A Quick Reference Guide to Common Conditions Related to Sexual Health: Bacterial Infections
Published on Jul 9, 2024. Updated on Sep 16, 2024.
Sexual health includes the respect, protection, and fulfillment of sexual rights, along with ensuring we're free of disease. It's a vital part of our overall well-being, including not only our physical health but also our emotional, mental, and social health with respect to our sexuality and reproductive system. Our patient's sexual health can be unexpectedly compromised through infections of the reproductive tract. These infections, caused by bacteria, viruses, fungi, or even parasites, can impact every facet of our health, and the ability to understand and address any issues with our sexual health is crucial for a healthy and fulfilling sex life.
Today, we're taking a closer look at the bacterial infections that can affect sexual health.
Chlamydia and Gonorrhea
The Centers for Disease Control and Prevention (CDC) reported 1,649,716 cases of chlamydia in 2022, making it the most common sexually transmitted infection (STI) in the US. There were 648,056 cases of gonorrhea reported in the US in the same year, with the CDC estimating that more than 700,000 Americans are newly infected each year, with less than half of them reported.
Chlamydia and gonorrhea are caused by bacterial infections Chlamydia trachomatis and Neisseria gonorrhoeae, respectively. Both infections can affect the eyes, mouth and throat, urethra, vagina, and anus and are transmitted through sexual contact, including oral, vaginal, and anal contact.
Signs and symptoms of genital chlamydia or gonorrhea infections often include discharge that is white, yellow, gray, or green; painful intercourse; vaginal bleeding between periods; vaginal or penile itching or burning; pain with urination; and lower abdominal pain. Redness, discharge, swelling, crusting, and visual changes may occur if the patient's eyes are affected. If the mouth or throat is affected, redness, sore throat, and pain may be present.
Chlamydia and gonorrhea are both diagnosed using a swab of the affected area or through a urine sample. Chlamydia is treated with antibiotics such as doxycycline or azithromycin, while gonorrhea is treated with antibiotics like ceftriaxone. Treatment also includes disclosing to any sexual partners and encouraging them to get treatment to prevent re-infection or further spread.
If left untreated, chlamydia and gonorrhea bacteria can ascend into the upper reproductive organs (i.e., uterus, fallopian tubes, and ovaries), causing pelvic inflammatory disease (PID). Transmission of chlamydia and gonorrhea can be minimized by using condoms or dental dams during sexual contact.
Syphilis
The National Institutes of Health notes that syphilis has been around for a very, very long time, emerging from endemic syphilis in South-Western Asia around 3000 BC due to the lower temperatures of the post-glacial era, eventually spreading into Europe and the rest of the world. A systemic infection caused by the Treponema pallidum bacterium, it's transmitted through sexual contact, much like chlamydia and gonorrhea,
Syphilis progresses through four distinct stages: primary, secondary, latent, and tertiary. Each stage has its own signs and symptoms. Primary syphilis typically presents at the site of transmission, usually the genitals, as a chancre. A chancre is a firm, round, painless ulcer and can go undetected by patients, especially if it's located in the vaginal canal, on the cervix, or underside of the penis. At this stage, lymphadenopathy, or swollen lymph nodes, may also be present.
Unless found and treated early in the disease process, syphilis bacteria can quickly spread from the site of transmission, leading to secondary syphilis. Secondary syphilis presents with nonspecific symptoms like fevers, body aches, loss of appetite, weight loss, and sore throat. A widespread maculopapular rash is characteristic of this stage. It typically starts on the trunk and spreads to the arms and legs, eventually to the palms and soles.
If syphilis reaches the secondary stage and remains untreated, it can progress into latent syphilis, which involves the resolution of previously seen signs and symptoms (hence the name). As the infection continues to go untreated, patients may develop tertiary syphilis. This stage can take 20 to 30 years to develop and can present with differing manifestations, including meningitis, weakness, sensory loss, aortic aneurysm, cardiac ischemia, or nodules that develop in the skin, liver, and other organs.
Diagnosis is made with blood tests, and if the neurologic system is suspected to be affected, testing can also include a lumbar puncture to obtain cerebrospinal fluid. Treatment includes antibiotics like penicillin, which can treat syphilis at all stages of the infection but works best if administered during the primary stage. In individuals who are pregnant and go untreated, syphilis bacteria can cross the placenta, infecting the fetus and leading to congenital syphilis, which is serious and life-threatening. Transmission of syphilis can be minimized by using condoms or dental dams during sexual contact.
Mycoplasma Genitalium
A lesser-known sexually transmitted infection is mycoplasma genitalium, or MGen for short, caused by a bacterium of the same name. First isolated and identified in 1981, MGen can infect the throat, urethra, cervix, and anus and is transmitted through sexual contact.
Signs and symptoms of MGen include pain with urination, burning in the genital region, vaginal or penile discharge, vaginal odor, and bleeding between periods. If the throat is affected, there may be a sore throat, and if the anus is affected, rectal pain may occur. However, some individuals are asymptomatic.
Diagnosis of MGen is typically done with a swab of the affected area or a urine sample. Treatment involves antibiotics like azithromycin and/or moxifloxacin, and due to the increasing antibiotic resistance to MGen, multiple antibiotics or rounds of treatment may be required for resolution. Treatment also includes treating any sexual partners to prevent re-infection or further spread. If left untreated, MGen can lead to complications like PID, infertility, or scar tissue formation in the reproductive organs.
Bacterial Vaginosis
Bacterial Vaginosis, or BV, isn't a sexually transmitted infection. However, an increase in sexual activity can increase the risk of developing BV. So, what is it? It's what's referred to as a dysbiosis, which is an imbalance of flora normally found in a specific part of the body, like the vagina. With BV, the Lactobacillus species that usually make up most of the vaginal flora are replaced by an overgrowth of anaerobes such as Gardnerella vaginalis, which increases the vaginal pH. This can be due to factors that disrupt the vaginal flora, like cigarette smoking, douching, recent antibiotic use, or even changes in diet. Other factors that increase the risk of BV include certain sexual behaviors, such as having a new partner, having multiple partners, and not using a condom.
Although some patients may be asymptomatic, typical signs and symptoms include foul-smelling vaginal discharge that's white to gray in color, burning with urination, pain with sexual intercourse, and localized redness, itching, or swelling of the vulvar or vaginal regions. Potential complications of BV include an increased risk of acquiring a sexually transmitted infection, cervical or endometrial inflammation, increased risk of an ectopic pregnancy, and premature birth.
BV can be diagnosed using a vaginal swab or the Amsel criteria and requires three of the following four criteria to be present to diagnose BV:
Presence of uniform vaginal fluid that's white-milky to gray
Shift of the vaginal pH to >4.5
Positive whiff test, or a fishy odor produced after adding 10% potassium hydroxide (KOH) solution to a wet mount
>20% clue cells noted on microscopy, which are vaginal epithelial cells studded with adherent bacteria
While BV can resolve on its own, most patients can be treated with antibiotics such as Metronidazole, taken as an oral pill or vaginal suppository. Some individuals may have recurrent BV despite treatment, so discussing prevention strategies such as smoking cessation, avoiding douching, taking a daily probiotic, limiting the number of sexual partners, using condoms, wearing breathable underwear, and avoiding scented vaginal products can help minimize recurrence.
About the Author
Kelsey LaFayette, DNP, ARNP, FNP-C, Nursing Content Manager at Osmosis from Elsevier, obtained a Bachelor of Arts in Nursing degree from Luther College in 2011. As an RN, she has a clinical background in medical and pulmonary inpatient units, urgent care, and critical care, and obtained her Doctor of Nursing Practice degree at the University of Illinois at Chicago in 2022. Throughout her career, Kelsey has had many opportunities to function in an education role by being a charge nurse, preceptor to new RNs and nursing students, as well as a Clinical Team Lead in charge of creating orientation programs and policies. Through these opportunities, Kelsey realized her ideal career path should focus on the education of nurses, nursing students, patients, families, and anyone else with a desire to learn. Kelsey serves as a manager on the Nursing Content team and has been able to work on various projects that fulfill her love of perpetual learning.
Reviewer
Lisa Miklush, PhD, RN, CNS, Senior Content Editor
References
- https://www.cdc.gov/mgen/about/index.html
- https://www.cdc.gov/sexualhealth/Default.html
- Chan PA, Robinette A, Montgomery M, et al. Extragenital infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae: A review of the literature. Infect Dis Obstet Gynecol. 2016;2016:5758387. doi:10.1155/2016/5758387
- Coudray MS, Madhivanan P. Bacterial vaginosis-A brief synopsis of the literature. Eur J Obstet Gynecol Reprod Biol. 2020;245:143-148. doi:10.1016/j.ejogrb.2019.12.035
- Detels R, Green AM, Klausner JD, et al. The incidence and correlates of symptomatic and asymptomatic Chlamydia trachomatis and Neisseria gonorrhoeae infections in selected populations in five countries. Sex Transm Dis. 2011;38(6):503-509.
- Gupta M, Verma GK, Sharma R, Sankhyan M, Rattan R, Negi AK. The changing trend of syphilis: Is it a sign of impending epidemic?. Indian J Dermatol. 2023;68(1):15-24. doi:10.4103/ijd.ijd_788_22
- Gustin AT, Thurman AR, Chandra N, et al. Recurrent bacterial vaginosis following metronidazole treatment is associated with microbiota richness at diagnosis. Am J Obstet Gynecol. 2022;226(2):225.e1-225.e15. doi:10.1016/j.ajog.2021.09.018
- Lopez P, Kwentoh I, Valdez Imbert M. A peculiar presentation of syphilis as a mysterious rash: A dermatological dilemma. Cureus. 2023;15(9):e45328. Published 2023 Sep 15. doi:10.7759/cureus.45328
- Park IU, Tran A, Pereira L, Fakile Y. Sensitivity and specificity of treponemal-specific tests for the diagnosis of syphilis. Clin Infect Dis. 2020;71(Suppl 1):S13-S20. doi:10.1093/cid/ciaa349
- Peter C, Alec M, Bigoni J, Toutous-Trellu L, Yaron M. Le point sur Mycoplasma genitalium chez la femme [Update on Mycoplasma genitalium among women]. Rev Med Suisse. 2018;14(624):1893-1897.
- Vallely LM, Egli-Gany D, Pomat W, et al. Adverse pregnancy and neonatal outcomes associated with Neisseria gonorrhoeae, Mycoplasma genitalium, M. hominis, Ureaplasma urealyticum and U. parvum: A systematic review and meta-analysis protocol. BMJ Open. 2018;8(11):e024175. Published 2018 Nov 28. doi:10.1136/bmjopen-2018-024175
- Workowski KA, Bolan GA; Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015 Aug 28;64(33):924]. MMWR Recomm Rep. 2015;64(RR-03):1-137.