STDs in men

What are STDs?

STDs or “sexually transmitted infections” (STIs) describe diseases that are mainly transmitted through sexual contact (genital, anal or oral). Some pathogens can also be transmitted through other contacts, such as kissing, petting or blood contact. Pathogens of sexually transmitted diseases are bacteria, viruses, fungi, protozoa and arthropods. Since the symptoms of sexually transmitted diseases in men are diverse and usually difficult to recognise, the sexual transmission of the pathogens to others often happens unknowingly.

How common are STDs?

With the exception of the notifiable venereal diseases (HIV and Syphilis), it is difficult to make statements about the actual occurrence of venereal disease infections in the UK or even worldwide. The reason for this is the high number of asymptomatic infections. Here are some estimates and study results:

➜ The World Health Organization (WHO) estimated in 2012 that around 357 million new infections of four treatable venereal diseases occur in people aged 15 to 49 worldwide every year. Of these, around 131 million infections are caused by chlamydia, 78 million by gonococci, 6 million by syphilis and 142 million by trichomonads.¹

➜ The Robert Koch Institute (RKI) carried out an STD sentinel in the UK between 2003 and 2009 . More than 200 health authorities, STI counseling centers, specialist outpatient clinics and medical practices acted as “sentinels” and collected important information about the frequency and geographical distribution of STIs, for which there is no obligation to report. The results showed no clear trends . The most common STDs were chlamydia and genital warts².

➜ Some STDs such as gonorrhea (‘clap’) and syphilis (‘syphilis’) appear to be increasing in the UK . According to the federal government, there were 5,821 cases of syphilis in the UK in 2014, compared to a total of 7,889 cases in 2019³. Other venereal diseases, on the other hand, are becoming rarer . This includes HIV with around 2,400 new infections per year (as of 2018)⁴.

How can STDs be transmitted?

STDs are most often the result of a sexually transmitted infection. This means that one person transmits pathogens to another person during sexual intercourse , anal intercourse , oral sex , or any other sexual practice . Sexually transmitted diseases are transmitted in the form of microorganisms (e.g. bacteria, viruses, fungi) or parasites (e.g. worms, lice, protozoa) adhering to and penetrating the body and then multiplying in the body⁵.

When it comes to transmission, there are different routes of infection and portals of entry for the pathogen.

Possible routes of infection of sexually transmitted diseases are:

• Direct sexual transmission via the exchange of bodily fluids. The probability of infection depends on the type and amount of bodily fluids as well as the duration and intensity of sexual contact. Body fluids that are fairly harmless are saliva, tears or sweat. On the other hand, blood, semen and vaginal and anal secretions are critical. The direction of sexual contact is also important here. The “passive” partner absorbs bodily fluids and therefore has a slightly higher risk of infection. An example of transmission is when a man ejaculates directly into the rectum, vagina or mouth. Are transmitted so z. E.g. hepatitis B or HIV. ‍

• Close contact between the mucous membranes and the skin , for example when kissing or petting. For example, Candida fungi, Chlamydia or Siphilys are transmitted. HPV and herpes can also be transmitted through skin-skin or mucosa-skin contact.

• ‍ Smear infection . With this contact infection, pathogens are passed on via an object (e.g. a dildo) or via a part of the body (e.g. a finger) on which infectious bodily secretions are found.

As the name suggests, most STDs are transmitted through the genitals and urinary tract , but also through the digestive tract . In order to penetrate the body, however, the pathogens usually have to overcome the uppermost layer of the skin or mucous membrane , which represents an important barrier against pathogens. In the case of the mucous membranes, the secretions (“mucus”) also have a protective function.

The most important entry points of pathogens of sexually transmitted diseases are:

• skin . If the skin is intact, it offers good protection against various STI pathogens. It becomes problematic if you have inflammation, ulcers or small injuries on the skin. These do not necessarily have to be visible, because tiny, invisible lesions are enough for the pathogen to penetrate. Some pathogens, such as herpes or human papilloma viruses (HPV), typically penetrate at the transitions from skin to mucous membrane (e.g. at the glans or the foreskin). In men, the glans, inner foreskin and frenulum are the main entry points for STI pathogens.

• urethra . The urethra is very sensitive to many different pathogens (e.g. chlamydia, gonococci, intestinal bacteria). Because men’s urethra is considerably longer than women’s, men are less at risk of contracting urinary tract infections.

• anus, rectum, intestines. Anal intercourse in particular is a common transmission path here.

• mouth, oral cavity, throat. The oral mucosa is more resistant than other mucous membranes, especially since saliva “washes away” the pathogens and dilutes their concentration. Nevertheless, venereal diseases can be transmitted during oral sex . ‍

• ‍ eye . Sexually transmitted diseases such as gonococci or herpes can be transmitted to the conjunctiva by smear infection .

What sexually transmitted diseases are there in men?

Itching and burning underneath after a wild one-night stand is an indication of an STD. But not all sexually transmitted diseases make themselves felt so quickly with such obvious symptoms. Some cause symptoms only after many weeks , while others are completely symptom -free . In Table 1 you can find out which sexually transmitted diseases exist, how they are transmitted, how they become noticeable and whether or how they can be treated .

What are the most common sexually transmitted diseases in men?

Common sexually transmitted diseases in men – as in women – are chlamydia , gonorrhea , syphilis , genital herpes and HPV . Chlamydia is at the top of the list: In a study by the Robert Koch Institute between 2008 and 2013, 11.0% of the samples from men tested positive for chlamydia⁹. Gonorrhea is also common among men. In 2012, the European Center for Disease Prevention and Control (ECDC) gave an incidence rate of 25.7 per 100,000 men. Like chlamydia, the infections occurred predominantly in young people between the ages of 15 and 24¹⁰. ‍

Men who have sex with men (MSM) are most affected by STDs. Approximately 85% of syphilis diagnoses are found in MSM¹¹. The situation is similar with HIV: In 2015, around 57% of new HIV diagnoses were in men who have sex with men¹².

What are the most common symptoms of STDs?

The symptoms of sexually transmitted diseases in men vary greatly depending on the pathogen , the stage of the disease , the state of health and many other factors. Sexually transmitted diseases can be completely asymptomatic or have few symptoms , or they can cause a variety of different symptoms. The symptoms of sexually transmitted diseases are usually localized in the genital and anal region . However, they can also occur in other parts of the body or trigger non-specific symptoms such as exhaustion, a general feeling of illness, loss of appetite or fever.

Typical symptoms of various sexually transmitted diseases in men are:

• Burning or painful urination
• Itching on the genitals or in the anal region
• Pain and swelling in the lower abdomen, penis or testicles
• white or foul-smelling discharge from the penis or anus
• swollen lymph nodes in the groin
• unusual skin changes
• Ulcers, blisters, nodules or warts on the genitals, in the anal region or on/in the mouth
• Redness or whitish to yellowish coverings on the genitals, in the anal region or on/in the mouth
• weeping, rashes, redness
• Blood in your stools or urine, discoloration of your urine or stools

Which sexually transmitted diseases do you not notice?

Not everyone is “lucky” enough to be made aware of their sexually transmitted disease through itching, burning or blisters. In many men, sexually transmitted diseases such as chlamydia, syphilis or HPV are completely asymptomatic .

Such an asymptomatic course is problematic:

➊ On the one hand, the venereal disease remains untreated and can be delayed . This becomes particularly dangerous with diseases that can spread to other areas of the body , such as syphilis or chlamydia. For example, untreated chlamydia can threaten a man’s potency, and untreated syphilis can even kill his life.

➋ It is not just your own health that is endangered by asymptomatic sexually transmitted diseases, but also that of your sexual partners . Because if you don’t know anything about your own misfortune, you are probably also less careful in sexual contact – and you immediately infected your fellow human beings.

How are STDs progressing?

Depending on the pathogen, infections spread in different ways¹⁴:

• In the case of a local infection , the pathogens only cause an infection in the vicinity of the portal of entry (e.g. in the case of candidiasis).
• In the case of an ascending infection , the pathogens continue to migrate from the portal of entry (e.g. gonococci, chlamydia). In men, the infection can spread from the urethra to the prostate or along the vas deferens to the testicles and epididymis.
• In the case of a systemic infection , the pathogens spread via the bloodstream via an organ system (e.g. herpes) or the entire organism (e.g. syphilis).

In addition to the type of spread of venereal diseases, they can also be differentiated according to their course over time:

• acute or chronic infection
• recurrent infection (the disease recurs after apparent recovery )
• latent (hidden) or reactivated infection

Which sexually transmitted diseases are deadly, incurable or cause infertility?

Most sexually transmitted diseases are easily treatable and leave little or no consequential damage if treated in good time . An exception is the HIV infection: Although this can be treated with medication, it is not curable.

Delayed or non-existent treatment of venereal diseases can lead to complications or long-term effects of all kinds¹⁵:

➜ Chronic bacterial inflammation of the sex organs (e.g. caused by chlamydia or gonorrhea) can lead to infertility .

➜ Left untreated, gonorrhea can lead to inflammation of the joints , eyes and heart .

➜ Chronic syphilis can affect the nervous system and lead to paralysis , life-threatening physical damage or dementia . From stage 3, the damage is irreparable.

➜ Infection with HPV is associated with an increased incidence of penile and anal cancer and cervical cancer in women.

➜ Chronic hepatitis B or C are associated with an increased incidence of liver inflammation , liver failure , liver cirrhosis and hepatocellular carcinoma .

➜ An untreated HIV infection usually leads to severe damage to the immune system .

The rare infectious diseases donovanosis and lymphogranuloma venereum can lead to severe physical damage .

Suspicion of a sexually transmitted disease – the diagnosis

If you discover typical symptoms of an STD in yourself, have had unprotected sex in the past, or your partner has an STD, you should consult a doctor.

You should definitely refrain from a “self-diagnosis” given the variability of symptoms. Because if a sexually transmitted disease remains undetected or untreated for too long, it can be delayed and have fatal health effects. In addition, you endanger your fellow human beings through a possible infection with your own sexually transmitted disease.

When the doctor diagnoses an STD, it’s unpleasant, but it’s also good news because it can now be treated and, depending on the disease, cured. As is so often the case, the earlier you start treatment, the easier and more promising it is . It is also strongly recommended that your partner is also examined, advised and, if necessary, treated. Because if the partner remains untreated, a so-called ping-pong effect can occur. It can also be useful to inform previous partners.

Where do you test for STDs?

Many are wondering where a man can be examined or tested for sexually transmitted diseases. In principle, STI diagnostics can be carried out by many different doctors – for example by a general practitioner or a dermatologist. However, it usually makes sense for men to consult a specialist in urology if they have sexually transmitted diseases . Women, on the other hand, are advised to consult a specialist in gynaecology.

In addition, most health authorities, AIDS organizations and test projects offer free and anonymous advice on sexually transmitted diseases, where you can get advice and sometimes even be examined and treated.

STD test in men?

The diagnosis of an STD is based on various pillars. Among other things, the history of the patient is particularly important here , especially his sexual activities in connection with the current symptoms. There is also a clinical examination. The visual diagnosis says a lot for some diseases such as genital warts, fungus or genital herpes. In addition, various laboratory tests of blood, urine, stool, tissue and secretions (e.g. from the urethra, penis, throat or rectum) provide indications or precise information about what you are dealing with:

• Microscopic examination : Some pathogens (e.g. gonorrhea, syphilis) can be stained under the microscope.
• Antibody detection : Pathogen-specific antibodies in the blood or tissue indicate that the body has already had contact with the respective pathogen or is still in contact with it at the current time.
• Antigen detection: Antigens are components of pathogens and prove the existence of an infection (eg hepatitis or HIV). Antigens can be detected earlier than antibodies.
• Nucleic acid detection: This method is used, among other things, to determine the quantity of pathogens (e.g. in the case of an HIV infection). 

Pathogen cultivation : With this method, pathogens are cultivated on culture media. This allows pathogens to be identified. In addition, it can be tested whether the pathogens are resistant to drugs.

How much does an STD test cost?

If you have typical symptoms of a sexually transmitted disease or there is a concrete suspicion of an STD – for example because your partner has a sexually transmitted disease – the costs for the test are usually covered by health insurance.

In addition, most health authorities and local AIDS organizations offer the opportunity to get advice, tests and, in special cases, treatment for sexually transmitted diseases  free of charge and without a medical certificate.

STD self testing

Many men find it uncomfortable to go to a doctor or a counseling center for matters as personal and sensitive as sexually transmitted diseases. However, this false shame can be fatal, as undetected and untreated STDs pose serious health risks.

Self-tests for sexually transmitted diseases at home offer an important alternative to visiting a doctor . These can be purchased in pharmacies or through various online providers such as EASY-Testen.

Blood and urine samples as well as swabs are taken independently and then sent to an appropriate laboratory . Here the samples are evaluated and the result is passed on to the person. This can be done in person, over the phone or anonymously online using a tracking code. The length of time before you get the test result varies depending on the disease being tested. It usually only takes a few days.

Sexually transmitted diseases that can be diagnosed by self-test are, for example, hepatitis, HIV, syphilis, chlamydia or gonorrhea .

 

How are STDs treated?

Most sexually transmitted diseases can be treated with medication and do not leave any lasting damage to your health – provided that they are recognized in time. Unfortunately, STDs are still a taboo subject. This is why the treatment is often started too late, or those affected try to treat themselves . However, as with self-diagnosis, this is strongly discouraged.

The basis for therapy is normally a reliable medical diagnosis . Depending on the disease, appropriate therapy can then be initiated.

▶ Antibiotics are usually used for bacterial infections . These are either bacteriostatic (inhibit bacterial growth), bactericidal (kill the bacteria) or bacteriolytic (dissolve the bacteria). Antibiotics are usually well tolerated. The increasing resistance of bacteria to antibiotic substances is problematic.

▶ The therapy of viral infections is difficult and lengthy ; an HIV infection even has to be treated for life. The treatment of herpes can only shorten the acute illness – but the viruses remain in the body. Problems during therapy can be the development of resistance.

▶ Fungal diseases are treated with antimycotics . Here, too, the development of resistance is an increasing problem.

▶ Protozoa can be treated with antiprotozoal agents . Pubic lice and itch mites are controlled with insecticides . Worms are treated well and effectively with so-called anthelmintics .

Sexual intercourse and other sexual activities (e.g. anal sex, oral sex) should be avoided until the treatment of venereal diseases has been successfully completed . In addition, previous partners should be informed about the sexually transmitted disease and treated if necessary . In addition, those affected should observe special hygiene measures and should not donate blood if they have specific illnesses (e.g. HIV, hepatitis) .

Proper protection against sexually transmitted diseases

The risk of becoming infected with sexually transmitted diseases can be significantly reduced. A particularly important point is Safer Sex . Safer sex is about avoiding the exchange of potentially contagious bodily fluids such as blood, menstrual blood, semen, vaginal and anal secretions. Condoms, femidoms and dental dams (“wet wipes”) help with this.

✔ Condoms, femidoms and dental dams.

When used correctly, condoms and femidoms protect against most sexually transmitted diseases during vaginal, anal and oral sex. They can also act as a contraceptive, i.e. to protect against unwanted pregnancy. During cunnilingus, the oral satisfaction of women, dental dams protect against vaginal secretions or menstrual blood.

✔ Forbearance is safe.

Contact with visibly changed and inflamed areas of skin and wounds should be avoided, particularly if you have different sexual partners. The exchange of blood and other bodily fluids should also be avoided as a matter of urgency. If there is body fluid on the hands, they should be washed thoroughly. The same goes for items like dildos.

✔ Vaccinations.

Vaccination offers the best protection against hepatitis A and B and the most common and dangerous HPV strains.

✔ HIV prevention.

HIV pre-exposure prophylaxis (PrEP) offers HIV-negative people reliable protection against HIV after a risky contact.

Since venereal diseases can be transmitted despite the appropriate precautionary measures, regular examination and testing is of great importance, especially in the case of frequently changing sexual partners.