Sexually Transmitted Diseases

Sexually transmitted diseases are diseases that are transmitted through any type of sexual contact. This includes homosexual and heterosexual contact and does not necessarily have to involve penetration. This class of diseases, called STDs for short, includes any infection spread by having sex. STDs include gonorrhea, syphilis, HIV (the AIDS virus), chlamydia, trichomoniasis, herpes, pubic lice, and genital warts. Many sexually transmitted diseases can be cured with a week or two of treatment. If not treated, however, some of these diseases can cause infertility. Others eventually can be fatal. You can't tell by looking whether someone has an STD, and many people don't know they are infected.

Here are a few basic facts everyone should know for his or her own protection:

Bacteria, Viruses and Bugs
Over a lifetime, the body can host many different kinds of germs including those that cause sexually transmitted diseases. There are three types of STDs bacterial, viral, and bugs.

Bacterial STDs are transient which means they will respond to medication and can be kicked out of your system. However, if they remain untreated they can cause very serious damage.

Bacterial STDs include gonorrhea, a bacteria which can cause infertility, heart disease, blindness, damage to the urinary tract, arthritis, and damage to an unborn child; chlamydia, which has been implicated as a risk factor for cervical cancer and is a major cause of infertility; syphilis, which can affect the nervous system, cause blindness, deafness, heart disease, insanity, and result in the birth of a stillborn or crippled child; and chancroid, which causes genital sores and enlarged lymph nodes.

Viral STDs are permanent. Once you acquire one, it stays in your system forever. You will not be troubled by a viral STD as long as it remains dormant, but they do act up now and then. Human Papilloma Virus (HPV) generally hides in the genital tract, and causes genital warts from time to time over the years. Some strains can lead to cervical cancer. Herpes Simplex Virus (HSV) lives in nerves at the base of the spine and causes painful blisters to form, mostly on the vulva and in the mouth. Human Immunodeficiency Virus (HIV) can also remain in the system but once it manifests itself, it becomes a deadly disease with no
cure and limited treatment options. HIV is discussed in detail in chapter 13, The Growing Danger of AIDS.

Sexually transmitted skin infestations are caused by tiny bugs called arthropods. Using pesticides will easily rid you of them.

The two most common are pubic lice, a.k.a. crabs and scabies. Pubic lice attach themselves to the base of pubic hairs where they bite the skin and lay their eggs. Scabies burrow into the skin to lay eggs. They are much tinier than pubic lice and cannot be seen with the naked eye.

Sexually transmitted diseases threaten everyone who is sexually active, although certain groups (such as prostitutes, drug users and promiscuous individuals) are at higher risk than others.

Sexually transmitted diseases can have very serious consequences if not treated, especially for pregnant women. All can be passed from mother to baby either during the pregnancy or at birth.

All sexually transmitted diseases require medical treatment. If you suspect you may have a sexually transmitted disease or have any of the symptoms listed below, you should see your doctor or make an appointment to visit a Sexually Transmitted Disease or Genito-Urinary clinic.

With the exception of HIV ({aids} covered here), sexually transmitted diseases respond well to treatment in most cases.

The following section discusses the eight most common STDs in North America, grouped by symptoms. The first group discussed here, Human Papilloma Virus (HPV), Herpes Simplex Virus (HSV), syphilis, and chancroid, is characterized primarily by lumps, bumps and sores. The second group, chlamydia and gonorrhea, is characterized mainly by vaginal discharge. The last section covers pubic lice and scabies, the hallmark of which is itching. Each disease has more than one symptom, but this arrangement will get you started. Additional details are found in the box below, “Matching Your Symptoms to an STD.”

MATCHING YOUR SYMPTOMS TO AN STD
It is important for your doctor to know as much as possible about your condition, since, if you have an STD, you will want it to be properly diagnosed. Check the following chart and read the matching sections on the infection you think you might have. Then give your doctor as many specifics as you can.
If you've noticed:	see the sections on:
Fever	Herpes Simplex Virus (HSV) Chlamydia, Gonorrhea
Flu-like symptoms	Herpes Simplex Virus (HSV) Syphilis
Hair loss	Syphilis
Itching or tingling in the genital area	Human Papilloma Virus (HPV) Herpes Simplex Virus (HSV) Pubic lice, Scabies
Itching on the body	Pubic lice, Scabies
Lower abdominal or rectal pain	Chlamydia, Gonorrhea
Painful urination	Herpes Simplex Virus (HSV) Chlamydia, Gonorrhea
Rash	Syphilis Gonorrhea Scabies
Sore vulva	Herpes Simplex Virus (HSV) Gonorrhea
Sores or blisters	Herpes Simplex Virus HSV) Syphilis Chancroid
Swollen glands	Herpes Simplex Virus (HSV) Syphilis Chancroid
Unusual vaginal bleeding	Chlamydia, Gonorrhea
Vaginal discharge	Chlamydia, Gonorrhea
Warts or other growths	Human Papilloma Virus (HPV)

HPV refers to a group of more than 60 viruses. They are responsible for warts anywhere on the body, but only certain types are sexually transmitted. These are called condylomata acuminatum, better known as genital warts or venereal warts. Like other warts, they can not be cured but they can be treated.

These are caused by the human papilloma virus which is spread by genital contact. In men, warts appear on the penis; in women, on the external genital area, in the vagina and on the cervix. The warts may be removed by simple medical procedures and this can lessen the risk of passing on the infection. There is a strong link between genital warts and cancer of the cervix in women. Some of the viruses that cause genital warts are thought to be a major factor in causing the cells of the cervix to become cancerous. A genital wart virus infection is not always so obvious in women, so a smear test is required for the early diagnosis of cervical cancer.

Warts are the “clinical” version of this infection; that is, they can easily be seen and diagnosed. However, there is a much more common version, referred to as “subclinical,” in which the virus resides under the skin and cannot be seen. Some experts believe that HPV causes warts in about 30 percent of infected people and subclinical infections in the other 70 percent. The subclinical varieties have been linked to cancer, so it is important for women to have yearly checkups including Pap smears to detect precancerous cervical changes.

HPV is coming close to being considered an epidemic in the United States, with a 1,000 percent increase in the number of HPV patients since 1987. Since it is a nonreportable disease, accurate figures aren't available, but it is believed that 48 million to 50 million Americans currently live with this virus. Almost one million Americans are newly infected with the HPV virus every year.

• Risk factors: You are more likely to get genital warts if you are between the ages or 20 and 24, if you and your partner have multiple or casual sexual partners, and if you have another STD, such as chlamydia or herpes simplex virus (HSV). If you are pregnant, using oral contraceptives, or have a condition that suppresses the immune system such as Hodgkin's disease or leukemia, you are also at higher risk for viruses such as HPV. Researchers have also found that white people have higher rates of HPV than do others. People who smoke put themselves at higher risk as well.

GENITAL WARTS:
DON'T JUDGE BY APPEARANCES

Although these warts signal the presence of the human papilloma virus (HPV), they show up in as few as 30 percent of infections. The cases in which the wart doesn't appear are actually more dangerous, since this type of HPV has been linked to the development of cervical cancer. The danger of cancer resulting from undiscovered infection makes the need for regular checkups all the more urgent. When discovered early enough, cervical cancer can usually be cured.

• Signs and symptoms: Many people with HPV have no signs or symptoms. If and when warts appear, they can be on the vulva, in or around the vagina or anus, on the cervix, or anywhere on the groin or thighs. They may also be found in the mouth. Warts on men usually show up on the penis or scrotum. The warts can appear as raised or flat, small or large, and single or clumped in a group that sometimes looks like cauliflower. Normally, the warts are flesh-colored and painless. They can also appear as slightly pink or grey. Rarely, they cause itching, pain, or bleeding.

• Cause: HPV is spread by skin to skin contact, especially during vaginal, anal, or oral intercourse. It is thought that the virus enters the body through tiny breaks in the skin, which could be caused by the friction of sex or even by using tampons incorrectly. Once it is in the skin, the virus makes its way into the lower layers of skin. It can stay there for months or years, and may never come back up to the surface at all. For this reason, it is important to understand that if you are diagnosed with HPV, you could have gotten it at any time in your past sexual life.

• Incubation period: Viral infections are harder to get than bacterial ones. It can take from four to six weeks to infect a partner with HPV. In two-thirds of infected people, it can be up to nine months before any warts appear.

• Possible health affects: Although the reason is unclear, women with HPV are at increased risk for cancer of the vulva and cervix. However, only a few strains have been linked to cancer (types 16, 18, 31, 33, and 35) , and the potential for malignancy is low. These strains usually cause subclinical infections. The strains that cause growths (types 6 and 11) do not lead to cancer. Annual pap smears, are particularly important for women with malignant strains, and for women at high risk for exposure to any type of STD. In addition, women with HPV should periodically have an examination of the cervix, vagina, and vulva.

• Diagnosis: HPV remains a mystery because it can not be grown in the lab and there is no blood test for it. For the 30 percent of people with the clinical or outward expression of the virus — the warts — diagnosis is made just by looking at them. Some warts are very hard to see because they are flat and look like normal skin, so your doctor will look at them through a magnifying lens called a colposcope. Also, your doctor or nurse will probably put a vinegar-like substance called acetic acid on your cervix and on the skin of your vagina. If the area then turns white, it is possible you have HPV. If the diagnosis is still unclear, several more sophisticated tests are available.

• Treatments: Treatment of HPV should be considered cosmetic rather than curative. Like other viruses, no therapy has been shown to cure HPV. Many treatment regimens are available and the choice is based on factors, such as the size and number of warts, as well as the expense, convenience, and potential adverse effects of the treatment.

Regardless of treatment, one in four HPV-infected people will have a recurrence within three months. Many studies have shown that small warts and warts that have been present for less than one year are the ones most amenable to treatment. In any case, never use an over-the-counter wart remedy for genital warts.

Genital Warts - Sporadic Signs of a Permanent Infection

The hallmark of a herpes infection, these tiny blisters may break out for up to three weeks, then disappear on their own—only to return at unpredictable moments later on. Treatment with the drug Zovirax can ease the severity of an outbreak, but won't eradicate the infection. Because the herpes virus can be passed along even when there are no blisters in evidence, chances of contracting it are comparatively high: 200,000 new cases are reported each year.

Here is a list of available treatments, along with their best use and potential side effects:

Nothing. Letting the warts go away by themselves is actually a common treatment. Within three months, 20 to 30 percent of patients' noncervical warts will have cleared up on their own.

Cryotherapy. The warts are frozen with liquid nitrogen. This relatively inexpensive treatment is best used for small, single warts. There may be pain at the site where the liquid is applied.

Podofilox (Condylox). This prescription drug is applied at home with a cotton swab, twice daily for three days, followed by four days of no treatment. You can repeat this cycle up to four times. This safe and relatively inexpensive drug is for external warts only, not those that might be in the vagina or on the cervix. You will probably feel burning and experience some irritation. Do not use this drug if you are pregnant.

Podophyllin (Pododerm, Podocon-25). This chemical, applied by a doctor or nurse, is best used on small, external warts. It too is safe and relatively inexpensive, but causes mild to moderate pain and discomfort at the site. It should not be used on large vulvar surfaces. Podophyllin needs to be washed off after one to four hours and you will need to be treated weekly for up to six weeks. Very large amounts can cause harmful side effects, including nerve damage. Do not use this treatment if you are pregnant.

Trichloroacetic acid (TCA). TCA is absorbed by the wart and causes it to slough off. You will feel some burning at the site of application. Application is repeated weekly for up to six weeks. It is also best used for external warts.

Electrocautery. Warts are destroyed with an electric current. Local anesthesia is required, and discomfort is moderate.

Laser vaporization. Intense light is used to destroy the wart. This procedure is useful for extensive warts on the genitals or vocal cords and should be tried only after other regimens have failed. Local anesthesia is required, scarring and infection are possible, and you will probably need analgesic for the pain for about three weeks. Laser treatment is also expensive.

Interferon therapy. Injected into the wart itself, this antiviral drug is not generally recommended because it is expensive, time-consuming, produces adverse effects in many people, and has not proven to be any more effective than other treatments.

• Follow-up: If either you or your partner are being treated with medication, it is advisable to abstain from sex, due to the possibility of reinfection and because the friction caused by sex could impede healing. Once the warts are gone, you do not need to return to your clinic. If your partner does not have obvious warts, there is no need for him to be treated.

• Prevention: Most experts believe that recurrences of warts are caused by the virus being reactivated rather than by reinfection. {sex_diseases_condom} condoms do offer some protection from reinfection, though. Obviously, areas not covered by the condom, like the vulva and scrotum, are vulnerable to repeat infection. Spermicides have not proven to be effective against HPV.

You can help protect yourself from HPV by trying to prevent the tiny skin abrasions through which the virus can enter the body. For example, the tender lining of the vagina can tear easily when it is dry. Since sexual intercourse can cause lacerations of the vagina, use a lubricant if dryness is a problem. Also, don't use tampons at the beginning or end of your period when the vagina is dry; use a sanitary pad instead, until your period is well underway and again towards the end.

• Pregnancy: Pregnant women should not use podophyllin and podofilox. Other treatments should be discussed with your doctor. Infants born to HPV-infected mothers can be born with warts in and around their larynx (voice box) although this is very rare. Cesarean deliveries are not necessary unless warts are so extensive that they block the birth canal.

Herpes Simplex Virus (HSV)

HSV is a member of the family of viruses responsible for chicken pox, shingles, and infectious mononucleosis. The strain HSV-1 of this common virus is also responsible for cold sores, canker sores, and fever blisters that appear on the mouth. HSV-1 may be responsible for the genital sores we think of in relation to herpes, but more often the strain HSV-2 is the cause of sores and blisters below the waist. Like other viruses, there is no cure for HSV, but there are drugs to help manage most infections.

The virus which causes herpes lives in nerve cells at the bottom of the spine, and “creeps” to the surface once in a while to cause sores and blisters. In fact, herpes is named after the Greek word for “creeping”. Recent studies have shown that most people with a herpes infection — probably as many as three-quarters — don't even know they have the disease because they have no symptoms: they never have any sores or blisters to alert them to the infection.

People who are unaware that they are infectious can unwittingly spread the disease. But even people who are aware of their infection can unknowingly spread it because viral particles are “shed,” meaning they are present on the skin of the genitals, even when no sore or blister is apparent. This “asymptomatic” shedding happens prior to reappearance of the sore.

Because of its ease of transmission, the virus has become extremely common. HSV is not a reportable disease, but an estimated 30 million Americans or more are thought to have it. More than 200,000 new cases are expected each year.

• Risk factors: You are more likely to get herpes if you or your partner have multiple or casual sexual partners. Rates are high among all racial groups. Approximately one in every five 30-year-old white females has HSV.

• Signs and symptoms: Many people with HSV have no signs or symptoms. If and when trademark sores appear, they can be on the vulva, in or around the vagina, in the anus, or on the cervix. Many women notice itching or a tingling sensation in the genital area before the sores appear. These are known as “prodromal symptoms.”

The first “outbreak” of a herpes infection is always the most severe, often lasting for three weeks or longer. The average length of time for a first episode is 12 days. Fever, headaches, swollen lymph glands, and sore muscles (especially in the legs) are common, in addition to the painful blisters. Some people will have one blister during an outbreak, while others will have many. Blisters deep in the vagina or cervix may not cause any pain. Recurrent episodes, during which the virus is reactivated, are milder and usually last about five days. For many people, the recurrences will occur less frequently over time.

• Cause: HSV is spread by skin to skin contact, especially during vaginal, anal, or oral intercourse. HSV-1 and HSV-2 are almost identical, so someone with a cold sore performing oral sex can give his or her partner genital herpes. It is thought that 20 percent of genital herpes is transmitted during oral sex.

Once the virus enters the genital area, it quickly camps out in clumps of nerves at the base of the spine. It can lie dormant there for the rest of one's life, as it does in about 10 percent of all cases, or it can reappear sporadically. Many things can trigger recurrence of symptoms: surgery, illness, stress, fatigue, skin irritation (such as sunburn), dietary imbalance, menstruation, hormonal imbalance, or vigorous sexual intercourse.

• Incubation period: Symptoms usually start appearing within a week after infection if they are going to appear at all (remember, as many as 75 percent of people with HSV may be asymptomatic.) However, symptoms have been known to start one day to 26 days after exposure to the virus.

• Possible health affects: One complication from HSV is very rare and easily avoided: accidentally spreading the infection to the eyes. This can occur if you should happen to rub your eyes or put in contact lenses after touching an HSV sore. The herpes virus is easily killed with soap and water, though, so an eye infection can be avoided through stringent hygiene during outbreaks.

Although an association between herpes and cervical cancer has not been established, women with the virus should have regular Pap tests because of their increased risk of other infections such as HPV.

• Diagnosis: It is important to see your doctor while symptoms are still present, because diagnosis is made by viewing sores and by taking a sample from the sore to look at under a microscope. Blood tests that detect antibodies to HSV are also reliable. You can request a specific culture for HSV, but it is fairly expensive and takes about a week to give results.

• Treatments: Although nothing is available to rid the body of a virus, acyclovir (Zovirax) can alter the herpes virus' ability to cause damage once it comes out of its hiding place in the nerve ganglia.

Zovirax is the most frequently prescribed drug for an initial herpes outbreak. Duration of symptoms can be reduced from nine days to about five; healing time is reduced from about three weeks to about two weeks; and viral shedding can be cut down from 10 days to about two.

The topical cream form of Zovirax can be effective for the initial outbreak, but rarely works well for recurrences. Taking oral Zovirax for recurrent outbreaks, while it can still be effective, has a less significant impact for some people.

The recommended regimen for an initial herpes outbreak is 200 milligrams orally five times a day for seven to 10 days or until symptoms disappear. If you are aware enough of your body and can know when a herpes attack is about to strike, taking Zovirax within two days of onset can help lessen the severity of recurrences. Usually the initial warning symptoms — muscle aches, genital itching and tingling — will alert you. For recurrent outbreaks, you will probably take Zovirax for five days, at a dose of either 200 milligrams five times a day, 400 milligrams three times a day, or 800 milligrams twice a day. This conservative therapeutic approach can reduce shedding time by almost half, from nearly four days to slightly over two days.

Taking Zovirax only at the onset of an outbreak is referred to as “episodic” therapy. If you suffer from many outbreaks a year — once every month or two — or if having herpes is causing you great psychological distress, you might consider “suppressive” therapy. Taking the drug suppressively (400 milligrams twice a day, every day), reduces outbreaks by at least 75 percent among patients with frequent outbreaks. It has not, however, been shown to cut down on viral shedding, so you could still pass the disease to a partner, and the outbreak will resume when therapy stops.

There is varying opinion on how long a person should stay on suppressive therapy. The U.S. Food and Drug Administration currently recommends only one year, although studies have shown that patients do well with three or even seven years. Additionally, suppressive therapy's expensive, costing between $2 and $4 a day. Talk with your doctor to decide what is best for you.

Drug companies are working hard to come up with new drugs to fight herpes outbreaks. Zovirax was a breakthrough that helped many people, but it has its flaws. Only 15 percent of the drug is actually absorbed into your body for use against the virus. For this reason, it is important to understand that if your bowels are moving more quickly than normal (as with gastrointestinal problems), you may not be getting a high enough level of the drug.

A new drug called valacyclovir is being studied, and researchers believe it will have an absorption rate of about 80 percent. Neither valacyclovir, or another drug, famcyclovir, will be available until clinical studies are completed and the drugs have received FDA approval.

• Follow-up: If an initial outbreak warns that you have herpes, tell all sex partners from the prior three weeks. If you find out some other way, from a blood test for example, you may not know when you were infected. It is up to you and your doctor to decide which partners to tell. It is also up to you to decide when and if to tell a new partner about your infection.

• Prevention: People with herpes are most likely to shed the virus asymptomatically for up to three months after the initial outbreak. It is not known exactly how often asymptomatic shedding occurs, though researchers believe it is a major cause of the high numbers of herpes cases. However, in long-standing marriages where one partner is infected and the other is not, the uninfected partner often stays herpes-free. Use of {sex_diseases_condom} condoms and spermicides (which kill the herpes virus) is an important part of any prevention strategy.

HSV-1 and HSV-2 can easily migrate through the body, so oral sex should be avoided when there is an active sore on the mouth or genitals.

• Pregnancy: The most serious known complication of herpes threatens infants born to HSV-infected mothers. An HSV-infected baby is at risk for blindness, brain damage, and even death. Fortunately, the risk of transmitting the infection to a newborn at birth is low, even for women who have long-standing, recurrent outbreaks. If the baby does get infected (a less than 3 percent chance for women with recurrent infections), Zovirax will probably be used as treatment. HSV also increases the risk of miscarriage or premature labor and delivery.

The group at highest risk are women who acquire HSV late in their pregnancy, particularly those who have no immune defense to the virus (developed from having had diseases like chickenpox, or cold sores, etc.). Women with immune defense, which can be measured by antibodies to HSV in the blood, pass immunity to the baby through the placenta during the third trimester of pregnancy. Infants born to HSV-infected and antibody-carrying mothers are thus protected from the disease should they come into contact with it as they pass through the birth canal. Most HSV-infected women can have normal, vaginal deliveries. Having an active sore at the time of delivery will warrant a cesarean delivery.

If you are pregnant and either have HSV or have sex with an infected partner during your pregnancy, or if you or your partner have sex with more than one partner during your pregnancy, be sure to tell your doctor. He or she will then test to see if you are shedding the virus when it comes time to deliver the baby.

Zovirax has not been thoroughly studied for use by pregnant women, so your doctor will probably advise stopping suppressive or episodic therapy during pregnancy.

This is a very common sexually transmitted disease in underdeveloped countries, where its incidence far exceeds that of syphilis. It is included here because experts at the Centers for Disease Control and Prevention believe that rates of chancroid in the United States are under-reported.

In 1990, 4,223 cases were reported, down only slightly from the 5,035 cases reported in a 1987 epidemic. Researchers say that as many as seven outbreaks may have gone unreported in the U.S. since 1987, due to a lack of standardized reporting procedures.

• Risk factors: You are more likely to get chancroid if you or your partner have multiple or casual sexual partners. Risk factors, like prevalence rates, are not well understood.

• Signs and symptoms: Chancroid is characterized by soft, gray, painful ulcers containing pus. The ulcers often have ragged edges and bleed easily when touched. Another symptom is markedly enlarged lymph nodes in the groin.

If it's a chancre sore, you can expect a diagnosis of syphilis. The sore itself is painless and will disappear on its own in three to eight weeks—but if untreated, the underlying syphilis infection will remain to ravage the body in later years. Of the two kinds of sores, this is the more insidious one: easy to ignore, yet ultimately life-threatening.

Chancroid, on the other hand, is much more likely to send you to the doctor in a hurry. The sores are painful, tend to merge into large patches of damaged tissue, and are often accompanied by an infected abscess in the groin. If left untreated, they can spread to new locations; and they provide an ideal entryway for HIV, the cause of AIDS.

• Cause: Chancroid is caused by a bacterium known as Haemophilus ducreyi which is transmitted by sexual contact.

• Incubation period: Ulcers appear within two to seven days after infection.

• Possible health affects: Chancroid is associated with human immunodeficiency virus (HIV). The open sores on the genitals facilitate HIV transmission.

• Diagnosis: Chancroid is often misdiagnosed as genital herpes (HSV) or syphilis by doctors unfamiliar with the disease. Since a precise diagnosis requires a culture with a substance that is not readily available, many doctors or clinics are unable to make a definitive diagnosis. They, therefore, start by ruling out syphilis and HSV through tests for those infections. If the tests come back negative, they then diagnose chancroid.

• Treatments: The recommended treatment regimens are either azithromycin (Zitromax), 1 gram orally in a single dose, ceftriaxone (Rocephin), 250 milligrams intramuscularly in a single dose or erythromycin (PCE, ERYC, others), 500 milligrams orally four times a day for seven days.

• Follow-up: You should be re-examined within a week after you begin taking medication. All sex partners during the 10 days before your symptoms started should be notified and treated.

• Prevention: Use of a latex {sex_diseases_condom} condom and spermicides to kill bacteria will help protect you from chancroid.

• Pregnancy: Zithromax's effect on pregnant women has not been adequately studied; therefore the drug is typically not recommended when a woman is pregnant. There are no reports of adverse effects from chancroid in infants.

Chlamydia is a bacterial infection. Although carried by and affecting both sexes, its effects are more dangerous for women. Together with gonorrhoea, from which it is often clinically indistinguishable, chlamydia is a major factor in pelvic inflammatory disease (PID), a serious condition that can cause infertility, miscarriage, ectopic pregnancy and other serious health problems. Chlamydia is spread by direct genital contact. It is often found in people with other sexually transmitted diseases. Sexually active young adults and teenagers are particularly at risk. Chlamydia can usually be cured by a course of antibiotics. Although it is the most common sexually transmitted disease and carries serious health implications, chlamydia is still a bit of a mystery. If you've never heard of it, you're not alone.

Only recently have laboratories been able to prove the existence of the chlamydia germ; and there is no national surveillance system for the disease, though many states mandate doctors to report cases they find to the Centers for Disease Control. Based on information from these states, experts estimated that there are between three and four million cases of chlamydia in the U.S. each year. The American Social Health Association, an organization dedicated to researching STDs and their effects, predicts that by the year 2000, there will be 40 million cases.

• Risk factors: You are more likely to get chlamydia if you are under the age of 20, if you or your partner have had many other partners, if you are using oral contraceptives, and if you have an inflamed cervix (cervicitis). Statistics show that people under age 20 more often have multiple sex partners, and that teenagers are more likely to experience a form of cervicitis called cervical ectopy. Having cervical ectopy means that thin and vulnerable layers of your cervical cells are exposed, increasing your chance of infection there. Taking oral contraceptives also causes some increase in your chances of having cervical ectopy.

As with other STDs, chlamydia strikes women harder than men. From one act of unprotected intercourse with an infected partner, 40 percent of women will contract the disease while only 20 percent of men will do so.

• Signs and symptoms: The symptoms of chlamydia are similar to those of gonorrhea. Women with symptoms usually experience a yellowish vaginal discharge called mucopurulent cervicitis. Other symptoms include pain when urinating, lower abdominal or rectal pain, mucus-covered stools, intermittent vaginal bleeding, and pain or bleeding during intercourse.

The lack of symptoms in many people is what makes chlamydia such a dangerous and mysterious disease. Up to 25 percent of infected men and 75 percent of infected women are usually asymptomatic, that is, they have no signs or symptoms of the disease, and can therefore spread it unknowingly.

• Cause: Although chlamydia is caused by a bacteria, the germ shares properties with viruses, including dependence on the host cell for energy and division. This combination of characteristics has made the Chlamydia trachomatis bacterium elusive to researchers, and is the reason diagnostic tests are difficult and expensive.

• Incubation period: Signs of the disease, if any, usually show up between one to two weeks after infection.

• Possible health affects: Public health experts believe that one-quarter to one-half of the one million yearly cases of Pelvic Inflammatory Disease (PID) are due to chlamydia. PID can lead to tubal infertility and ectopic pregnancy, a potentially dangerous situation in which the fertilized egg implants in the fallopian tube instead of in the uterus. Reports from the Centers for Disease Control and Prevention show that 30 percent of women with untreated chlamydia infections will become sterile.

Recent research on chlamydia-caused PID points to either an allergic response to the proteins of the bacteria or an immune response. Since chlamydia proteins and human proteins look alike, the body could mistake its own normal cells as foreign and attack them. Either reaction would cause the scarring and tubal obstruction that are the hallmarks of PID.

• Diagnosis: Your doctor will suspect chlamydia if your cervix is red and swollen and bleeds easily. He or she will confirm the diagnosis with either a tissue culture, a test called an enzyme-linked immunosorbent assay (ELISA for short), or a process called immunofluorescence.

• Treatments: The recommended treatment is either doxycycline (Doryx, Vibramycin, others), 100 milligrams orally twice a day for seven days, or azithromycin (Zithromax), in a new single-dose treatment of 1 gram orally. The effectiveness of the two drugs is the same. You should decide what's best for you: Doxycycline is four times less expensive, but azithromycin is much more convenient.

Other treatments include ofloxacin (Floxin), 300 milligrams orally twice a day for seven days, erythromycin (PCE, ERYC, others), 500 milligrams orally four times a day for seven days, or sulfisoxazole (Gantrisin), 500 milligrams orally four times a day for 10 days. Sulfisoxazole treatment is not as effective as the other regimens.

• Follow-up: You won't need to be retested for chlamydia after you have finished your medication unless your symptoms continue or you have been re-exposed to the disease. If you do need retesting, it should be at least three weeks since you have finished the medication.

Since chlamydia can also cause infertility in men, it is important that all your recent sexual partners receive treatment as well. If you are symptomatic, all partners from the last 30 days should be notified. If you are asymptomatic, it's harder to be sure who might have been infected, but you should at least notify all partners from the last 60 days.

• Prevention: {sex_diseases_condom} condoms can protect you from the chlamydia bacteria. Other methods, such as the diaphragm, cervical cap and spermicides may also help protect you. It is advisable not to have sex during your treatment.

• Pregnancy: Pregnant women who also have chlamydia have been known to get postpartum endometriosis. Endometriosis is a condition in which pieces of the lining of the uterus are found in abnormal locations outside the uterus, such as the lining of the pelvis or the ovaries, bowel, fallopian tubes, and even the lungs.

Pregnant women with chlamydia are also at increased risk for spontaneous abortions and stillbirths. Infants born to chlamydia-infected mothers are at greater risk for conditions such as eye infections, pneumonia, and bronchitis.

This is a bacterial infection that is carried by and affects both sexes. Gonorrhoea is more prevalent in sexually active young adults and teenagers. In men, gonorrhoea causes inflammation of the urethra (the tube carrying urine from the bladder) and the anus. In women, it affects the genitals and reproductive organs and can cause infertility and other serious health problems and, like chlamydia, is a major cause of PID. Early detection and treatment are important to avoid long-term damage to health. Gonorrhoea can usually be cured by a course of antibiotics. If left untreated, the bacteria may infect the joints, the blood and heart and also cause meningitis, all of which can be treated with antibiotics.

This is the oldest known sexually transmitted disease. In the 14th century it became known as the clap, a name we still use today. It is also referred to as “the drip” or “the dose.”

Until 1991, gonorrhea was the most commonly reported STD in the United States, even though rates have been steadily decreasing since the mid 1970s. The number of cases reported to the Centers for Disease Control and Prevention in 1992 was 433,949; by the end of November 1993, the number of cases was 336,169. Some experts believe many cases go unreported, and they estimate the actual number to be about two million a year.

• Risk factors: You are more likely to get gonorrhea if you or your partner have casual sexual contacts with others and if you are under the age of 20. From 1981 to 1991, adolescents were the only group of Americans showing an increase in the number of cases; people aged 15 to 19 have twice the number of infections as those aged 20 to 24. People living in the South Atlantic region of the U.S. (from Delaware down the eastern seaboard) may be at higher risk because this region has the highest number of reported cases.

People with limited access to health care also seem to have a higher risk for getting gonorrhea. Other groups at high risk of this or any other STD include people living in large cities, singles, those who have had past gonorrhea infections, drug users, and prostitutes.

A man having unprotected sex once with a woman infected with gonorrhea has a 20 percent to 25 percent chance of catching the disease. A woman having unprotected sex once with an infected man has an 80 percent to 90 percent chance of catching it.

• Signs and symptoms: The symptoms of gonorrhea are similar to those of chlamydia. Women with symptoms usually experience increased vaginal discharge. Other symptoms include pain when urinating, lower abdominal or rectal pain, intermittent vaginal bleeding, pain or bleeding during intercourse, and fever. Half of all women with gonorrhea infections also have a gonococcal rectal infection and may have discomfort in the anal area.

TUBAL INFERTILITY AND GONORRHEA

A recent study suggests that women who've had gonorrhea are much more likely to be infertile because of obstructions in or adhesions on their fallopian tubes. The risk is also twice as high for women who've had past trichomoniasis infections. (See {fertility_impotence} Infertility). Women who reported having herpes, genital warts or yeast infections were at no higher risk than any other women.

The researchers also found some other risk factors for tubal infertility. The women they studied were older, more likely to be smokers, had higher rates of pelvic inflammatory disease (PID), and were more likely to have used an intrauterine device (IUD) for contraception in a monogamous relationship.

Up to 70 percent of infected women are asymptomatic. Only 10 percent of infected men are without symptoms. Therefore, your first warning of infection may be from your partner. He will experience painful urination and have a milky discharge from his penis. He may feel the need to urinate frequently.

• Cause: Gonorrhea infections are caused by a kidney bean-shaped bacteria scientists call Neisseria gonorrhea. These germs live in the cervix in women and inside the urethra (the tube that carries urine) in men.

• Incubation period: Symptoms usually develop within 10 days of infection.

• Possible health affects: Untreated infections can lead to Pelvic Inflammatory Disease (PID), which increases by 40 percent your chance of having a tubal (ectopic) pregnancy or becoming infertile. You also become susceptible to septicemia (blood poisoning), arthritis, or problems related to the skin, heart, or brain.

• Diagnosis: For men, a simple test called a gram stain is sufficient for diagnosis, but for women a tissue culture is often needed, since many organisms in the cervix look similar to the gonorrhea bacteria. A blood sample may be taken to test for syphilis, and a test for chlamydia may be done. Your tissue culture should be ready within 48 hours.

• Treatments: Many strains of gonorrhea are now resistant to standard drugs such as penicillin and tetracycline. However, two new types of drugs, the cephalosporins and the quinolones, are highly effective in treating gonorrhea. The cephalosporins include ceftriaxone (Rocephin) in a single 125-milligram intramuscular injection, and cefixime (Suprax) 400 milligrams orally in a single dose. The quinolones include ciprofloxacin (Cipro) 500 milligrams orally in a single dose, and ofloxacin (Floxin) 400 milligrams orally in a single dose. Ceftriaxone is expensive but offers higher and more sustained activity against infection than does cefixime. Ciprofloxacin is less expensive than ceftriaxone and has proven to be highly effective.

For those who are allergic to or who can not tolerate the cephalosporins and the quinolones, an injection of spectinomycin (Trobicin), is given in a single 2-gram intramuscular injection. Though spectinomycin is expensive, it will cure gonorrhea infections of the throat..

Your doctor may also suggest treatment for chlamydia since the two infections frequently occur together and chlamydia is often asymptomatic. For information on chlamydia treatment, see the previous section.

There are many other drugs available to treat gonorrhea. You can discuss them with your doctor.

• Follow-up: You won't need to be retested for gonorrhea after you have finished your medication unless your symptoms continue or you have been re-exposed to the disease.

If you received treatment because you had symptoms, all sex partners from the prior 30 days should also get treatment. If your infection was found incidentally, all sex partners from the last 60 days should be treated.

• Prevention: Latex {sex_diseases_condom} condoms can protect you from the gonorrhea bacteria. Other methods, such as the diaphragm, cervical cap and spermicides also offer some protection. It is advisable to abstain from sex during your treatment, and until all tests are negative.

• Pregnancy: Pregnant women with gonorrhea can not be treated with quinolones or tetracyclines. If you are pregnant, you may be given a cephalosporin or a single injection of spectinomycin.

These lice are wingless insects with six legs and a square body. They look like sea crabs, which is why they are often referred to as “the crabs.” The lice cling to pubic hair and feed on blood. The female of the species lays about 50 eggs, called nits, and attaches them to the base of a hair strand. The average life-span is 25 to 30 days.

There has been a resurgence of pubic lice that parallels increasing rates of other sexually transmitted diseases.

• Risk factors: You are more likely to get pubic lice if you or your partner have multiple or casual sexual partners. It's easier to get lice than any other STD. From just one sexual encounter with an infested person, you have a 95 percent chance of picking them up.

Named for their crab-like appearance, pubic lice are large enough to be visible, and leave little bluish marks where they bite. If your sexual partner has lice, you have a 95 percent chance of picking them up. Some of the old wives' tales are true, too. You can catch lice from dirty sheets and towels, though not from toilet seats.

• Signs and symptoms: You will know if you have contracted pubic lice because you can see them. You may also see little bluish marks in the pubic area or thighs where they've bitten you. The lice often cause itching, which is thought to be from an allergic reaction to their bites. Although crabs are found most often in the pubic area, they can be found on any other hairy part of the body, such as the chest, armpits, beard, and eyelashes. They normally leave the hair on the head to their cousins, body lice.

• Cause: Pubic lice is caused by a parasite known as Phthirus pubis that is transmitted by close body contact, most often by sexual intercourse. Since the lice can live away from their host for 24 to 48 hours, there are other possible modes of transmission such as sheets and towels (but not toilet seats).

• Incubation period: Eggs hatch in seven to 10 days. But depending on the number of lice transmitted, it could be two to four weeks before you notice anything.

• Possible health affects: Having pubic lice raises the suspicion of other STDs.

• Diagnosis: You can tell if you have pubic lice just by looking for them. This is how your doctor will diagnose them.

• Treatments: Shaving the hair is unnecessary. Recommended treatment regimens are either a 1 percent lindane shampoo (Kwell), applied for four minutes and then washed off, or a 1 percent permethrin cream rinse (Rid) which is washed off after 10 minutes. Both of these pesticide treatments require a prescription, with lindane being the less expensive. Lindane should not be used by people with extreme dermatitis because it could cause seizures.

You can buy other pesticide treatments, containing pyrethrin with piperonyl butoxide (A-200, Rid), without a prescription. They are applied for 10 minutes and then washed off. If you are allergic to ragweed, you should avoid these products. There are also products for inanimate objects such as furniture. These should not be used on humans or animals.

If you have lice clinging to your eyelashes, do not use any of these pesticide treatments to get rid of them. Instead, put some Vaseline on the edges of your lids twice a day for 10 days, which will smother the lice. You can also pluck them and the nits off with tweezers.

• Follow-up: You should be re-examined after a week if the lice do not disappear. It is normal to still feel itchy for several days after treatment. All sex partners from the last month should be notified and treated. Avoid sexual contact until the lice and nits are gone. Clothing and bed linen used in the two days prior to treatment should be washed and dried, or dry cleaned.

• Prevention: There is no certain prevention, but since lice are mostly spread in environments where there is lack of good hygiene, avoid using unclean towels, bedding, or clothing. Using a latex {sex_diseases_condom} condom will not protect you from pubic lice because it does not cover the pubic hair

• Pregnancy: Pregnant or breastfeeding women should not use lindane shampoo or a pesticide containing pyrethrin with piperonyl butoxide.

Scabies has been around for a long time and is probably responsible for the term, “Seven Year Itch.” These bugs have three pairs of strong, stubby legs, which the female uses to burrow under the skin.

This extremely common skin infestation has been on the rise in the United States since 1973. Actual prevalence rates are unknown, but epidemics appear to be associated with wars. Unlike other parasitic infestations such as pubic lice, scabies is hard to contract. It requires prolonged contact with an infected person or infected belongings such as bedding.

You'll never see the tiny bugs called scabies. Instead, their presence is announced by the severe itching they cause as they burrow under the skin. Unlike crabs, they are picked up only through prolonged contact with an infected person. Though they do not pose a serious threat to your health, you'll want to get rid of them as quickly possible, using a preparation such as Elimite, Eurax, or Kwell.

• Risk factors: You are more likely to get scabies if you or your partner have multiple or casual sexual partners. Overcrowded living conditions, poor hygiene, and malnutrition probably contribute to the problem.

• Signs and symptoms: Itching, which gets worse at night, after exercise, or after hot baths or showers, is the main complaint with scabies. Hands, arms, feet, ankles, armpits and buttocks, as well as the genitals, can all be affected.

Scabies are so tiny, they can not be seen with the naked eye. However, you can often see the burrows under the skin made by the female when she lays her eggs, particularly in the spaces between your fingers.

• Cause: Scabies is caused by the mites Sarcoptes scabiei var hominis. It is passed from person to person through close contact, including sexual activity. It can also spread through sheets, clothes and furniture.

• Incubation period: The typical incubation time is five weeks, but since symptoms are due to an allergic reaction, if you've had scabies before, you'll notice symptoms sooner.

• Possible health affects: Approximately 7 percent of all people infected with scabies get a rash of itchy, reddish-brown bumps, especially on the genitals. This is just a more severe allergic reaction than normal but it may take weeks or months to disappear. People whose immune systems are working overtime—for example, those who've had another illness for a long time—may notice thick, flaky lesions on their skin. This is called Norwegian scabies, and it is extremely contagious.

• Diagnosis: You will probably be able to see the burrows made by the female under your skin. If you're not sure it's a scabies burrow, you can apply some blue or black ink from a pen or marker to the suspect area. Soak a cotton swab with alcohol and rub off the excess ink. If you're dealing with a burrow, the ink will be sucked into it and you will be able to see a thin line of ink under your skin. For an exact diagnosis, your doctor can scrape off some affected skin and examine it under a microscope.

• Treatments: There are several recommended treatment regimens. One is 5 percent permethrin cream (Elimite) applied all over the body, and washed off eight to 14 hours later. Another treatment is a one ounce application of 1 percent lindane lotion or 30 grams of lindane cream (Kwell) applied thinly all over the body and washed off eight hours later. Both of these treatment are effective, but lindane is less expensive. Lindane should not be used by people with extreme dermatitis because this could cause seizures.

Crotamiton 10% (Eurax) can also be used. It is applied after a bath or shower, with a second application 24 hours later. A cleansing bath should be taken 48 hours after the last application.

• Follow-up: You might be asked to come in for a follow-up after a week if the symptoms do not disappear. It is normal to feel itchy several weeks after treatment. All sex partners from the last month should be notified and treated, and family members should be checked too. Clothing and bed linen used in the two days prior to treatment should be washed and dried, or dry cleaned.

• Prevention: There is no certain prevention, but since scabies are mostly spread in environments where there is a lack of good hygiene, avoid using unclean towels, bedding, and clothing.

• Pregnancy: Pregnant or breastfeeding women should not use treatments containing lindane.

NSU refers to inflammation of the urethra in men that is not caused by gonorrhoea. It is most commonly caused by chlamydia (see above) and can usually be cured by a course of antibiotics.

Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium Treponema pallidum. It has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. It is spread by any sexual contact involving the exchange of body fluids, including saliva. It can affect both sexes and is most common among sexually active high-risk groups.

Left untreated, syphilis passes through several stages with increasingly damaging effects on health. Ultimately, usually after a latent period, it can cause heart disease, dementia, paralysis and death. Syphilis is most infectious in its early stages. The first symptom is a painless sore (called a chancre) that usually appears on the genitals or, less frequently, the anus, lips or throat. The chancre heals spontaneously after four to eight weeks and is followed by a conspicuous skin rash. Other symptoms of this second stage include fatigue, fever, headaches, loss of appetite and highly contagious sores.

Syphilis can usually be cured by a course of antibiotics. The treatment may have side effects in some patients, especially in the later stages of the disease.

It is advisable that people who test positive for syphilis also have a test for HIV because they are also likely to be at high risk for this disease.

Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. Transmission of the organism occurs during vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies they are carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

Depending on how long a pregnant woman has been infected, she has a good chance of having a stillbirth (syphilitic stillbirth) or of giving birth to a baby who dies shortly after birth. If not treated immediately, an infected baby may be born without symptoms but could develop them within a few weeks. These signs and symptoms can be very serious. Untreated babies may become developmentally delayed, have seizures, or die.

A health care provider can diagnose syphilis by using dark field microscopy to examine material from infectious sores. If syphilis bacteria are present in the sore, they will show up with a characteristic appearance.

A blood test is another way to determine whether someone has syphilis. Shortly after infection occurs, the body produces syphilis antibodies that can be detected by an accurate, safe and inexpensive blood test. A low level of antibodies will stay in the blood for months or years even after the disease has been successfully treated. Because untreated syphilis in a pregnant woman can infect and possibly kill her developing baby, every pregnant woman should have a blood test for syphilis.

In the United States, over 35,600 cases of syphilis were reported by health officials in 1999, including 6,650 cases of primary and secondary syphilis (a decline of 5.4% from 1998) and 556 cases of congenital syphilis in newborns. More cases occur each year than come to the attention of health officials. Of the nine states with the highest 1999 syphilis rates (2-5 times higher than the national rate of 2.5 cases per 100,000), eight were in the South. Although syphilis rates remain higher in the South than in other regions, the South had a 32% decline in the primary and secondary syphilis rate from 1997 to 1999, illustrating that the greatest improvements in disease control have taken place where syphilis incidence has been the greatest. In 1999, 25 counties accounted for 50% of all primary and secondary syphilis cases. Two hundred sixty-five counties had syphilis rates above the U.S. Public Health Service's Healthy People 2000 objective of 4 cases per 100,000. These 265 counties (9% of the total number of counties in the U.S.) accounted for approximately 74% of the total primary and secondary syphilis cases reported in 1999.

In 1999, syphilis occurred primarily in persons aged 20 to 39, and the reported rate in men was 1.5 times greater than the rate in women. The incidence of syphilis was highest in women aged 20 to 29 years and in men 30 to 39. Some fundamental societal problems, such as poverty, inadequate access to health care, and lack of education are associated with disproportionately high levels of syphilis in certain populations. Cases of primary and secondary syphilis in 1999 had the following race or ethnicity distribution: African Americans 75%, whites 16%, Hispanics 8%, and others 1%. Syphilis reflects one of the most glaring examples of racial disparity in health status, with the rate for African Americans nearly 30 times the rate for whites.

While the health problems caused by syphilis in adults and newborns are serious in their own right, it is now known that the genital sores caused by syphilis in adults also make it easier to transmit and acquire HIV infection sexually. There is a 2- to 5-fold increased risk of acquiring HIV infection when syphilis is present.

Yes! A single dose of penicillin, an antibiotic, will cure a person who has had syphilis for less than a year. Larger doses are needed to cure someone who has had it for longer than a year. For people who are allergic to penicillin, other antibiotics are available to treat syphilis. There are no home remedies or over-the-counter drugs that will cure syphilis. Penicillin treatment will kill the syphilis bacterium and prevent further damage, but it will not repair any damage already done. Persons who receive syphilis treatment must abstain from sexual contact with new partners until the syphilis sores are completely healed. Persons with syphilis must notify their sex partners so that they also can be tested, and, if necessary, receive treatment.

Having had syphilis does not protect a person from getting it again. Antibodies are produced as a person reacts to the disease, and, after treatment, these antibodies may offer partial protection from getting infected again, if exposed right away. Even though there may be a short period of protection, the antibody levels naturally decrease in the blood, and people become susceptible to syphilis infection again if they are sexually exposed to syphilis sores.

Two people who know that they are not infected and who have sex only with each other cannot contract syphilis. When someone's syphilis status is unknown, a good defense against becoming infected during sex is to use a latex {sex_diseases_condom} condom before beginning sex and to keep it on until the penis is withdrawn. However, condoms do not provide complete protection because syphilis sores can sometimes be on areas not covered by a condom. This is equally important for other STDs, including HIV, as well. Only lab tests can confirm whether someone has syphilis. Because syphilis sores can be hidden in the vagina, rectum, or mouth, it may not be obvious that a sex partner has syphilis. Washing the genitals, urinating, or douching after sex does not prevent STDs, including syphilis. Any unusual discharge, sore, or rash, especially in the groin area, should be a signal to stop having sex and to see a doctor at once.

Medical Diagnosis & Treatment / Nutritional Treatment / CRA Treatment / Diet / Chiropratic Treatment

Prepare for questions
You and your doctor will try to match your symptoms with an STD. You should also expect to be asked what may seem like very personal questions. This is called taking a sexual history. Here are some questions that doctors and nurses often ask in order to know what infections to test for, plus the reasons they ask them:

If you suspect you have a sexually transmitted disease, or you've recently been told by a sex partner that he has been diagnosed with one, you'll want to seek medical attention as soon as possible. There are a number of different options.

The level of privacy and confidentiality can vary by state due to different reporting laws, and even by clinic and doctor. Your best bet is to ask your doctor or nurse about their accommodations for keeping information private. Ask these questions:

After you are diagnosed with an STD, your doctor will either let you know your treatment options or simply give you a prescription. It is extremely important that you finish all medications completely, even if you're feeling better in a day or two. Incomplete drug treatments are responsible for the super bugs those germs that don't respond to the treatment that once knocked them out. Being exposed to a small amount of the medication instead of all of it allows germs to mutate and become stronger.

As far as sexual activity, it's best to avoid any type of contact that could infect your partner or delay your healing. Check with your doctor about what to avoid and for how long.

If you are asked to return to your doctor or the clinic for follow-up, plan to do so. Even if you feel well, they will want to ensure that you are completely cured or at least, that you were properly treated. This follow-up could save you from pain and suffering later if they find that further treatment is needed.

You may be asked how you plan to notify past sexual partners about your infection. Partner notification is essential in stopping the spread of STDs. If you can't bear to tell past partners yourself, many health workers (especially those working at the state health department) will do it for you without using your name. For guidance in telling current and potential partners, see “Finding the Support You Need, later in this chapter.

CHECKUPS: HOW OFTEN
IS RIGHT FOR YOU?

You are at high risk and should be checked every one to three months if...

You currently have many sexual partners
You currently have casual sex with partners you know nothing about
Your sexual partner currently has many partners
You or your nonmonogamous sexual partner live in a city with high STD rates

You are at moderate risk and should be checked every three to six months if...

You exchange body secretions or make contact with the oral or anal mucous membranes of others during sexual intercourse
You or your partner sustain slight damage to the tissues of the vagina or anus during sex

You are at low risk and should be screened every 12 months for two years if...

You and your partner have been monogamous for a long time.

Based on which organ systems are affected, the following supplements are indicated:

These reflexes should be tested and treated with the proper supplementation. You should take this preliminary free test or be examined by a competent health care practitioner for testing. A liver/gallbladder flush and intestinal detoxification program may also be recommended.

Most sexually transmitted diseases have yeast/and/or parasites as a common denominator. The {yeast} yeast diet should be followed.

Chiropractic in itself does not address STD's directly, however, the immune system can be influenced with chiropractic care. Go here for information regarding chiropractic care.

This article is to help you understand why it's important to use condoms (rubbers, prophylactics) to help reduce the spread of sexually transmitted diseases. These diseases include AIDS, chlamydia, genital herpes, genial warts, gonorrhea, hepatitis B, and syphilis. You can get them through having sex -- vaginal, anal, or oral.

The surest way to avoid these diseases is to not have sex altogether (abstinence). Another way is to limit sex to one partner who also limits his or her sex in the same way (monogamy). Condoms are not 100% safe, but if used properly, will reduce the risk of sexually transmitted diseases, including AIDS. Protecting yourself against the AIDS virus is of special concern because this disease is fatal and has no cure.

About two-thirds of the people with AIDS in the United States got the disease during sexual intercourse with an infected partner. Experts believe that many of these people could have avoided the disease by using condoms.

Condoms are used for both birth control and reducing the risk of disease. That's why some people think that other forms of birth control -- such as the IUD, diaphragm, cervical cap or pill -- will protect them against diseases, too. But that's not true. So if you use any other form of birth control, you still need a condom in addition to reduce the risk of getting sexually transmitted diseases.

A condom is especially important when an uninfected pregnant woman has sex, because it can also help protect her and her unborn child from a sexually transmitted disease.

Note: Condoms are not 100% safe, but if used properly, will reduce the risk of sexually transmitted diseases, including AIDS.

The male condom, a thin sheath placed over the glans and shaft of the penis, acts as a physical barrier. The condom prevents pregnancy by blocking the passage of semen and is effective only when used from "start to finish" during every act of intercourse. Among barrier contraceptive methods, the condom provides the most effective protection of the genital tract and is thus the most effective method for preventing sexually transmitted diseases (STDs).

A sheath worn over the penis can be traced as far back as 1350 B.C., when Egyptian men wore decorative covers for their penises. In 1564 A.D., Fallopius first described linen sheaths used to protect against syphilis. Protective sheaths made from dried animal intestines followed in the 18th century, when they were first given the name "condom," presumably after inventor Colonel Cundum. With the advent of vulcanized rubber in 1843 came the mass production of synthetic condoms. In the 1990s, manufacturers began to use plastics (e.g., polyurethane).

Until recently, most commercially available condoms were manufactured from latex ("rubber" condoms), while about 5 percent were made from the intestines of lambs ("natural skin," "natural membrane," or "lambskin" condoms). Natural membrane condoms may not offer the same level of protection against STDs as latex condoms, however. Unlike latex condoms, natural membrane condoms contain small pores that may permit passage of viruses, including hepatitis B virus, herpes simplex virus, and HIV. They are recommended for contraceptive use only.

New condoms manufactured from polyurethane are thinner and stronger than those manufactured from latex, provide a less constricting fit, are more resistant to deterioration, and may enhance sensitivity. Unlike latex condoms, condoms made of polyurethane are compatible with oil-based lubricants. Plastic condoms have not been well studied for protection against STDs but are believed to provide protection similar to that of latex condoms. Current studies of their effectiveness are under way. As of mid-1997, two polyurethane condoms have been approved by the U.S. Food and Drug Administration (FDA) for latex-sensitive persons and are commercially available in the United States: the Avanti condom (Durex Consumer Products) and the Reality female condom (The Female Health Company). Two new polyurethane condoms with a loose fit are also being developed. Acceptability studies have been encouraging for both condoms. Plastic condoms manufactured from materials other than polyurethane may soon be marketed.

Latex Condoms:

Brand Names: Numerous
Material: Natural Rubber
Lubricant Use: Water-based only
Cost: Low
Prevention of Pregnancy: Yes
Prevention of STDs & HIV: Yes

Natural Membrane Condoms:

Brand Names: Fourex, Naturalamb
Material: Lamb skin
Lubricant Use: Water-based only
Cost: Low/Moderate
Prevention of Pregnancy: Yes
Prevention of STDs & HIV: No

Plastic Condoms:

Brand Names: Avanti, Reality
Material: Polyurethane*
Lubricant Use: Water-based only
Cost: Moderate/high
Prevention of Pregnancy: Yes
Prevention of STDs & HIV: Likely

* Non-polyurethane plastic condoms may become available soon.

A person who takes part in risky sexual behavior should always use a condom.

The highest risk comes from having intercourse -- vaginal, anal, or oral -- with a person who has a sexually transmitted disease. If you have sex with an infected person, you're taking a big chance. If you know your partner is infected, the best rule is to avoid intercourse (including oral sex). If you do decide to have sex with an infected partner, you should always be sure a condom is used from start to finish, every time.

And it's risky to have sex with someone who has shared needles with an infected person.

It's also risky to have sex with someone who had sex with an infected person in the past. If your partner had intercourse with a person infected with HIV (the AIDS virus), he or she could pass it on to you. That can happen even if the intercourse was a long time ago and even if your partner seems perfectly healthy.

With sexually transmitted diseases, you often can't tell whether your partner has been infected. If you're not sure about yourself or your partner, you should choose to not have sex at all. But if you do have sex, be sure to use a condom that covers the entire penis to reduce your risk of being infected. This includes oral sex where the penis is in contact with the mouth.

If you think you and your partner should be using condoms but your partner refuses, then you should say NO to sex with that person.

No. There's no absolute guarantee even when you use a condom. But most experts believe that the risk of getting AIDS and other sexually transmitted diseases can be greatly reduced if a condom is used properly.

In other words, sex with condoms isn't totally "safe sex," but it is "less risky" sex.

A condom acts as a barrier or wall to keep blood, or semen, or vaginal fluids from passing from one person to the other during intercourse.

These fluids can harbor germs such as HIV (the AIDS virus). If no condom is used, the germs can pass from the infected partner to the uninfected partner.

Always read the label. Look for two things:

The condoms should be made of latex (rubber). Tests have shown that latex condoms can prevent the passage of the AIDS, hepatitis and herpes viruses. But natural (lambskin) condoms may not do this.

In the future, manufacturers may offer condoms of other materials and designs for disease prevention. As with all new products that make medical claims, such as "prevention of sexually transmitted disease," these new condoms would have to be reviewed by the Food and Drug Administration (FDA) before they are allowed to be sold.

The package should say that the condoms are to prevent disease. If the package doesn't say anything about preventing disease, the condoms may not provide the protection you want, even though they may be the most expensive ones you can buy.

Novelty condoms will not say anything about either disease prevention or pregnancy prevention on the package. They are intended only for sexual stimulation, not protection.

Condoms which do not cover the entire penis are not labeled for disease prevention and should not be used for this purpose. For proper protection, a condom must unroll to cover the entire penis. This is another good reason to read the label carefully.

The FDA is working with condom manufacturers to help ensure that the latex condoms you buy are not damaged.

Manufacturers "spot check" their condoms using a "water-leak" test. FDA inspectors do a smilar test on sample condoms they take from warehouses. The condoms are filled with water and checked for leaks. An average of 996 of 1000 condoms must pass this test.

(Don't try the water-leak test on condoms you plan to use, because this kind of testing weakens condoms.)

Government testing can not guarantee that condoms will always prevent the spread of sexually transmitted diseases. How well you are protected will also depend a great deal on which condoms you choose and how you store, handle and use them.

The Surgeon General has said, "Condoms provide some protection, but anal intercouse is simply too dangerous to practice."

Condoms may be more likely to break during anal intercourse than during other types of sex because of the greater amount of friction and other stresses involved.

Even if the condom doesn't break, anal intercourse is very risky because it can cause tissue in the rectum to tear and bleed. These tears allow disease germs to pass more easily from one partner to the other.

In test tubes, a spermicide called nonoxynol-9 (a chemical used to kill the man's sperm for birth control) has been shown to kill the germs that cause sexually transmitted diseases. Some experts believe nonoxynol-9 may kill the AIDS virus during intercourse, too. So you might want to use a spermicide along with a latex condom as an added precaution in case the condom breaks during intercourse.

Condoms with spermicides have an expiration date. Pay attention to that date.

Spermicides generally come in the form of jellies, creams or foams. You can buy them in pharmacies and some grocery stores.

You can also buy condoms with a small amount of spermicide already applied. But some experts believe it's a good idea to add more spermicide to the amount that comes on the condom.

If you do add spermicide, place a small amount inside the condom at its tip. After the condom is on the penis, put more on the outside. Spermicides can also be put inside the woman's vagina. Follow the directions for use.

If you have oral sex, use a condom without a spermicide. Although swallowing small amounts of spermicide has not proven harmful in animal test, we don't know if this is always true for people.

Spermicide products and condoms with spermicides have expiration dates. Don't buy or use a package that is outdated.

Some condoms are already lubricated with dry silicone, jellies, or creams. If you buy condoms not already lubricated, it's a good idea to apply some yourself. Lubricants may help prevent condoms from breaking during use and may prevent irritation, which might increase the chance of infection.

If you use a separate lubricant, be sure to use one that's water-based and made for this purpose. If you're not sure which to choose, ask your pharmacist.

Never use a lubricant that contains oils, fats, or greases such as petroleum-based jelly (like Vaseline brand), baby oil or lotion, hand or body lotions, cooking shortenings, or oily cosmetics like cold cream. They can seriously weaken latex, causing a condom to tear easily.

It's most important to choose latex condoms that say "disease prevention" on the package. Other features are a matter of personal choice.

Some packages show "DATE MFG." This tells you when the condoms were made. It is not an expiration date.

Other packages may show an expiration date. The condoms should not be purchased or used after that date.

You should store condoms in a cool, dry place out of direct sunlight, perhaps in a drawer or closet. If you want to keep one with you, put it in a loose pocket, wallet, or purse for no more than a few hours at a time.

Extreme temperature -- especially heat -- can make latex brittle or gummy (like an old balloon). So don't keep these latex products in a hot place like a glove compartment

Gently! When opening the packet, don't use your teeth, scissors or sharp nails. Make sure you can see what you're doing.

If the condom material sticks to itself or is gummy, the condom is no good. Also check the condom tip for other damage that is obvious (brittleness, tears, and holes). Don't unroll the condom to check it because this could cause damage.

Never use a damaged condom

Learn the facts so that you can protect yourself and others from getting infected. Condoms are not 100% safe, but if used properly, will reduce the risk of sexually transmitted diseases, including AIDS. If you have unprotected sex now, you can contract sexually transmitted diseases. Later, if you decide to have children, you might pass the disease on to them.

If you would like more information about condoms and how to prevent sexually transmitted diseases, talk with your doctor or call the National AIDS Hotline. It's open 24 hours a day. Trained operators will answer your questions and can send you more information.

For AIDS information in English, 800-342-AIDS

For AIDS information in Spanish, 800-344-SIDA

Deaf Access, 800-AIDS-TTY

The National STD Hotline, 800-277-8922

Use this handy shopping guide as a reminder of what to look for when buying condoms, lubricants and spermicides.