Sexually transmitted diseases (STDs) are
spreading rapidly. Although they are more common now than ever before, many
people fail to understand how to prevent themselves from contracting an STD.
Furthermore, many people do not recognize the early symptoms, or do not know
how to get diagnosed and treated for such problems.
Parents
often fail to discuss STDs with their children, because they are afraid of
talking about sex. The information and education on STDs are limited in some
school systems, although these diseases should be fully addressed in junior
highs and high schools. The increased sexual promiscuity in the
Some
of the most dangerous STDs, including syphilis and gonorrhea, may occur without
symptoms. Sexually active persons can carry an STD from one relationship to the
next, infecting their new partners, while remaining completely unaware of the
presence of disease.
Although
most types of STD can be cured with antibiotics, there can be long-term,
serious consequences. Many viruses are incurable, and a growing number of STDs
can cause infertility in women. The best protection against STDs is to prevent
them from occurring and, when they do occur, to obtain treatment immediately.
The
surest way to avoid an STD is to avoid sex. Some women may find abstinence an
undesirable option, however. Sexually active women should practice safe sex:
Practicing
safe sex means being responsible for yourself as well as your partner. Safe sex
can keep you from contracting one of the many types of STDs, including chlamydia, gonorrhea, herpes, syphilis, and genital warts.
These types of STD are highly contagious and can be contracted easily. There is
no vaccine that can prevent them. Practicing safe sex can also help protect
against becoming infected with human immunodeficiency virus (HIV), which causes
AIDS (see Chapter
Other
than abstinence, monogamy with an uninfected partner is the best way to avoid
picking up an STD. Having several sexual partners greatly increases your risk
for STDs. Ask your sexual partners if they have ever had an STD or if they are
having sex with others.
|
The Female Condom There
is now a condom that women can use themselves rather than relying on their
male sex partners. Called the female condom, it consists of two rings with a
latex sheath between them. The closed end of the sheath is inserted into the
vagina, and the ring is placed high up around the cervix. The open end of the
sheath remains outside the uterus. (See Fig. Like
the condom for men, female condoms can be bought in drugstores without a
prescription. It should be used once and then thrown away. Used as directed,
it can be effective in preventing STDs and pregnancy. |
Condoms,
when used properly, are the most effective method to keep an STD from
spreading. A woman should insist that a male sexual partner wear a condom, even
if she is using another form of birth control. This is also true for women who
do not need birth control, such as those who have gone through menopause or who
have had their uteruses removed. If a male sexual partner does not want to use
a condom, there is now a condom that women can use (see "The Female
Condom," below). Women must learn to refuse to have sex with a man unless
a condom is used.
Condoms
are readily available over the counter in most drug stores, and there are many
kinds. Condoms made of natural materials do not keep some viruses from passing
between you and your partner, so latex condoms should always be used. A spermicide used with a condom may offer additional
protection.
You
cannot catch most types of STDs from nonsexual contact, such as hugging or
holding hands. Most STD organisms cannot survive outside the body for long, so
catching an STD from sitting on a toilet seat is very unlikely.
In
addition to taking steps to prevent getting or passing on an STD, it is
important to recognize the symptoms of these diseases. The better a woman
understands her body, the better prepared she is to recognize such symptoms.
The
following discussion covers the major types of STDs along with their symptoms,
causes, diagnosis, and treatment. Some general guides apply to most STDs (see
"General Management of STDs," below).
Chlamydia
Symptoms
Chlamydia
often has no symptoms, and women are less likely to have symptoms than men.
Signs of infection may only be noted during a doctor's physical examination.
The type of symptoms depends on the type of chlamydia
infection and the area it attacks. One of the most common signs in women is a
creamy white discharge from the vagina.
When
symptoms do occur, they usually appear
Chlamydia
commonly results in a genitourinary infection, such as nongonococcal
urethritis (NGU), which is marked by a thin penile
discharge in men and mild vaginal discharge in women. Chlamydia can infect the
cervix (the opening of the uterus) a condition called cervicitis.
If the cervicitis is not treated, the infection can
move up into the uterus and the fallopian tubes. Infection of the tubes can
cause a dangerous condition called pelvic inflammatory disease (PID) which may
result in infertility.
Men
and women who have anal sex, can have chlamydia infections of the rectum (proctitis).
Swelling and soreness of the lymph nodes and rectal bleeding are signs of
infection.
Newborns
who get chlamydia from their
mothers develop pneumonia and eye infections. Chlamydia is the leading cause of
blindness in babies born in developing countries.
Cause
Chlamydia
infections are caused by the bacterium Chlamydia trachomatis . This
infection is the most common STD in the
Diagnosis
Diagnosis
of chlamydia is often difficult because it may have
no symptoms. A woman may be tested if her partner has been found to be
infected. Or she may be tested if she has symptoms, such as vaginitis
or PID.
A
sample of discharge can be taken from the vagina or the cervix and tested. A
culture is the most accurate way to diagnose chlamydia.
Treatment
The
antibiotics recommended for treatment of chlamydia
are doxycycline or azithromycin.
Doxycycline must be taken for
Pregnant
women with chlamydia infection are advised to use
erythromycin, since tetracycline can adversely affect the fetus.
All
sex partners should be informed of the infection. They should be tested if
possible, but if testing is not available, they should be treated for chlamydia infection even if they have no symptoms.
|
General Management of STDs Some
guidelines about STDs apply regardless of the type of disease. For the best
results, follow these recommendations:
|
Gonorrhea
Symptoms
Both
men and women can contract gonorrhea. Women may have no symptoms; however, they
usually occur and can include vaginal discharge and dysuric
(painful urination). Women may delay treatment because they do not think the
discharge is serious.
Men
may have no symptoms for a
Symptoms
vary, depending on the site infected. Men and women who have anal sex may have
rectal discharge and discomfort; men and women who engage in oral sex may
experience sore throat, pain on swallowing, cervical lymph nodes, and red
tonsils with a discharge, often confused with strep
throat. Women who have infection of the reproductive organs can have severe
lower abdominal pain and fever. These signs may be the beginning of PID, a
common cause of infertility in women. Infection of the fallopian tubes occurs
in nearly
In
its advanced stages, gonorrhea can enter the bloodstream and spread throughout
the body, causing complications. It can attack the heart and joints, but these
developments can be prevented through treatment.
Cause
Gonorrhea
is caused by the bacterium Neisseria gonorrhoeae
. It is second only to chlamydia in terms of
number of cases in the
Diagnosis
Gonorrhea
is diagnosed from a specimen taken from the infected area. A swab is used to
take a sample of discharge from the urethra, cervix, rectum, or throat,
depending on which areas were exposed. A sample will be cultured so that every
involved area can be definitively diagnosed.
Treatment
Women
with gonorrhea as well as their sex partners should be treated. Anyone with
gonorrhea should avoid all sexual activity while under treatment, because the
disease is very easily spread.
Many
types of drugs are used to fight gonorrhea. Although once antibiotics such as
penicillin and tetracycline were the mainstays of treatment, today a large
percentage of gonorrhea bacteria are resistant to these drugs. Therefore, newer
drugs like ceftriaxone are used. Because gonorrhea
and chlamydia often occur together, doctors usually
recommend that patients also take doxycycline to
eliminate any undiagnosed chlamydia.
Pregnant
women can be safely treated with ceftriaxone. In case
they also have a chlamydial infection, they are
usually treated with erythromycin as well.
In
women with simple infections whose symptoms are cleared by treatment, further
testing is not needed. However, women who continue to have symptoms should be
tested to see if the bacteria persists, and if so,
what types of antibiotics are likely to eliminate it.
Genital Warts
Symptoms
Genital
warts begin as tiny red or pink bumps. After about
Cause
Also
called venereal warts or condyloma, genital warts are
caused by the human papillomavirus (HPV). This virus
causes warts on the skin of men and women and is easily transmitted by sexual
contact. There are many different types of HPV that can cause warts. Some types
have been linked to a risk of cervical cancer. (See Chapter
Diagnosis
Genital
warts look similar to typical skin warts. A trained eye often can diagnose
genital warts without any tests. Painting the area with a weak acid solution
causes the warts to turn white, which can help in diagnosis. Warts on the
cervix can be detected by a Pap test, in which a sample of cells is removed
from the cervix for study under a microscope. A sample of the wart can be taken
and studied to reveal what type of HPV is causing the infection.
Treatment
Genital
warts are treated by removing the warts from both partners. Medications that
are placed on the wart include a natural resin called podofilox
(which inhibits wart growth) and acids such as trichloroacetic
or bichloroacetic acid (which dry
up the warts). Podofilox should not be used by
pregnant women.
Other
options include laser surgery and freezing the warts, called cryotherapy. Electrodesiccation
(sending an electrical current through the tissue, which then dries up) is also
used to remove the warts.
Although
the visible warts can be removed, this does not cure the virus. As yet there is
no cure or vaccine for HPV. Since the virus may remain in the body, warts may
come back and require further treatment. Because of the risk of cancer, women
who contract the virus should have frequent and regular Pap tests.
|
Pelvic Inflammatory Disease When
an STD moves from the vulva and vagina up to the uterus and fallopian tubes,
it causes pelvic inflammatory disease (PID). PID can cause infertility in a
woman even without symptoms. Most
cases of PID occur when Chlamydia trachomatis
or Neisseria gonorrhoeae
spreads up the fallopian tubes, but they can be caused by other STDs as well.
The
use of an intrauterine device (IUD) for birth control can increase the risk
of PID, with the greatest risk is coming a few months after the IUD is
inserted. Women who develop PID after using an IUD are usually advised to
have it removed. A
woman may have no symptoms of PID until its advanced stages. Then, it can
cause abdominal and low back pain and fever. White blood cells, working to
eliminate the infection, may cause a discharge. PID
is one of the major preventable causes of infertility in women. The infection
in the fallopian tubes can cause abscesses and scar tissue to form in the
tubes that may block sperm from passing through them, leaving the woman
infertile. Approximately PID
is diagnosed during a gynecological exam and lab testing for STDs. Although chlamydia and gonorrhea are commonly diagnosed as the
causes of PID, these two types of bacteria can die quickly. They may not be
present at the time testing is done. The common bacterium Escherichia
coli, found in the digestive and genital tracts of healthy men and women,
is often the only type of bacteria noted at the time of the diagnosis. PID
is treated with antibiotics that may be administered orally or intravenously,
depending on the severity of the infection. In some cases, surgery is
required to remove abscesses that remain after antibiotic treatment. |
Genital Herpes
Symptoms
The
symptoms of genital herpes first appear after a
The
symptoms are usually preceded by a tingly or burning sensation in the area, that will later develop into tiny red blisters in both
men and women. These blisters then grow into larger pimplelike
bumps that have a watery yellow center. The blisters rupture, and within
In
both sexes, the blisters can appear in the genital area and on the thighs,
abdomen, buttocks, and anus. In women blisters usually appear on the labia and
around the clitoris. In men, they may appear on the penis and scrotum.
Sometimes blisters near the opening of the urethra and on the tip of the penis
will swell up, making urination difficult and painful.
Blisters
may also develop internally on the female cervix and vaginal walls or inside
the male urethra. These internal lesions may make it difficult for men to
urinate and difficult to detect the virus in women.
The
entire process of a herpes outbreak, from initial tingle to dried-up crust, can
last about
Even
though the symptoms subside, the virus moves to the nerve cells in the base of
the spinal chord, where it is dormant. During a recurrent outbreak, the virus
travels down the nerves to the genital area and causes a new set of blisters
and more distress. Between
There
is no cure for genital herpes, but each successive outbreak has fewer and
weaker symptoms. After a number of years, the outbreaks may disappear.
If a
pregnant woman has open herpes lesions, she runs the risk of infecting her baby
as it passes through the vagina at birth. If infected, the baby may suffer
brain damage, blindness, or death if not treated. A pregnant woman with herpes
will be examined when she is in labor. If she has active sores, she should have
her baby by cesarean section.
Cause
About
The
virus is transmitted through sexual contact -- vaginal, anal, or oral -- and
can also enter the body through mucous membranes or cuts in the skin. Genital
herpes can also infect the eyes if fingers carrying the virus touch the eyes.
Active genital herpes is highly contagious. Transmission is known to occur
during inapparent activation of the infection, even
when blisters or open sores are not visible.
Diagnosis
A
diagnosis of genital herpes is made by taking a sample culture from a
liquid-filled blister or a sore in its early phase.
Treatment
Genital
herpes has no cure but a vaccine for prevention is being developed. Keeping the
infected area clean and dry can help improve a person's comfort when having an
outbreak. Use of the oral drug acyclovir can reduce the length of time the
virus can be transmitted, shorten the healing time, and decrease the severity
of symptoms. Pregnant women are best served by using the topical form. Persons
who have frequent recurrences can take acyclovir daily to prevent attacks.
Because the infection is usually contracted while sores are present, abstaining
from sex until sores are completely healed can help stop the spread of herpes.
Transmission, however, can occur during active disease without blisters or
symptoms; therefore the safest approach is to use a condom.
Syphilis
Symptoms
Syphilis
occurs in three stages: primary, secondary, and tertiary. The signs of primary
syphilis are painless sores called chancres on the genitals, tongue, lips,
breast, or rectum, along with swollen lymph nodes in the adjacent area. If the
sore is located in a woman's vagina, it can easily go undetected. The
incubation period for primary syphilis is
Secondary
syphilis begins in
An
infected person then can go through a period when syphilis is latent, that is without signs or symptoms. They may be
followed by tertiary syphilis if the person is not treated. Latent syphillis can be life threatening because the bacteria by this time has spread throughout the body and
into the blood system, and brain. Tertiary syphilis, which appears years later,
can cause a number of problems, including nerve and brain damage and heart
disease. These severe symptoms are not very common in the
Women
infected with syphilis can pass the infection to their unborn fetus during
pregnancy. About
Cause
Until
the recent arrival of acquired immunodeficiency syndrome (AIDS), syphilis was
the most serious of the STDs. It is caused by the bacterium Treponema
pallidum . Although it was once a very common infection, today
syphilis is rarer than chlamydia and gonorrhea. In
the past few years, however, the incidence of syphilis has increased,
especially within the homosexual community.
Syphilis
is contracted during sexual contact, through cuts or sores in the skin or
mucous membranes. The disease is very contagious. It can also pass through the
blood and to an unborn fetus from an infected mother.
Diagnosis
Infection
is suspected based on the presence of sores (for primary syphilis) or rash and flulike symptoms (for secondary syphilis). A positive blood
test is necessary to diagnose syphilis. Even if a person has no symptoms, a
blood test can usually detect syphilis.
Some
states require syphilis tests before issuing marriage licenses, so some people
learn only then that they have syphilis at that time. Others are tested for
syphilis when they enter a hospital. Because of the danger of syphilis for the
fetus, all pregnant women are tested for syphilis.
Treatment
Penicillin
given intramuscularly is effective for primary and for secondary syphilis.
Latent syphilis can also be treated with penicillin to prevent complications,
but must be given longer and at higher doses to achieve success during this
phase. Penicillin can be used safely to treat pregnant women and prevent
transmission to their fetus. It can also be used to treat infected infants.
Penicillin is the most commonly used antibiotic for syphilis, but doxycycline or tetracycline can be used for those who are
allergic to penicillin.
Because
syphilis can be spread when open lesions are present, sexual contact of any
kind should be avoided during this time. Routine blood tests are required for
one year following the initial syphilis infection to determine whether
treatment has been successful.
Trichomonas
Symptoms
Common
symptoms in women include an abundant yellow frothy musty smelling discharge.
Sores may form on the cervix. The vulva may itch, and urinating may be painful.
Most men with trichomonas infection do not have
symptoms.
Trichomonas infection is caused by a small organism called Trichomonas vaginalis.
It affects about
Diagnosis
To
diagnose trichomonas infection, a sample of the
discharge is taken and examined under a microscope.
Treatment
Trichomonas infection is not usually serious and can be treated
easily with metronidazole. Usually just one dose is
needed, but some doctors choose to give a lower dose for
Cytomegalovirus
Symptoms
CMV
often has no symptoms. Women who do have symptoms may have a mild illness
similar to the flu. Although CMV is not harmful for most women, it causes
special concerns for a pregnant woman, who can pass CMV to her fetus through
the umbilical cord. CMV is most risky if a woman first becomes infected while
she is pregnant. If this happens, the fetus can be harmed. CMV can also be
passed to the infant during birth and later through breast milk. Approximately
Cause
Cytomegalovirus
(CMV) is caused by a virus with the same name. Up to
Diagnosis
Cytomegalovirus
is diagnosed through a blood test for CMV antibodies. Infection in the fetus
can be diagnosed by testing blood or the amniotic fluid.
Treatment
There
is no cure for CMV. Because a fetus can develop severe abnormalities if
infected with the virus early in development, tests are performed early in
pregnancy. Infection of the fetus late in pregnancy may lead to childhood
hearing and learning problems.
Chancroid
Symptoms
The
initial symptoms are one or more painful swellings (boils) that appear in the
genital area. If ignored, these lesions will rupture and release pus.
Cause
Rare
in the
Diagnosis
A
microscopic examination of the pus is necessary to determine the cause of any
lesions. Syphilis has similar symptoms, so this examination will rule out
syphilis.
Treatment
Azithromycin, ceftriaxone, or
erythromycin is most commonly given to treat the patient and prevent spread of
the disease. Gentle pressure on the lesions can also help accelerate their
healing. Even if they don't have symptoms, sex partners of women with chancroid should also be examined and treated.