexual health clinics in York Region and Durham Region require that you call in advance to book an appointment for testing. To book an appointment or find out more information about testing in your area visit these pages for sexual health clinics in York Region and Durham Region. If you have a regular doctor and feel comfortable talking about your sex life with them, you can also ask your doctor to have you tested for STIs. If you see your doctor and get lab work done on a regular basis, STI tests can be added to your routine lab work. Keep in mind that your regular doctor may not be as familiar with HIV and STI testing as staff at sexual health clinics.

I found out I have an STI, now what do I do?

If you have an STI, it’s important to talk to a doctor or medical professional about what treatment options exist. Depending on what STI you have, there may be a way to treat or cure the infection. View the Common STIs section to find out more about treatment options for specific STIs. Common treatment options include:

  • Antibiotics - STIs that are caused by bacterial infections- things like Syphilis, Gonorrhea, and Chlamydia- can be easily treated with antibiotics. Testing clinics should be able to provide you with a prescription to treat these types of STIs. If you’re prescribed antibiotics for an STI, make sure to finish all the antibiotics you’ve been prescribed, even if your symptoms have gone away.
  • Support your immune system - Some STIs can be cleared by your immune system, but they can use a boost from you. Proper diet and adequate rest can help strengthen your immune system to fight off infections.
  • Medicine - There are some pharmaceuticals that can cure certain STIs or reduce their symptoms and impact on your health. Testing clinics should be able to provide you with a prescription for these medications. If you’re prescribed medication for an STI, make sure to follow the directions to make the treatment you’re receiving as effective as possible.

Chlamydia

  • Very similar to Gonorrhea
  • Type of Infection: Bacterial
  • Transmitted by: Sexual fluids (cum, pre-cum, vaginal/fronthole secretions) coming in contact with mucous membranes (oral, anal, and vaginal/fronthole sex)
  • Symptoms: discharge, pain in the infected area, painful urination, itchiness
  • Many people are asymptomatic
  • Possible long term issues: Pelvic inflammatory disease (women, trans men), epididymitis (men, trans women) if left untreated
  • Treatment: Easily treated with antibiotics. Your body may clear the infection on its own after a year or more, but you can be reinfected, especially if you’ve passed the infection to a regular partner.
  • Risk Reduction Techniques: Using condoms when you’re having sex is the most effective way to prevent transmission.

Gonorrhea

  • Very similar to Chlamydia
  • Type of Infection: Bacterial
  • Transmitted by: Sexual fluids (cum, pre-cum, vaginal/fronthole secretions) come in contact with mucous membranes (oral, anal, and vaginal/fronthole sex)
  • Symptoms: discharge, pain in the infected area, painful urination, itchiness
  • Many people are asymptomatic
  • Possible long term issues: Pelvic inflammatory disease (women, trans men), epididymitis (men, trans women) if left untreated
  • Treatment: Easily treated with antibiotics. Your body may clear the infection on its own after several months, but you can be reinfected, especially if you’ve passed the infection to a regular partner.
  • Risk Reduction Techniques: Using condoms when you’re having sex is the most effective way to prevent transmission.

Syphilis

  • Type of Infection: Bacteria
  • Transmitted by: It’s spread when your skin — especially mucous membranes like those found in your mouth, throat, penis, ass, frontal genital area (for trans guys) and the top inside of your nose — comes into direct contact with syphilis sores or rashes. Sharing equipment for injecting, smoking and/or snorting drugs can also pass syphilis from one person to another. Transgender people should take note that sharing needles to inject hormones is also considered a high risk activity.
  • Symptoms: Many people with Syphilis have no symptoms and are unaware that they have it. Some people may develop a small, painless sore or chancre at the location of the infection. If untreated, the chancre may develop into a rash that can appear anywhere on the body, on the palms of the hands and soles of the feet.  This rash is usually not itchy. At this stage of infection, a person may also experience flu-like symptoms.
  • Possible long term issues: If left untreated, syphilis can lay dormant for 10 to 30 years before reemerging with severe symptoms including damage to the brain, nerves, blood vessels and heart. This can lead to blindness and even death.
  • If you are living with HIV: Syphilis may increase your ‘viral load’ (a measure of HIV in your blood). This can speed up the rate at which HIV damages your immune system. If your HIV is not being well-controlled through medications, and your CD4 counts are lower, this can put you at risk for getting neurosyphilis (syphilis infection of the brain or spinal cord), which can lead to dementia, lack of coordination, and stroke.
  • Syphilis makes you more likely to transmit HIV to sex partners. Many STIs including syphilis will increase the amount of HIV in your blood, semen and for trans guys frontal genital fluids, making it easier to transmit HIV. Similarly, if you have HIV your immune system may be less able to control the amount of syphilis bacteria in your body making syphilis easier to pass along to your sex partners as well.
  • Treatment: Syphilis can be treated with antibiotics if it is caught in the early stages. If you use injection drugs, always use fresh injection needs.
  • Risk Reduction Techniques: The best means of preventing transmission is to use barriers, like condoms or dental dams, over the site of infection (i.e. any sores that may be visible). Don’t share injection, smoking and/or snorting drug use equipment, or share cigarettes. Trans guys should take note that sharing needles to inject hormones is also considered a high risk activity.

Intestinal Parasites (Giardia, E. Coli, and others)

  • Type of Infection: Parasites
  • Transmitted by: Oral contact with the ass or anything that has been inside it (fingers, penis, toys, etc.)
  • Symptoms: Depending on the parasites, may have loose foul-smelling stools, diarrhea, mucous in stools, abdominal cramps and gas. Many parasites don’t have symptoms, particularly in North America.
  • Possible long term issues: If you are HIV+ (or suspect you may be) certain parasites may weaken your immune system.
  • Treatment: Treatments vary based on the type of parasite. For many people with intestinal parasites, no treatment is required. If you are having severe symptoms, you will need to visit your doctor to decide on the best course of treatment.
  • Risk Reduction Techniques: If you have parasites, you can prevent passing them on to others by washing your hands carefully after having bowel movements, cleaning your ass before having sex, being careful when handling soiled condoms, washing anything inserted in the anus before putting it in the mouth. You can use a barrier (such as a dental dam or split in half condom) when rimming your partner.

Herpes

  • Type of Infection: Virus
  • Transmitted by: Herpes is spread through contact with infected areas in the body, usually the mouth area or the genitals. While different strains of the virus are more common for oral and genital herpes respectively, oral sex can transfer an infection from the mouth area to the genitals or vice versa. While transmission is easiest when someone has an active outbreak (e.g. visible sores), the virus can be active in affected areas without noticeable signs).
  • Symptoms: An initial herpes outbreak with rashes and blisters can occur within 2 days to 3 weeks of initial transmission. The primary outbreak may be accompanied by itching or tingling sensation on the skin, flu-like symptoms, fever, painful urination and/or enlarged nodes. Symptoms generally decrease in severity, with some people only experiencing an initial outbreak and others having continuous but less severe outbreaks over time.
  • Possible long term issues: Long term complications are rare. Herpes infections in the eye can cause blindness. Herpes outbreaks during childbirth can cause complications and should be discussed with a doctor.
  • Treatment: There is currently no cure for herpes. There is medication that you can take that speeds the recovery time during outbreaks, helping to reduce the possibility of transmitting the virus. Supplementing the diet with foods rich in the amino-acid lysine have also been shown to reduce outbreaks.
  • Risk Reduction Techniques: Avoiding sexual contact when you have an active outbreak can help reduce the risk of transmitting herpes to your partners. Latex barriers like condoms, dental dams, and latex gloves can help reduce some risk of transmission but do not provide full protection. Anti-viral medication speeds the recovery time during outbreaks, helping to reduce the possibility of transmitting the virus. Supplementing the diet with foods rich in the amino-acid lysine have also been shown to reduce outbreaks.

HPV/Genital Warts

  • Type of Infection: Virus
  • Transmitted by: HPV is spread by direct skin-to-skin contact with warts or an infected area. There do not have to be visible warts on an infected area for the virus to be transmitted.
  • Symptoms: Most types of HPV are asymptomatic. Certain strains of HPV can lead to visible genital warts. Genital warts are flesh colored growths that appear on affected areas and can cause itching, painful intercourse, and bleeding in the rectum and vagina/front hole.
  • Possible long term issues: Certain strains of HPV are associated with higher risk for various types of cancer, including cervical cancer and throat cancer.
  • Treatment?: There is no cure for HPV. Genital warts can be removed as they occur by doctors using either liquid nitrogen, Podophyllin, trichloroacetic acid, or a topical cream called Aldara. Genital wart removal is covered by OHIP. An HPV vaccine known as Gardasil can provide protection to uninfected people from the two types of HPV most commonly implicated in causing genital warts and the two that are most likely to cause cervical cancer. The vaccine comes in three doses; the cost is about $400-$500 total. While OHIP only provides the vaccine for free to high school age girls, private insurance coverage may cover the
  • Risk Reduction Techniques: Using latex condoms and avoiding sexual contact when warts are present offers significant but not total protection. Getting vaccinated against HPV is the best form of prevention now available.

Hepatitis B

  • Type of Infection: Virus
  • Transmitted by: HPV is spread by direct skin-to-skin contact with warts or an infected area. There do not have to be visible warts on an infected area for the virus to be transmitted.
  • Symptoms: Most types of HPV are asymptomatic. Certain strains of HPV can lead to visible genital warts. Genital warts are flesh colored growths that appear on affected areas and can cause itching, painful intercourse, and bleeding in the rectum and vagina/front hole.
  • Possible long term issues: Certain strains of HPV are associated with higher risk for various types of cancer, including cervical cancer and throat cancer.
  • Treatment?: There is no cure for HPV. Genital warts can be removed as they occur by doctors using either liquid nitrogen, Podophyllin, trichloroacetic acid, or a topical cream called Aldara. Genital wart removal is covered by OHIP. An HPV vaccine known as Gardasil can provide protection to uninfected people from the two types of HPV most commonly implicated in causing genital warts and the two that are most likely to cause cervical cancer. The vaccine comes in three doses; the cost is about $400-$500 total. While OHIP only provides the vaccine for free to high school age girls, private insurance coverage may cover the
  • Risk Reduction Techniques: Using latex condoms and avoiding sexual contact when warts are present offers significant but not total protection. Getting vaccinated against HPV is the best form of prevention now available.

Hepatitis C

  • Type of Infection: Virus
  • Transmitted by: Hepatitis C virus is spread by direct blood-to-blood contact with an infected person. Most people are infected through sharing used needles or other drug injection equipment (“works”), sharing straws or bills for snorting drugs (i.e., cocaine), or sharing crack pipes.
    • It can also be spread by unsterilized tattoo or body piercing equipment (needles, ink), haemodialysis, or accidental needle-stick injuries.  Less commonly, hepatitis C is spread through sexual contact, sharing household items such as razors or toothbrushes, or through birth from a mother infected with hepatitis C.
  • Symptoms: Because hepatitis C progresses slowly, 70–80 per cent of infected people experience no symptoms for up to twenty years. You may not know you have the infection until damage has already been done to your liver. If initial symptoms do occur, they tend to be very mild and resemble the flu. Symptoms may include tiredness, nausea, loss of appetite, fever, headaches, abdominal pain, dark urine, and jaundice (yellowish skin or eyes). People with symptoms tend to experience them about six to 12 weeks after exposure to the virus. Others may experience long-term health concerns such as fatigue, lack of energy, or digestive problems.
  • Possible long term issues: Chronic or long-term infection may lead to scarring of the liver called cirrhosis.  The chance of developing cirrhosis increases with the length of infection.  After 20 years, about two out of 10 people with hepatitis C will have cirrhosis.  Cirrhosis can lead to liver failure or liver cancer in a small number of people.  People who develop cirrhosis or liver cancer may be candidates for a liver transplant. About 20 per cent of people living with HIV are also infected with hepatitis C which can increase the rate of liver damage and make treatment decisions for both infections more complicated.
  • Treatment: Treatment for hepatitis C is available and can help up to 60 per cent of people get rid of the virus.  A healthcare provider can help people decide if treatment is right for them. If people are treated for hepatitis C and get rid of the virus, they can still be infected again. Duration of treatment can range from six months to one year depending on which strain of hepatitis C you have.  If treatment is not successful, you can make certain changes to your life to stay healthy and reduce liver damage.
  • Risk Reduction Techniques: If you use injection drugs, snort drugs, or smoke drugs from crack pipes, make sure that the works you are using are clean and you aren’t sharing them with others. Needle exchanges can provide clean injection drug equipment, and may also stock other clean works like straws and pipes. The risk of getting hepatitis C through sexual contact is low unless a person engages in blood and piercing play, has rough sex (like fisting), or if there is blood present from sores or menstruation. Having open sores or sexually transmitted infections (like syphilis, herpes and HIV) greatly increases the risk of transmitting and getting Hepatitis C. If you or your partner has Hepatitis C, using condoms or dental dams during these activities and avoiding direct blood exchange can help lower your risk of transmitting or getting Hepatitis C.

Where can I learn more about specific STIs?

The Hassle Free Clinic in Toronto provides in-depth information on how different STIs are transmitted, their symptoms, and how to get tested and treated for them. To find out more, visit www.hasslefreeclinic.org