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July 01, 2022
Do STDs go away on their own if left untreated?
A lot of questions are asked in our practice about the body's natural ability (because of its immune system) to clear STDs. Here are examples of those questions:
- Can chlamydia get better on its own?
- Can gonorrhea infection be cleared naturally?
- Can trichomoniasis resolve on its own?
- What STDs can be self-cured?
- What is the chance of an STD being cured naturally?
- What happens if I leave an STD untreated?
- What is the chance of the immune system fighting STDs?
Those are very difficult questions to answer for a few reasons:
- Not a lot of studies have been conducted to determine the natural ability of the body to clear STD infections on its own.
- No big studies are being conducted or will be conducted in the future for ethical reasons.
- No ethics board will allow scientists to run such an experiment and let the disease run its course, potentially causing irreversible complications.
- The studies that have been conducted are very limited and not conclusive.
Another important thing to mention (before we discuss individual STDs in detail) in the context of the body's ability to cure STDs is symptoms. We cannot judge the presence or absence of the disease by whether someone has or doesn't have symptoms.
Some STDs don't cause symptoms (including herpes in most people, primary syphilis, and hepatitis C), and in some, symptoms come and go (herpes can cause a flare-up that subsides, a syphilis rash can get better, chlamydia discharge can go away), which can make it seem like the infection went away when it hasn't.
So, the conclusion is that you cannot know your STD status unless you get tested, cannot self-diagnose STDs based on symptoms alone, and cannot assume an STD is getting better based on improvement of symptoms.
Nonetheless, people want to know if an STD can go away by itself. We'll answer this question the only way we can: by relying on the limited studies that have been conducted and our office experience (which is even more limited). Let's begin!
STDs can be caused by a virus, bacteria, or a parasite.
Viral STDs:
HIV, Herpes (HSV 1 and HSV 2), Hepatitis B, Hepatitis C, and HPV (Warts)
Some of the viral STDs such as HPV, Hepatitis C, and Hepatitis B, can be cleared by the
immune system given time.
HPV (warts)
Of HPV virus cases, 95% get cleared by the immune system within a two-year period
HPV facts
Most genital warts are caused by benign HPV virus types.
- HPV prevalence
- Most (70%-90%) of the general population (both males and females) are infected with the HPV virus during their lifetime, but only 1% get symptoms: visible warts.
- HPV testing
- Routine HPV screening (pap smear) for females and visual examination of the skin for males are available. Pap smear checks are done for malignant (cancerous) strains.
- HPV prevention
- An effective HPV vaccine (Gardasil) is available for prevention. It should be given, ideally, before puberty or before the beginning of sexual activity. But the vaccine can be helpful even if it is given at a later age-currently it is offered to people up to the age of 45.
Hepatitis B
About 90% to 94 % of people clear the hepatitis B infection spontaneously with full
recovery of the liver.
But 5%-10 % of people will have it for life unless it's treated.
Hepatitis B facts
Hepatitis B can be transmitted sexually.
- Hepatitis B prevalence
- In the U.S., 0.5% of people are positive for Hepatitis B.
- Hepatitis B symptoms
- About 30% of people with hepatitis B have no symptoms at all.
- In those who do, initial symptoms are very nonspecific and mild: fever, muscle aches, fatigue, loss of appetite, and nausea.
- Chronic hepatitis B does not cause symptoms at all until a very late stage.
- Hepatitis B screening
- It can be diagnosed via blood work.
- Hepatitis B treatment
- Effective, curative treatment for Hepatitis B virus is available.
- If left untreated
- If left untreated, Hepatitis B can cause liver cancer and cirrhosis. It might take over 20 years to get to that stage.
- Hepatitis B prevention
- An effective hepatitis B vaccine is available for Hepatitis B prevention.
Hepatitis C
About 30% of people clear the Hepatitis C infection spontaneously.
The remainder, 70%, will have it for life unless it's treated.
Hepatitis C facts
Hepatitis C can be transmitted sexually, but this isn't the most common means of transmission (it's mostly transmitted via blood transfusion or needle sharing).
- Hepatitis C prevalence
- Among the USA population, 1% of people have hepatitis C.
- Hepatitis C symptoms
- Most people have no symptoms.
- Hepatitis C screening
- Hepatitis C can be diagnosed via blood work.
- Hepatitis C treatment
- Effective treatment that can cure the condition is available for Hepatitis C.
- If left untreated
- Untreated chronic hepatitis C can cause liver cancer and cirrhosis.
- Hepatitis C prevention
- No vaccine exists.
Other viral STDs, such as Herpes and HIV, once contracted, stay in the body for life
Herpes
Once herpes is contracted, it stays in the patient's body for life. Herpes is forever.
Herpes facts
Herpes is a very common condition that creates a lot of social stigma.
- Herpes prevalence
- About 70% to 80% of people are believed to have herpes 1 or 2.
- Herpes symptoms
- Most people stay asymptomatic. Herpes remains suppressed by the immune system but may occasionally flare up when the immune system is temporarily depressed.
- Herpes screening
- No screening test is necessary, according to the CDC. But a swab test and IgG test are available, if necessary.
- Herpes treatment
- Effective medication is available for herpes treatment and suppression.
- Herpes prevention
- No vaccine is available. Prevention is achieved using protection and education.
HIV
The HIV virus multiplies so quickly that the immune system doesn't have a chance to
clear it. So, once HIV is contracted, it stays in the body forever.
HIV facts
Very common condition that has a lot of social stigma.
- HIV prevalence
- In the US, 1.2 million people live with HIV.
- HIV symptoms
- People with HIV might not have symptoms, or symptoms might come and go.
-
- An average of 80% (50%-90%) of people with HIV get symptoms within two to six weeks after acquiring it.
- Despite being positive, 21% of people never develop any symptoms.
- So, the absence or resolution of symptoms does not mean that the virus is gone.
- HIV screening
- Screening is done via a blood test.
- HIV treatment
- The HIV virus can be treated (suppressed) with medication very effectively.
- HIV prevention
- HIV can be prevented by medication called PrEP (this stands for preexposure prophylaxis).
- The PrEP regimen prevents someone from getting HIV after a high-risk contact.
Bacterial STDs:
Chlamydia, Gonorrhea, and Syphilis
The chance that chlamydia or gonorrhea will go away naturally is very low, according to a
few very limited studies and our office experience.
Chlamydia
A few limited studies
A study showed that 50% of females diagnosed with chlamydia still had chlamydia a year later. See here.
Another study showed that chlamydia persisted in males for at least a year without being cleared. See here.
Our office experience
We have asymptomatic, chlamydia-positive patients (about 20 patients of both genders) who didn't take the medication for at least three to six months for different reasons (some of them didn't believe they had it since they didn't have symptoms, some couldn't get the medication because they were abroad, some tried natural remedies, etc.).
Upon retesting, 80% them were still positive for chlamydia, and treatment was provided.
Gonorrhea
A few limited studies
In one study, of 16 females diagnosed with gonorrhea, 100% remained positive two month later. See here.
In another study, males were asymptomatic carriers of gonorrhea for six weeks. Five of 28 people cleared the infection. See here.
Our office experience
We have asymptomatic, gonorrhea-positive patients (about 30 patients of both genders) who did not take the medication for at least three to six months for different person reasons (some of them didn't believe they had gonorrhea since they didn't have symptoms, some couldn't get the medication because they were abroad, some tried natural remedies, some were afraid of a shot, etc.).
Upon retesting, 100% were still positive for gonorrhea, and treatment was provided.
Gonorrhea and chlamydia facts
Chlamydia and gonorrhea are the two most common bacterial STDs.
- Chlamydia and Gonorrhea prevalence
- Every year, 3 million people in the US get chlamydia.
- Every year, 0.7 million people in the US get gonorrhea.
- Chlamydia and gonorrhea symptoms
- The presence or absence of symptoms, or the resolution of symptoms, doesn't mean the infection is gone with either condition.
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- Fifty percent of males and up to 75% of females with chlamydia don't have symptoms.
- Fifteen percent of males and 80% of females with gonorrhea don't have symptoms.
- Chlamydia and gonorrhea testing
- Only testing can establish the diagnosis for both these conditions.
- Two different ways of testing are available: urine tests and swab tests.
- All areas of the body that came into contact with a partner should be tested: oral, rectal, vaginal, and penile
- Chlamydia and Gonorrhea treatment
- Effective treatment offering eventual cure is available for both chlamydia and gonorrhea.
- If left untreated
- If left untreated, both chlamydia and gonorrhea can cause very significant complications, such as pelvic inflammatory disease with infertility for females and orchitis (testicular infection) with infertility in males.
- Chlamydia and Gonorrhea prevention
- Using protection is the only method of prevention for both chlamydia and gonorrhea.
Syphilis
Syphilis bacteria, if contracted, do not get cleared by the immune system.
A recent study revealed that syphilis bacteria (Treponema pallidum) can evade the immune system through the modification of a surface protein. See here.
Syphilis facts
- Syphilis prevalence
- EAbout 130,000 cases a year are recorded.
- Syphilis symptoms
-
- Syphilis occurs in stages, with each being cleared by the immune system before the next stage appears.
- Half (50%) of syphilis patients don't have visible signs and symptoms.
- Resolution of symptoms (a painless sore for primary syphilis and skin rashes and lymph node enlargement for secondary syphilis) does not mean the patient has recovered from syphilis.
- Syphilis testing
- Only a blood test can establish the diagnosis.
- Syphilis treatment
- Effective treatment and cure are available.
- If left untreated
- If left untreated, syphilis can affect major organs (heart, brain, nervous system, vision, hearing, etc.). It may take up to 20 years to get to that stage.
- Syphilis prevention
- Only the syphilis testing can establish the diagnosis and response to the treatment and prevent syphilis transmission.
An STD Caused by a Parasite:
Trichomonas
Trichomonas Vaginalis
Trichomonas does not get better on its own. Once contracted, it can stay dormant for months and even years until the patient is treated.
Trichomoniasis facts
- Trichomonas prevalence
- Every year, 3.7 million people are infected, with females being affected twice as much as males: 2.1% of female and 0.5% of males have it.
- Trichomonas symptoms
- Up to 70% of people with trichomonas don't have symptoms.
- Trichomonas testing
- Only testing can establish the diagnosis for trichomoniasis. Two different methods of testing available: urine tests and swab tests.
- Trichomonas treatment
- Effective treatment and cure for trichomoniasis are available.
- If left untreated
- Trichomoniasis infection is not as aggressive as chlamydia and gonorrhea in terms of complications. It mainly increases the chance of getting other STDs, such as HIV.
- Trichomonas prevention
- The main way of preventing trichomoniasis is using protection while sexually active.
The bottom line is that it is possible for some-not all-STDs-to go away on their own, but it is also possible for a STD to persist for months and even for the rest of the patient's life, causing irreversible damage.
Remember, about 20% of the US population have an STD on any given day. If you could have been exposed to an STD, the best thing to do is to get tested - not to hope that if you were infected, it will just go away.
