Take Charge--Know Your Risk. About STDs: Most Common Questions

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1 Take Charge--Know Your Risk About STDs: Most Common Questions 1. What Are STDs? Sexually transmitted diseases (STDs) are spread through sexual contact. Sexual contact includes vaginal, anal, or oral intercourse, as well as skin-to-skin contact with sexual organs (penis, vagina, anus, and mouth). Sexually transmitted diseases can also be spread from a pregnant woman to her child. There are more than 25 STDs. The most common STDs in America are: Chlamydia, gonorrhea, bacterial vaginosis, syphilis, HIV/AIDS, genital warts (caused by a virus called human papillomavirus HPV), hepatitis B, trichomoniasis, pubic lice, scabies, and herpes. 2. How Are STDs Transmitted? Some STDs (syphilis, Chlamydia, gonorrhea, bacterial vaginosis, HIV) are transmitted by body secretions such as semen, blood, and vaginal fluids. Because of this, when sex toys are used and shared, there is a risk of spreading STDs. Although the risk is relatively low, the first documented case of the spread of HIV through the use of sex toys was reported in Other STDs, such as herpes or HPV (the virus causing genital warts), can be transmitted via skinto-skin contact. Pubic lice and scabies are associated with close body contact, not necessarily sexual contact. It's possible to become infected with pubic lice or scabies as a result of contact with infested clothes, sheets, or towels. 3. What Are the Symptoms of STDs? It is important to remember that some STDs cause no symptoms, and when symptoms do occur, they are often not recognized. Most people with STDs have no symptoms. You can be infected and infect someone else without knowing it. However, there are some common signs to watch for. The symptoms listed below are tricky. They can show up anywhere from 2 days to a couple of months after initial exposure to the disease. Sometimes, symptoms can show up as long as several years after the initial STD infection.

2 If you have any of these symptoms or think you have been exposed to an STD, contact a healthcare provider immediately. Specific symptoms might include: Bumps or blisters near the mouth or genitals; Burning or pain during urination or a bowel movement; Flu-like symptoms, including fever, chills, and aches; Swelling in the groin area. Symptoms specific to women are: Unusual pain or discharge from the vagina; Pelvic pain; Unusual vaginal bleeding; Pain during intercourse; Increased severity of menstrual cramps or menstrual abnormalities (like a change in the amount of flow). Symptoms specific to men: Discharge from the penis; Testicular pain; Pain during urination. 4. How Are STDs Prevented? Not having sex is the best protection against sexually transmitted diseases. Having sex with only one uninfected partner who only has sex with you is also safe. For sexually active people, using condoms (or other latex barriers) properly 100 percent of the time when they have vaginal, anal and oral sex is a proven way of reducing risk. But this will not prevent bacterial STDs 100 percent of the time. Other STDs like genital herpes and HPV/genital warts, are transmitted primarily through skin-toskin contact from sores or ulcers, or even infected skin or mucosal surfaces and fluids that look normal. Syphilis can also be transmitted this way, as well as through body fluids. These STDs can be passed even when no sores, warts, or other symptoms are present. Often, sores, warts, or lesions are very hard to see. Infected areas can be in genital areas that are covered or protected by a latex condom, but they can also occur in areas that are not covered or protected. Latex condoms used correctly all of the time, can reduce the risk of these STDs only when the infected areas are covered or protected by the condom. The effectiveness of condoms in

3 protecting against STDs depends on the location of the sore or lesion. If these sores are present on a part of the genital area that is not covered by a condom, STD transmission can occur. 5. How Are STDs Treated? There are two categories of STDs. Bacterial STDs are caused by bacteria, and viral STDs are caused by viruses. As a result of being caused by different microorganisms, bacterial and viral STDs vary in their treatment. Bacterial STDs, such as gonorrhea, syphilis, bacterial vaginosis, and Chlamydia, are cured with antibiotics. There is a preventative vaccine for the most common strains of HPV or genital warts (viruses). Currently, this vaccine is recommended only for young women 26 years old and younger. Also there are preventative hepatitis (viruses) vaccines recommended for both male and female children. Some viral STDs such as HIV and herpes have no cure, but their symptoms can be reduced with treatment. 6. How Can STDs Affect Me Long-term? Several STDs in addition to HIV/AIDS are quite serious. Diseases like syphilis, gonorrhea, and Chlamydia can have long-term consequences, including pelvic inflammatory disease, which can lead to sterility (losing the ability to get pregnant or to get someone pregnant) and chronic pelvic pain. Human papillomavirus (HPV), the virus that causes genital warts, is strongly linked to the development of cervical cancer. STD infection during pregnancy can cause pregnancy complications and, in some cases, lead to illness or death in the newborn. 7. How Can I Avoid Getting an STD? No method except abstinence (no oral, vaginal, or anal sex) is 100 percent effective. Being in a long-term, mutually monogamous relationship (both you and your partner are only having sex with each other) with an uninfected person, can also be a means of avoiding an STD. 8. How Can I Reduce My Risk of Getting an STD? According the Centers for Disease Control and Prevention (CDC), all partners should get tested for HIV and other STDs before initiating sexual intercourse. However, if you decide to be

4 sexually active with a partner whose infection status is unknown or who is infected with HIV or another STD, you can reduce your risk of getting an STD by: Asking a new sex partner if he or she has an STD, has been exposed to one, or has any unexplained physical symptoms. Do not have unprotected sex if your partner has signs or symptoms of STDs, such as sores, rashes, or discharge from the genital area. Many common STDs have no symptoms but can still be transmitted to a sexual partner. If your partner has had sexual relations with someone else recently, he or she may have an STD, even if there are no symptoms. Using a new condom for each act of insertive intercourse. More and more people are using condoms. Research shows that latex condoms, when always used and used correctly, are highly effective in preventing the transmission of HIV, the virus that causes AIDS. In addition, correct and consistent use of latex condoms can reduce the risk of other STDs such as Chlamydia, gonorrhea and trichomoniasis. One of the problems with condoms is that many people use them incorrectly or only use them some of the time. Getting regular checkups for STDs (even if you show no symptoms), and learning the common symptoms. Most STDs are readily treated, and the earlier treatment is sought and sex partners are notified, the less likely the disease will do severe and/or permanent damage. 9. If a Person Has No Symptoms, Can He or She Still Transmit an STD? People can be unaware they are infected with an STD for years. During that time, even though they show no symptoms, the STD can cause damage to their organs and tissues, and they can transmit the STD to their partners. This is why it is a good decision to wait to have sex or to protect yourself every time you do decide to have sex. All pregnant women should be tested for STDs in their first and third trimesters to ensure their child does not become infected and/or can be treated appropriately. Chlamydia, gonorrhea, syphilis, trichomoniasis, and bacterial vaginosis (BV) can be treated and cured with antibiotics during pregnancy. There is no cure for viral STDs, such as genital herpes and HIV, but antiviral medication may be appropriate for pregnant women with herpes and definitely is for those with HIV. For women who have active genital herpes lesions at the time of delivery, a Cesarean delivery (C-section) may be performed to protect the newborn against infection. A Cesarean section is also an option for some HIV-infected women. Women who test negative for hepatitis B may receive the hepatitis B vaccine during pregnancy.

5 10. What Should I Do if I Think I Have an STD? If you think you may have an STD or have been sexually exposed to an individual with an STD, see a health care provider as soon as possible. You can visit your city/county health department, hospital, physician, or health care clinic. If you are a minor (under the age of 18) in the state of Tennessee, and according to State Statute T.C.A (c), Any state, district, county or municipal health officer or any physician may examine, diagnose and treat minors infected with STDs without the knowledge or consent of the parents of the minors, and shall incur no civil or criminal liability in connection with the examination, diagnosis or treatment, except for negligence. The presence of an STD can weaken your immune system and make you more susceptible to more infections, including HIV. The sooner you seek medical care, the sooner you can treat the infection, and the healthier you will be. How to Talk to Your Health Care Provider about STDs Many people think they aren t at risk of an STD, but sexually transmitted diseases are the most common type of infection. You might think it couldn t happen to you; however, you are at greater risk if: You ever had unprotected sex( no condom use); You and your sex partner ever had more than one sex partner; You don t know your sex partner s sexual history; You have symptoms such as bumps, rashes, sores, or burning near your genitals. You might find it difficult talking to others, including your health care provider, about sexual topics. It can be embarrassing and uncomfortable. If you think you could have an STD, the longer you wait, the harder it can be to treat. Your health care provider is your first step towards protecting your sexual health. Remember that your health care provider is there for you. How to Begin You might expect your health care provider to begin the conversation about your sexual health. This isn t always true. Also, you will probably be more comfortable discussing this before the exam, while you are clothed. Here are some suggestions to begin the talk: I have a new boyfriend/girlfriend and we don t always use condoms. Am I at risk of a sexually transmitted disease? My girlfriend found out she has Chlamydia. I d like to be tested for Chlamydia and other STDs.

6 I have been dating several people and I ve had sex with them. I want to be tested for STDs. I have a new girlfriend and before we consider a sexual relationship, I want to be tested for STDs. What to Tell Your Health Care Provider Your health care provider needs to know specific information about you to best assess your risk of STDs. You should be prepared to openly discuss: Your sexual history; Your current sexual practices; Your condom use; If you are female, whether you could be pregnant; Any symptoms you might have. What to Ask Your Health Care Provider It s always a good idea to plan for your appointment. What questions do you want answered by your provider? Take the time to think ahead and then write them down. Sometimes during an appointment, you might forget to ask a question. If you have it written down, you don t have to worry about remembering it. It is also a good idea to write down your health care provider s answers to your questions, as well. You should ask: Could I have an STD and not know it? How often should I be tested for STDs? Should I be tested for any STD today? (If female) How often should a get a pap smear? How can I protect myself and my partner from STDs? How to Talk to Your Partner Talking about STDs can be difficult. However, the most important thing you can do with your partner before having sex is to have this conversation while you are both sober and in a good mood. So, if you re feeling a sexual attraction towards your partner, now is the time for the discussion. If you wait until after you have sex, you haven t protected yourself or your partner, and it can make it more difficult to have this important conversation. What should you do?

7 Remember that STDs are a medical issue, like the flu or chickenpox. Sometimes if you think of it as a medical issue, it can make it easier to discuss. Research the topic, prepare. The more facts you have, the easier it will be to discuss from a non-emotional viewpoint. Plan what to say. There s nothing wrong in practicing your approach. Know what you want ultimately what is the end result you re seeking from having this conversation? While social networking might encourage the use of and texting, this is an important conversation to have in person. Timing is everything choose the right time to discuss this privately. You don t want to start the conversation in the heat of the moment or after you ve had sex, or when you are under the influence of alcohol and/or drugs. You also don t want to discuss this when you re surrounded by people. Choose a quiet, safe place. If your partner becomes defensive, remind your partner of how much you care about him/her and you as well as each other s health. Recognize that this can be difficult for him/her to discuss. Don t let the discussion become an interrogation of you and your partner s risk factors. You might begin by naming of few of your own risk factors for TDs and ask him/her to name a few. Keep the discussion non-emotional and deal in factual information. Bring articles or brochures for your partner to read. Ask your partner to consider going with you for STD testing before committing to sex. You can call it a ritual of modern dating. This can make it easier for both of you to get tested. Share your test results with each other. If You Are Diagnosed with an STD According to the Centers for Disease Control and Prevention (CDC), in the U.S. alone there are approximately 19 million new STD cases each year, about half of which occur among youth ages years old. The good news is that all sexually transmitted diseases can be treated or cured. Some are bacterial infections (Chlamydia, gonorrhea, bacterial vaginosis, and syphilis) which can be cured with antibiotics. Others are viral infections (herpes, HIV, HPV) which can t be cured, but they can be treated to relieve symptoms. If you are diagnosed with an STD, here are some suggestions: Make peace with yourself. Don t feel guilty, dirty, or that you re a bad person for having an STD. Remember, you are taking responsibility for your sexual health by getting diagnosed and treated. You are protecting yourself and others by doing this. Follow the treatment advice of your provider. Repeat to your provider how you should treat/cure the infection. This helps you better understand what you will need to do. Ask your provider how you can prevent infecting your sexual partner and follow her/his advice. Tell your partner that you are being treated for an STD and that s/he should also be tested. You can begin the conversation by saying, I have something important to discuss with you.

8 Present the facts of the infection and what your partner will need to do. Give your partner as much information as possible. Understand that your partner may be upset. Give them time to adjust to the news. If s/he breaks up with you over this, then your relationship wasn t as strong as you believed. On the other hand, working through this can make your relationship stronger. Always remember that you are being responsible by informing her/him. Avoid sex until both you and your partner have successfully completed treatment. If your provider recommends a follow-up visit, make the appointment and participate in the subsequent care. However embarrassing, it is absolutely imperative that you inform your current and recent partners. Anonymous notification via an e-card is better than not informing partners of STD status: How Did I Get This STD? Most people don t realize that, like most infectious diseases, STDs take time to develop. The time from the moment of exposure to a bacterium, virus or parasite until signs and symptoms of the disease appear is called the incubation period. Many STDs can stay inactive in your system for days, weeks, months or years. So, before you consider accusing your partner of infidelity, consider the following: Bacterial Vaginosis The incubation period is anywhere from 12 hours to 5 days. Chancroid The incubation period is anywhere from 3-5 days, though it can extend up to 2 weeks. Chlamydia - Generally if there are symptoms they will start to show in 1 to 3 weeks. Up to twothirds of all women and one half of all men have no symptoms; others have symptoms so mild that they go unnoticed. If you re diagnosed, it is important to notify your partner(s). Chlamydia can be transmitted at delivery from mother to child. Genital Warts (HPV) - Only certain strains even show symptoms and when they do it could be a month to many years. Gonorrhea The incubation period is 1 to 14 days. Half of all women and approximately 10 percent of all men have no symptoms, so if you re diagnosed, it is important that you notify your partner(s). A pregnant woman can transmit the disease to her unborn child at the time of delivery. To prevent blindness, a newborn s eyes are treated with silver nitrate or antibiotics at the time of birth. Hepatitis - Here are descriptions of the most common forms of hepatitis -- A through D -- in the U.S. All cause inflammation of the liver.

9 Type A Hepatitis - Is contracted through anal-oral contact, by coming in contact with the feces of someone with hepatitis A, or by eating or drinking hepatitis A contaminated food or water. The incubation period is 14 to 45 days. Type B Hepatitis - Can be contracted from infected blood, seminal fluid, vaginal secretions, or contaminated drug needles, including tattoo or body-piercing equipment. It can also be spread from a mother to her newborn. The incubation period is days, with 90 days as the average. Type C Hepatitis - Is not easily spread through sex. You're more likely to get it through contact with infected blood, contaminated razors, needles, tattoo and body-piercing equipment, or manicure or pedicure tools that haven't been properly sanitized, and a mother can pass it to her baby during delivery. Most people do not have early symptoms of hepatitis C. In fact, most people (about 80 percent) who are infected with the hepatitis C virus (HCV) have no symptoms -- even after many years. You can look and feel perfectly healthy, yet still be infected with the disease and infect others. Type D Hepatitis - A person who is infected with the hepatitis D virus must also have a hepatitis B infection in order for the hepatitis D virus to multiply. For people who are infected with the hepatitis B virus at the same time as the hepatitis D virus, symptoms of hepatitis D can begin 4 weeks to 12 weeks (on average) after infection with the hepatitis D virus. The virus can be passed through contact with infected blood, contaminated needles, or by sexual contact with a hepatitis B-infected person. Herpes - The incubation period is 5 to 20 days. Herpes can stay dormant for years but can show symptoms around three months after infection. If a pregnant woman has an active case at the time of delivery, a Cesarean section will be performed to prevent infection and possibly death to her unborn child. HIV/AIDS - It can take as little as 90 days to years to develop. Pubic Lice - As long as a week if it's the first time you've had pubic lice; as little as a day if this is a recurrence. Symptoms can t really be missed and will generally show within a couple of days to a couple of weeks. Scabies - Scabies is a parasite and is hard to miss. It can take as long as a week if it's the first time you've been infected; a day if it's a recurrence. Syphilis The incubation period is 1 to 3 months. Syphilis goes through three different stages which can be hard to identify. A pregnant woman can transmit it to her unborn child during pregnancy and delivery. Trichomoniasis If symptoms appear, it takes 3 to 28 days to develop.

10 Most Common Sexually Transmitted Infections (in alphabetical order): 1. Bacterial Vaginosis 7. Herpes 2. Chancroid 8. HIV/AIDS 3. Chlamydia 9. Pubic Lice 4. Genital Warts (HPV) 10. Scabies 5. Gonorrhea 11. Syphilis 6. Hepatitis B 12. Trichomoniasis

11 What is it? Bacterial Vaginosis It is a change in the normal bacteria of the vagina. The exact cause of BV is unknown. There are many bacteria that live in a normal vagina. When you have BV, there are not enough good bacteria. This causes harmful bacteria to grow in the vagina, causing the vaginal environment to be out of balance. It is known that BV is associated with having a new sex partner or having multiple sex partners. What are the symptoms? Most women with BV have no symptoms at all. Sometimes a woman has more vaginal discharge than usual. The discharge might be milky with a fishy odor. The odor can be worse after sex. Other symptoms women may experience include itching or burning in or near the vagina. How serious is it? BV is usually not serious. In some cases, however, it can cause infections in the uterus and fallopian tubes. It is important to treat BV, especially before having an IUD inserted, or tests done on the uterine lining. BV during pregnancy may cause the baby to be born too soon. How is it diagnosed? The health care provider will do a few simple tests in the clinic. Looking at the vaginal discharge under the microscope for bacteria and checking the acid level of the vagina are two tests that help the health care provider decide if a woman has BV. How is it treated? The health care provider can prescribe an antibiotic, taken by mouth, called metronidazole or Flagyl. There is also a vaginal cream. This medicine can cause nausea or a metal aftertaste in the mouth for some people. Take it with food. DO NOT DRINK ALCOHOL ANY TIME WHILE TAKING THIS MEDICINE. This medicine can cause severe nausea and vomiting when combined with alcohol. Either use a condom or do not have sex until you have finished taking the antibiotic. The health care provider can order antibiotic vaginal creams or gels which work just as well, but the cost is higher. The side effects are less with vaginal antibiotics.

12 How can I reduce my chances of getting it? The following basic prevention steps can help reduce the risk of upsetting the natural balance of bacteria in the vagina and developing BV: Be abstinent. Limit the number of sex partners. Do not douche. Use all of the medicine prescribed for treatment of BV, even if the signs and symptoms go away.

13 What is it? Chancroid Chancroid is a bacterial disease that is spread only through sexual contact. Uncircumcised men are at much higher risk than circumcised men for getting chancroid from an infected partner. Chancroid is a risk factor for the HIV virus. The disease can also be spread when pus-like fluid from the ulcer is moved to other parts of the body or to another person by contact such as touch. What are the symptoms? Symptoms usually occur within 4-10 days from exposure. They rarely develop earlier than three days or later than 10 days. The ulcer begins as a tender, elevated bump, and then becomes a pus-filled, open sore with ragged edges. The ulcer is soft to the touch (unlike a syphilis chancre that is hard or rubbery). The term soft chancre is frequently used to describe the chancroid sore. The ulcers can be very painful in men but women are often unaware of them. Because chancroid is often asymptomatic in women, they may be unaware of the lesion(s). Painful lymph glands may occur in the groin, usually only on one side; but they can occur on both sides. How serious is it? Untreated chancroid often results in ulcers occurring on the genitals. Sometimes the ulcers persist for weeks or months. How is it diagnosed? Diagnosis is made by isolating the bacteria Hemophilus ducreyi in a culture from a genital ulcer. The chancre is often confused with syphilis, herpes or lymphogranuloma venereum; therefore, it is important that your health care provider rule out these diseases.

14 Chancroid, cont d. How is it treated? Chancroid may be successfully treated with certain antibiotics. Lesions and ulcers can be expected to heal within two weeks. What about my partner? Chancroid is contagious as long as the infected person has any open sores. The open sores contain bacteria and any contact with these sores can result in infection.

15 What is it? Chlamydia Among the more than 20 STDs that have now been identified, Chlamydia is the most frequently reported, with an estimated 4 million new cases nationwide each year. For 2009, Tennessee had 11,519 diagnosed cases of Chlamydia. Chlamydia infections are caused by a bacterium, Chlamydia trachomatis, and are transmitted during vaginal, oral or anal sexual contact with an infected partner. It can also spread from an infected pregnant woman to her child at birth. What are the symptoms? About three-fourths of infected women and about one half of infected men may have no symptoms at all. This is one reason Chlamydia is dangerous: asymptomatic individuals do not seek treatment and therefore can pass the infection on to others. If symptoms appear at all, it is usually one to three weeks after contact. Women report vaginal discharge, vaginal bleeding between periods, abdominal pain that is sometimes accompanied by fever and nausea, and burning or pain during urination. Men with the infection report burning or pain during urination and a discharge from the penis. If left untreated, individuals can develop complications from the infection. What kinds of complications can Chlamydia cause? In women, Chlamydia can result in pelvic inflammatory disease (PID), a serious complication that can cause both infertility and ectopic pregnancy among women of childbearing age. The infection also may be passed by a pregnant woman to her newborn baby during delivery, resulting in neonatal eye infection or pneumonia. In men, Chlamydia infections can lead to pain or swelling in the scrotum. This can be a sign of epididymitis, an inflammation of a part of the male reproductive system located in the testicles. Both PID and epididymitis can cause infertility. Other complications include proctitis (inflamed rectum) and conjunctivitis (inflammation of the lining of the eye). A particular strain of Chlamydia causes another STD called lymphogranuloma venereum, which causes major swelling and inflammation of the lymph nodes in the groin. Also, because of the symptoms associated with Chlamydia, infected individuals have a 3 to 5 times increase in the risk of acquiring HIV (the virus that causes AIDS) if exposed to the virus during sexual intercourse. To help prevent the serious consequences of Chlamydia, screening at least annually for Chlamydia is recommended for all sexually active women age 25 years and younger. An annual screening test also is recommended for older women with risk factors for Chlamydia (a new sex partner or multiple sex partners). All pregnant women should have a screening test for Chlamydia.

16 How is Chlamydia diagnosed? Several new tests for diagnosing Chlamydia have been developed recently. These tests are inexpensive and the results are available within two to three days. These new tests detect genetic material from Chlamydia and are very accurate. Urine, as well as genital secretions, can be collected as a specimen for these new test methods. How is Chlamydia treated? Chlamydia infections are treated with a seven-day course of antibiotics, usually doxycycline or erythromycin. A single dose of azithromycin also effectively treats Chlamydia infections. Penicillin is not effective against Chlamydia. A person must be sure to take all of the prescribed medication, even if symptoms disappear before taking all the antibiotics. An infected person should refrain from all sexual contact until completing the medication, and it is very important that all sex partners be tested and treated to prevent possible medical complications, re-infection and further spread of the disease. Women whose sex partners have not been appropriately treated are at high risk for re-infection. Retesting should be considered for women, especially adolescents, three to four months after treatment. This is especially true if a woman does not know if her sex partner received treatment. How can Chlamydia be prevented? Not having sex is the best protection against Chlamydia and other STDs. Having sex with only one uninfected partner who only has sex with you is also safe. How can I reduce my risk of getting Chlamydia? The use of latex condoms during sexual intercourse when always and correctly used can reduce the risk of transmission of Chlamydia. Because Chlamydia is highly contagious and yet may cause no symptoms, all men and women who have sexual contact with more than one partner should be tested regularly for the disease. Constant awareness and protection are necessary because a person who has once contracted the disease does not become immune. Many people acquire Chlamydia more than once.

17 Genital Warts or HPV (Human Papillomavirus) What is genital HPV infection? Genital HPV infection is a sexually transmitted disease (STD) that is caused by human papillomavirus (HPV). Human papillomavirus is the name of a group of viruses that includes more than 100 different types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum. These HPV types can also infect the mouth and throat. Most people who become infected with HPV will not have any symptoms and will clear the infection on their own. Some of these viruses are called high-risk types, and may cause abnormal Pap tests. They may also lead to cancer of the cervix, vulva, vagina, anus, or penis. Others are called low-risk types, and they may cause mild Pap test abnormalities or genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area, and sometimes are cauliflower-shaped. HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems. How common is HPV? Approximately 20 million Americans are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection. About 6.2 million Americans get a new genital HPV infection each year. How do people get genital HPV infections? The types of HPV that infect the genital area are spread most often through genital contact. Most HPV infections have no signs or symptoms; most infected persons are unaware they are infected, yet they can transmit the virus to a sex partner. Rarely, a pregnant woman can pass HPV to her baby during vaginal delivery. A baby that is exposed to HPV very rarely develops warts in the throat or voice box. What are the signs and symptoms of genital HPV infection? Most people who have a genital HPV infection do not know they are infected. The virus lives in the skin or mucous membranes and usually causes no symptoms. Some people get visible genital warts, or have pre-cancerous changes in the cervix, vulva, anus, or penis. Very rarely, HPV infection results in anal or genital cancers.

18 Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower-shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks, months, or not at all. Genital warts are diagnosed by visual inspection. Visible genital warts can be removed by patient applied medications such as Podofilox and Imiquimod or by treatments performed by a health care provider known as cryosurgery or by applying a weak acid solution. Some individuals choose to forego treatment to see if the warts will disappear on their own. No treatment regimen for genital warts is better than another and no one course of therapy is ideal for all cases. How is genital HPV infection diagnosed? Most women are diagnosed with HPV on the basis of abnormal Pap tests. A Pap test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. Also, a specific test is available to detect HPV DNA in women. The test may be used in women with mild Pap test abnormalities, or in women older than 30 years of age at the time of Pap testing. The results of HPV DNA testing can help health care providers decide if further tests or treatment are necessary. No HPV tests are available for men at this time. Is there a cure for HPV? There is no cure for HPV infection, although in most women the infection goes away on its own. The treatments provided are directed to the changes in the skin or mucous membrane caused by HPV infection, such as warts and pre-cancerous changes in the cervix. What is the connection between HPV infection and cervical cancer? All types of HPV can cause mild Pap test abnormalities which do not have serious consequences. Approximately 10 of the 30 identified genital HPV types or high-risk types can lead to the development of cervical cancer. Research has shown that for most women (90 percent), cervical HPV infection becomes undetectable within two years. Although only a small proportion of women have persistent infection, persistent infection with high-risk types of HPV is the main risk factor for cervical cancer. A Pap test can detect pre-cancerous and cancerous cells on the cervix. Regular Pap testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life-threatening cervical cancer. The Pap test used in U.S. cervical cancer screening programs is responsible for greatly reducing deaths from cervical cancer. Most women who develop invasive cervical cancer have not had regular cervical cancer screening.

19 How can I reduce my risk for genital HPV infection? The surest way to eliminate risk for genital HPV infection is to refrain from any genital contact with another individual. There are several ways that people can lower their chances of getting HPV: Vaccines can protect males and females against some of the most common types of HPV. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given before a person's first sexual contact, when he or she could be exposed to HPV. o Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Both vaccines are recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls as young as 9 years of age. It is recommended that females get the same vaccine brand for all three doses, whenever possible. o Boys and men: One available vaccine (Gardasil) protects males against most genital warts. This vaccine is available for boys and men, 9 through 26 years of age. For those who choose to be sexually active, a long-term, mutually monogamous relationship with an uninfected partner is the most likely to prevent future genital HPV infections. However, it is difficult to determine whether a partner who has been sexually active in the past is currently infected. For those choosing to be sexually active and who are not in long-term mutually monogamous relationships, reducing the number of sexual partners and choosing a partner less likely to be infected may reduce the risk of genital HPV infection. Partners less likely to be infected include those who have had no or few prior sex partners. HPV infection can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. While the effect of condoms in preventing HPV infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPVassociated disease.

20 Gonorrhea What is gonorrhea? Gonorrhea is a sexually transmitted disease (STD) caused by a bacterium, Neisseria gonorrhoeae (gonococcus), that grows and multiplies in moist, warm areas of the body such as the cervix, urethra, throat or rectum. In women the cervix is the most common site of infection. However, the disease can spread to the uterus and fallopian tubes, resulting in pelvic inflammatory disease. This can cause infertility and ectopic pregnancy (a pregnancy outside the uterus). How is gonorrhea spread? Gonorrhea is most commonly spread during genital contact, but it can also be passed from the genitals of one partner to the throat of the other during oral sex. Gonorrhea of the rectum can occur in people who practice anal intercourse and may also occur in women due to the spread of the infection from the vaginal area. Gonorrhea can be passed from an infected woman to her newborn infant during delivery. What are the symptoms of gonorrhea? The early symptoms of gonorrhea are often mild, and most women who are infected have no symptoms. If symptoms do develop, they usually appear within 2 to 10 days after sexual contact with an infected partner, although a small percentage of patients may be infected for several months without showing symptoms. The initial symptoms in women include a painful or burning sensation when urinating or an abnormal vaginal discharge. More advanced symptoms, which indicate progression to pelvic inflammatory disease, include abdominal pain, bleeding between menstrual periods, vomiting or fever. Many men with gonorrhea may have not symptoms at all. Some men have a discharge from the penis and a burning sensation during urination that may be severe. These symptoms appear within 3 to 5 days after sexual contact. Symptoms of rectal infection in men and women include discharge, anal itching and sometimes painful bowel movements. Symptoms of gonorrhea in the throat may vary from a mild to a severe sore throat. How is gonorrhea diagnosed? Several laboratory tests are available to diagnose gonorrhea. A doctor or nurse can obtain a sample for testing from the parts of the body likely to be infected (cervix, urethra, rectum, or throat) and send the sample to a laboratory for analysis. Gonorrhea that is present in the cervix or urethra can be diagnosed in a laboratory by testing a urine sample. A quick laboratory test for gonorrhea that can be done in some clinics or doctor s offices is a gram stain. A gram stain of a sample from a urethra or a cervix

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