STBBIs

What is an STBBI?

Sexually transmitted and blood-borne infections (STBBIs)
are caused by bacteria, viruses or parasites.

They are transmitted through sexual relations with or without penetration, through the exchange of sex toys, through direct or indirect contact with the blood of an infected person, through the sharing of drug or steroid injection equipment and inhalation equipment, or through tattoos or piercings made with non-sterile equipment.

What's it all about?

  • It is the most common bacterial sexually transmitted infection in the world;
  • Most of these infections are detected in people aged 15 to 24, and more frequently in women;
  • The cervix and urethra, and occasionally the rectum, throat and eyes, may be affected.

How is chlamydia transmitted?

  • During sexual intercourse with penetration of the penis into the vagina or anus;
  • Transmission does not require penetration or ejaculation;
  • During oral-genital intercourse (stimulation of the genitals with the mouth);
  • During a sex toy exchange;
  • An infected mother can transmit the bacteria to her baby during childbirth.

What are the signs and symptoms?

  • Many infected people have no symptoms at all;
  • Symptoms may appear several weeks after initial exposure to the bacteria.

 In women

  • Vaginal discharge;
  • Painful urination;
  • Pain in the lower abdomen or back;
  • Vaginal bleeding after intercourse or between periods;
  • Pain during intercourse;
  • Ocular or rectal infection (rarely).

In men

  • Clear or milky aqueous discharge from the urethra;
  • Itching of the urethra;
  • Painful urination;
  • Painful urination;
  • Ocular or rectal infection (rarely).

Screening

  • Sampling in the infected area;
  • Urine sample for men;
  • Urine sample for women when a pelvic examination is not indicated.

Treatment

Antibiotics.

Other information

If left untreated, chlamydia can have serious health consequences :

In women

  • Infertility;
  • Ectopic pregnancy (in the fallopian tubes);
  • Chronic pain in the lower abdomen;
  • Complications for pregnant women.

In men

  • Inflammation of the testicles, prostate and scrotum;
  • Rashes, sores and joint pain;
  • Infertility (in rare cases).

What's it all about?

  • The second most common bacterial STBBI;
  • People aged 15 to 29 are the most frequently affected;
  • May affect cervix, urethra, rectum, throat and occasionally eyes;
  • Often manifests as a co-infection with chlamydia.

How is gonorrhea transmitted?

  • During sexual intercourse with penetration of the penis into the vagina or anus;
  • Transmission does not require penetration or ejaculation;
  • During oral-genital intercourse (stimulation of the genitals with the mouth);
  • During a sex toy exchange;
  • An infected mother can transmit the bacteria to her baby during childbirth.

What are the signs and symptoms?

There are often no symptoms.

In women

  • Increase in vaginal discharge;
  • Painful urination;
  • Pain in the lower abdomen or back;
  • Vaginal bleeding after intercourse or between periods;
  • Pain during intercourse;
  • Rectal pain, itching or discharge;
  • More rarely, sore throat.

In men

Most men develop symptoms within two to seven days of infectious contact :

  • Thick yellow-green discharge from the penis;
  • Painful urination;
  • Testicular swelling or pain;
  • Rectal pain, itching or discharge;
  • More rarely, sore throat.

Screening

  • Sampling in the infected area;
  • Urine sample if sampling is not possible.

Treatment

With antibiotics.

Other information

  • Gonorrhea is often associated with other undetected or untreated infections;
  • People infected with gonorrhea are more likely to contract and transmit HIV.

If left untreated, gonorrhea can have serious health consequences:

In women

  • Chronic pelvic pain;
  • Infertility;
  • Risk of ectopic pregnancy.

In men

  • Testicular inflammation;
  • Rashes, sores and joint pain;
  • Infertility (in rare cases).

What's it all about?

  • An infection sometimes called the great imitator because the symptoms mirror some common conditions;
  • Progress in stages;
  • Contagious in the first year after infectious contact.

How is syphilis transmitted?

  • During sexual intercourse with penetration of the penis into the vagina or anus;
  • During oral-genital intercourse (stimulation of the genitals with the mouth);
  • Intimate (skin-to-skin) contact with an infected person with lesions;
  • During a sex toy exchange;
  • An infected mother can transmit the bacteria to her baby during pregnancy and childbirth;
  • More rarely, by injection of drugs with contaminated equipment.

What are the signs and symptoms ?

There are often no symptoms. Symptoms, when present, vary according to the stage of infection :

  • Stage 1 (3 to 90 days after sexual intercourse with an infected person or sexual contact with a contaminated sex toy):
    Presence of painless ulcers usually located on the genitals, anus, mouth or throat;
  • Stage 2 (2 weeks to 6 months after onset of infection):
    Fever and other flu-like symptoms, redness or pimples on the palms of the hands, soles of the feet or elsewhere on the body;
  • Stage 3 (1 year to over 20 years):
    Damage to heart, brain, bones and liver. In some cases, death may result.

Screening

  • Blood test;
  • Sampling in the infected area.

Treatment

Injectable antibiotics.

Other information

  • Symptoms of the 1st and 2nd stages disappear without treatment, but the bacteria are still present;
  • A person is most likely to transmit the infection in the year in which he or she becomes infected;
  • Because of the lesions and sores, syphilis increases the risk of transmission or HIV transmission;
  • If a mother can transmit syphilis to her child during childbirth, this can result in death or congenital syphilis in the infant.

What's it all about?

  • Herpes simplex virus (two types : herpes simplex virus type 1, traditionally associated with cold sores, and herpes simplex virus type 2, traditionally associated with anogenital herpes);
  • May cause a single rash or recurrent outbreaks.

Recurrent outbreaks can be triggered by:

  • The menstrual cycle in women;
  • Emotional stress;
  • Illness (especially fever);
  • A sexual relationship;
  • A surgical intervention;
  • The use of certain medications.

How is genital herpes transmitted?

  • Direct vaginal, oral or anal sexual contact with an infected partner;
  • By oral-genital contact with a person with a history of cold sores;
  • By asymptomatic excretion of the virus (transmission of the virus when there are no symptoms or lesions);
  • From an infected woman to her child during pregnancy or childbirth;
  • Less frequently, it is transmitted by infected materials in contact with contaminated objects such as towels;
  • Can be transmitted even when the person has no visible lesions.

What are the signs and symptoms ?

There are often no symptoms. When there are:

Primary infection

Symptoms disappear after 15 to 23 days.

  • Flu symptoms;
  • Swollen nodes;
  • Pain when urinating;
  • Genital ulcers;
  • Genital pain.

Recurrent infection

The infection may begin very intensely or go undetected.
Symptoms may recur, preceded by warning signs (itching, burning sensation).

  • Small, painful water blisters on the genitals, thighs, buttocks, anus, or sometimes inside the vagina;
  • Burning sensation when urinating;
  • Pain or discharge from the anus;
  • Fever, aches and pains, headaches.

The number and intensity of these episodes vary from person to person.

Screening

  • Sampling from an active lesion;
  • Blood test.

Treatment

There is no effective treatment for this infection. However, medication is available to relieve symptoms, reduce the duration and frequency of lesions, and thus reduce the risk of transmission.

What's it all about?

  • Virus affecting the liver;
  • A virus found in the blood and body fluids including vaginal secretions, semen, breast milk and saliva of infected individuals;
  • Most infected people (90%) naturally produce antibodies to fight the disease, but some people develop chronic hepatitis B; they carry the virus and are contagious for the rest of their lives;
  • Chronic infection can cause considerable damage to the liver.

It is most often found in developing countries.

How is hepatitis B transmitted?

  • By contact of the genitals, anus or a wound with the blood, semen or vaginal secretions of an infected person.
  • By blood-to-blood contact:
    • Sharing injection or inhalation equipment;
    • Tattoo or piercing with contaminated material.
  • During an exchange of sex toys;
  • The mother can transmit the virus to her baby during pregnancy or childbirth.

What are the signs and symptoms?

There are often no symptoms. Between 50% and 70% of people have no apparent signs of infection.
Up to eight weeks after exposure to the virus, some people experience flu-like symptoms, including:

  • Fatigue;
  • Nausea and vomiting;
  • Loss of appetite;
  • Eruption;
  • Joint pain;
  • Yellowing of the eyes and skin (in rare cases).

Screening

Blood test.

Treatment

The virus can disappear on its own, or remain in the body for life (the person then becomes a "chronic carrier"). For chronic carriers, regular medical follow-up is essential, and vaccination against hepatitis A (a virus that also attacks the liver) is recommended.

Treatments can limit the severity of the infection and, in some cases, lead to recovery.

Other information

  • Canada has a hepatitis B vaccination program for infants and young people in schools;
  • All people who have sexual or family contact with people who have hepatitis B should be encouraged to get vaccinated to prevent infection;
  • Chronic hepatitis B can lead to serious liver damage, including cirrhosis (chronic destruction of the liver) and cancer;
  • Babies born to mothers with hepatitis B are at high risk of becoming chronic carriers. They should receive an antibody injection immediately after delivery, followed by the vaccine.

What's it all about?

Hepatitis C Virus (HCV) is a virus that attacks the liver. When the virus enters the body, it causes inflammation of the liver which, in the long term, leads to serious complications (cirrhosis, cancer). The virus is robust, living up to 3 days in the open air and several weeks in a closed environment, such as inside a syringe.

Evolution of HCV

Of those who contract HCV, around 1 in 4 will recover from the infection within 2 to 6 months, as the immune system produces antibodies to eliminate the virus. For those whose infection becomes chronic (3/4 of sufferers), the evolution of hepatitis C infection of the liver follows certain stages:

  1. Fibrosis: tiny scars created to defend against inflammation;
  2. Cirrhosis: generalized scarring so that the liver cannot function normally (usually occurs 20 years after infection);
  3. Liver failure: as cirrhosis worsens, the liver becomes less able to eliminate waste and toxins from the body, and has difficulty producing coagulants. Transplantation is inevitable at this stage;
  4. Liver cancer : the damage caused sometimes leads to cell carcinogenesis.

A person living with HCV (PLHCV) may be asymptomatic (symptom-free) for many years. When symptoms do occur, they may include fever, fatigue, decreased appetite, joint pain, dark urine and jaundice.

HCV in numbers

The World Health Organization estimates that 58 million people worldwide are living with HCV, with 1.5 new infections every year.

In Canada, estimates are 204,000 HCVP, including 9,500 new infections for 2019.

Transmission

HCV is transmitted by blood-to-blood contact with an infected person:

  • Share injection equipment : syringe, swab, spoon, filter;
  • Share sniffing equipment (straw, pencil, paper) or smoking materials (crack pipe);
  • Tattooing or piercing with non-sterile needles or contaminated ink;
  • Share objects that may have come into contact with blood: toothbrushes, nail clippers, razor blades, knives, etc.

In the case of sexual intercourse, the risk is low. However, the risk increases when sexual intercourse is unprotected and blood is present (during menstruation or receptive anal sex, for example).

However, certain populations are disproportionately affected by HCV:

  • Injecting drug users;
  • Incarcerated persons;
  • Aboriginal communities;
  • Men who have sex with men (MSM);
  • The immigrant population;
  • People born between 1945 and 1975.

How to protect yourself

The best way to protect yourself from hepatitis C is to:

  • Always use sterile equipment (injection, crack pipe, straw) when using drugs;
  • Always have your own personal hygiene items;
  • Make sure that the tattooist tears open the envelope containing the new needle to be used for tattooing/piercing, and that the ink used is for one person only. The virus can live for 72 hours in the open air or in the ink;
  • Wear a condom during sexual relations;
  • Wear latex gloves when you may be exposed to blood.

Treatment

HCV treatments have greatly evolved since 2015: they are shorter and have fewer side effects.

Treatment consists of taking 1 to 3 tablets every day for 8 to 12 weeks. The cure rate is over 95%. Some side effects may occur, but these diminish over time. Treatment can cure hepatitis C and prevent progression to liver failure.

Unlike hepatitis A and B, there is no vaccine to prevent infection.

Note that 1/4 of people whose HCV has cleared naturally, and people who have recovered from HCV with treatment, can contract HCV again if exposed to the virus. The body does not develop permanent immunity.

What is it all about?

  • One of the most common sexually transmitted infections, especially among young people;
  • It is estimated that 75% of the adult population will have at least one HPV infection in their lifetime;
  • Low-risk HPV types cause anogenital warts and other benign lesions;
  • High-risk types are associated with cancer (mainly cervical cancer);
  • The vaccine offers protection against 7 HPV types associated with 90% of cervical cancers. e vaccin offre une protection contre 7 types de VPH associés à 90% des cancers du col de l’utérus.

How is the human papillomavirus (HPV) transmitted?

  • During sexual intercourse with or without penetration of the penis into the vagina or anus;
  • During oral-genital intercourse (stimulation of the genitals with the mouth);
  • Intimate (skin-to-skin) contact with an infected person (with or without lesions);
  • During a sex toy exchange;
  • Rarely, the mother can transmit the virus to her baby during childbirth.

What are the signs and symptoms?

  • Many people infected with low-risk HPV types have no symptoms (no visible warts or lesions);
  • In some people, anogenital warts develop within one to eight months (on the vulva, cervix, penis, scrotum, anus or in the urethra). These excrescences may be small, soft, flesh-coloured and cauliflower-like in appearance.
  • The size and number of warts may change over time, but most warts will eventually disappear;
  • During pregnancy, warts may increase in size and number, then regress/resorb after delivery.

Other symptoms may include:

  • Itching;
  • Discomfort during sexual intercourse;
  • Bleeding during sexual intercourse.

Screening

  • Physical examination for visible warts;
  • PAP test to detect abnormal cells in the cervix.

Treatment

  • In most cases, the lesions disappear naturally within 18 months, but this does not mean that the infection has been cured. Treatment will be prescribed by the doctor.

Other information

  • It is important to have regular gynecological check-ups (Pap test);
  • Condom use is essential. However, transmission is still possible in infected areas not covered by a condom.

What is it all about?

  • Viral infection generally endemic in Central and West Africa. In 2022, several cases were reported in Europe and America, where the disease is not normally found.
  • In Canada, numerous cases have been reported in Montreal and Toronto.
  • Mpox can affect anyone (regardless of gender or sexual orientation) who is in close contact with an infected person.

How is Mpox transmitted?

  • During sexual intercourse with penetration of the penis into the vagina or anus.
  • During oral-genital intercourse (stimulation of the genitals with the mouth).
  • Intimate (skin-to-skin) contact with an infected person with lesions.
  • During a sex toy exchange.
  • Through respiratory secretions (prolonged exposure required).

What are the signs and symptoms?

First symptoms appear within 5 to 7 days of infection (up to 21 days in some cases) and generally last 2 to 4 weeks.

  • Skin lesions, particularly around the mouth, genitals and anus
  • Swollen nodes
  • Fever
  • Extreme fatigue
  • Headaches
  • Joint and muscle pain
  • Sweating, night sweats

In the event of symptoms, we recommend wearing a mask, avoiding sexual contact, covering lesions and promptly consulting a healthcare professional.

Screening

  • Medical examination
  • Skin sampling

Treatment

  • Wound care and pain management. Most infections heal on their own.
  • Certain antivirals can be used for severe forms of the disease and for people at risk of complications, such as those living with HIV.
  • Vaccination is offered to people exposed to a case or as a preventive measure.
  • Two doses are required for optimum protection.

What is it all about?

Pubic lice

These are tiny, crab-shaped insects that nest in pubic hair; they are also found on the chest, underarms and facial hair, eyebrows and eyelashes.
Adult insects bite the skin and feed on the blood of their hosts. They lay small eggs (nits) that adhere to the hair shaft.

Scabies

These are parasitic mites that burrow under the surface of the skin.
Eggs laid under the skin hatch; the larvae colonize other spots and spread the infection. Moths prefer warm spots (folds of skin at elbows, wrists, buttocks, knees, shoulder blades, waist, breasts, penis, between fingers and under fingernails).

How are crabs and scabies transmitted?

  • By intimate or sexual contact with an infested person;
  • Skin-to-skin contact;
  • They can survive for up to three days in contaminated clothing and bedding.

What are the signs and symptoms?

Pubic lice

Pubic lice and nits are tiny and can be difficult to detect. Infected individuals are likely to experience the following symptoms:

  • Skin irritation and inflammation accompanied by itching and redness;
  • Small blue spots on the skin corresponding to lice bites;
  • Lice excrement (in the form of small black particles) in underwear.

Scabies

After three or four weeks:

  • Intense itching, especially at night;
  • Reddish rashes (on fingers, wrists, armpits, waist, nipples and penis);
  • With each recurrence, the same symptoms set in more quickly.

Screening

Examination of skin, hair and scalp.

Treatment

Anti-parasite lotions, creams and shampoos.

Other information

Pubic lice

  • Constant scratching of irritated skin can cause a secondary bacterial infection;
  • All sexual partners who came into contact with the infected person in the month prior to diagnosis must be treated to prevent re-infection;
  • Contaminated objects should be washed or dry-cleaned, or left in a bag for a week. Items that cannot be washed or bagged should be vacuumed.

Scabies

  • Constant scratching of irritated skin can cause a secondary bacterial infection;
  • All household items and sexual partners encountered in the past month should be treated to prevent re-infestation;
  • Contaminated objects should be washed or dry-cleaned, or left in a bag for three to seven days. Items that cannot be washed or bagged should be vacuumed;
  • Serious infections usually occur in people with weakened immune systems: the skin may become covered with scales or crusts, requiring more complex and radical treatment.

What is it all about?

It's an infection caused by Trichomonas vaginalis, a single-cell micro-organism found in the urethra, bladder, vagina, cervix or under the foreskin.

How is trichomoniasis transmitted?

Unprotected sexual activity, including mutual masturbation and the sharing of sex toys.

What are the signs and symptoms?

In women

About half of infected women show signs of infection, including:

  • Bullous, whitish or yellow-green vaginal discharge;
  • Irritated or itchy vagina;
  • Pain during intercourse or urination.

In men

Trichomoniasis is generally asymptomatic. When symptoms appear, they may be :

  • Redness or irritation of the urinary meatus;
  • Burning sensation during urination or ejaculation.

Screening

  • Physical examination;
  • Vaginal sampling.

Treatment

Antibiotics.

Other information

  • Trichomoniasis can increase the risk of contracting and transmitting HIV;
  • Trichomoniasis can occur at the same time as other STBBIs, such as gonorrhea, chlamydia, syphilis, HIV and hepatitis B;
  • During pregnancy, trichomoniasis can increase the risk of premature delivery and the birth of low-weight babies.

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