STDs: AIDS Is Not The Only Threat!

Concerns about AIDS in recent years have overshadowed other Sexually Transmitted Diseases (STDs) that also have serious health consequences, including sterility, cancer or death. Some STDs can even make you more prone to the AIDS virus. Learn how to safeguard your health and recognize signs of an STD.

Every year, 12 million Americans are infected with a sexually transmitted disease (STD). STD is an umbrella term that encompasses over 20 contagious diseases spread through sexual contact. And that does not mean just intercourse. Any close contact that involves the genitals, the mouth or the rectum can transmit an STD (once referred to as a venereal disease). Most STDs can be cured with antibiotics. However, some of these diseases have become resistant to antibiotics, and STDs caused by viruses, such as herpes, genital warts and AIDS, have no cure.

Everyone who is sexually active should understand how to prevent STDs, recognize symptoms of an infection and have enough trust in their partners to discuss the issue openly. By knowing the facts and taking precautions, you can protect yourself against the serious problems caused by these infectious diseases.

Prevention is the Name of the Game:

• Practice "Outercourse." Many things that feel good are safe because no blood, semen or vaginal secretions get into the body. These include hugging, cuddling, masturbating, fantasizing, body-to-body rubbing and massage.
• Use condoms. Reduce your risk by always using a condom for vaginal, oral or anal sex. Condoms are now available for either men or women to wear. Everyone who is sexually active should carry condoms and insist on using them for every sex act.
• Limit the number of partners. Mutual monogamy between two uninfected people is safe. But since many STDs have no signs or symptoms, either partner could have an STD and not know it.
• Learn to talk with your partner about condoms and safer sex. The adjustment to safer sex and condom use can be hard, but it can also be fun if done in a playful and creative way.
• Avoid mixing drugs with sexual activities. They could cloud your judgment and lead you to engage in unsafe sexual practices.
• For vaginal intercourse, the spermicides in birth control foam, jelly and cream provide extra safety in killing some STD germs. But they should be used with condoms, NOT in place of them.
• If you inject drugs, seek help. And never share a needle.
• If you are having sex with several different partners, ask your doctor to check you for STDs every six months, even if you don't have any symptoms. This is particularly important for women who often have no symptoms.

Using Condoms:

Next to abstinence, condoms (also called rubbers) are the best form of protection against most STDs. Used correctly, condoms can help protect both partners by preventing contact with body fluids such as semen and vaginal secretions.

They also prevent the spread of infections on any skin they cover or touch. However, for condoms to be effective you have to use them correctly every time you have sex. And it is important to realize that condoms are not fool-proof.

For example, if your partner has a herpes sore on a place not covered by a condom, the sore may touch your skin and infect you. Several types of condoms are now available:

• The male latex condom is the most effective at preventing STDs and pregnancy. It is inexpensive and may even help a man last longer during sex. With latex condoms, you should never use any lubricating oil-based products, such as skin lotions, baby oil, Vaseline® or cold cream, because the oil weakens the condom. If you use a lubricant, use one made with water, such as K-Y® jelly, instead of oil.
• The female condom is also very effective at preventing STDs and pregnancy. The female condom is a plastic pouch that fits inside a woman's vagina. It has a soft ring on each end. The outer ring stays on the outside of the vagina and partly covers the labia (vaginal lips).
• The inner ring fits inside the vagina, much like a diaphragm, to hold the condom in place. Since the woman wears the female condom, she has more control over seeing that a condom is used. She can put it in up to two hours before sex.
• The male plastic condom is still under study to determine how effective it is in preventing STD infection and pregnancy.
• It is particularly useful for those allergic to latex and some say they feel "warmer" than latex condoms.
• Natural membrane ("animal skin") condoms are not recommended for STD prevention.

The Seven Most Common STDs

Chlamydia

Chlamydia can grow in the male and female urethra (where the urine comes out), as well as in the eyes. In women it can also grow deep inside the pelvis.

Symptoms:

Most women (75 percent) and about half of all men infected with chlamydia have few or no symptoms when they are first infected. When they do occur, symptoms may appear anywhere from 2 days to 3 weeks after contact with an infected partner. In women and men, the most common symptoms include:

• Painful or frequent urination
• Redness and irritation of the affected area
• If the eye is infected it can become hugely swollen and red.

In women:

• Burning or itching in the vaginal area
• Unusual vaginal discharge
• Redness, swelling or soreness around the vagina
• Pain in the pelvis or abdomen during sex
• Bleeding between periods

In men:

• Discharge from the penis
• Burning and itching around the opening of the penis
• Pain and swelling in the testicles

Complications:

Left untreated, chlamydia can permanently damage the reproductive organs. It is especially dangerous for women because the bacteria easily infects the warm, moist surface of the cervix. This can lead to pelvic inflammatory disease (PID), which can cause infertility.

In men, chlamydia can cause a discharge from the penis and pain when urinating and, in rare cases, untreated chlamydia can lead to infertility.

Treatment:

Chlamydia is usually easy to treat. Since it is caused by bacteria, it can be treated with antibiotics, which your doctor will prescribe.

It is important that you finish all your medication and that you stop having sex until both you and your partner have finished the treatment. Otherwise, you will keep spreading the infection back and forth and you'll never get well.

Gonorrhea

Though the rate of this bacterial infection has declined over the last 20 years, it is still high in some groups. For example, it seems to be increasing among teenagers. Gonorrhea is very contagious. People can get it from any sexual contact involving the penis, vagina, mouth or anus. Gonorrhea can be found on the tip of the penis, in the anus, in the vagina, in the throat and in the eye. Women may get an anal infection even if they don't have anal sex because discharge from the vagina can spread the bacteria to the anus.

Both sexes can have an infection of the throat from oral sex. Babies born to infected mothers can get their eyes infected, which may cause blindness.

Symptoms:

About one-fourth of men and most women with gonorrhea have no symptoms. Men who do have symptoms usually notice them 3 to 5 days after having sex with an infected person.

Women who have symptoms usually notice them within one month of being infected. The most common symptoms include:

In women:

• A yellowish vaginal discharge
• Burning or pain when urinating
• The need to urinate frequently
• Burning or itching in the vaginal area
• Redness, swelling or soreness of the vulva
• Pain in the pelvis or abdomen during sex
• Abnormal vaginal bleeding

In men:

• A yellowish discharge from the urethra
• Painful or frequent urination
• Blood in the urine
• Swollen glands in the groin
• Redness on the tip of the penis

In both men and women, a gonorrhea infection in the rectum can cause discharge, itching around the anus, and pain during bowel movements. Gonorrhea can also infect a woman's or man's throat, which will cause a sore throat.

Complications:

Untreated, gonorrhea can cause serious and permanent problems. In men, it can move from the penis up to the prostate gland, bladder or testicles. It can make urinating difficult. The testicles can swell and become tender.

The man can become sterile (unable to have children). In women, gonorrhea can spread into the womb and fallopian tubes, causing PID, which can make a woman sterile as well as cause long term pelvic pain. Any damage the disease causes before a person is treated is permanent. Therefore, early treatment is crucial.

Treatment:

Fortunately, gonorrhea is usually easy to treat with antibiotics. Your doctor will probably give you a shot or some pills. It is important that you finish all your medication and that you stop having sex until both you and your partner have finished treatment and are free of infection.

Herpes:

Herpes simplex is a common virus that causes sores on or near the mouth and around the genitals. There are two types of herpes. Type I is generally found on the lips (commonly referred to as cold sores) and type II is found more often on the genitals, but the two viruses can easily infect any mucous membranes. Direct skin contact with an open sore can cause infection on the lips, anus, penis, vagina, and eyes.

Herpes can also be spread when no sore is present. Before having a skin outbreak, some people notice itching, tingling or other sensations. These are called "prodromal symptoms," and they warn that the virus may be present on the skin.

Herpes is most likely to be spread from the time these first symptoms are noticed until the area is completely healed and the skin looks normal again.

But it may be a good idea to use condoms even in between outbreaks because many genital herpes infections are spread when small amounts of the virus are on the skin without any signs at all. This is called "asymptomatic shedding."

Symptoms:

• Signs of herpes infection usually develop within 2 to 20 days after contact with the virus. Some people infected with herpes have no symptoms at all. Or a first attack of the virus can be so mild that it goes unnoticed.
• For others, the first episode causes the skin to become inflamed and blisters or bumps may appear. The area is often painful and may itch, burn, or tingle. Flu-like symptoms are also common. These include swollen glands, headache, muscle aches, or fever. Herpes might also infect the urethra, and urinating might cause a burning sensation.
• The first bout with herpes, known as a primary infection, usually lasts about 3 weeks. During this time the lesions break open and "weep," then gradually shrink and dry up. Rarely are scars left behind. The virus then retreats into the nervous system and lies dormant there.
• In recurrent infections there is usually no swelling in the genital area, fever or flu-like symptoms, and there are fewer sores that heal more quickly--often within a week or two--and the outbreak is less painful. Most people with genital herpes do have recurrences. The average is about four recurrences per year, and for many people the number of recurrences decreases as time goes on.
• Recurrences can occur for a variety of reasons, which vary from person to person. Many people report that the following factors sometimes induce an outbreak: surgery, illness, stress, fatigue, skin irritation (such as sunburn), diet, menstruation, or vigorous sexual intercourse.

Complications:

One possible complication involves moving the virus from the location of an outbreak to other places on the body by touching the sores. The finger, eyes, and other body areas can accidentally become infected this way. To avoid this problem do not touch the affected area during an outbreak--especially the first outbreak. If you do, wash your hands as soon as possible. The herpes virus is easily killed with soap and water.

Treatment:

Since herpes is caused by a virus, there is no cure for it. However, in many cases the prescription drug acyclovir is effective in reducing the frequency and duration of genital herpes outbreaks.

In addition, there are some steps you can take to minimize the discomfort of the outbreaks as much as possible. During an outbreak, keep the infected area as clean and dry as possible. This will help your natural healing processes. To prevent chafing, some people find it helpful to avoid tight-fitting undergarments. Also, a healthy immune system seems to be important in controlling the virus, so don't ignore the need for proper nutrition, exercise and rest.

Hepatitis B

About 300,000 Americans get Hepatitis B each year. Most of them are adolescents and young adults. Hepatitis B is common on college campuses, but anyone can get it. Like AIDS, you can get hepatitis B from sexual contact or any contact with infected blood or body fluids. However, hepatitis B is 100 times more contagious than AIDS. You are at increased risk for hepatitis B if you: share needles for injecting drugs; work in health care; are a native, or spend a long time, in areas where hepatitis B is common, such as Alaska, the Pacific islands, Africa, Asia and the Amazon region of South America.

Symptoms:

Many hepatitis B carriers have no symptoms (but they can still infect others). On the other hand, some people become so ill they cannot work for weeks or months. Symptoms may include:

• Jaundice, a yellowing of the skin and eyes.
• Symptoms similar to a stomach virus, including nausea, tiredness, dark urine.

Complications:

A Hepatitis B infection may clear up in six months or it can linger for a lifetime. Chronic hepatitis B carriers may develop cirrhosis, a disease that scars the liver. Chances of getting liver cancer are 200 times higher for hepatitis B carriers.

Treatment:

There is no cure for hepatitis B. The best "treatment" therefore, is not to get it. Fortunately, there is a vaccine against hepatitis B, which is part of regular childhood immunization. If you were never immunized against hepatitis B and you are a young adult or travel to the areas mentioned above, talk to your health care provider about getting the vaccine.

If you do get hepatitis B, the only available treatment is rest combined with a high protein diet to repair damaged cells and a high carbohydrate diet to protect the liver. If you suspect you have been exposed to the virus, your doctor can give you the Hepatitis B Immune Globulin (HBIG) shot along with the hepatitis B vaccination series. The HBIG shot gives protection from the virus for the first 1 to 3 months; then the vaccine takes over and gives long lasting protection.

HPV

Human Papillomavirus (HPV) is one of the most common STDs in this country. An estimated 40 million Americans are infected with HPV, with a million new cases each year. HPV is the name for a group of viruses that includes more than 70 different types. Some of these cause warts on the hands or feet, while others can cause genital warts. However, sometimes HPV infection causes no warts, so many people with genital HPV do not know they have it.

Symptoms:

The only symptom you are likely to have is warts, which are growths or bumps that can appear on the vulva, cervix, penis, scrotum, groin or thigh, and in or around the vagina or anus. They may look raised or flat, appear alone or in groups, be small or large. Some cluster together forming a cauliflower-like shape. In rare instances, they cause itching, pain or bleeding.

Complications:

While most HPV infections are not a serious threat to your health, some can increase the risk of getting cervical cancer. This is why regular checkups that include Pap tests are so important for women who have had genital warts.

Treatment:

• There are many ways of treating the changes caused by the virus. While the treatments listed below can destroy the wart caused by HPV, the virus can persist after treatment and produce new growths sometimes weeks or even months after the old ones have been destroyed. In such cases, the same treatment or a new one may be tried. Your doctor will advise how often to get a Pap test to help detect any abnormal growths.
• Trichloroacetic acid (TCA) and bichloroacetic acid (BCA) are strong chemicals sometimes painted on genital warts to destroy them. These drugs may cause some burning and must be used very carefully.
• Podophyllin is a drug that may be used on genital warts. But because it can burn and should not be used during pregnancy, it is now used less often.
• Interferon is a new drug used to treat genital warts. It may be injected into the warts themselves or into the underlying muscle.
• Cryotherapy is a freezing process that can destroy warts and other growths.
• Laser treatment uses a high-intensity beam of light to destroy the growths.
• Electrosurgery uses an electric current to burn away lesions or shave them.
• Excisional biopsy, in which the warts are surgically cut off, may sometimes be needed to remove warts.

All of the above procedures can be done in the gynecologist's office. However, if you have a lot of warts or if they are particularly large, they may need to be surgically removed in an operating room with anesthesia.

Trichomoniasis

Trichomoniasis or "trich" infection is caused by a parasite. It is usually transmitted through sexual contact, but can also be transmitted by wet clothes or towels.

Symptoms:

Men usually have no symptoms. Among women the symptoms are similar to a yeast infection, including:

• A heavy yellow-green discharge that has a foul odor
• Discomfort during intercourse
• Itching
• Abdominal pain

Complications:

If left untreated, trichomoniasis infection can lead to urethral and bladder infections in both men and women.

Treatment:

Trichomoniasis is treated with an antibiotic (metronidazole). This medication may cause some side effects and you should never use alcoholic beverages while taking it. Make sure you take all the medication prescribed, even after symptoms disappear.

STDs and Pregnancy

STDs can be passed from an infected mother to her baby during pregnancy or at birth. If the disease is detected soon enough, precautions can often be taken with many STDs so that the disease is not spread to the baby. If the mother is untreated, the baby could suffer permanent damage or even death. Below are some common problems STDs can cause your newborn baby:

Chlamydia and Gonorrhea can give newborn babies an eye infection that can lead to blindness. Chlamydia can also cause pneumonia. Since babies get them during birth, treatment during pregnancy will protect your baby. Just make sure you tell your doctor you are pregnant so antibiotics can be prescribed that will not harm the baby.

Genital Herpes may cause very painful blisters on the skin, or damage the eyes, brain and other internal organs, and may lead to retardation. While herpes is rare in babies, about one in six babies who get it will not survive. Since babies most often get herpes at delivery, there are ways to protect your baby from the infection if you know you have it.

Syphilis causes eye damage, dental and bone deformities, blindness, brain damage, and even death. Symptoms might appear at birth or months or even years later. Early treatment will protect your baby, so make sure you tell your doctor if there is any chance the baby might have syphilis.

Many babies whose mothers have the AIDS virus will get it and develop AIDS during early childhood. Treatment during pregnancy can help protect your baby. Babies can get the AIDS virus during pregnancy, during birth or possibly through breast milk.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease (PID) is an infection of the uterus, fallopian tubes, and other reproductive tissues inside a woman's pelvis. It almost always results from an untreated infection, such as chlamydia or gonorrhea, that spreads upward into the pelvic area. It is the most common serious infection in women ages 16 to 25 and the most common preventable cause of infertility in the United States. It can also lead to long-term pelvic pain.

It is not always easy to detect PID because the sites of infection cannot be easily examined. Symptoms may be mild, severe or non-existent. A PID infection can cause mild, aching pain in the pelvic area, vaginal discharge, painful urination, or abnormal uterine bleeding. More severe cases may be marked by fever, chills, nausea and vomiting.

If PID lasts a long time or comes back, a woman may have problems getting pregnant. This is because the infection can scar the fallopian tubes, blocking them partly or completely. When this happens, an egg released by an ovary may not be able to move through the tube to the uterus to implant properly or sperm may not be able to reach the egg to fertilize it.

PID also increases the risk of ectopic pregnancy for the same reason: The egg cannot move into the uterus so it begins to grow outside of the uterus, usually in the fallopian tube. An ectopic pregnancy can damage a woman's reproductive organs and cause severe pain. Treatment for an ectopic pregnancy usually involves aborting the developing egg before it grows big enough to rupture the fallopian tube. The chances for a successful pregnancy are lower after an ectopic pregnancy.

Antibiotics are used to treat PID. In severe cases, treatment in a hospital may be needed so the medicine can be given through a vein in the arm. If PID lasts a long time or comes back, surgery may be needed to repair or remove damaged reproductive organs.

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Topics:

• Fertility and sexual health
• HIV/AIDS