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Politics aside, there has been one undeniable upside to the Affordable Care Act: no-cost screenings for STDs (like chlamydia, gonorrhea, and HPV) for women with an increased risk of infection. (Usually this means sexually active woman age 25 or younger.) The downside: More than half of Americans still aren’t getting these critical sexual health services, according to the National Coalition for Sexual Health.

Why? For one, many women think, “I was tested a year ago, and was negative, and I’m sure my boyfriend has been faithful,” says H. Hunter Handsfield, M.D., a professor emeritus at the University of Washington Center for AIDS and STD. What many women don’t realize: These problems are common—and “bad outcomes are more common in females than in males” when it comes to STDs, Handsfield adds.

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But even more worrisome is this: “The large majority of human infections are asymptomatic. For every person with strep throat and a sore throat, there are a large number of other people who have strep in their throat and don’t get sick,” says Handsfield. “It’s the same with STDs.”

That means it’s critical to seek screenings (annually or every couple of years, depending on your age and sexual habits)—especially for these “sleeper” STDS, which often show no signs of infection. [Tweet this!]

Chlamydia

As few as 5 percent of women with chlamydia develop symptoms, the Centers for Disease Control and Prevention (CDC) reports. And even if you do develop symptoms, they can be so non-specific—increased vaginal discharge or burning—that you may not suspect an STD, he says. But chlamydia is one of the most common curable STDs, says Patricia Elliott, Ph.D., a clinical assistant professor at the Boston University School of Public Health. And if left undetected, the infection can spread to your uterus and fallopian tubes, and your body can create scar tissue, possibly leading to pelvic inflammatory disease, says Elliot. As a result, your fallopian tubes may become blocked, increasing your risk of infertility, chronic pelvic pain, or ectopic pregnancy. “Chlamydia can also lead to increased risk of contracting HIV if exposed,” says Elliott. If you become pregnant, you can pass chlamydia onto your child during a vaginal birth, potentially leading to respiratory or eye infections in your baby.

Gonorrhea

Elliott estimates that half of cases in women are asymptomatic—and if you do show signs, the infection may be mistaken for a bladder or vaginal infection, according to the CDC. That said, “gonorrhea has a bit of a safety valve,” says Handsfield, because when symptoms do develop, they’re often severe enough—in contrast to chlamydia—prompting women to see a doctor. Like chlamydia, untreated gonorrhea can lead to pelvic inflammatory disease. And it's often severe: “gonorrhea is a more inflammatory disease than chlamydia,” says Hansfield. “So it causes a greater amount of tubal damage,” potentially priming you for infertility or ectopic pregnancy. The bacteria can also spread to your bloodstream, leading to a specific type of arthritis or fatal infections of the heart valve (although rare), he says.

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HPV

HPV has become the common cold of STDs: It’s the most rampant sexually transmitted infection in the United States, despite being one of the only ones you can get vaccinated against, according to the CDC. Even though many of us know we have it, there are still a large number of cases that go undetected. “HPV usually goes away on its own,” says Elliott. “But it can stay in your body for a long time and remain asymptomatic.”

Besides putting you at risk of genital warts, a lingering case of HPV can raise your odds of cervical cancer, as well as cancers of the throat, vulva, vagina, and anus. “A woman who has HPV may not develop cancer for decades,” says Elliott. But there’s still a health risk associated with precancerous cells in your uterus. “These abnormal pap smears require colposcopy treatment, which involves surgically removing part of the cervix,” says Handsfield. That can raise your risk of preterm delivery if you become pregnant.

Genital Herpes

You probably expect to develop a nasty rash if you catch herpes, but the truth is, “most cases are asymptomatic or cause such mild symptoms that many patients don’t realize anything is abnormal,” says Handsfield. Even if you’re totally symptom-free, you can transmit HSV2—the virus known to cause genital herpes—to your partner, he adds. The CDC doesn't currently recommend routine testing in symptom-free people, but if you suspect a partner had it or you've slept with multiple people, you should talk to your doctor about testing.

Why? If you don’t manage herpes in its early phases—remember, it’s incurable—you may be more prone to recurrent outbreaks. “Women have more painful outbreaks than men do,” Handsfield says. And, scarily, you can pass the infection on to your baby during vaginal childbirth. “Neonatal herpes is rare, but when it occurs, it often kills the baby,” says Handsfield.

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