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Sexually transmitted diseases (STDs) can be transmitted through various sexual activities – oral, anal, or vaginal intercourse. Anyone who is sexually active is potentially at risk of getting STD.
It is a common misconception that not having symptoms means that one does not have any STD. In fact, most STDs can be completely asymptomatic while some may only cause symptoms much later when the disease is more severe. Hence, people who look and feel entirely well can still have and transmit STD to their sexual partners.
In this article, we will learn that many STDs may cause similar symptoms. Certain STDs also cause very non-specific symptoms which may often be wrongly attributed to other medical conditions. The only way to be sure that one is clear of STDs is through screening.
Chlamydia
Chlamydia is a common STD, caused by Chlamydia trachomatis and can occur in the genital tract or even be carried in the throat. It can often be asymptomatic, with studies estimating up to half of men and 70-90% of women not experiencing any symptoms with Chlamydia.
If symptoms do occur, they usually surface from a few days to 2-3 weeks after initial infection.
In men:
- Painful urination
- Penile discharge
- Urinary urgency or frequency.
- Chlamydia can also cause more serious infections like epididymoorchitis, where one experiences pain and swelling of the testicles or epididymis (a gland that sits near the testicle).
- Anal pain and discomfort can occur with Chlamydia infections of the rectum, transmitted through anal intercourse
In women:
- Abnormal vaginal discharge
- Bleeding after intercourse
- Abnormal spotting in between menstrual periods
- Pain during sexual intercourse
- Chlamydia can cause a more serious infection known as pelvic inflammatory disease where the infection spreads to affect the uterus and fallopian tubes. This may manifest as abdominal pain and fever but can frequently be mild and silent
- Infertility due to scarring of the fallopian tubes is a possible late symptom of undetected Chlamydia
Gonorrhea
Gonorrhea is a bacteria STD of the genital tract and can also occur in the throat from oral intercourse. Symptoms tend to surface within a few days up to 2 weeks after initial infection.
In men:
- Painful urination
- Thick, pus-like penile discharge
- Urinary urgency or frequency
- Gonorrhea can also cause more serious infections like epididymoorchitis, where one experiences pain and swelling of the testicles or epididymis (a gland that sits near the testicle).
- Anal pain and discomfort can occur with Gonorrhea infections of the rectum, transmitted through anal intercourse
In women:
- Abnormal vaginal discharge
- Bleeding after intercourse
- Abnormal spotting in between menstrual periods
- Pain during sexual intercourse
- Gonorrhea can cause a more serious infection known as pelvic inflammatory disease where the infection spreads to affect the uterus and fallopian tubes. This may manifest as lower abdominal pain and fever.
Trichomonas
Trichomoniasis is a genital STD caused by a parasite called Trichomonas vaginalis. Symptoms usually surface several days up to a month after initial infection.
In men:
- Discomfort or irritation or an itching sensation in the urine tract
- Painful urination
- Penile discharge
In women:
- Abnormal vaginal discharge (classically described as “frothy green discharge”, sometimes with a foul odour)
- Vaginal itching
- Spotting in between menstrual periods
- Bleeding after intercourse
- Painful intercourse
Mycoplasma spp and Ureaplasma spp
Certain strains of Mycoplasma (e.g. Mycoplasma hominis, Mycoplasma genitalium) and Ureaplasma (e.g. Ureaplasma urealyticum, Ureaplasma parvum) are bacterial STDs which typically affect the genital tract.
In men:
- Painful urination
- Discomfort or irritation in the urine tract
- Penile discharge
In women:
- Abnormal vaginal discharge and discomfort
- Abnormal bleeding/spotting between menses or after intercourse
- Mycoplasma genitalium specifically: may be associated with increased risk of pelvis inflammatory disease and resultant infertility due to scarring. There is also some evidence to suggest pre-term delivery may occur in pregnant women
Syphilis
Syphilis is caused by a bacteria called Treponema pallidum. As it is an infection with different stages, it may manifest with a variety of symptoms. These symptoms can sometimes be so mild or unnoticeable that they may be dismissed, which is why syphilis is often diagnosed incidentally on screening (through a blood test).
If left untreated, the infection can spread to involve multiple organs including the brain, eye, nerves and heart. The symptoms of syphilis are similar in both males and females and can manifest anytime from weeks to months or even years after initial infection.
Primary syphilis (manifests a few weeks up to 3 months after infection)
- Painless ulcer known as a “chancre” – either on the genital, anal or oral region. This may disappear and heal as the infection progresses
Secondary syphilis (manifests months or more after initial infection)
- Rash – reddish or brownish patches, anywhere on the body and can affect the palms and soles. This rash may come and go
- Ulcers in the mouth or genital region
- Raised greyish patches of skin in the moist areas of the body like the groin or armpits – known as “condylomata lata”
Tertiary syphilis – this list is non-exhaustive and symptoms depend on the organ affected
- If the brain is affected, numbness, weakness, incoordination and dementia can occur
- Heart problems can arise if syphilis causes inflammation of the aorta and associated aortic valve (aortitis)
Latent syphilis – this is when an infected individual has NO symptoms but the disease can progress to tertiary syphilis with devastating consequences.
Neurosyphilis – when syphilis affects the eye and nervous system – can occur anytime, and result in visual problems and even blindness.
Syphilis can also cause general symptoms like fever, enlarged lymph nodes, sore throat, which may be incorrectly attributed to other causes.
Herpes
Herpes is a common type of STD caused by the Herpes Simplex Virus type 1 or type 2 (HSV-1 or HSV-2) and can be spread through bodily secretions like saliva or genital fluids. Once infected, individuals may experience flares or outbreaks of herpes from time to time. In between flares, they are asymptomatic. These outbreaks occur typically in the oral, genital or anal region.
The symptoms of herpes are similar in both males and females.
Symptoms of herpes occur only during a flare or outbreak
- Prodromal stage – a vague tingling or discomfort may occur over skin
- Stage 2 – nonspecific red spots appear over the skin
- Stage 3 – these red spots turn into painful, fluid filled blisters which may resemble tiny pimples
- Stage 4 – the blisters burst and form painful, shallow ulcers
- Stage 5 – the ulcers crust and scab over and heal
The first flare of herpes after initial infection is typically the worst and may even be associated with fever, fatigue and swollen lymph nodes.
Many individuals with HSV have NO symptoms whatsoever and may not even be aware that they carry the virus. Even when absolutely asymptomatic, they can still transmit the virus to others.
Human Papilloma Virus (HPV)
HPV is a very common STD. Most people who are sexually active are likely to be exposed to various strains of HPV at some point in their lives. Most HPV infections are asymptomatic and infected individuals can still spread the virus to their sexual partners.
Different strains of HPV are associated with various cancers or warts.
Symptoms of HPV in both men and women:
- Genital warts – flesh coloured, cauliflower like bumps or lumps can occur around the genital and perianal region. In women, these can grow outside on the vulva or perianal region, or inside the vaginal canal and on the cervix. In men, these can occur anywhere on the penis, the groin, and the perianal region
- HPV related oral or anal cancers can occur in both men and women
Symptoms of HPV in women:
- Certain high-risk types of HPV can result in pre-cancerous or cancerous changes in the cervix. This may cause abnormal spotting or bleeding after intercourse or in between menses, but may have no symptoms and only be detected in an abnormal PAP smear.
Human Immunodeficiency Virus (HIV)
HIV is often the first and most dreaded STD that people think about. It infects the body’s immune system. Over time, it reduces the number of immune cells in the body, leading to a state of weakened immunity where individuals are susceptible to unusual and severe infections as well as cancers.
The symptoms of HIV are widely variable, depending on the stage of infection. Not everyone will experience the same symptoms. Many individuals infected with HIV may have no symptoms whatsoever.
Symptoms of early HIV infection (several weeks after infection)
- These symptoms are due to seroconversion i.e. your body’s immune response to having detected the virus
- Flu-like symptoms with high fever, swollen lymph nodes, sore throat, rash, muscle aches
- NOT EVERYONE experiences these symptoms; some people can be infected and completely skip this phase
Symptoms of chronic HIV infection
- There may be NO SYMPTOMS for years after initial infection as the virus silently multiples in the body
Symptoms of AIDS (Acquired Immunodeficiency Syndrome, the late stage of HIV infection) – the bulk of these symptoms are due to unusual infections which can occur because of a severely weakened immune system. The following list is not exhaustive.
- Rapid unexplained weight loss
- Fevers and night sweats
- Fatigue
- Swollen lymph nodes
- Chronic diarrhoea
- Recurrent yeast (candida) infections
- Unusual lung infections (e.g. pneumocystis carinii pneumonia)
- Unusual skin cancers (e.g. Kaposi’s sarcoma)
- Neurological problems like memory loss or nerve problems
The bottom line is that there are no tell-tale symptoms of HIV infection. The only way to know is to get tested. Early diagnosis is crucial for early treatment, which in turn enables people with HIV to live normal and healthy lives.
Asymptomatic STDs
Certain blood borne STDs like Hepatitis B and Hepatitis C may have no symptoms. They infect the liver and cause chronic inflammation. Infected individuals may feel perfectly fine for years. Blood tests for liver function may show some inflammation during this time. Actual symptoms may only manifest much later on in the form of symptoms of end stage liver disease, when the damage to the liver is extensive enough.
If you have any symptoms that may suggest an STD, do see a doctor and get yourself screened. If you feel well but are sexually active and have not gone for screening before, or have a new sexual partner, it is important to remember that lack of symptoms does not mean being free of STDs!
Take charge of your health and get screened for STDs regularly.
Boon Lay Clinic & Surgery
Boon Lay Clinic & Surgery is a primary care clinic brand under Singapore Paincare Holdings Limited; the goal is to bring affordable medical treatments to the heartland areas.
Led by Dr. Julian Ng, Boon Lay Clinic & Surgery provides chronic disease management, men’s health (men’s HIV & STD screening), women’s health, health screenings, vaccinations, corporate healthcare, medical examinations (maid/ employment permit/insurance/student pass).
Address: 221 Boon Lay Place, #01-240 Singapore 640221
Contact number: +65 6265 5247
