The question of whether sexually transmitted infections (STIs) cause pain is complex, and the answer is not a simple yes or no. STIs are infections passed from one person to another through sexual contact. Relying on pain as an indicator of infection is dangerous, as many infections cause no discomfort at all, even while they are being transmitted and causing internal damage. Pain is one possible symptom, but its absence should never be taken as proof that a person is free from infection.
Why Many Infections Go Unnoticed
The majority of curable STIs are asymptomatic, meaning they produce no noticeable symptoms in the infected individual. This lack of pain or visible signs makes infections like Chlamydia and early-stage Gonorrhea particularly insidious, allowing them to spread undetected. Studies estimate that up to 80% of women infected with Chlamydia may not experience any symptoms.
The pathogen can still cause significant damage even when the host does not feel pain. The bacteria that cause Chlamydia can silently move into the upper reproductive tract, leading to serious complications in women. Similarly, a substantial portion of men with Gonorrhea may have no initial symptoms, yet they can transmit the infection to partners.
Because the absence of symptoms is so common, these infections are often referred to as “silent.” The infected person can unknowingly pass the STI to sexual partners, which highlights why routine testing is necessary for sexually active individuals.
Localized Pain and External Symptoms
When pain does occur, it is often localized to the genital or oral areas, and it can manifest in several distinct ways. One common form of discomfort is dysuria, a burning or stinging sensation felt during or after urination. This symptom is typically caused by inflammation of the urethra, often seen with infections like Chlamydia, Gonorrhea, and Trichomoniasis.
External symptoms may also include localized pain from physical changes on the skin or mucous membranes. Infections like genital herpes or syphilis can cause the formation of lesions, blisters, or ulcers, which may be painful, tender, or itchy. The irritation or discomfort can be external to the urethra, such as generalized itching or soreness around the genitals or anus.
For example, a herpes outbreak frequently involves small, painful blisters that eventually rupture to form shallow ulcers, which can be particularly tender when touched or when exposed to urine. Syphilis, in its primary stage, usually produces a firm, painless ulcer called a chancre, but if the lesion becomes secondarily infected, it may cause localized pain.
Internal Spread and Systemic Pain
If left untreated, some STIs can ascend from the initial infection site and cause significant internal or systemic pain. This occurs when the bacteria spread beyond the urethra or cervix and begin to infect deeper tissues and organs. This progression leads to severe, widespread inflammation that signals a more advanced stage of disease.
In women, the ascending infection of Chlamydia or Gonorrhea can result in Pelvic Inflammatory Disease (PID), which is characterized by pain in the lower abdomen and pelvic area. PID is a serious condition that involves the uterus, fallopian tubes, and ovaries, potentially causing persistent pelvic pain or tenderness upon movement of the cervix. This internal inflammation is a major cause of infertility and ectopic pregnancy.
Men can experience epididymitis, which is an inflammation of the coiled tube at the back of the testicle that stores sperm. This condition, often caused by untreated Chlamydia or Gonorrhea, results in testicular pain, swelling, and a feeling of heaviness, sometimes accompanied by pain in the lower abdomen or groin. In rare cases, the infection can become systemic, leading to widespread symptoms like fever, joint pain, or body aches, indicating the pathogen has entered the bloodstream.
When to Seek Testing and Treatment
Because pain is an unreliable indicator of infection, regular testing is the most effective strategy for managing STIs, regardless of whether symptoms are present. Sexually active individuals should consider routine screening, with frequency depending on age, number of partners, and other risk factors. The Centers for Disease Control and Prevention (CDC) recommends annual screening for Chlamydia and Gonorrhea for all sexually active women under 25.
Immediate care should be sought anytime new, unusual symptoms appear, such as unexplained discharge, any new sores or bumps, or pain during urination or sex. If the pain is internal, severe, or accompanied by systemic symptoms like fever or persistent abdominal discomfort, a medical evaluation is urgent. Prompt diagnosis and treatment are necessary to prevent the infection from progressing to the severe, pain-inducing complications.