STI Guide: Information for Men

Produced by: Hassle Free Clinic
66 Gerrard Street East
2nd Floor
Toronto · Ontario · M5B 1G3
Phone: 416 · 922 · 0566 (men’c clinic)
Web: hasslefreeclinic.org
Last updated: 18 January 2000

Urethritis

Urethritis is an infection of the inside of the penis. The two most important causes are gonorrhea and chlamydia. There are other causes of urethritis as well, not all of which require treatment.

Causes and symptoms

Gonorrhea, a bacteria that causes a white or yellow pus discharge, mild to severe burning when urinating and itching inside the head of the penis. Symptoms usually begin in two-six days, though sometimes men have no symptoms at all.

Chlamydia, a bacteria-like organism that causes milder symptoms than gonorrhea (a white or clear discharge with mild burning). Symptoms can take seven to 21 days to start. However, in up to 30 per cent of cases, there are no symptoms at all.

Trichomonas is an organism passed on during vaginal sex. Men generally have no symptoms but can carry trichomonas inside the penis and transmit it to female partners. Sometimes it causes a slight discharge or itching inside the head of the penis.

Non-specific urethritis (NSU). If you have symptoms but nothing shows up in your lab tests, you may have non-specific urethritis (NSU). “Non-specific” means you have an infection, but the lab can’t tell what is causing it.

In many cases, NSU is probably caused by chlamydia. This is hard to prove, however, since chlamydia doesn’t always show up in lab tests.

Other minor organisms and bacteria can be picked up from a partner’s vagina or anus, or from the throat (e.g. strep bacteria). These organisms may cause symptoms but they are not considered dangerous, so the lab often doesn’t test for them. Treatment may be given for the symptoms, though they sometimes clear up on their own.

Temporary symptoms may result from other causes like too much alcohol, spicy foods, reactions to soaps or cosmetics, stress or minor damage from rough sexual activity.

How you get it

These infections are passed on during sexual contact between the penis and the rectum, throat or vagina. You can pass them on even if you have no symptoms. You can also transmit them to your eyes via your fingers, though this rarely happens.

Gonorrhea and chlamydia cannot survive outside the body, so you can’t pick them up from shared towels, toilet seats or locker rooms. However, women can pick up trichomonas this way.

Complications

If you don’t get treated early, gonorrhea and chlamydia can occasionally lead to complications such as arthritis, infections of the prostate, and scarring of the tubes connected to the testicles (epididymitis), resulting in sterility. Women can suffer serious complications as well.

Testing

Your doctor will take a sample from your penis using a thin cotton swab. If you go to an STI clinic, the doctor will look at the sample under a microscope in order to tell whether you have an infection. A microscopic exam is the only way to detect trichomonas. The sample will then be sent to a lab for testing. Try not to urinate for two hours before getting tested, since you might wash away the organism causing the infection. Make sure your doctor takes a swab test before treating you, since it is important to know the exact cause of your infection.

Treatment

Antibiotics will cure all the above infections. Gonorrhea is usually treated with Suprax, other infections with doxycycline or Zithromax. Men whose regular female partners have trichomonas should be tested and treated with Flagyl. Be sure to take all your medication regardless of how soon symptoms clear up. Otherwise the infection might return, and you could infect other partners.

Note: Don’t treat yourself with old, leftover antibiotics. What works for a sore throat will not clear up urethritis! Taking medications without knowing the proper dosage leads to the development of resistant strains of bacteria. Besides, if you treat yourself, it may be impossible for your doctor to find out the cause of the infection. Finally, some antibiotics, such as doxycycline, actually become toxic when they are old.

Follow-up

If you tested positive for gonorrhea or chlamydia, you must get a follow-up test after treatment because medications may not completely work, even when symptoms appear to have cleared up. Don’t have sex again until a follow-up test shows the infection is gone. Tell your partners to get tested and treated.

Prevention

Condoms, properly used, will prevent transmission of the bacteria that cause urethritis. Use latex condoms and water-soluble lube only. If the condom breaks, urinating immediately after having sex and washing your penis might help but this practice is much less reliable than using a condom.

Proctitis

Proctitis is an infection of the anus or rectum. It can be caused by organisms such as gonorrhea, chlamydia and herpes (see also sections on herpes and intestinal parasites).

Symptoms

  • Itching and/or burning around the anus
  • Pus or mucous discharge in stools (shit)
  • Mild to severe pain on bowel movements
  • Occasional diarrhea or fever
  • Some men have no symptoms at all

How you get it

Gonorrhea, chlamydia and herpes are passed on during sex, from the penis to the rectum or vice versa. They can also be passed on by sharing sex toys (dildos, vibrators) or, more rarely, by fingers. Anal herpes may also be passed on during rimming.

Testing

Your doctor will take a sample from your anus with a swab. The sample will then be tested in a laboratory for gonorrhea and in some cases, for chlamydia. As with urethritis, it may be difficult to tell exactly what kind of infection you have, since the organisms do not always show up in lab tests. Rectal sores should be swabbed for herpes. If possible, your doctor should use an anoscope when taking the swab, in order to look inside your rectum. Your doctor can also advise you whether it is necessary to test for any other infections.

Treatment

Gonorrhea can be treated with Suprax; chlamydia and non-specific proctitis with doxycycline. In some cases, no treatment will be necessary.

Follow-up

If you tested positive for gonorrhea or chlamydia, you must have follow-up testing after treatment. Two follow-up tests are needed, since rectal infections are more difficult to test for, and harder to treat successfully. As for sex partners, anyone who performed anal sex on you should be tested and possibly treated.

Prevention

Condoms, properly used, will protect you against some forms of proctitis (gonorrhea, chlamydia, herpes). Use latex condoms and water-soluble lube only. It’s better not to share sex toys such as dildos, but if you do, use condoms and sterilize them with a bleach solution before and after using them.

Oral (throat) infections

Symptoms

Gonorrhea, and occasionally chlamydia, can also infect the back of the throat, but not inside the mouth. These infections rarely cause throat symptoms, so you may not realize you are infected.

How you get it

You can get gonorrhea or chlamydia in the back of the throat by performing oral sex on an infected penis. It is almost impossible to get infected by deep kissing, oral-vaginal sex or rimming.

Treatment and follow-up

Oral gonorrhea is treated with Suprax, chlamydia with doxycycline. You need two follow-up tests because these throat infections are more difficult to test for, and harder to treat. Men on whom you have performed oral sex should get treated too.

Syphilis

Syphilis is caused by a bacteria called Treponema pallidum. It goes through three distinct stages after infection, with different symptoms for each stage of the disease.

Symptoms

Primary stage:

During the first or primary stage, a small ulcer or “chancre” appears on your penis, or on or inside your rectum, or mouth. The chancre is usually painless. During this stage, you are highly infectious to your sexual contacts. The chancre will appear two to four weeks after you picked up the infection, and will remain for another three to six weeks. It will disappear on its own without treatment, but you will still have the infection.

Secondary stage:

After the chancre disappears, there is a period with no symptoms lasting three to six weeks. Then, the second stage begins. You may get a rash on the palms, soles, chest or back. The rash is generally not itchy. Other symptoms might include persistent fever, patches of hair loss, and flat, wart-like growths on the penis, scrotum or anus. During this stage, you are also very infectious to your sexual contacts. Secondary symptoms disappear after a few weeks, without treatment, but may return.

Late (tertiary) stage:

A long period with no symptoms follows the secondary stage, during which you are not infectious. However, this does not mean the infection is over. Symptoms of late syphilis may take from 10 to 30 years to develop. They can be very serious resulting in blindness, heart or brain damage, and in some cases, even death. Fortunately, syphilis can be detected and treated before it reaches this stage.

How you get it

You get syphilis from direct sexual contact with the sores or rashes on an infected person’s body. Sometimes these symptoms are not visible (inside the mouth or rectum), so you may be unaware that you or your partner has syphilis.

Testing

The most common means of detecting syphilis is through a blood test. This test becomes positive anywhere from two weeks to three months after infection. Your doctor or the lab may also be able to examine fluid from the primary sore under a microscope.

If you are HIV+, it may be more difficult to detect syphilis in your blood. In this case, your doctor should ask for a “confirmatory” test as well.

Treatment

If detected within one year of infection, syphilis is easily treated with penicillin injections, or with doxycycline or erythromycin, for people allergic to penicillin. If syphilis is detected later than one year, you will require longer courses of treatment. It is currently felt that HIV+ people may need a longer course of treatment to successfully cure a syphilis infection.

Prevention

You should have a syphilis blood test at least once a year if you are sexually active with casual partners. Using condoms can prevent syphilis transmission, as long as the sore is covered. Tell your sex partners to get tested as well.

Herpes

Herpes is caused by two related viruses; Herpes simplex 1 or 2. Type 1 usually occurs around the mouth; type 2 more often on the genitals or anal area. However, both types can be transmitted to either area.

Symptoms

The symptoms are one or more blisters or small sores. They are often itchy or painful and quickly develop into small ulcers. They appear from two to 20 days on the part of your body where you picked up the infection. The sores begin to heal within a week, but may take several weeks to disappear.

With anal herpes, you may experience pain, fever, difficulty urinating, and tenderness on the inside of your legs before the sores appear.

After the sores clear up, the virus becomes inactive but stays in your body for life. The sores may never recur, but in most cases, the virus is reactivated, causing similar symptoms in the same area. We don’t yet understand why herpes is reactivated. Periods of stress, sickness or being run down may cause symptoms to return. Herpes doesn’t cause complications in men, but pregnant women with active herpes run the risk of passing herpes to their child during childbirth.

How you get it

You can get herpes by having direct contact with the herpes sores on someone else’s body, including on their lips. Usually it is not contagious if there are no sores. However, there have been a few cases where the virus was passed on, even when the infected person had no visible symptoms. This is a recent discovery (1990s) and we don’t yet understand why it happens.

Testing

Herpes can be diagnosed by taking a sample of fluid from sores with a swab. Blood tests for herpes are not reliable, and should not be used for diagnosis. However, if you have sores, it is important that you take a blood test to make sure the sores are not syphilis.

Prevention

Condoms may prevent you from getting herpes or passing it to others, if the condom covers the herpes sore. If you have herpes, you should always use condoms, even if no sores are present. It’s a good idea to inform regular sexual partners.

Treatment

There is no cure for herpes, at present. Herpes can be treated with acyclovir and related medications in pill form. Treatment works best when started as soon as sores appear, or just before an outbreak. Acyclovir ointment is available, but is not as effective, and is useful only with the first outbreak of herpes.

Genital warts

Genital and anal warts are caused by the human papilloma virus (HPV). They vary in size from tiny rough raised areas on the skin to large cauliflower-like growths, and appear on the penis, around or inside the vagina and anus, or on the mouth. Some people are carriers only, and do not develop symptoms (though they can spread the virus to others). HPV is not considered dangerous to men, but certain strains have been linked to cervical abnormalities in women.

How you get it

You get warts by direct contact with a wart on another person’s body. Warts take anywhere from three weeks to nine months to appear.

Testing

Warts are diagnosed by visual examination. If you have external anal warts, your doctor should check inside your anus, as well. You should take a blood test to rule out syphilis, since one symptom is wart-like growths in the anus or on the penis.

Treatment

Warts are treated by freezing them with liquid nitrogen. They can also be treated with the chemicals podophyllin and bichloracetic acid. Treatment continues once a week, until the warts disappear. You must have follow-up examinations, since the warts may return. In some cases, warts keep returning for several years, even with treatment, until your immune system learns to fight the virus that causes them. Warts that don’t respond to treatment can be treated surgically in hospital.

Prevention

Condoms will prevent transmission of warts as long as the wart is covered. If you have penile warts you should inform partners with whom you’ve had anal or vaginal sex.

Molluscum

Molluscum is a small growth on the skin, caused by a virus. It is smooth in texture and dome-like in shape, with an indentation in the centre. It is usually flesh-coloured, but can be pink or greyish-white. Molluscum can grow anywhere on the body, but is generally seen on the shaft of the penis, or the face and hands. It is not dangerous, and sometimes disappears on its own.

Symptoms

Molluscum generally causes no discomfort, although it may become infected with bacteria, which may cause itchiness, redness and irritation.

How you get it

Molluscum is passed by direct contact with the molluscum growths on someone else’s body. An infected person can also transmit it to others on his fingers, after touching the growths on his own body. Molluscum appears anywhere from one week to six months after contact.

Treatment

Molluscum is treated with liquid nitrogen. As with warts, it may take a number of treatments before it clears up, and symptoms may return after treatment.

Crabs

Crabs are a form of lice that live in the hairy parts of your body, most often the pubic area. They are very small and difficult to see, and look like tiny crabs under a microscope. They live for about 30 days, although they can only survive for two or three days off the body. Crabs lay their eggs (“nits”) on individual body hairs, where the hair joins the skin. The eggs look like tiny brownish dots, and can live up to 30 days off the body.

Symptoms

Crabs are not dangerous. The main symptoms are itching, particularly at night, and reddish-brown flakes (of dried blood) in the underwear.

How you get it

You get crabs by sexual contact, sleeping in the same bed, or by sharing clothes and towels with someone who has crabs. Since crabs and nits can survive off the body, you don’t need direct physical contact with another person to catch them (e.g. you can catch them from toilet seats and saunas).

Treatment

You can get rid of crabs with shampoos or lotions (such as Kwellada or NIX) available in drug stores without a prescription. The shampoo is easier to use than the lotion, but some doctors believe the lotion is more effective. Before using these shampoos or lotions, be sure to read the instructions carefully. A single application is usually enough. If you feel the treatment did not work, do not repeat it before seven to 10 days; and consider seeing your doctor before a second treatment.

Some treatments for crabs contain a chemical called lindane, which may be toxic if large amounts are absorbed into your body. A single application should not be a problem, but if numerous applications are necessary, you may risk damaging your nervous system. A safe non-lindane alternative is permethrin (NIX).

You must also clean any clothes, bed sheets or towels that you have used in the past few weeks, in hot soapy water and a hot dryer. Your sexual partners and people you sleep with should follow the same procedures.

Scabies

Scabies is a skin rash caused by a tiny insect or mite. The mite is invisible to the naked eye, and burrows into your skin to lay its eggs.

Symptoms

Scabies symptoms are itchy red spots which could resemble a rash. The spots normally appear on your wrists, ankles, penis, hands, chest or back, but rarely appears on the face or scalp.

How you get it

You can get scabies from direct contact with an infected person, or infected clothes, towels, or bed sheets.

Treatment

Scabies is treated with Kwellada or Scabine lotion. See the section under “crabs” for precautions, including telling partners.

Intestinal parasites

Parasites are micro-organisms which live in the intestines. Some cause symptoms while others can live for long periods in the bowel without causing symptoms or requiring treatment.

Symptoms

Some intestinal parasites (e.g. E. histolytica, Giardia) can cause symptoms such as loose foul-smelling stools, diarrhea, mucous in stools, abdominal cramps and gas. These symptoms may last for weeks and return several times a year. Other parasites are harmless and often don’t cause symptoms (e.g. E. hartmanni, E. coli). In North America and Europe, parasites rarely cause serious complications. If you are experiencing any of the above complaints, see your doctor.

How you get it

You can get parasites the same way you get hepatitis A, from oral contact anywhere in the anal area. This includes contact with fingers which have been in the anus, and handling soiled condoms. Parasites can also be transmitted in food and water.

Prevention

If you have parasites, you can prevent passing them on to others by washing your hands carefully after having bowel movements, cleaning the anal area before having sex, and being careful when handling soiled condoms. These precautions are especially important for food handlers and care givers. If you are HIV+ (or suspect you may be) avoid rimming, since certain parasites may weaken your immune system.

Testing and treatment

Your doctor sends stool samples to a lab for testing. If you have intestinal parasites, treatment will depend on the type of parasite found in your stool. Some doctors say that since parasites rarely cause complications, treatment should be given only if your symptoms are bothersome. The treatments themselves contain very potent chemicals that could be harmful if taken incorrectly.

Hepatitis

Hepatitis is inflammation of the liver. There are many causes of hepatitis (including certain chemicals and alcohol abuse), but infection with a virus is the main cause. The common types of viral hepatitis are hepatitis A, B and C (discovered in the late 1980s). There are other types of viral hepatitis (D and E), but little is known about them, yet.

Symptoms

  • flu-like symptoms, including loss of appetite and fatigue
  • dark orange urine
  • pale-coloured stools (shit)
  • dark yellow colour to the skin and eyes (jaundice)
  • pain in the right upper side of the abdomen (where the liver is located)

Some people show only mild symptoms or none at all, so you may not realize you are infected.

With hepatitis A, symptoms may begin from two to six weeks after exposure; with hepatitis B, from two to six months; and with other kinds of hepatitis, from two weeks to six months.

How you get it

Hepatitis A can be transmitted by different kinds of sexual contact (especially oral-anal) and by contaminated water or food. This is because it is found in a person’s stool, and is passed on to others via the hands if the person does not wash carefully after bowel movements. Once symptoms have cleared up, you are no longer infectious for hepatitis A, and you will become immune. Re-infection with hepatitis A is very rare.

Hepatitis B is found generally in the blood, semen, and in smaller amounts, in saliva. Like the AIDS virus, you can get hepatitis B if someone else’s infected blood or semen gets into your blood-stream. For this reason, unsafe anal sex and needle-sharing are very risky. You can also contract hepatitis B during oral sex, if you get semen in your mouth. Transmission by saliva is very rare, and can only happen if an infected person bites you and saliva gets into your bloodstream. Blood tests will tell when you are no longer infectious.

Hepatitis C is found in the blood, and is transmitted by sharing needles. Before 1990 when a test for hepatitis C became available, it was also passed on by blood transfusions. Sexual transmission may occur, but has not yet been documented.

Complications

There usually are no serious complications with hepatitis A. Once you are infected, your body produces antibodies which protect you against re-infection (i.e. you become immune).

With hepatitis B, most people recover within six months, and become immune to it. However, about 10 per cent of people develop chronic hepatitis, and become carriers (i.e. they continue to be infectious). Some carriers become immune, while others may get recurrent bouts of hepatitis B or develop liver damage that can eventually lead to cirrhosis, cancer and death. With hepatitis C, it is not yet clear what percentage of patients recover from their infection and what percentage remain carriers.

Testing

Your doctor can diagnose hepatitis A, B and C by testing your blood. Blood tests are also used to assess the degree of damage to the liver (called liver function tests). You should take these tests routinely, until your liver is functioning normally.

Treatment

There is no treatment for hepatitis. Your body’s own defense mechanisms can eliminate the infection, in most cases. You should avoid alcohol and certain drugs that can cause liver damage until you have recovered. Also avoid fatty and hard-to-digest foods, and get lots of rest. You must continue to have medical check-ups until you have recovered completely.

Prevention

There are now vaccines available to prevent both hepatitis A and B. They are given in two and three injections respectively, over a six-month period. The hepatitis B vaccine is free in Ontario. The hepatitis A vaccine must be purchased. Both are highly recommended for people who have numerous sexual partners or who share needles. People from countries where hepatitis is very common may already be immune.

Practicing safer sex may also prevent you from getting hepatitis B and C. With hepatitis A, you must take more careful precautions. If you are infected, you should wash your hands after bowel movements and before handling food. The virus can be passed by oral-anal sex, or on fingers or soiled condoms, so care must be taken here.

With hepatitis A and B, partners in the past two weeks should get injections of immune globulin or hepatitis B immune globulin (HBIG) respectively, which give short-term immunity. Partners of hepatitis B carriers should be vaccinated with the hepatitis B vaccine as well.

How you can prevent getting or passing on STIs (including HIV)

Using condoms during anal and vaginal sex will stop most types of STI. Use latex condoms and water-soluble lube, and squeeze out air from the tip of the condom. There are also non-latex alternatives available, but if you use lambskin, cover it with a latex condom. Pulling out before you “ome might guard against infection if the condom breaks during intercourse.

If the condom breaks, urinating immediately after sex and washing your penis with soap and water may help prevent urethral infections, although this method is not very reliable.

During oral sex, don’t get semen, blood or vaginal fluid in your mouth, since there is a risk (low) of picking up HIV and hepatitis B this way. Using a condom prevents spreading HIV and other STIs from oral sex.

It is also advisable not to perform oral sex within two hours of flossing or brushing your teeth, since these activities could cause cuts in the gums, providing entry points for HIV.

Similarly, you should be careful after recent dental surgery, or if you have problems with bleeding gums or other sores in your mouth. If you’re worried because someone has performed oral sex on you, washing and urinating may help, as noted above.

Performing oral sex may also expose you to hepatitis A and parasites. The virus can be present anywhere in the anal area or on fingers which have touched the anus of an infected person.

Rimming is risky for the person doing the rimming, since it may expose them to parasites and hepatitis A. You and your partners should wash the anal area thoroughly, before engaging in any oral contact near the anus. Douching is not a good idea, since it can damage the anal canal and drive infections further in.

Sex toys can pass on parasites, hepatitis A, HIV and a number of other STIs. Cover sex toys with condoms, or wash them carefully with bleach and rinse well before and after using. Keep in mind that the lining of the anus is easily damaged by fists, dildos and other sex toys, so precautions should be taken.

Routine testing is very important for people who have casual sex. You can pick up a number of STIs without having symptoms, so testing may be your only way of knowing whether or not you’re infected. If you have casual sex, get a syphilis blood test at least once a year, depending on how many different partners you have had, and whether or not you had unprotected sex. You may also need urethral, anal and throat swabs for gonorrhea and chlamydia, depending on what sexual activities you engage in.

Get an HIV blood test, to find out if you’ve been infected with HIV. Don’t assume you’re negative because you feel well, or because you haven’t had unsafe sex for a long time. Also, don’t assume that your sexual partners are HIV negative. Keep in mind that there is now a lot you can do to stay well, if you test positive. Don’t wait until it’s too late.

Consider getting vaccinated for hepatitis A and B, if you are at risk (i.e. multiple sexual partners, or sharing needles).

Inform your sexual partner(s) if you have an STI. Speak to a nurse or counsellor first to decide whom you need to inform.

Do not donate blood, semen or organs, unless you know you have never been infected with HIV, hepatitis or syphilis.