Sexually transmitted diseases (STDs) are infectious diseases that are spread through sexual contact. STDs are among the most common infectious diseases in the world today. There are over 20 types, affecting more than 13 million men and women in the United States alone each year, and the incidence is on the rise. Some of the most common STDs include chlamydial infection, genital herpes, genital warts, gonorrhea, HIV (human immunodeficiency virus, the microorganism that causes AIDS), and syphilis.

STDs often occur without symptoms, particularly in women. However, STDs may be accompanied by the following signs and symptoms:

• Itching
• Discharge
• Pustules (pus-containing blisters)
• Genital lesions including ulcers, blisters, rashes, and warts; ulcers may be painful
• Abdominal pain
• Rectal infection and inflammation of the rectum
• Fever
• Muscle pain
• Painful urination
• Swollen lymph glands in the groin

STDs are caused by microbial agents and spread primarily (but not exclusively) through sexual contact. Some STDs can also be passed from a mother to her baby during delivery and through breastfeeding while infected. Others may be passed by sharing infected needles. Some of the most common STDs and the microorganisms that cause them are listed below.

• AIDS—human immunodeficiency virus (HIV)
• Chlamydial infection—Chlamydia trachomatis
• Genital herpes—herpes simplex virus (HSV)
• Genital warts—human papillomavirus (HPV)
• Gonorrhea—Neisseria gonorrhoeae
• Syphilis—Treponema pallidum

In addition, there are certain infections classified as STDs that may be sexually transmitted but often are not. Candidal (yeast) infections and Gardnerella (an organism that frequently lives in the vagina) are examples that may cause vaginal inflammation.

People with the following conditions or characteristics are at risk for developing STDs.

• Having a sexual partner with an STD; again, in many cases, an STD may be present without symptoms
• Having many sexual partners, or a partner who has many sexual partners
• Having sex without the use of condoms or other protective devices
• Having one STD increases the likelihood of contracting another
• Adolescents are at highest risk for acquiring an STD for the first time
• Living under stress from poverty, poor nutrition, or poor or absent healthcare
• Practicing anal intercourse increases risk for HIV, gonorrhea, and syphilis
• Having a weakened immune system
• Using intravenous drugs
• Using spermicidal foams and jellies does not protect against STDs and may, in some cases, even promote contraction of certain STDs, including HIV

Your healthcare provider will do an examination and check for physical signs. Blood tests and other diagnostic procedures including cultures from the genitalia can reveal the microbial agent responsible for the STD and allow the provider to select the right therapy.

There are many ways in which people at risk can reduce the likelihood of contracting or spreading STDs:

• Have a mutually monogamous sexual relationship with an uninfected partner
• Correctly and consistently use a male or female condom for every act of oral, anal, or vaginal intercourse
• Use clean needles if injecting intravenous drugs
• Prevent and control other STDs
• Have regular checkups for STDs even if you have no symptoms, especially if you are having sex with a new partner or with multiple partners
• Learn the common symptoms of STDs and seek medical help immediately if you develop any symptoms 

Anyone diagnosed with an STD should be treated, avoid sexual activity while being treated, notify all recent sexual partners, complete the course of any medications prescribed, and take a follow-up test.

STDs are generally treated with antibiotics. See the monograph on HIV and AIDS for details on how that condition is treated.

There are some possible applications of CAM therapies in the case of STDs—as adjunctive treatment, as prevention, to improve symptoms, or to reduce certain complications, such as arthritis from gonorrhea. In general, much of the research regarding CAM therapies for STDs is too preliminary to draw conclusions, but the results are intriguing. The descriptions that follow may give some sense of the direction in which research may go to evaluate CAM modalities for STDs. It is important to remember that none of these approaches offers a cure or an isolated treatment option. They cannot and should not be used instead of conventional care. Even during treatment, STDs remain highly contagious and the necessary precautions to prevent transmission to sexual partners must be taken (see section on Prevention).

Experimental studies have shown that ascorbic acid (vitamin C), a powerful antioxidant, may help prevent cellular damage from chlamydia. Ascorbic acid and other antioxidant nutrients known for their ability to rid the body of free radicals (harmful by-products of your cells' metabolism) may prove useful in treating chlamydia when used along with standard antibiotics.

Some healthcare providers recommend Lactobacillus acidophilus in either food or supplement form to help restore normal organisms in the body in the case of Candida (yeast) infections or after antibiotic use.

Propoli is rich in flavonoids, and has antimicrobial and anesthetic properties. A multicenter study compared a Canadian propolis ointment, the drug acyclovir, and placebo ointments in 90 patients with recurring chronic genital herpes lesions. Treatment began in the blister phase of infection. Patients were checked periodically and did not know which treatment they were receiving. Propolis was found to be significantly more effective than both acyclovir and placebo in clearing up lesions and shortening the time to heal.

Case reports of four patients treated with an oral herbal formula called WTTC (Wisteria floribunda, Terminalia chebulae, Trapa natans, and Coicis semen), combined with two other herbs, showed complete resolution of both oral herpes (cold sores around the mouth) and genital herpes within 3 to 7 days. The study's authors suggest the formula may help reduce recurrence of HSV and pain, and speed recovery. However, it is too early to draw definitive conclusions about the value of this particular remedy.

The following herbs, often used in clinical practice for STDs, have not yet been researched adequately for effectiveness by scientific studies: licorice root (Glycyrrhiza glabra) and lemon balm (Melissa officinalis) for HSV; thuja (Thuja occidentalis) for HPV; and garlic (Allium sativum) and essential oils of oregano (Oreganum vulgare), lavender (Lavandula angustifolia), and tea tree (Melaleuca alternifolia) for HPV and Candida viruses. For herbal treatment of STDs, see a licensed naturopathic doctor or other specialist trained and certified in the use of herbal remedies.

Homeopaths use various homeopathic remedies to treat STDs. However, so far no scientific studies have evaluated homeopathy for this purpose. An experienced homeopath would consider each individual case and may recommend treatments to address both the underlying constitution and the specific symptoms of the STD.

Four hundred five men with urethritis caused by organisms other than gonorrhea, such as Chlamydia trachomatis, were treated with 1 hour of daily acupuncture over a 22-month period. Patients were asked to abstain from all sexual activity during treatment and for 1 month after treatment ended. The patients' sexual partners were treated as well. The results showed the treatment was extremely effective in 64% of cases, which were considered cured (the men's symptoms cleared and tests showed no sign of infection). It was at least somewhat effective in about 86% of the men.

Several successful cases of treating herpes simplex with acupuncture have been reported. For example, researchers treated two patients with oral herpes and three with genital herpes using acupuncture points generally used for skin conditions. One to four sessions cleared active, recurring infections in this group of patients. It is too early to know the significance of these results, but they suggest that acupuncture may help to heal herpes lesions, lengthen the period of remission, and reduce recurrences of the infection.

One hundred sixteen patients with gonoccocal arthritis were treated with a combination of acupuncture, garlic moxibustion (burning of the herb over the skin), pricking blood, cupping (affecting blood flow by placing suction cups on the skin), and removing fluid from the joints. A course of treatment consisted of 10 days of treatment with a 2- to 3-day interval between courses. Of the 116 patients, 64% were considered cured after 1 to 3 courses of treatment (symptoms cleared, function returned to normal, and joint fluid tested negative). Overall, at least some improvement was shown in about 85% of the patients.

When diagnosed and treated early, many STDs can be treated effectively. However, there are many possible complications that can result from not treating STDs. Some types of STDs commonly recur; some can result in permanent damage to the reproductive organs and infertility. Having other STDs increases the risk for becoming infected with HIV. Antibiotic resistance by organisms that cause certain STDs may interfere with the effectiveness of treatment.

Depending on the type of STD you have, your provider may want to see you for follow-up visits to be sure the disease has not recurred or to continue your treatment. If you are pregnant, an STD can cause serious complications for your unborn baby. Your provider will discuss treatment options with you.

Azenabor AA, Mahony JB. Generation of reactive oxygen species and formation of membrane lipid peroxides in cells infected with Chlamydia trachomatis. Int J Infect Dis. 1999;4(1):46-50.

Berger RE. Sexually transmitted diseases: the classic diseases. In: Walsh PC, ed. Campbell's Urology. 7th ed. Philadelphia, Pa: W.B. Saunders Co; 1998.

Burnham RC. Diseases caused by chlamydiae. In: Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders Co; 1996.

Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Hijikata Y, Tsukamoto Y. Effect of herbal therapy on herpes labialis and herpes genitalis. Biotherapy. 1998;11(4):235-240.

Hitley RJ. Herpes simplex virus infections. In: Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders Co; 1996.

Hook III, EW. Syphilis. In: Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders Co; 1996.

Jernigan JA, Rein MF. Sexually transmitted diseases. In: Reese RE, Betts RF, eds. Practical Approach to Infectious Diseases. 4th ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1996.

Kaplan MS. The abbreviated history and development of acupuncture and moxibustion. North American Society of Acupuncture and Alternative Medicine. Accessed at www.nasa-altmed.com/alterna3.htm on September 18, 2000.

Liao SJ, Liao TA. Acupuncture treatment for herpes simplex infections: A clinical case report. Acupunct Electrother Res. 1991;16(3-4):135-142.

Mandel RM, Arguinchona H. Chlamydial sexually transmitted diseases. In: Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999.

Martin DH. Chancroid. In: Rakel RE, ed. Conn's Current Therapy. 51st ed. Philadelphia, Pa: W.B. Saunders Co; 1999.

Pointer JE, Mulligan-Smith DA. Genital infections. In: Rosen P, Barkin R, eds. Emergency Medicine: Concepts and Clinical Management. 4th ed. St. Louis, Mo: Mosby-Year Book; 1998.

Sparling PF. Introduction to sexually transmitted diseases and common syndromes. In: Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine. 20th ed. Philadelphia, Pa: W.B. Saunders Co; 1996.

Talwar GP, Raghuvanshi P, Mishra R, et al. Polyherbal formulations with wide spectrum antimicrobial activity against reproductive tract infections and sexually transmitted pathogens. Am J Reprod Immunol. 2000;43(3):144-151.

Vynograd N, Vynograd I, Sosnowski Z. A comparative multi-centre study of the efficacy of propolis, acyclovir and placebo in the treatment of genital herpes (HSV). Phytomedicine. 2000;7(1):1-6.

Wang K. 116 Cases of gonococcal arthritis treated with acupuncture. J Tradit Chin Med. 1996;16(2):108-111.

Wang K. Acupuncture for non-gonococcal urethritis: clinical observation of 405 cases. Int J Clin Acupunct. 1997;8(4):359-362.