Sexual health should never feel shameful, mysterious, or too embarrassing to discuss. If we are old enough to be having sex, we deserve clear information about the risks, the screenings, the symptoms, and the ways we can protect ourselves and our partners.
In this candid conversation, Dr. Thais Aliabadi joins Mary Alice Haney to answer the questions that often get saved for the final seconds of an appointment, or never get asked at all. We cover the real difference between STIs and HPV, why a negative test is not always the full story, how herpes actually spreads, what symptoms deserve prompt attention, and why vaccination and regular care matter so much.
Table of Contents
- Starting With the Basics: STI, STD, HPV and Sexual Health
- HPV Screening, Pap Smears and Cervical Cancer Prevention
- Why the HPV Vaccine Matters for Everyone
- Chlamydia and Gonorrhea: Common, Treatable and Often Silent
- Herpes: Separating Facts From Fear
- Condoms, Testing and Safer Sex Decisions
- Is It an STI, a UTI or a Yeast Infection?
- Sexual Health Is for Everyone
- Sex During Pregnancy and After Delivery
- The Message We Want Everyone to Remember
Starting With the Basics: STI, STD, HPV and Sexual Health
Why do so many people feel embarrassed bringing up sexual health with their doctor?
Dr. A: Sexual health is incredibly private, so the discomfort is understandable. Younger patients can feel intimidated, particularly when they are seeing a new physician or a male OB/GYN. But even adults who are married or have been sexually active for years can hesitate.
Sometimes a patient will get through an entire appointment, then quickly say, “By the way, can we add STI testing?” right as we are wrapping up. There is no need for that shame. We ask these questions because protecting sexual health is part of protecting overall health.
We also use the term STI, meaning sexually transmitted infection, more often than STD. It is a better term because many infections cause no symptoms and are manageable or treatable before they become a disease.
What is the difference between an STI and HPV?
Dr. A: HPV, or human papillomavirus, is one type of STI. STI is the broad category. It includes infections such as HPV, herpes, chlamydia, gonorrhea, syphilis, HIV, hepatitis B, and hepatitis C.
HPV is the most common STI. By age 50, about 80 percent of women have been exposed to some form of HPV. There are more than 100 strains of the virus, around 30 of which can affect the genital area. About 15 strains are considered high risk because they can be associated with cervical cancer.
The strains we pay closest attention to include HPV 16, 18, and 31. HPV 16 and 18 are associated with the majority of cervical cancers. That is why cervical screening and HPV vaccination are not optional afterthoughts. They are powerful preventive care.
For a more detailed overview of high risk and low risk strains, screening, genital warts, and prevention, visit our HPV patient education resource.
HPV Screening, Pap Smears and Cervical Cancer Prevention
Is a Pap smear the same thing as an HPV test?
Dr. A: No. A Pap smear and an HPV test are related, but they look for different things.
During a speculum exam, we can see the cervix, which is the opening to the uterus. We collect cells from the cervix using a brush and sampling device. A Pap smear evaluates those cervical cells for abnormal, atypical, or precancerous changes. The HPV test looks for high risk HPV virus on the cervix.
A Pap smear alone is not as strong as a Pap smear combined with high risk HPV testing. We want patients to ask what is being checked at their annual exam, rather than assume every test includes every screening.
What happens if a Pap smear is normal but high risk HPV is positive?
Dr. A: This does not mean someone has cervical cancer. It means we need to take follow-up seriously. If high risk HPV is positive, we may repeat the Pap and HPV testing after a year. If HPV remains positive, even when the Pap remains negative, further evaluation is important.
For certain high risk results, including HPV 16, 18, or 31, we recommend a colposcopy. During a colposcopy, we place a speculum, apply acetic acid, similar to vinegar, to the cervix, and examine the area under magnification. If there are suspicious areas, we take small biopsies and send them to the lab.
Experienced gynecologists are trained to recognize patterns that can suggest abnormal tissue. The purpose is prevention. We identify precancerous changes early, before they have the opportunity to become cervical cancer.
Does HPV always cause cervical cancer?
Dr. A: No. High risk HPV can increase risk, but an HPV diagnosis is not a cancer diagnosis. Many people suppress or clear the virus over time. We are concerned when high risk HPV persists and causes cellular changes, which is exactly why screening exists.
HPV can also be associated with cancers in other areas, including the throat and anus. If there has been known exposure to high risk HPV strains, discussing symptoms and individual risk with an appropriate physician is reasonable. We do not want fear. We want informed follow-up.
Can HPV be detected in men?
Dr. A: This is one of the most important facts people need to understand. There is no routine, reliable HPV screening test for men comparable to cervical HPV testing. When a male partner says he has been “tested for everything,” that generally does not mean he has been tested for HPV.
There is also no standard routine herpes test included in every STI panel. This is why a conversation about sexual history, condom use, symptoms, vaccination, and individual risk matters so much more than simply saying, “We were both tested.”
Why the HPV Vaccine Matters for Everyone
Who should receive the HPV vaccine?
Dr. A: Boys and girls should receive HPV vaccination. We generally recommend it as part of routine childhood vaccination, beginning around ages 9 to 11. For people who missed that window, vaccination can still be offered through age 45.
The current vaccine, Gardasil 9, protects against nine HPV strains. This vaccine is not about encouraging teenagers to have sex. That is a myth that causes harm. Vaccination protects people before exposure. If a child later chooses to become sexually active, we want them protected from a virus that can cause cancer.
We have extensive data on the HPV vaccine. It is an important tool in reducing cervical cancer risk. If we vaccinate broadly and screen appropriately, we can prevent a tremendous amount of disease.
Chlamydia and Gonorrhea: Common, Treatable and Often Silent
What should we know about chlamydia?
Dr. A: Chlamydia is one of the most common STIs we see, particularly in younger sexually active people. The major problem is that about half of patients may have no symptoms. That means they can pass the infection without realizing it.
When symptoms do occur, they can include:
- Pelvic or lower abdominal pain
- Abnormal vaginal discharge
- Discomfort during urination
- Cervical tenderness during an exam
- Symptoms of pelvic inflammatory disease
Chlamydia is a bacterial infection, not a virus, so it can be treated with antibiotics. But treatment needs to include the partner. We also want follow-up testing to make sure treatment worked and to reduce the risk of reinfection.
Untreated chlamydia can lead to pelvic inflammatory disease, tubal scarring, blocked fallopian tubes, and even tubo-ovarian abscesses. For someone who wants children in the future, this is why screening is so important.
Can chlamydia affect fertility?
Dr. A: It can, especially when an infection went undetected or untreated for a prolonged time. Chronic infection can damage the fallopian tubes. If someone has had chlamydia and later struggles to conceive, a physician may consider evaluating whether the tubes are open with a hysterosalpingogram.
However, we do not want people to panic. If regular testing has been negative, there is no reason to assume infertility. The key is to test, treat, and avoid letting a silent infection sit untreated.
How is gonorrhea different from chlamydia?
Dr. A: Gonorrhea is also a bacterial STI, so it is treatable with antibiotics. It can cause symptoms very similar to chlamydia, including abnormal discharge, pelvic pain, and urinary discomfort. Sometimes discharge may appear greenish or more purulent, but symptoms alone cannot tell us what infection is present.
That is why laboratory testing matters. We should not diagnose ourselves based on a search online or assume every symptom is a yeast infection.
Our STI testing guide explains common infections, testing methods, and why transparent conversations with a trusted clinician matter.
Herpes: Separating Facts From Fear
Are HPV and herpes the same thing?
Dr. A: Absolutely not. HPV and herpes are different viruses with different symptoms and different health concerns.
HPV can cause genital warts and is associated with cervical cancer. Herpes can cause oral cold sores and genital herpes. There are two main types: herpes simplex virus type 1, or HSV-1, and herpes simplex virus type 2, or HSV-2.
Many people believe HSV-1 is always oral and HSV-2 is always genital. That is false. Most oral herpes is HSV-1, but oral HSV-2 can occur. Genital herpes can be caused by either HSV-1 or HSV-2.
Why is routine herpes blood testing not always included in an STI panel?
Dr. A: A blood test can show antibodies to HSV-1 or HSV-2, but it cannot tell us where the infection is located. Someone who has had cold sores since childhood may test positive for HSV-1. That does not tell us whether they have oral or genital herpes.
If someone has active genital sores, the best way to diagnose is to test the lesion directly. A culture or lab test of an active lesion can identify whether it is herpes and whether it is type 1 or type 2.
Blood testing can be useful in specific situations, such as when a partner has known HSV-2 and someone wants to understand whether they have been exposed. But it is not a simple universal answer for every person without symptoms.
What does a first genital herpes outbreak feel like?
Dr. A: The first outbreak can be extremely painful. People may have ulcerated sores, itching, irritation, pain when sitting, swollen lymph nodes in the groin, fever, and flu-like symptoms. Often, the story is so characteristic that we have a strong suspicion before the exam.
HSV-2 tends to recur more often and may be more aggressive than genital HSV-1, but both types need honest discussion and appropriate care.
Can herpes spread when there are no visible sores?
Dr. A: Yes. This is one of the biggest herpes myths. Herpes can spread through viral shedding even when there are no visible blisters or lesions. Someone can carry the virus, never recognize a typical outbreak, and still transmit it.
That does not mean people should live in fear or stigma. It means that people with known genital herpes need to share that information with partners and use prevention strategies. Learn more about symptoms, diagnosis, treatment, and pregnancy considerations in our genital herpes resource.
Can genital herpes be treated?
Dr. A: Herpes remains in the body, but it can be managed. Antiviral medications such as valacyclovir can shorten outbreaks and, when used as daily suppressive treatment, can reduce recurrence and transmission risk.
The first outbreak can take longer to resolve and can be particularly uncomfortable if untreated. Recurrent outbreaks are often milder. Some people notice tingling, itching, skin sensitivity, or irritation before an outbreak. Recognizing that early warning can help people contact their clinician and begin treatment promptly.
Condoms, Testing and Safer Sex Decisions
Do condoms protect against herpes and HPV?
Dr. A: Condoms reduce risk, and we absolutely recommend them, but they do not eliminate risk for infections spread through skin-to-skin contact. Herpes lesions or shedding can occur on skin not covered by a condom. HPV can also be transmitted through skin contact.
For known herpes, the strongest prevention approach combines honest disclosure, avoiding sexual activity during outbreaks, condom use, and daily antiviral medication when recommended by a clinician.
For HPV, condoms are helpful, but vaccination and cervical screening are crucial layers of prevention.
Can we stop using condoms after both partners have negative STI tests?
Dr. A: This deserves a more nuanced answer than a simple yes or no. Both partners should discuss what was actually tested. Standard testing does not necessarily provide certainty about HPV or herpes, especially for men and people without lesions.
Before making a decision about condoms in an exclusive relationship, have a direct conversation about:
- Recent and past STI testing
- Known history of cold sores, genital herpes, or HPV
- HPV vaccination status
- Recent partners and timing of potential exposures
- Pregnancy prevention needs
- Whether both partners are truly comfortable with the remaining risks
Every sexual relationship involves trust, but it should also involve informed consent. We cannot make a good decision if we do not have the full information.
When should we get tested after unprotected sex?
Dr. A: Timing matters. Chlamydia, gonorrhea, and herpes may show up within the first one to two weeks, while HPV does not become testable immediately. For a concerning exposure, we may recommend testing within the first couple of weeks, then repeat testing around two months and again later depending on the infection and the circumstances.
If pregnancy is possible and someone is not using reliable contraception, emergency contraception may be appropriate. But we should also speak with a physician about a regular method of birth control, so every sexual encounter is not followed by panic.
Is It an STI, a UTI or a Yeast Infection?
Can burning with urination and discharge be a yeast infection?
Dr. A: Yeast infections typically cause significant itching and a thicker, cottage cheese-like discharge that often does not have a strong odor. They do not usually cause bladder symptoms.
If there is burning during urination along with unusual discharge, we need to think more broadly. We should consider a urinary tract infection, chlamydia, gonorrhea, and other causes. A urine culture can help assess for a bladder infection, while STI testing helps rule out infections that can cause urinary discomfort, discharge, and pelvic pain.
Do not dismiss these symptoms as “probably yeast” without getting checked. The right treatment depends entirely on the cause.
Sexual Health Is for Everyone
Do women who have sex with women still need STI testing?
Dr. A: Yes. Every STI that can affect heterosexual women can affect women who have sex with women. Sexual orientation does not remove the need for Pap smears, HPV screening, STI testing, or honest conversations about exposure.
A full STI panel may include testing for HIV, hepatitis B, hepatitis C, syphilis, gonorrhea, and chlamydia. Screening needs depend on age, symptoms, sexual practices, partners, vaccination status, and individual history.
What is the most dangerous STI?
Dr. A: HIV remains extremely serious, although treatment has improved dramatically. Hepatitis C is concerning because it can lead to liver damage and cirrhosis years after infection. Hepatitis B can become a lifelong infection and can be transmitted to a baby during childbirth if not identified. HPV can cause cancer.
There is no prize for choosing which infection is worse. We want to prevent all of them whenever possible. Testing, vaccination, barrier protection, treatment, and communication are our tools.
Sex During Pregnancy and After Delivery
How long should we wait to have sex after giving birth?
Dr. A: In general, we recommend waiting about six weeks postpartum, particularly if there was a vaginal tear or stitches. Healing takes time. For someone with a first, second, third, or fourth degree tear, we want the tissue to recover before resuming intercourse.
Even without a tear, postpartum vaginal dryness is very common, especially during breastfeeding. Hormonal changes can make intercourse uncomfortable at first. Lubrication can help, and this generally improves over time.
Is sex safe during a high risk pregnancy?
Dr. A: It depends entirely on why the pregnancy is considered high risk. Someone with diabetes may be able to have sex safely. But someone with placenta previa, bleeding, a short cervix, preterm contractions, or another reason for pelvic rest needs to follow their physician’s recommendation.
“High risk pregnancy” is a broad category, not one single diagnosis. We should always ask our own doctor what applies to our individual pregnancy.
The Message We Want Everyone to Remember
We cannot protect ourselves with silence. HPV, herpes, chlamydia, gonorrhea, yeast infections, pregnancy prevention, and postpartum sex are all normal medical conversations. There is no shame in asking for testing. There is no shame in asking what a test actually covers. And there is no shame in asking a partner difficult questions before sex.
Our health depends on being direct. Get regular gynecologic care, stay current on Pap and HPV screening, consider HPV vaccination, use protection, and get evaluated when something feels different. We know these conversations can feel awkward. But a few uncomfortable minutes can protect our future fertility, our relationships, and sometimes even our lives.
Concerned About Your Health? Talk to Dr. Aliabadi
Dr. Aliabadi is an expert OB/GYN who is knowledgeable in all aspects of women’s health and well-being. Dr. Aliabadi and her caring, supportive staff are available to support you through PCOS, endometriosis, menopause, childbirth, infertility, or routine gynecological care. We invite you to establish care with Dr. Aliabadi. Call us at (844) 863-6700 or
Frequently Asked Questions About STIs, HPV and Herpes
Can a normal Pap smear mean we do not have HPV?
No. A Pap smear checks cervical cells for abnormal changes, while an HPV test checks for high risk HPV. A Pap can be normal while HPV testing is positive, which is why both tests may be important.
Can HPV stay dormant for years?
HPV can be suppressed by the immune system and may become detectable after years. A positive result does not necessarily identify when the infection was acquired or which partner transmitted it.
Does herpes only spread during an outbreak?
No. Herpes can spread during asymptomatic viral shedding, when there are no visible sores. Condoms and daily antiviral treatment can reduce, but not completely eliminate, transmission risk.
Are chlamydia and gonorrhea curable?
Yes. They are bacterial infections and can be treated with antibiotics. Partners also need treatment, and follow-up testing may be recommended to confirm the infection has cleared.
Should boys receive the HPV vaccine too?
Yes. HPV vaccination is recommended for boys and girls. It protects individuals from HPV-related disease and helps reduce transmission because there is no routine HPV screening test for men.
