Pictured above: https://twitter.com/CDCSTD/status/619286164315353088
Can gonorrhea go away without treatment? Does chlamydia eventually clear up? Can trichomoniasis go away on its own? These are the kinds of questions people pose to Google before Google sends them here — at least that’s what I learned by looking at the blog’s stats. They’re tricky questions to tackle, and for so many reasons.
Some viral STDs stay with you for life, such as herpes and HIV. Others, such as hepatitis B and human papillomavirus (HPV), can be prevented with vaccines but cannot be cured. It’s also possible for the immune system to defeat hepatitis B virus and HPV — but in some cases, these viruses are able to settle in for the long haul, causing chronic infections that can endure for life and even lead to cancer.
Left untreated, syphilis can kill, and gonorrhea can cause infertility.
Non-viral STDs, like chlamydia and gonorrhea, can be cured. However, they usually don’t have symptoms, or symptoms can come and go, making it seem like an infection went away when it actually didn’t. You can’t know your STD status without getting tested, and you can’t self-diagnose an STD based on symptoms and then assume the infection went away when symptoms subside. Getting tested can uncover a problem and clear the way for treatment.
Nonetheless, people want to know if an STD can go away by itself — but there aren’t many studies on the “natural history” of curable STDs like gonorrhea, chlamydia, and trichomoniasis. Studying the natural course of a curable infection would require that scientists put their subjects at risk of the dangers of long-term infection, and no ethics board would approve such an experiment.
“Do STDs go away?” isn’t the right question. The best question is, “What happens if STDs aren’t caught and treated?” If you think you might have an STD, the best course of action is to see a medical professional. Don’t cross your fingers and hope it just goes away. Symptoms might fade, but the bugs can still be wreaking havoc behind the scenes. And, even if your immune system does manage to fight off the infection, irreversible harm might have already been done.
Gonorrhea and Chlamydia
Gonorrhea and chlamydia often don’t have symptoms, but either infection can harm fertility and increase risk for HIV transmission. In people with uteruses, chlamydia or gonorrhea can lead to pelvic inflammatory disease, which can cause tissue damage to the reproductive organs resulting in infertility, ectopic pregnancy, and chronic pain. Furthermore, either infection can be passed to infants during childbirth. (Also, while the science is far from settled, there is emerging evidence that chlamydia might increase risk for cervical cancer.) In people with testicles, gonorrhea and chlamydia can cause scarring that blocks sperm’s movement out of the testes, resulting in epididymitis, which is associated with infertility, chronic scrotal pain, and testicular shrinkage. Chlamydia is the leading cause of epididymitis in heterosexuals 35 years old and younger.
Due to the difficulties in conducting ethical studies, the natural histories of untreated chlamydia and gonorrhea infections are not well understood. Sometimes, researchers can examine stored specimens that were taken for other studies and retroactively test them for chlamydia or gonorrhea to get a sense for how these infections develop over time. They can also look at asymptomatic people receiving regular STD screening — when their test results come back positive, they’re called back for treatment, but first re-tested to see if the infections went away on their own. This type of study can’t ascertain how long an infection had persisted before being diagnosed, or how long it can endure without treatment, since most participants receive antibiotics a couple of weeks after first being tested.
The “natural history” of chlamydia has been examined, mostly in women, using that kind of study design. Several studies have found that around 80 percent of people with asymptomatic chlamydia were still infected when they came back for treatment. Most of these studies suffered from small sample sizes, and usually included only small numbers of men (if any). A few studies examined chlamydia over the course of a year — including the first one, from the 1970s, when chlamydia was first identified as an STD — and have found that, among women infected with chlamydia, roughly half will still have it a year or more later. One 1975 study mentioned instances of chlamydia persisting in men for at least a year. Another study provided evidence that chlamydia infections caused by certain bacterial strains can last for many years, although no men were included in this analysis.
As for gonorrhea, one study found that most infections in 16 female subjects “did not appear to resolve spontaneously,” as most were still infected after two months. Another study, performed on male subjects, found that men could be asymptomatic carriers of gonorrhea for at least six weeks, but because patients were given antibiotics at the end of the study period, it can’t be said whether men can be infected with gonorrhea indefinitely. Of 28 subjects, only five cleared their infections without treatment.
Before it could be cured with penicillin, syphilis was the most feared STD out there, and for good reason. It often doesn’t have symptoms, but even when symptoms do appear, they only flare up for a short time before retreating. When symptoms disappear, in what is known as the “latent” phase of infection, the sufferer can be lulled into a false sense of security — while the bacteria that cause syphilis are still working away, doing permanent damage to the body.
Syphilis comes in three “stages.” At any stage, syphilis can harm a pregnancy and make it easier to contract HIV. The first stage is characterized by painless sores, which even without treatment will heal. The second stage is characterized by rashes and lesions, which also go away without treatment. (These sores and rashes aren’t always noticeable, or might be confused for other conditions.) But it’s the late stage that’s the most infamous. According to the CDC, 15 percent of people infected with untreated syphilis reach the late stage, which can occur up to 20 years after initial infection. It includes severe damage to the nervous system, brain, heart, or other organs, and can be fatal. Symptoms can include difficulty coordinating movement, numbness, paralysis, weakening eyesight, or dementia.
In light of the serious damage syphilis can do, do you want to take the chance that your untreated syphilis infection will be latent for life, but not progress to the late stage? Syphilis bacteria can lurk in your body for years without giving you symptoms, only to cause serious disease or even death years later, so why take the risk? Get tested and treated!
Trichomoniasis is the most common curable STD in the country, infecting an estimated 3.7 million Americans at a time — 70 percent of whom don’t have symptoms. A trichomoniasis infection increases risk for HIV transmission, and during pregnancy it increases risk for preterm birth and low birth weight.
Men can get trichomoniasis, but they usually don’t have symptoms and aren’t screened for it as part of routine STD testing. One small study found that 64 percent of men testing positive for trichomoniasis still had it after an average of three weeks had passed — but one subject allowed his infection to be monitored for four months before requesting treatment, meaning that it’s possible for the parasite that causes trichomoniasis to live safely ensconced in a male reproductive tract for at least that long.
Another study found that trichomoniasis can persist without symptoms in high-school-aged girls for at least three months — or longer. Additionally, there are anecdotes of female nursing-home patients who deny engaging in sexual activity for years, who nonetheless experience persistent trichomoniasis. If these reports are true, it could indicate that the organism can inhabit a female body for years, only occasionally “flaring up” to cause symptoms.
The upshot is that it’s possible for some — not all — STDs to go away by themselves, but it’s also possible for STDs to persist for months, years, or the rest of your life. If you could have been exposed to an STD, the best thing to do is get tested — not to hope that if you did get something, it’ll just go away. You can be tested and treated for STDs, be vaccinated against HPV or hepatitis B, or drop by to pick up condoms at any Planned Parenthood health center.