STIs in Women: Why So Many Go Undetected and What the Consequences Are
Doctor consulting patient.
Sexually transmitted infections (STIs) in women are more common than most people acknowledge — and far more likely to be asymptomatic than in men. The majority of chlamydia infections in women produce no symptoms whatsoever. No discharge, no pain, no signal. The infection silently damages the fallopian tubes over months to years, causing scarring that only becomes apparent when a woman investigating infertility is found to have blocked tubes.
This is why STI testing is a component of responsible gynaecological care — not just a response to symptoms.
Dr. Shachi Singh, consultant gynaecologist at Prakash Hospital, Sector 33, Noida, explains.
Chlamydia: The Silent Epidemic
Chlamydia trachomatis is the most common bacterial STI globally, and the most clinically consequential in women because of its tendency to ascend to the upper genital tract without causing symptoms.
In women: 70 to 80% of genital chlamydia infections are asymptomatic. When symptoms occur: increased or altered vaginal discharge, intermenstrual bleeding, postcoital bleeding, mild lower abdominal discomfort. Symptoms are non-specific and easily attributed to other causes.
Consequences of untreated chlamydia:
- Ascending infection → pelvic inflammatory disease (PID)
- PID → tubal scarring → blocked tubes → infertility
- Increased ectopic pregnancy risk
- Pelvic adhesions causing chronic pelvic pain
- Reactive arthritis (in a minority)
Testing: NAAT (nucleic acid amplification test) on a vulvovaginal swab or urine sample — highly sensitive and specific. Self-collected swabs are adequate.
Treatment: Azithromycin single dose or doxycycline for 7 days. Partner treatment is essential — without treating the partner, reinfection occurs immediately.
Gonorrhoea
Neisseria gonorrhoeae — like chlamydia, frequently asymptomatic in women (approximately 50%). When symptomatic: increased vaginal discharge, dysuria (burning urination), irregular bleeding.
Gonorrhoea also ascends to cause PID, tubal damage, and infertility — and causes septic arthritis and disseminated gonococcal infection systemically. Antibiotic resistance is an increasing global problem — treatment now typically requires ceftriaxone IM injection (dual therapy with azithromycin in many guidelines).
Bacterial Vaginosis (BV)
Bacterial vaginosis is not technically a sexually transmitted infection — it is a disruption of the normal vaginal microbiome (Lactobacillus species replaced by anaerobic bacteria including Gardnerella vaginalis). But it is strongly associated with new sexual partners and is a significant gynaecological condition.
Symptoms: An offensive fishy-smelling discharge (grey-white, thin, homogeneous), particularly notable after intercourse (semen raises vaginal pH). Itch is NOT a feature — itch suggests thrush (candida) rather than BV.
Consequences: Increased risk of acquiring other STIs (including HIV); increased risk of PID if there is concurrent STI; in pregnancy, BV is associated with preterm birth and late miscarriage.
Diagnosis: Clinical (Amsel criteria) or Whiff test/Clue cells on microscopy. Treatment: metronidazole (oral or vaginal gel).
Trichomonas Vaginalis
Trichomonas vaginalis is a protozoal STI — transmitted sexually. In women, it causes frothy, greenish-yellow discharge with vulval itching and burning. Some women are asymptomatic.
In pregnancy, TV is associated with preterm birth. Treatment: metronidazole. Both partners must be treated.
Genital Herpes (HSV-2 and HSV-1)
Herpes simplex virus causes painful genital ulcers — but many people with genital herpes are either asymptomatic or have symptoms so mild they are attributed to other causes. The initial (primary) episode is typically the most severe: painful vesicles → ulcers on the vulva, vagina, and cervix, with dysuria and systemic flu-like symptoms.
After the primary episode, the virus remains latent and can reactivate to cause recurrent outbreaks (typically milder). Transmitted by skin-to-skin contact even when no lesions are visible (asymptomatic shedding).
In pregnancy: Primary herpes in the third trimester carries a risk of neonatal herpes — a serious neonatal infection. Existing (recurrent) genital herpes in pregnancy is managed with suppressive aciclovir in the third trimester if there is a history of genital herpes; elective caesarean is recommended if lesions are present at the time of delivery.
When to Get Tested
Testing should be considered in any woman who:
- Has new or multiple sexual partners
- Is pregnant (standard booking screen includes some STIs — HIV, syphilis, hepatitis B)
- Is investigating infertility (particularly unexplained infertility)
- Has symptoms: discharge, bleeding, pelvic pain, dysuria
- Has a partner who has been diagnosed with an STI
STI testing is not judgemental. It is straightforward healthcare.
Gynaecological Care in Noida and Greater Noida
Dr. Shachi Singh at Prakash Hospital, Sector 33, Noida, provides confidential STI testing and treatment as part of comprehensive gynaecological care for women across Noida and Greater Noida.
To book a confidential consultation, call: +91 97023 46853
Clinic Hours: Monday to Saturday, 9 AM – 6 PM | Sunday, 10 AM – 2 PM
Address: D-12A, 12B, Sector-33, G.B. Nagar, Noida, UP 201301
This blog is for educational purposes only. All consultations are strictly confidential.
