Viral STIs

Overview

Herpes Simplex Virus (HSV) is a sexually transmitted infection (STI) that causes painful sores of the mouth or genitals. If transferred to a newborn, it can cause severe complications or death.

Prevalence

There were approximately 18.6 million new and ongoing cases of HSV in the U.S. in 2018 (amongst ages 18-49) (Spicknall et al., 2021). It is most common among young adults, women, and those who are immunocompromised (Jain et al., 2024).

Transmission

HSV spreads through direct contact with a sore, through bodily fluid (saliva or genital fluids), or through contact with mucous membranes (skin of mouth or genitals)  (McCance & Huether, 2019 & CDC, 2024). In other words, HSV can spread by kissing, sex (oral, vaginal, or anal), or by sharing sex toys or eating utensils.

HSV is more likely to spread when sores are visible, but it can also spread when no signs or symptoms are present.

Though rare, HSV can spread from a pregnant woman to her fetus through the placenta. More often, infants acquire herpes from a mother during childbirth or when family members with herpes cold sores in the mouth kiss the infant. Herpes simplex virus is very dangerous for a newborn.

Symptoms

Oral Herpes

Oral herpes presents as a cluster of painful sores around the mouth or lips. They last for a few days to weeks. The most common type of oral herpes is HSV1.

Genital Herpes

HSV, either type 1 or 2 causes recurrent episodes of painful sores on or near the genitals. The sores break open, then crust over after a few days to weeks. During the first episode people often experience a fever or body aches. The first episode often lasts the longest and is the most severe.

Other symptoms include discomfort with urination, urinary retention, or vaginal discharge.

Prior to an episode, someone may experience tingling or itching, a “prodrome” that the sores are about to appear. 

Neonatal Herpes (HSV in Infants)

Infants may experience HSV infections of the skin, eyes or mouth. The virus can enter their nervous system, causing seizures or death.

Complications

HSV complications include infections of the eyes (keratitis), liver (hepatitis), nervous system/brain (meningitis, encephalitis), or throat (pharyngitis). Additionally, open HSV sores may become infected.

Someone with active HSV has a 4 times higher risk of acquiring HIV if exposed.

Neonatal herpes can infect the organs and cause disability or death.

Diagnosis

Typically HSV is diagnosed when a health care provider visualizes the painful sores. However, the sores can be swabbed and cultured to determine the type of HSV to better direct treatment.

Treatment

HSV is not curable but it is treatable. Antiviral medications decrease the length and severity of episodes and help prevent complications.

Prevention

HSV is most contagious during the time immediately before an outbreak (prodromal period) and during outbreaks, however, it can spread at any time, since the virus remains present in the body.

Condoms reduce the risk of acquiring HSV by 30% when used consistently and correctly
 (Martin et al., 2009).

The best way to prevent spread of STIs is to avoid sex outside of a long term mutually monogamous relationship.

HSV in infants is very serious and can cause death. Pregnant women should notify their health care provider of a history of HSV or an HSV outbreak. People with HSV should wash hands frequently around infants, keep any sores covered, and avoid kissing infants — especially on the lips.

Overview

Human Immunodeficiency Virus (HIV) is a virus spread sexually and through other body fluids. Untreated, it can lead to a dangerous end stage disease called acquired immunodeficiency syndrome (AIDS). While there is no cure for HIV, treatment now is highly effective in helping people live longer and healthier lives.

Prevalence

The first cases of HIV were identified in the early 1980s. HIV incidence peaked in the U.S. in the mid 1980s. As public efforts to understand, prevent, and treat the disease increased, the number of affected people decreased — though many died from end stage HIV or AIDS. In 2022, there were approximately 32,000 new infections and 1.2 million total infections in the U.S. (ages 13 and older) (HIV.gov, 2025) . Of the new infections, males accounted for 81%,  and females accounted for 19%.  Men who have sex with men (MSM) accounted for 67%. People who inject drugs accounted for 7% of new infections. Young adults were most affected. The disease disproportionately affects Black/African Americans individuals (37% of new cases), then Hispanic individuals (33% of new cases), then white individuals (24%).

Transmission

HIV is transmitted by bodily fluids, including blood, semen, pre-semen, rectal and vaginal fluids, and breast milk (CDC, How HIV spreads, 2024 & McCance & Huether, 2019). It enters the body through mucous membranes or open or damaged skin. HIV is not transmitted by contaminated surfaces, hugging, or saliva.

Sexual Activity

HIV can be obtained by vaginal or anal sex. Receptive anal sex is the sexual act that puts someone at highest risk. HIV only transmits through oral sex if there are cuts/sores in the mouth of the receptive partner. Consistent condom use reduces risk of acquiring HIV by 70% in MSM (Smith et al., 2015), and 80% in heterosexual couples (Weller & Davis, 2002). Having other STIs increases someone’s risk of acquiring HIV substantially.

Pregnancy, Childbirth, and Breastfeeding

A mother may transmit HIV to her child during pregnancy, childbirth, or breastfeeding.

Other

A contaminated needle during drug use, tattoo art, or medical needle stick can also transmit HIV. Other shared drug equipment such as syringes or shared cookers can also spread HIV. Blood transfusions are a rare form of exposure due to extensive blood screening methods.

Symptoms

Not all stages of HIV infection are symptomatic. The most symptomatic periods are early in the disease and late in the disease. AIDS is the last stage of HIV infection. Consistent HIV treatment can prevent AIDS. 

Acute Stage

1-4 weeks after infection, some people have symptoms of an acute viral disease. These include body aches, fever, fatigue, swollen lymph nodes, sore throat, or a rash (Sax & Berry; McCance). During this time, the virus is quickly replicating and CD4 cells (immune cells) are being destroyed. The virus is highly contagious at this time.

Chronic/Asymptomatic Stage

After the acute phase, HIV often has few visible signs. For 2-10 years, the HIV virus remains at a steady level in the body. However, healthy immune cells, known as CD4 cells, are slowly decreasing.

Acquired Immunodeficiency Syndrome (AIDS)

AIDS is the final stage of HIV. People who take treatment consistently typically do not reach this stage. During this time the viral level of HIV is high, and the number of CD4 cells are very low. The immunosuppression of AIDS gives way to a variety of “opportunistic infections” such as pneumonia or meningitis caused by bacteria, funguses, or parasites. These type of infections are rarely seen in healthy individuals. A few types of cancers, such as non Hodgkin’s lymphoma, Kaposi sarcoma, or cervical cancer are more common in people with AIDS. Life expectancy is 2-3 years in this stage.

Diagnosis

Routine screening recommendations, suspicious symptoms, or fear of exposure prompt testing for HIV. Bloodwork is necessary for a confirmatory diagnosis. However, initial testing is often with home kits or rapid tests which use oral swabs, urine, or blood.

Testing for HIV immediately after exposure will not be accurate. HIV tests have a “window period” of days to months after exposure until the test is accurate. It is important to retest for HIV after the window period.

Screening

Currently the CDC and American College of Obstetricians (ACOG) recommend all people ages 13-64 be tested at least once in their lifetime for HIV (CDC, Getting tested for HIV, 2025 & ACOG, 2014). Additionally, higher risk groups should be retested once a year. This includes MSM, people who inject drugs, people who exchange sex for money or drugs, people who have a partner with HIV, or those with a new partner of unknown HIV status or a partner who engages in any of the above activities.

Treatment

Treating HIV with Antiretroviral Treatment (ART)

HIV is not curable but it is treatable — making HIV a managed chronic disease. Most people with managed HIV can live long lives.

HIV treatment, called antiretroviral therapy, or “ART”, lowers the amount of HIV in the blood to low or undetectable amounts. Someone on ART will likely never experience AIDS. Opportunistic infections are rare with ART.

ART therapy must be taken consistently and not stopped for the virus to remain undetectable. It can take 6 months of treatment before HIV is undetectable. Occasionally, treatment resistance or side effects develop — so frequent medical appointments are necessary to monitor viral levels and the body’s response.

A scientifically sound concept known as “Undetectable = Untransmittable” or “U=U”, means that someone with an undetectable viral load (due to consistent medication) cannot transmit HIV sexually. ART is not as effective at preventing transmission by contaminated needle/syringe.

ART comes in pill or injection form. It must be taken exactly as prescribed to be effective.  It cannot be stopped — medication use is lifelong. 

PEP and PrEP

PEP is a 28 day medication regimen prescribed to people who have been exposed to HIV.  It reduces the risk of acquiring HIV. It must be started immediately after exposure — the sooner the better. It cannot be started later than 72 hours after exposure.

PrEP is a medication used to prevent HIV for those who are frequently exposed. It comes in pill or injection form. Recommended groups include those with multiple or new partners, MSM, those with an HIV infected partner, or those who share drug equipment.

Prevention

Ultimately, STIs are best prevented by avoiding sex outside of a long term mutually faithful and monogamous relationship. However, this is not the exclusive reality of current sex culture and combining other forms of prevention are necessary to stop the spread of this disease.

Medication as Prevention

Treating HIV prevents further spread. This includes taking antivirals preventatively (PrEP), after exposure (PEP), or for HIV treatment.

Condoms

Condoms reduce the risk of acquiring HIV by 70-80%. (Weller et. Al, 2022; Smith et al., 2015). Anyone with a sexual partner with HIV or of unknown status should use condoms to reduce risk of STI acquisition.

PPE and Safe Needle Practices

In healthcare, personal protective equipment (PPE) should be used when exposed to body fluids or mucous membranes.  This includes gloves, goggles, gowns, and hand washing as indicated. Additionally, anyone working with needles or syringes should use safe practices to prevent sticks, and dispose of equipment properly. Needles should never be reused.

Pregnancy and Breastfeeding

Since HIV can spread from mother to child during pregnancy, childbirth, or breastfeeding, women with HIV or with a partner with HIV should seek medical care early and often to lower risk of spread to child. Antiviral treatment and behavioral interventions reduce the risk of transmission.

A Medical Home

Having a consistent “medical home” for routine screenings and consistent treatment promotes early detection of HIV and consistent treatment.

Overview

Human Papillomavirus (HPV) is a virus that spreads primarily by sexual contact, but also by contact with infected skin and contaminated objects. It is a leading cause of several cancers. Pap smears are highly effective at detecting HPV early and preventing cervical cancer.

Prevalence

Human Papilloma Virus (HPV) is the most common sexually transmitted virus. An estimated 85% of sexually active people have it in their lifetime (Chesson et al., 2014, CDC, 2024). Typically, the immune system eliminates the virus, but if it does not, a high-risk strain can cause cancer.

Transmission

HPV can be spread through secretions during sex (oral, vaginal, or anal sex) or by contact with infected skin or contaminated objects. HPV warts are highly contagious and spread through touch.

Symptoms

HPV may be wart causing or cancer causing. Someone with wart causing HPV may have clustered warts on the genitals or other parts of the body. The warts may itch, bleed, or cause pain with sex. Cancer causing types of HPV (called “high risk” types) may only have symptoms when the cancer is at a later and more difficult to treat stage.

Symptoms may show up months to decades after acquiring the virus.

Complications

HPV can cause several cancers (cervical, vaginal, penile, oropharyngeal, etc.).

Diagnosis

The HPV warts are diagnosed through visualization by a health care provider.

Cervical cancer causing HPV is diagnosed by pap smears or HPV testing. These tests are completed by cervical swab. Pap testing/HPV testing is recommended every 3-5 years, or sooner if abnormal, in women ages 21-65.

Menstrual sampling may also be an effective form of HPV testing, but this form of testing is not yet widely available (Chakravarti et al., 2022).

Treatment

Warts are treated through topical medication or other treatments, such as freezing. HPV related cancer has differing treatments depending on location.

Prevention

The best way to prevent an HPV infection is to avoid sexual activity outside of a long term faithful relationship. HPV often has no symptoms and spreads easily. Condoms reduce the risk of spreading HPV during sex by 30-50% (Winer et a., 2006 & Pierce Campbell et al., 2013).

Additionally, living a healthy lifestyle — including avoiding excessive alcohol or smoking— helps the body clear HPV.

A vaccine also exists to prevent certain strains of HPV, and may be administered to children ages 9-26, and those at higher risk. Obtaining routine Pap smears is key to detecting HPV early.