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Neat Little Guide — 25 minutes

What is an STBBI and how is it transmitted?

STBBIs: Modes of transmission and symptoms

a couple

A sexually transmitted and blood-borne infection (STBBI) is contracted through vaginal, oral or anal sex. Most STBBIs are transmitted through the exchange of bodily fluids, but some can be contracted through skin-to-skin contact. Even if you do not have any symptoms, you can transmit an STBBI to another person without knowing you are infected.

Human immunodeficiency virus (HIV) and AIDS

The human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). It attacks and weakens your immune system until it can no longer fight infections and viruses.

HIV can be transmitted during sexual intercourse or if you come into contact with contaminated blood (pre-ejaculatory fluid, semen, vaginal and anal secretions, breast milk from infected people).

The two main modes of transmitting HIV from person to person are:

  • unprotected sex (anal or vaginal intercourse without a condom)
  • the sharing of needles and other instruments for injecting drugs (including steroids)

Other modes of HIV transmission:

  • Oral sex without a condom or rubber dam (not as risky as vaginal or anal sex)
  • The sharing of sex toys, tattoo needles and ink, piercing jewelry or acupuncture needles
  • If you are a mother and infected with HIV, you can pass it on to your child during pregnancy, delivery or breastfeeding.

HIV is not transmitted:

  • through simple contact such as hugging, kissing and the sharing of utensils or food
  • by coughing or sneezing
  • by sitting on toilet seats or drinking from fountains
  • by insects or animals

Symptoms of HIV

If you are infected, you can remain symptom-free and healthy for many years, but most will eventually contract diseases caused by a compromised immune system. Some people with HIV develop general symptoms similar to those found in people with health problems such as:

  • chronic vaginal yeast infections
  • persistent fatigue
  • unexplained weight loss
  • diarrhea
  • swollen lymph nodes (neck, armpits or groin area)
  • fever or night sweats
  • oral candidiasis (whitish, thick, persistent granules on the tongue or in the mouth)

Symptoms of AIDS

The most critical stage of HIV infection is AIDS. If you have AIDS, the damage to your immune system puts you at risk of contracting serious diseases such as:

  • pneumocystis pneumonia (PCP), a lung infection that causes severe shortness of breath and coughing
  • invasive cervical cancer
  • a brain infection and direct damage to brain cells, causing confusion, disorientation and loss of concentration
  • Kaposi’s sarcoma, a form of skin cancer


Chlamydia is the most common sexually transmitted infection (STI). It is caused by a bacterium called Chlamydia trachomatis which is transmitted during unprotected vaginal, oral or anal sex with an infected person. You can transmit chlamydia to your partner without even knowing you are infected.


Symptoms may appear within two to six weeks following contact with the bacterium, but it is important to note that most people do not have symptoms:

  • Burning sensation while urinating
  • Change or increase in vaginal discharge
  • Clear or milky discharge from the penis
  • Burning or itching sensation on the glans, inside the penis or near the rectum
  • Testicular pain and/or swelling
  • Lower abdominal pain
  • Pain or bleeding during sex
  • Light bloody discharge or vaginal bleeding between menstrual periods

Genital herpes (HSV)

Genital herpes is a sexually transmitted infection (STI) caused by the herpes simplex virus (HSV). The two main types, HSV-1 and HSV-2, can cause blisters in and around the mouth and on the genitals.

There is no cure for genital herpes. If you are infected, you will have recurring episodes of symptoms.

  • It is always possible to transmit the virus during the latency phases (no symptoms).
  • Genital herpes is transmitted through skin contact, usually during oral, vaginal or anal sex.
  • Even if you do not have visible lesions, you can still transmit the virus to your sexual partner.


Symptoms of a primary HSV episode usually occur 6 to 21 days after skin contact. Many people do not notice the primary infection and cannot tell whether they are infected.

Primary episodes

  • Small vesicles in the vagina, on the vulva or uterus, on or around the penis or testicles and anus, or on the thighs or buttocks
  • Pain while urinating
  • Fever and pain in the joints or muscles
  • General malaise

Secondary episodes

  • The number of episodes and amount of time between episodes vary from person to person (rare to frequent).
  • Generally in the same area as the primary episode
  • Itching or tingling at the site of the infection
  • Less serious and of shorter duration


Gonorrhea is a sexually transmitted infection (STI) caused by a bacterium called Neisseria gonorrhoeae. It is transmitted through unprotected vaginal, oral or anal sex with an infected person. You can transmit gonorrhea to your partner without even knowing you are infected.


Most people do not feel any symptoms. If symptoms occur, they usually appear 2 to 7 days after exposure to the bacterium:

  • Thick, yellowish vaginal or rectal discharge
  • Thick, greenish-yellow discharge from the penis or rectum
  • Burning or itching sensation on the glans, inside the penis or near the rectum
  • Testicular pain and swelling
  • Burning sensation while urinating
  • Lower abdominal pain
  • Pain or bleeding during sexual intercourse
  • Abnormal vaginal bleeding
  • Sore throat

Hepatitis A

The hepatitis A virus is present in the feces of an infected person. Feces can end up in food, water or on different surfaces, and they are not always visible.

Hepatitis A can be transmitted through:

  • the consumption of contaminated food or water
  • contact with contaminated objects
  • contact of the mouth with the anus
  • the sharing of sex toys
  • the preparation or consumption of drugs under unsanitary conditions

In most cases, hepatitis A does not require treatment and is usually eliminated by the body within two (2) months. Once hepatitis A is eliminated, your body has produced antibodies that protect you for life.


  • Fatigue
  • Loss of appetite, nausea or vomiting
  • Stomach pains
  • Fever
  • Diarrhea
  • Yellow skin and eyes (jaundice)
  • Pale stools and dark urine

By getting vaccinated, you protect yourself against serious illnesses. Have it done quickly and efficiently at a Biron Service Center.

Hepatitis B

Hepatitis B is a very serious viral STBBI that attacks the liver and causes chronic liver disease, cirrhosis or liver cancer.

It is transmitted by:

  • contaminated blood
  • other bodily fluids (open wounds, breast milk, tears, saliva, semen and vaginal secretions)
  • a mother to her fetus during pregnancy
  • sharing needles for injecting drugs


  • Fatigue
  • Fever
  • Headaches
  • Loss of appetite
  • Vomiting
  • Abdominal pain
  • Jaundice
  • Dark urine
  • Pale stools
  • Diarrhea

Hepatitis C

Hepatitis C is also a viral infection that attacks the liver and can cause chronic and fatal liver disease (cirrhosis, cancer).

The main risk factors for the transmission of hepatitis C are:

  • the sharing of equipment (needles, syringes, water, stove, swabs, etc.) used for injecting drugs or steroids, even once in a person’s life
  • the sharing of equipment (straws, rolled-up currency, crack pipes, etc.) used for consuming drugs
  • receiving blood products or immunoglobulin before 1992

There are other less common ways to contract the virus:

  • Sexual intercourse with a partner who has hepatitis C
  • Tattooing, piercing and acupuncture when non-sterile equipment is used
  • The sharing of personal hygiene items (razors, toothbrushes, nail clippers, etc.)
  • Children born to an infected mother


  • Fatigue
  • Jaundice
  • Dark urine and pale stools
  • Abdominal pain, nausea, vomiting, poor appetite

Some points to note:

  • You can live your entire life without the virus causing liver damage.
  • The virus can cause mild to moderate liver damage.
  • If you have cirrhosis, you may develop liver cancer or suffer liver failure and need a transplant.

Human papillomavirus (HPV)

Human papillomavirus (HPV) includes more than a hundred different virus strains or types that are grouped based on their link to cancer.

Infections with “low-risk” types of HPV cause genital warts, while “high-risk” types are the cause of 70% of cervical cancers. Genital warts are lesions caused by HPV, a common virus that is also the most common STBBI in Canada. Up to 75% of the population will come into contact with the virus in their lifetime and be able to eliminate it within two years of the infection.

Most women who have been exposed to HPV do not develop cervical cancer, even if infected by a type of HPV that causes cancer. However, for some women, the infection may persist and, if left undetected and untreated, can slowly become cancerous.

HPV is transmitted from person to person through direct skin contact during sexual activity. If you do not have any symptoms, you could be infected without knowing it and transmit the virus to your sexual partners.


  • In many cases, HPV is not accompanied by any symptoms, which means that you may be infected without knowing it.
  • Symptoms may appear two to three months, or even years, after infection.
  • HPV can cause warts on your genitals which look like ordinary warts. They usually take the form of hard or soft growths that are pink, beige, white, brown or grey in colour.


Depending on the type of HPV, if you are infected, your partners may develop:

  • genital warts (resemble ordinary soft or hard warts). In women, the warts appear on the vulva, vagina, cervix and anus. In men, at the entrance to the urethra, on or under the foreskin, on the penis, and around the anus.

Lymphogranuloma venereum

Lymphogranuloma venereum (LGV) is a sexually transmitted infection (STI) caused by Chlamydia trachomatis. If you are infected, you can transmit LGV even if you have no symptoms. Sexual transmission can occur through the following:

  • Oral sex (contact of the mouth with the penis, vulva, vagina or anus)
  • Vaginal intercourse (penetration of the vagina with the penis)
  • Anal intercourse (penetration of the anus with the penis)
  • Contact between the partners’ genitals
  • The sharing of sex toys

Sexual transmission can occur even without penetration, orgasm or ejaculation. If you are a mother and are infected, you could also transmit LGV to your baby at the time of delivery.


First stage (3 to 30 days after infection):

  • Small, painless bumps at the point of infection (penis, rectum, oral cavity, vagina or cervix)

Second stage (2 to 6 weeks after first bumps appear):

  • Painful and swollen lymph nodes in the groin and thighs
  • Blood loss through the rectum
  • Flu-like symptoms

Third stage:

  • Chronic lymphogranuloma venereum
  • Risk of complications if the infection is not treated (severe genital edema, scarring, surgical recourse to control the damage)

Molluscum contagiosum

Molluscum contagiosum is a skin infection caused by a virus belonging to the poxvirus family. If you are infected, you can transmit it through the following means:

  • Direct skin-to-skin contact
  • Wet towels, sports equipment or tanning beds
  • Sexual contact
  • Scratching lesions and then touching another part of your body, thereby spreading the infection


  • The infection causes small, flesh-coloured or pearly-white growths or firm bumps with a smooth surface and sagging centre.
  • There may be one or more bumps in several places on your body.
  • If you are sexually active, the bumps may be on your genitals, inner thighs or abdomen.
  • The infection usually appears 1 to 3 months after exposure to the virus. The bumps can last from 6 months to 2 years and the virus is eliminated when the bumps disappear.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an inflammation of the uterus, fallopian tubes, ovaries and surrounding tissue. It can be caused by a variety of bacteria or viruses, including sexually transmitted infections (STIs). The bacteria most frequently responsible are Neisseria gonorrhoeae and Chlamydia trachomatis, but bacteria normally found in the vagina and cervix can also be the cause.

Although many people do not experience symptoms, the following signs are possible:

  • Lower abdominal pain
  • Increased or abnormal vaginal discharge
  • Pain during sexual intercourse
  • Bleeding between your menstrual periods or after sex
  • Increased menstruation
  • Chills or fever

Pubic lice and scabies

Also called “crabs,” pubic lice are small insects that live in your genital hair. The lice can be transmitted during sexual contact and spread to the hair, chest and armpits and, more rarely, to the beard, moustache and eyelashes.

The lice are grey-brown in colour, the size of a pinhead, and are often difficult to see with the naked eye. They lay eggs (nits) at the base of the hair which look like small white dots.

The following symptoms may be observed 2 to 6 weeks after exposure to the parasites:

  • Itching in the genital or anal area
  • Skin irritation (redness) and inflammation
  • Small blue spots on the skin resulting from insect bites
  • Visible eggs (nits) or lice

Scabies is caused by tiny mites, visible to the naked eye, which embed themselves underneath the skin to dig furrows and lay their eggs. Scabies can be transmitted during sexual intercourse or other intimate contact.

The following symptoms may appear 2 to 6 weeks after exposure to the parasites:

  • Intense itching, especially at night
  • Skin rashes that take the form of thin greyish or red lines
  • Lesions that usually appear on the wrists, between the fingers and toes, on the armpits and groin, on the penis or breasts, and in other folds of the skin
  • Irritated, red, or inflamed penis skin


Syphilis is a sexually transmitted infection (STI) caused by a bacterium called Treponema pallidum. The infection develops in three stages and the first symptoms appear between 10 days and 3 months after exposure.

Syphilis is transmitted through sexual contact (oral, genital or anal) with a contagious lesion or rash.

  • If you are an infected mother, you could pass it on to your baby during pregnancy and at the time of delivery.
  • Rarely, it can be transmitted when contaminated equipment is used to inject drugs.

Syphilis can cause serious long-term health problems and has the following symptoms in stages:

Primary stage (3 to 90 days):

  • Appearance of a painless ulcer (canker) in or around the mouth, genitals or anus
  • Swelling or inflammation of the lymph nodes which can last from one to six weeks before beginning to heal

Secondary stage (2 to 12 weeks, up to 6 months):

  • Itch-free skin rashes on the palms of the hands, soles of the feet or the entire body
  • Flu-like symptoms (headaches, muscle and joint pain, loss of appetite, fever)
  • Hair loss

Stages of the latency period

Early latent stage (less than one year):

  • No symptoms or reappearance of contagious lesions
  • The infection can be transmitted to other people.

Late latent stage (more than one year):

  • The latency period can last 20 to 30 years.
  • During this stage, a person is no longer infectious.
  • If untreated, the infection progresses to the tertiary stage in 30% of cases.

Tertiary stage

In the tertiary stage, syphilis can cause heart problems, hematological diseases and skin, bone and joint damage as well as neurological problems.


Trichomoniasis is caused by a parasite called Trichomonas vaginalis that lives in a woman’s vagina and a man’s urethra. The parasite can survive for a short time outside the body, but is usually transmitted through sexual contact.

The following symptoms are possible:

  • Yellowish vaginal discharge
  • Fish smell from the vagina
  • Itching and redness of the vulva and vagina
  • Burning sensation while urinating


At Biron, we offer all the STBBI screening tests, and most results are available in just 24 hours.

Human immunodeficiency virus (HIV) and AIDS

If you recently tested positive for HIV, your immune system has started producing antibodies. A blood test measures the presence of these antibodies. HIV antibodies appear in the blood up to 12 weeks after exposure to the virus. Different tests for detecting HIV exist. At Biron, fourth-generation tests are used, meaning that the minimum time period between exposure and testing can be at least 14 days. Laboratories using third-generation tests cannot detect HIV as quickly, therefore a person must wait 6 to 12 weeks after probable exposure to the virus to check for HIV in the blood.


The detection of a Chlamydia trachomatis infection is mainly done with a nucleic acid amplification test (NAAT).

  • Urine sample
  • Sample from the cervix, urethra, throat or rectum with a cotton swab

Genital herpes (HSV)

  • Sampling a lesion and culture or a NAAT
  • Under certain circumstances, a blood test to detect antibodies to HSV

Human papillomavirus (HPV)

  • Cervical sampling to detect high-risk HPV (potentially causing cervical cancer) with a NAAT
  • The presence of HPV in the cervix can be detected with regular Pap tests.
  • A health care professional can examine your skin for genital warts.


The detection of a Neisseria gonorrhoeae infection is performed mainly with a nucleic acid amplification test (NAAT).

  • Urine sample
  • Sample from the cervix, urethra, throat or rectum with a cotton swab

Hepatitis A, B and C

  • Blood test to detect antigens and/or antibodies

Lymphogranuloma venereum

  • Urine sample
  • Sample from the cervix, urethra, throat or rectum with a cotton swab

Molluscum contagiosum

  • Examination of your skin by a health care professional

Pelvic inflammatory disease

  • Blood test to confirm the presence and type of STI
  • Laparoscopy to determine the precise site of infection
  • Ultrasound to get an image of the genitals

Pubic lice and scabies

  • Examination of your skin by a health care professional


  • Blood test to detect antibodies or other substances


A Trichomonas vaginalis infection can be detected with a NAAT using an endocervical, vaginal or urine sample, a microscopic examination, or a culture of a fresh specimen.

Learn more about sexually transmitted and blood-borne infections.


According to a report by the Institut national de santé publique du Québec (2014), more than 29,000 cases of STBBIs were reported in Quebec in 2014 and they represent 75% of all infections recorded in the database of diseases that must be reported.

In addition:

  • The incidence of reported cases of Chlamydia trachomatis and gonococcal infections is steadily increasing, particularly among young people aged 15 to 24, with the increase more pronounced among young men.
  • The resistance of the gonococcus bacterium to antibiotics used to treat this infection poses several challenges, including the ability to track the resistance (and the resulting treatment failures) and propose new treatment regimens in the event that the resistance spreads.
  • Almost half (47%) of gonococcal infections in men are only rectal and pharyngeal infections.
  • The infectious syphilis epidemic, initially concentrated in the Montreal area, now affects most regions of Quebec. The significant increase observed in recent years now seems to be stabilizing.
  • An outbreak of lymphogranuloma venereum has been observed since spring 2013. This increase intensified sharply in 2014 and 2015.
  • The incidence rate of reported cases of hepatitis B has stabilized in recent years in Quebec, underscoring the importance of continuing vaccinations against hepatitis B, particularly among people at risk who have not benefitted from a school-based program.
  • Approximately 1,100 cases of hepatitis C were reported in 2014, increasing the pool of infected individuals and highlighting the need for access to treatment to prevent liver complications.
  • The annual number of new HIV diagnoses is decreasing. An upward trend was observed between 2009 and 2013 among 15- to 24-year-old men who have sex with men (MSM), but this increase did not seem to continue into 2014. This trend should be interpreted with caution, however, due to the small number of cases.

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