I know Valentine's Day is coming up and perhaps I should be writing something sexy and romantic to get you in the mood. However during the month of January a very close friend of ours was diagnosed with Hepatitis B, so as a sex educator I felt the responsibility to postpone my planned romantic column and write this nasty STD column instead. Even though we love to think of sex as all good sensations and pleasure, sometimes it's just the opposite.
Contracting an STD not only affects your health, it affects your inherent sense of sensuality and sexuality. It brings your sex life to a grinding halt. My friend recently wrote me an email and she laments, "For the first time, I have no sexual appetite. I don't feel sexy anymore. Strange losing that part of myself, that confidence. I feel deflated. I am immersed in sexual innuendo, but practice none of it. Not now. Will I ever again?"
Every woman, especially she who is not in a trusting, monogomous relationship, should take a moment to educate herself about the dangerous world of STDs. Even if you think you know everything about STDs, take a look, I was surprised at what I learned.
More than twenty million North Americans are infected with STDs each year. STD stands for Sexually Transmitted Diseases and describes all the viruses, bacteria, and parasites that can be transmitted via sexual contact.
Many of these diseases can be prevented by taking some fairly simple precautions like wearing condoms every time you have sex; choosing your sexual partners wisely and asking about their sexual history (including whether or not they get tested for STDs regularly); and getting tested regularly yourself, ideally after every new sexual partner. A lot of STDs are asymptomatic and you could very easily unknowingly pass a disease on to your partner who in turn will pass it on to every other person s/he sleeps with after you. This is why STDs spread so rampantly. Also, if you ever are diagnosed with an STD it is your responsibility to contact all possibly infected partners so that s/he can get tested and treated and prevent further transmission of the disease.
The following is a description of the most common STDs infecting millions of people every day. There really is no need to learn the hard way about the ramifications of irresponsible sexual behavior. Educate yourself and practice safer sex.
*Note I did not cover HIV in this column as that would require a great deal more information than I have room for - however if you are sexually promiscuous and not in a trusting, monogomous relationship, make HIV blood tests a regular task on your to "do list" either after every new sexual partner or at least two to four times a year depending upon your level of sexual activity. *
Chlamydia
What is it? Chlamydia acts like a parasite, entering cells and using their energy. It is caused by an organism known as Chlamydia trachomatis.
How it is spread: Chlamydia is typically spread through vaginal secretions and semen.
Initial Symptoms: The symptoms of early-stage chlamydia are usually nonexistent for four out of five women. The most common symptom, if any, is increased or abnormal vaginal discharge, which usually develops about fourteen days after infection. Sometimes a strong, foul vaginal odor develops as well. Painful urination, unusual vaginal bleeding, bleeding after sex, and minor abdominal pain may also be signs. If your cervix bleeds easily after a Pap smear, this could also be a symptom.
Diagnosis: Ten percent of the time, people who have chlamydia will test negative for it. The best thing you can do if you're sexually active is to be regularly screened for chlamydia by your gynecologist. The test is 90 percent accurate. The screening is simple: your doctor takes a culture swab of cervical mucus. It can be done in conjunction with a Pap test. If you test negative but still suspect it, request antibiotic treatment anyway. Even if you are treated for nonexistent chlamydia, the treatment is relatively harmless to you, other than the mild side effects of antibiotics.
Long Term Complications: Chlamydia can lead to pelvic infections, tubal pregnancies due to scarring of the fallopian tubes, urethral infections, cervicitis (inflammation of the cervix), and pelvic inflammatory disease (PID - read more below), which can lead to infertility or complications during pregnancy or childbirth.
Treatment: The good news is that chlamydia is very easy to treat. The antibiotic Zithromax®, (azithromycin) is often prescribed and it only takes 4 tablets as a single dose regimen to clear the infection. After you've finished your antibiotics, you will want to see your doctor for a followup culture to be certain that the infection is gone. Abstain from all sexual activity until you're sure that you are cured.
Gonorrhea
What is it? Gonorrhea is caused by the bacterium gonococcus. This bacterium grows in the genitals and urinary organs and affects the cervix, urethra, and anus.
How it is spread: You can transmit the virus through oral sex, anal sex, and regular intercourse. If an infected person has gonorrhea discharge on his or her fingers and then touches your eyes, you can also get gonorrhea and develop conjunctivitis.
Initial Symptoms: Early-stage gonorrhea is asymptomatic about 80 percent of the time. Symptoms depend on where the gonococcal bacteria are living. Cervical infection is the most common. About three days after infection, a discharge may develop, caused by an irritant released when the bacteria die. If your urethra was infected, you'll experience painful and more frequent urination. Conjunctivitis, menstrual irregularities, spotting after intercourse, and swelling of the vulva (vulvitis) are also symptoms. If you contracted gonorrhea in your throat through oral sex, you may have a sore throat and swollen glands.
Diagnosis: The best thing to do if you suspect gonorrhea is to request two culture tests one week apart. Usually, culture tests for gonorrhea are 90 percent accurate.
Prevention: During your annual pelvic exam, your doctor will check your cervix for any unusual discharge and may take a culture as a routine screening. Be aware that many women mistake gonorrhea discharge for a yeast infection. They then self-treat with over-the-counter yeast infection medication. Whenever you notice unusual discharge, always get it checked by your gynecologist.
Long Term Complications: If gonorrhea spreads to your fallopian tubes, it will have progressed to PID. When gonorrhea progresses into something called disseminated gonococcal infection, symptoms can get really nasty: rashes, chills, fever, painful joints and tendons in the wrists and fingers, and sores on the hands, fingers, feet, and toes.
Treatment: Gonorrhea is easily treated with antibiotics, one dose of ceftriaxone (Rocephin) will clear the infection. If you're diagnosed with gonorrhea, you'll also be treated for chlamydia.
Pelvic Inflammatory Disease (PID)
What is it? Pelvic inflammatory disease is a general term that refers to infection and inflammation of one or more of your pelvic organs: your cervix, uterus, fallopian tubes, or ovaries.
How it is spread: Bacteria causes PID. Normally, the cervix acts as a barrier and prevents bacteria from getting inside the upper pelvic region. But when the uterus is invaded by an STD or dilated for any reason, bacteria can enter the uterus and do a lot of damage.
Bacteria can also get inside your pelvis through IUD insertion; douching; pelvic surgical procedures including abortions; and natural phenomena such as miscarriages and childbirth. Smoking has also been linked to PID.
Initial Symptoms: The most common symptom of PID is lower abdominal pain. This pain may be sporadic or chronic and may occur only during or after intercourse, menstruation, or ovulation. Often the pain is on one side of the abdomen and increases with movement.This pain is always present during a pelvic examination.
Other symptoms include lower back pain, nausea and dizziness, a low fever, chills, bleeding between periods, bleeding after intercourse, heavier menstrual cramps and flows, frequent urination, burning during urination or an inability to empty the bladder, unusual vaginal discharge with a foul odor, feeling like you have to constantly move your bowels, a general feeling of ill health, and abdominal bloating.
Diagnosis: First, during the speculum examination, your doctor will look for pus that might be coming out of the cervix. If there is pus, a sample will be taken and sent to a lab. During a normal pelvic exam, your doctor should insert two fingers into your vagina, while simultaneously feeling your abdomen on the outside with the other hand. S/he will feel for contours and abnormalities. Pain and swelling are classic signs of PID that an experienced gynecologist will immediately notice.
A blood test can indicate whether you're fighting an infection of some sort. If you are, you'll have increased levels of white blood cells.
An ultrasound test may be used to determine whether an abscess has formed on the organs.
Finally, if all else fails, a laparoscopy can be performed, which will definitely confirm a PID diagnosis. (Laparoscopy is a surgical procedure that uses a thin, lighted tube called a laparoscope inserted through an incision in the abdominal wall to examine your pelvic organs).
Prevention: In many cases, PID can be avoided by an accurate diagnosis of the initial STD that caused PID in the first place. (Usually chlamydia and/or gonorrhea).
Don't use an IUD; women who wear IUDs are three to nine times as likely to develop PID.
Avoid douching. Douching may alter the vaginal environment and make it less protective against harmful bacteria, and douching may flush vaginal and cervical bacteria into the upper pelvic region, causing infections, which may lead to PID
Long Term Complications: PID infections can also spread to other parts of your body, infecting your abdominal cavity, kidneys, liver, lungs, and so on. PID may cause inflammation of the fallopian tubes, leading to infertility. Ectopic pregnancy can also result from PID.
Treatment: Upon diagnosis, your doctor will prescribe antibiotics. Your partner will also need to be treated for infection to prevent reinfecting you or someone else. After treatment a follow-up exam and repeat cultures are necessary. You should refrain from sexual activity while you're healing.
Human Papillomavirus (Genital Warts)
What is it? Human papillomavirus (HPV) is the most common sexually transmitted disease in North America. This virus is very similar to the one that causes skin warts, but there are approximately 70 strains of HPV floating around.
Initial Symptoms: Warts are painless and can appear on the vulva, cervix, or penis. They are visible unless the warts are on the cervix, and then they can go unnoticed until your pap smear.
Diagnosis: Your doctor can usually spot the warts and treat them with a solution that will burn the wart off. HPV on the cervix can take the form of raised or flat lesions. Both types of lesions will be picked up by a Pap smear.
Long Term Complications: If left untreated, HPV causes cervical dysplasia and cervical cancer.
Treatment: HPV can be treated but never cured. Once the warts are removed, the virus may not cause any further problems. However, recurrences are common. It's also possible to be infected with another strain of the virus, since infection with one strain doesn't protect you from another. Follow-up Pap smears at least twice a year for the first couple of years after HPV diagnosis and annual Pap smears after that will enable you control HPV.
Fortunately, a vaccine for HPV will soon be available, although most adults will be unable to get the vaccine (as about 70% already carry the disease), parents should have their children vaccinated just before the onset of puberty.
Hepatitis B
What is it? Hepatitis B (HBV) is a virus that causes inflammation of the liver. It is a serious, sometimes life-threatening STD, and it is a hundred times more infectious than HIV.
How it is spread: HBV is transmitted through contaminated needles or blood and also through mucus-sharing activities that involve saliva, semen, or vaginal fluid, which enter the bloodstream of an uninfected person.
Initial Symptoms: It can take up to 180 days after infection for any HBV symptoms to develop. In an extreme case of hepatitis B, symptoms include skin lesions, arthritis, fever, fatigue, nausea, diarrhea, and vomiting. The second phase of the illness is characterized by jaundice, dark urine, pale stools, and a tender, enlarged liver. Most people who get hepatitis B remain well, have no symptoms, and completely recover. However, even if you're asymptomatic, the virus can cause damage to the liver, which can lead to serious illness and even death.
Diagnosis: If you've never been vaccinated for HBV you should request a blood test from your physician. If there are no HBV antibodies in your blood stream, you should request the HBV vaccination series.
Prevention: Using condoms is not considered adequate protection from hepatitis B; only the HBV vaccine will protect you. The vaccine is given by injection, three doses over a six-month period. The second shot is given one month after the first shot; the third shot is given five months after the second. Children and health care workers are routinely given the vaccination these days, but if you do not fall in this category you may want to request one from your physician.
Long Term complications: Most people fully recover from HBV and go on to develop an immunity to the virus. But the illness can cause you to feel ill for several months. Some people will become life-long carriers of the hepatitis B virus and will remain infectious to others. In some cases the virus can cause severe damage to the liver, which can lead to serious illness and even death.
Treatment: There is no cure for hepatitis B, however most people are able to completely recover over time and they become immune to further infection. Alcohol should be avoided during the course of the illness as it can lead to accelerated damaging of the liver.
Herpes
What is it? Herpes is caused by the herpes simplex virus. The virus enters the body through the skin and mucous membranes of the mouth and genitals and then makes its home in the base of the spine. There are two types of herpes: herpes simplex virus type I (HSV I), which is characterized by cold sores and fever blisters on the mouth and face, and herpes simplex virus type II (HSV II), or genital herpes.
How it is spread: HSV I can be transmitted through kissing. You can also contract both HSV I and HSV II if you have oral sex or intercourse with an infected partner or HSV I if you receive oral sex from an HSV I-infected partner. Herpes is contagious whether the sores are active or not; it is most contagious, however, when the sores are active, although most infections takes place when the sores are inactive. Touching the sores with your fingers and then touching the skin of a healthy person may transmit the virus.
Initial Symptoms: The herpes sores are called vesicles; they are painful, watery blisters that occur anywhere from two to twenty days after infection. Just before the vesicles appear, a herpes outbreak can be preceded by a tingling or itching sensation on the skin surrounding the outbreak. The vesicles that women get in HSV II are most commonly found on the labia, clitoris, vaginal opening, and perineum and sometimes on the vaginal walls, buttocks, thighs, anus, and navel. Women can also have sores on the cervix, but these are not painful. Within a few days, the vesicles rupture, leaving behind shallow blisters that may ooze or bleed. After three or four days, scabs form and the vesicles fall off, healing by themselves without treatment.
Long Term complications: The initial outbreaks last about two to three weeks. Then the virus will start to taper off, and you may go from monthly initial outbreaks to just annual outbreaks. Then recurrences become milder and far more sporadic, perhaps once every two years. Factors such as poor diet, caffeine, and hormonal elements trigger herpes outbreaks. The presence of other infections, such as vaginitis, genital warts, or yeast, can also trigger a recurrence.
Treatment: Like many viruses, there is still no cure for herpes; but there is treatment available to both control the symptoms of outbreaks and prevent future outbreaks. The standard treatment for a primary infection or first outbreak episode is oral antiviral medication, in the form of oral acyclovir, valacyclovir, or famcyclovir.
If you have herpes don't have sex when you have active sores, and insist that your partner wear a condom, even when there are no sores present. And take care of yourself. Exercise, get enough sleep, and eat well. Cut down on the bad habits (smoking, drinking, etc.). This will help prevent outbreaks.
Syphilis
What is it? Syphilis is caused by a bacterium known as spirochete. There are four stages of syphilis: primary, secondary, tertiary (late stage), and neurosyphilis.
How it is spread: Syphilis is transmitted through sexual or skin contact with someone who is already infected. Syphilis spreads through open sores called chancres or rashes that pass through the mucous membrane lining the mouth, genitals, anus, or broken skin.
Initial Symptoms: Primary Syphilis
In primary syphilis a chancre will develop. Chancres can look like pimples, open sores, or blisters and are generally painless. It can take between nine and ninety days for a chancre to develop after infection. Chancres usually appear on the genitals, but they can also show up on the fingertips, lips, breasts, anus, or mouth. Ninety percent of the people with chancres don't notice them. This is unfortunate, since it is at the primary stage that syphilis is most infectious. If left untreated, syphilis progresses to the secondary stage within six weeks to three months after infection.
Diagnosis: Diagnosing syphilis is tricky, syphilis has symptoms that imitate other symptoms and can be misdiagnosed. Syphilis is diagnosed through a blood test that checks for antibodies in the bloodstream.
Long Term Complications: Secondary syphilis can last for months, even years. Symptoms include hair loss, sore joints, widespread rashes including on the palms or soles, swollen lymph nodes, weight loss, and flulike symptoms. There may also be a raised area around the genitals and anus. At this point syphilis can be transmitted through mucus and contact with the raised patches. If it's still not treated by this time, syphilis will go into a type of remission known as a latent stage. Here, someone with syphilis will feel fine and experience no symptoms at all. When syphilis goes into a latent stage, it can last for up to twenty years.
If the syphilis remains untreated, it will move to the tertiary stage, where it can attack the heart, eyes, nervous system, or brain. It's extremely rare for anyone to get to this stage. Tertiary syphilis is not contagious.
If tertiary syphilis is not treated, it can move into the final, most advanced stage of syphilis, neurosyphilis, which can cause serious problems in the brain and nervous system. It is diagnosed through a spinal tap. Symptoms are headaches, stiffness in the neck, confusion, blurred vision, blindness, abnormal eye movements, facial weakness, hearing loss, or loss of balance. This stage is not contagious.
Treatment: The first two stages of syphilis can be completely cured, leaving no permanent damage. Tertiary syphilis and subsequent neurosyphilis (when the disease spreads to the brain) can also be cured, preventing any further damage. Once damage is done, however, that damage can't be repaired. Syphilis is treated with simple antibiotics. After you've been treated for syphilis at any stage, you'll need to have a follow-up test to make sure you've been cured.
Crabs
What is it? The name of this particular kind of louse is Phthirus pubis. These round, pinhead-size bugs look like crabs. If you look hard enough, you can actually see them. They live in pubic hair, chest hair, armpit hair, and even eyelashes and eyebrows.
How it is spread: You generally get crabs by having pubic-hair-to-pubic-hair contact with someone else who has them. But you can also get them from sleeping on infested bedding, using infested towels, or borrowing clothing from someone who has them.
Initial Symptoms: Intolerable itching in the infested area, and you can see the crabs without a microscope. Unfortunately, scratching the itch makes it worse and can transfer the lice to other parts of your body.
Long Term Complications: Crabs are bloodsuckers, and the main health danger is that they can give you other diseases such as typhus.
Treatment: Treatment involves pesticide lotions: permethrin 5 percent (Elimite) and lindane 1 percent (Kwell), both of which should be used very carefully.
Once you're treated, you'll need to wash all your clothing, bedding, and towels in hot water. Otherwise, the eggs can live up to six days, and you can reinfest yourself or someone else.
The facts in this column were found at www.webmd.com and http://health.yahoo.com/ as well as from OB/GYN and sexual health counselor Miami Pepper.
Originally published February 2006 - "L'Amour"