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EXUALLY

RANSMITTED
ISEASES

Elaine Landau
Foreword by Donald Armstrong, M.D
Preface by H. Hunter Handsfield,

M.D

S
RANSMITTED
EXUALI7

In

the

ISEASES
transmitted

sexually

past,

were discussed mainly

diseases

medical

textbooks.

The

in

current

the spread of these diseases

rise in

concern

should

be

among

all

individuals,

icularly

among young people who

cause

for

but

part-

making choices about sexual

are

activity.

Young

should

people

learn

about the dangers of such diseases.

They can cause

serious complica-

tions,

and

The

sterility,

time

even

become

to

death.

informed

about chlamydia, gonorrhea, AIDS,

STDs is
young person has become

numerous

and

before a

other

sexually active.

The
careful,

author

has

informative

this

subject.

she

describes

In

developed

approach

to

language,

clear

the

major

STDs

and includes the symptoms, diagnosis,

and treatment for each. The

book
it

is

also

particularly valuable because

includes

known STDs such

numerous

lesser-

as chancroid.

Being informed about

transmitted diseases and

sequences

is

making

responsible,

i[\y

991

valuable

com

decision about sexual practices

JBAUSALITO PUBLIC LIBRARY

;v/

..

Sexually

Transmitted
Diseases
Elaine

Landau

ENSLOW PUBLISHERS,
Bloy

St.

& Ramsey

Box 38
Aldershot

P.O.

Ave.

Box 777
Hillside, N.J.

07205

INC.

Hants

U.S.A.

SAUSALITO PUBLIC LIBRARY

GU12 6BP
U.K.

DRAWINGS BY HERMELIE HEIMLICH

Copyright

1986 by Elaine Landau

All rights reserved.

No

part

of this

book may be reproduced by any means

without the written permission of the publisher.


Library of Congress Cataloging in Publication Data

Landau, Elaine.
Sexually transmitted diseases.
Bibliography: p.

Includes index.

Summary:
diagnosis,
1.

Describes the characteristics,


symptoms,
and treatment of venereal diseases and infections.

Venereal

diseases]

I.

diseases-Juvenile

literature.

RC200.2.L35

1986

616.9'5

ISBN 0-89490-1 15-X


Printed in the United States of America

10

[1.

Venereal

Title.

987654321

85-4349

Contents
Foreword by Donald Armstrong, M.D

M.D

Preface by H. Hunter Handsfield,

A Word About

Sexually Transmitted Diseases

Part One: Diseases Caused

By

a Single

Organism

15

Gonorrhea

17

Chlamydial Infections

23

Lymphogranuloma Venereum

26

Syphilis

29

Herpes

35

Genital Warts

42

Acquired Immune Deficiency Syndrome

45

Chancroid

50

Donovanosis

52

54

Miscellaneous
Pubic Lice, Scabies, Molluscum Contagiosum, Viral Hepatitis,

Cytomegalovirus, The Genital Mycoplasmas, The Enteric Pathogens:


Shigellosis,

Part

Two:

Pelvic

Campylobacter, Giardiasis, Amebiasis

Diseases Caused

By More Than One Organism

Inflammatory Disease

69
71

Nongonococcal Urethritis

76

Cervicitis

79

Vaginal Infections

81

Trichomoniasis, Yeast Infections, Bacterial Vaginosis

Epididymitis

87

Glossary

89

Diagrams of Male and Female Reproductive Systems

90

Further Reading

93

Index

94

For some outstanding young adult

York Public Library


in

my

librarians at

The New

for their generous help and guidance

creations:

Ruth Rausen -Coordinator, Young Adult


Beryl Eber

Bonnie Goldstein

Services

FOREWORD
The time
diseases

for

is

young people

before their

first

to learn about sexually transmitted

sexual experience.

Many

schools in

the United States have a course in family living and


sexuality;

all

should.

human

The course should include sexually

trans-

mitted diseases (STDs).


This book
is

presents

factual

information about STDs.

written clearly and in a straightforward

It

manner without

attempting to unduly scare the reader. Sexually transmitted


diseases,

however, should be a cause for concern. They can

cause disfigurement,

sterility,

and even death.

There are ways to prevent these diseases and to stop their


spread.

The author

presents these

methods

in plain

language

while stressing early diagnosis and treatment. These messages

should reach young people and be heeded.

Donald Armstrong, M.D.


Chief, Infectious Disease Service

Director, Microbiology Laboratory

Memorial Sloan-Kettering Cancer Center


Professor of Medicine
Cornell University Medical College

-5-

PREFACE
For most of recorded history, sexually transmitted diseases have
accounted for a large proportion of all deaths, disability, human
misery, and economic loss due to illness. Prevention and control
of these diseases have always been hampered by the limits that
Western societies have placed on the study and discussion of sex
and sexuality. The "sexual revolution" has contributed to the
current epidemic of sexually transmitted diseases, but also has
fostered changes in attitudes that have

them and

made

easier to control

it

to educate the public about them. This

book

is

manifestation of these changes.

Most sexually transmitted diseases have a far greater impact


on women than on men, although responsibility for spreading
them falls equally upon both. The majority of these infections
cause more subtle symptoms in women, leading to delays in
seeking medical attention. They are harder to diagnose in
women than in men, and women are much more likely to suffer
serious consequences.

The
tions

is

risk

of sexually transmitted diseases and their complica-

greatest in sexually active

at highest risk are those


cal,

with the

young people. Thus, the ones


least

awareness of the medi-

psychological, and social consequences of careless sexual

behavior and the least knowledge about prevention of these

consequences. According to some estimates,

fifty

percent or more

of young adults will acquire a sexually transmitted infection


before age thirty -five.

There can be no doubt that knowledge


necessary
diseases.

weapon

is

a potent

and

against the threat of sexually transmitted

In the absence of knowledge, stern advice to limit

sexual activity has

This book

is

little effect.

written to help anyone

who

reads

it

make

responsible, informed choice about his or her sexual practices.

The parent, counselor, or teacher who discusses it with a young


person will be making a tangible investment in that person's
health and happiness.

H. Hunter

Handsfield, M.D.

Director, Sexually Transmitted Disease

Control Program
Seattle-King County Department of Public Health

Associate Professor of Medicine


University of Washington School of Medicine

A WORD ABOUT
SEXUALLY TRANSMITTED DISEASES
Sexually

transmitted

diseases

(STDs) are

epidemic

in

the

United States and Canada today. Each year over ten million

new

cases arise.

active

is

As

a result,

at greater risk

anyone who

is

currently sexually

than ever before of contracting a sexually

transmitted disease.

There are a number of reasons for the marked increase and


spread of these diseases, which were formerly grouped under
the

name

venereal diseases (VD).

The

two decades have

last

Many

witnessed a dramatic shift in sexual values.

people have

developed a new, freer sense of morality, resulting

number of sexual contacts per person

in a greater

as well as an overall

increase in sexual relations. In addition, as sexual practices and

techniques

become more

either the

mouth

varied, infections

or the genitals are

now

once confined to

spread to different

parts of the body.

Contraceptive modes have also influenced the spread of


sexually

transmitted

such as the

diseases.

Previously,

condom and diaphragm were

barrier

the most

methods

commonly

used forms of birth control. In addition to preventing pregnancy,

-7-

methods

these barrier

some protection

also provided

against

contracting a disease transmitted sexually.

Modern preferred methods of birth control do not offer such


protection.

has been found recently that

It

(intrauterine device) or the

render a
diseases.

woman more
Some

pH

for contraception

susceptible to

some

may

body chemistry which

IUD

actually

sexually transmitted

researchers believe that use of the

certain changes in

balance or

Pill

using an

Pill

causes

alter the acid/alkaline

thereby creating a more con-

level of the vagina,

ducive environment for the growth of some of the organisms


responsible for certain sexually transmitted diseases. However,
this hypothesis

hangs

down

is still

uncertain.

The IUD contains

may

into the vagina and

a cord that

inadvertently serve as a

sort of passageway into the uterus for infectious germs.

Individuals

who make

the decision to be sexually active bear

the responsiblility to maintain good sexual health for themselves


as well as for their partners. Prevention plays

an important role

in staying well.

There are a number of precautions which any

sexually

active

individual

chances

of contracting or spreading a sexually transmitted

may

take to

minimize his or her

disease.

Included
signs

among

of sexual diseases and making certain not to

in sexual activities

A
is

these are learning to recognize any overt

who

with a partner

engage

symptoms.

exhibits such

cold, clinical examination of one's partner's genitals usually

not feasible, but

symptoms during
any suspicious

it

is

important to try to be

foreplay.

An

individual

sores, blisters, or

who

sees or feels

bumps should immediately

ask his or her partner about whatever

No one

alert to revealing

it is

that

is

of concern.

should hesitate out of fear of offending his or her

partner, since such concern simply reflects a responsible attitude.

-8-

partner

If the

explanation,

unable to immediately offer a believable

is

it is

important not to proceed with sexual relations,

may be

person

as an uninfected

jeopardizing his or her

good health. This book contains


for

a description of

own

symptoms

each sexually transmitted disease. These sections should

be read carefully, since such information

make

the reader to

is

sign of sexual disease in

amount of

clear, odorless fluid

opening. This natural lubrication

ment. However,

which

is

is

may be

it

prior to ejaculation

fluid

foul smelling or cloudy, or

before erection,

from the urethral

indicative of sexual excite-

male secretes

if

both men and

During sexual foreplay the male normally

a discharge.

secretes a small

better enable

accurate and sensible judgements.

The most common

women

will

if

there

is

any discharge

best to reconsider the originally

planned course of action.


In the female, a light, white-colored discharge

may be

the

result of the vagina cleansing itself. In addition, during times

of sexual arousal there


odorless

lubrication

smelling discharge
In

some

woman who

slippery, generally

any thick or

However,

secreted.

may

good deal of

foul-

be considered suspect.

odor can

also serve as another

of sexual infection. Contrary to popular myth,


practices

odor from her


healthy

situations, a strong

sign

telltale

may be

good hygiene need not emit an offensive

genitals.

Similarly, the

semen ejaculated by

male should not have a harsh,

overpowering odor. However,


offensive odor, this

may be

uncharacteristically

either partner emits a strong

if

indicative of a sexual disease, inade-

quate personal cleanliness, or both.


If

the individual's sexual

partner claims to

sexual health and appears to have

of infection, there are

still

no

visible

number of

9-

be

in

good

symptoms indicative

additional precautions

which may be taken to help avoid contracting

a sexually trans-

mitted disease. Always urinate following sexual intercourse,


as this serves to cleanse the urethra, flushing

might eventually cause a urinary

that

out some organisms


infection.

tract

Wash

thoroughly with soap and water both before and after having
sexual intercourse. This

who

is

especially important for individuals

practice anal intercourse in addition to genital intercourse,

since germs are easily transmitted

from one area of the body

to another.
It

important to thoroughly wash one's hands as well

is

as one's genitals, since bacteria are often inadvertently trans-

mitted during sexual foreplay. The use of a

important

measure

protective

transmitted diseases.

A condom

against

condom

is

contracting

another
sexually

provides a protective barrier

which does not allow the disease organisms to spread

to another

person. Diaphragms and contraceptive foams, jellies, or sponges

may

also

some protection. Anyone who has

offer

knowledge that

his or her partner

or

is

suffering

the

from

certain

a sexually

process of being

transmitted

disease

treated

one, should not engage in sexual relations with

for

that individual under

is

currently

in

any circumstances.

Certain sexual lifestyles increase the risk of contracting a


sexually transmitted disease. Individuals

who

engage in sexual

intercourse with multiple partners or prostitutes are at a higher


risk.

The

risk

is

very low in

committed relationships with

single partners.

Any

sexually active individual should have regular medical

checkups which include testing for sexually transmitted diseases


to be certain that he or she remains disease free and in

sexual

health.

good

However, pelvic examinations are not always

routinely done except by gynecologists. Unfortunately, there

-10

is

our society attached to having a disease

a stigma in

still

that was sexually transmitted. Often people feel guilty, ashamed,

and embarrassed when they discover that something of


nature

affecting their lives. In reality, sexually transmitted

is

diseases

this

are

not

relegated

sexually active person

is

to

"bad" or "dirty" people any

some

at

discriminate and affect people of

risk.

all

The organisms do not

ages, races,

and socioecon-

omic backgrounds.
In

some

instances, long-time family physicians

may

feel

embarrassed by a patient's medical problem brought about

through a sexual encounter. They

may

insulting their patient if they suggest that

tested

feel that

they

may be

he or she be routinely

transmitted diseases. If the doctor does

for sexually

not work in a clinic specifically designed to treat such diseases,


or in a large urban clinic where the diagnosis and treatment of
disorders

these
believe

that

are

routine,

such a "nice young person" has contracted a

disease of this type.

true

he or she may be reluctant to

Many

people find this to be especially

of family physicians in small towns

who have

treated

everyone in their family ever since they can remember.


Nonetheless, any person

who

is

sexually active should have

a blood test for syphilis (see page 33

as well as yearly tests for

gonorrhea (see page 20) and chlamydia (see page 25).

Women

should also have regular Pap tests and be checked for vaginal
infections.
It is

this

every sexually active individual's responsibility to request

type of testing.

feel sufficiently

It

is

also

important that each individual

comfortable with his or her physician to be

able to be completely candid regarding the level of his or her

sexual

activity

as

well

as

the specific nature of the sexual

practices involved.

11

Anyone who

believes that he or she

transmitted disease, or

and wishes to

who

initiate routine

good relationship with

have a sexually

has recently become sexually active

may take
An individual who has

checkups and

advantage of several available resources.


a

may

his or her family

testing,

doctor and believes

that physician to be capable of providing objective supportive

care while guarding the patient's confidentiality

may

find this

doctor a good source to seek treatment from.

Often individuals
transmitted

treated

disease

the staff

instances,

more comfortable having

feel

is

many

within a clinic setting. In

thoroughly familiar with

may

problem, and there

a sexually

this

type of

be excellent diagnostic equipment on

the premises as well. Most public health departments run free or


low-cost

STD

They can

symptom information and

also refer individuals to other clinics

which

specialize in particular sexually transmitted diseases.

Many

treatment.

may

provide

clinics that

communities

have other free clinics set

up

expressly for this

purpose. These centers are usually listed in the telephone book,

but

anyone who experiences

number should

difficulty

finding

the

correct

ask the operator for directory assistance.

Other resources include the Planned Parenthood


affiliates located in

forty-two states. In

many

clinics

and

areas these clinics

provide contraceptive information as well as treatment for


sexually transmitted diseases. Usually their staff

members

are

supportive to the patient and nonjudgmental in attitude. There


is

also a

VD

(venereal disease) National Hotline where trained

volunteers provide information regarding sexually transmitted


as

well

as refer individuals to

their areas.

The

toll-free

diseases

fornia call

number

is

treatment centers in

1-800-227-8922. In Cali-

1-800-982-5882.

In most states, a minor does not need parental approval to

be treated for a sexually transmitted disease, and a teenager's

12-

confidentiality

may

believes that he or she

may

mitted disease and feels that

have contracted a sexually trans-

it is

essential that his or her parents

or guardians not be informed, should


to

call

the treatment center

which he or she intends to go and inquire

policy

is

who

be legally guarded. However, a minor

as to

regarding the confidentiality of minors.

what

It is

their

not man-

datory for a person to furnish his or her parents' or guardians'


address in order to be treated for a sexually transmitted disease.

The law

requires that a doctor

syphilis, gonorrhea, or

AIDS

health department. This

is

who

treats a patient for

name

report his or her

to the state

to enable a public health investigator

to contact that person to ensure that

all

of the individual's

may

sexual contacts are notified of the possibility that they

be infected. Also, in

some

states doctors

must report cases of

chlamydia.
Usually these

investigators are quite discreet and

example, they are contacting a minor at home, they

whomever answers

stating to

for

if,

may

call,

the phone something like they

are calling for the school nurse to notify that person that he or

she should

done
and

at

make an appointment

school.

to have a routine hearing test

However, practices vary

in

different

concerned individual has the right to inquire

areas

how

his

or her partner(s) will be notified. Currently, gonorrhea, syphilis,

and AIDS are the only major sexually transmitted diseases which

must be reported by law. However,

since such diseases

often be fatal or result in serious complications


it is

if left

untreated,

essential that every infected person receive treatment

any circumstances, and that


After

all

may

under

parties involved be contacted.

reading this book, anyone

who

suspects

that

he

or she has contracted a sexually transmitted disease should


seek treatment immediately.
as

Anyone who has such symptoms

an unusual or increased discharge from the vagina or penis,

13

pain

sores,

genital

genital area, or

during urination, intense itching in the

abdominal pain should see

a physician for

an

examination.

Many

sexually transmitted diseases are most easily diagnosed

and treated

Even

early.

if

the

initial

symptoms

disappear, the

Someone who has not been treated has not necbeen cured. The early symptoms have simply vanished,
disease may be progressing inside the person's body to a

disease remains.
essarily

but the

more

serious destructive stage. Complications

which may

from untreated sexually transmitted diseases

are

result

infertility,

ectopic pregnancy, and infections and mental retardation of

newborns.

Some

sexually transmitted diseases even result in

death.

Most sexually transmitted diseases can be


and

cured.

Following

measures,

preventive

easily treated

having

regular

checkups, and learning to recognize the symptoms or warning


signs

described in this

sexually

book

active individual.

are the responsibility of every

Each individual must become the

primary guardian of his or her

own good

health.

* * *

This book describes the various diseases that are spread by


sexual activity.
are caused

by

The

first

part of the

a single organism.

conditions or syndromes that

book

covers diseases that

The second section describes

may

be caused by more than one

organism. Diagrams of the male and female reproductive systems


are included in the final portion of the book, along with a

useful glossary.

Symptoms,
disease.

nosis

is

diagnosis,

Symptoms

and treatment are given for each

are the outward signs of the disease. Diag-

the act of identifying the disease. Treatment

to get rid of the disease.

-14

is

the means

Part One

Diseases Caused

By a Single Organism
GONORRHEA
CHLAMYDIAL INFECTIONS
LYMPHOGRANULOMA VENEREUM
SYPHILIS

HERPES
GENITAL WARTS
ACQUIRED IMMUNE DEFICIENCY SYNDROME

CHANCROID
DONOVANOSIS
MISCELLANEOUS

15-

GONORRHEA
known

also

Gonorrhea

is

generally thought to be

as the clap or the dose

among

sexually transmitted diseases in America.


bacteria Neisseria gonorrhoeae

The gonococcus

is

also

the most prevalent

It

known

carried

is

by the

gonococcus.

as the

able to survive only in the moist,

warm

atmosphere of the human body's mucous membranes. The most

common

sites are

the genital organs, the rectum, the inside of

the throat, and sometimes the eye.

Exposure to

light, air, detergent, or

water

sufficient to

is

destroy the gonococcus, which therefore makes

it

almost im-

possible to contract gonorrhea other than through vaginal, anal,

or oral-genital sex with an infected partner.

One of the few exceptions

is

the gonorrheal eye infections

which are most commonly contracted congenitally. When the


newborn's eyes come

in

membranes, the gonococci


can cause blindness
routinely

treat

if

contact with
eat

away

at

its

mother's infected

the eye's lining and

not treated. However,

now

all

hospitals

the newborn's eyes with silver nitrate drops

or erythromycin

to

avoid

this

17-

problem. Eye infections can

also be contracted if a person touches the infected area

and then

puts his or her hand to the eye.

Another exception

may unknowingly

is

that an adult infected with gonorrhea

pass this disease to a very

young

child

by

drying the child with a towel that has been recently soiled with

gonococcal discharge.

may

the discharge

may

disease

times

when

If the adult

be on

still

doesn't realize that

his or her

hands

some of

as well, the

be transmitted through touch. However, somea child develops gonorrhea, sexual abuse

may

be

suspected.

Gonorrhea

is

most

commonly

when

transmitted

mucous membranes of two people touch during

the

sexual contact.

Ejaculation by the male need not occur in order to infect his


partner.

The area of a woman's body most commonly affected by

gonorrhea

is

the cervix. Other areas which

may become

infected

are the urinary passage (urethra), the anus, as well as the Skene's

ducts (two small openings on either side of the urinary tract

which secrete

a fluid to help

keep the urinary opening moist)

and the Bartholin's glands (glands inside the vaginal opening

which secrete
in

a fluid to help

males most

keep the vagina moist). Gonorrhea

commonly occurs

in the urethra, the

narrow tube

within the penis through which both sperm and urine pass.

Due

to the proximity of infection-prone areas of the body,

especially in

women, gonorrhea may

also

be spread from one

region to another through vaginal discharge, sanitary napkins, or

menstrual blood. Anal or oral sex

may

also spread the disease to

the rectum or the throat.

As gonorrhea

is

highly infectious,

any sexual activity with anyone


suspects that he or she

sex with anyone

who

may

who

it

is

essential to avoid

either has gonorrhea or

have contracted gonorrhea. Having

has recently been exposed to an infected

partner jeopardizes the uninfected individual's health.

-18-

SYMPTOMS

number of women who contract gonorrhea experience


no symptoms. In others, weeks or even months may pass until
large

signs of the disease appear.

women who do

However, most

develop symptoms will usually do so between three and twelve

days after being infected.

The
a

earliest

woman

an increased vaginal discharge.

is

sensation during urination

nation

may

common symptom

and most

may

also occur.

reveal that the cervix has

of gonorrhea

in

painful burning

A physician's

become red and

exami-

swollen,

may be coming from it. If the rectum has been


there may be a mucous discharge from the anus.
Defecating may be painful and the stools may be bloody. In
instances where the Bartholin's glands are infected, there may be
and

a discharge

infected,

tenderness and swelling at the vaginal opening.

The

vast majority of

show obvious

rhea

men who become

early

symptoms.

in the male's urethra, there

may be

infected with gonor-

If the

infection occurs

painful urination. There

almost always a discharge. The discharge

may be

is

thin and clear,

or thick, creamy, and yellowish in color.


If left untreated, these

symptoms may disappear within

few weeks. However, although there may no longer be


signs

of the disease,

If

gonorrhea

infected

woman,

is

it

visible

often remains present within the body.

not recognized and treated

serious complications

may

at its

result.

onset in an

The

disease

can spread upward through the vagina, through the cervix and
infect

the uterus and

called pelvic

fallopian

rhea.

The

become

in

many

with pus.

become

(see

page 71). PID

women

with gonor-

inflamed and swollen and

Some gonococci may

-19

is

sexually transmitted diseases

approximately 20 percent of

fallopian tubes

filled

This complication

inflammatory disease, or PID

can be a complication of

and occurs

tubes.

may

even escape from

the tubal area, spilling out into the pelvic cavity. This inflam-

mation may cause the infected individual to experience pain,


fever, vomiting, as well as

length of time

takes for an untreated gonorrheal infection to

it

woman's body may vary

spread upward in a
viduals.

changes in her menstrual cycle. The

among indione month of

greatly

However, PID usually occurs within

acquiring gonorrhea.
Pelvic inflammatory disease carries serious consequences.

fallopian tubes

become

blocked, resulting in

infected and

sterility.

At

The

may become permanently

times, a surgical removal of the

may be necessary and in some


cases the disease has proved to be fatal when left untreated.
Untreated gonorrhea in the male may lead to complications
which affect the reproductive organs. The testicles may swell,
and the infected individual may experience severe pain in his

uterus, fallopian tubes, and ovaries

penis as well

as

develop abscesses within the urethra.

another potential danger which


has gone untreated

is

may

result

from gonorrhea that

scarring in the urethra. Scarring narrows

the urethra, which in turn causes urination to


painful. In

some

which

afflict

become extremely

may

cases, testicular scarring

may result in other


both men and women.

Untreated gonorrhea
tions

cause

sterility.

serious complicaIf the

gonococci

should enter the blood stream, blood poisoning (sepsis)


result.

Once the germs

are at liberty to attack

ments

as

gonococcal

Still

freely circulate in the

any organ

arthritis,

(endocarditis), or meningitis.

in the

may

blood stream they

body, causing such

ail-

inflammation of the heart lining

However,

if

the disease

promptly with the proper medication, such

is

treated

complications

are unlikely

DIAGNOSIS

person

who

suspects that he or she has gonorrhea can have a

culture test or a Gram-stain smear performed. In the culture test,

20-

a doctor uses a

swab to take

infected area and places

environment
ture dish

is

in

sample of the discharge from the

in a culture dish.

it

is

usually sent to a laboratory where

negative, and

it

is

must be treated for the


most cases

If gonococci

If

the test

on men.
In

It

It is

observed for

do not appear, the

positive, that person

is

disease.

a culture test

a fairly accurate

is

diagnosing gonorrhea. The culture test

gonorrhea.

it is

cul-

highly unlikely that the individual

being tested has gonorrhea.

In

a special

is

which any gonococci present can grow. The

twenty-four to forty-eight hours.


test

This

method

for

the main test for

is

always performed on women, and usually

is

more accurate than the Gram-stain

performing

the culture

many

test,

test.

doctors will not

automatically take a specimen from the anus. However,

if

an

individual

who

may have

gonorrhea, a specimen should be taken from the anus

and

practices anal intercourse suspects that he or she

a culture test

performed. Individuals

who practice oral-genital

sex should have a throat culture taken also.

It is

possible to have

gonorrheal infections simultaneously at more than one

site

on

an individual's body.

Another

test,

called the Gram-stain test,

is

perhaps most

commonly used in testing for the disease in males who exhibit


some symptoms. In a Gram-stain test, a sample of the discharge
is

taken with a swab, smeared on a glass

a special dye.

It is

slide,

and stained with

then examined for gonococcal bacteria under

a microscope. Magnified, the bacteria look like a small pair of

attached beads encased within the walls of a

negative Gram-stain

test

the individual that he or she


bility that the

body and

gonococci are

are not yet visible

is

still

safe.

still

There

is

always the possi-

incubating inside the person's

under

a microscope. There's also

the chance that the specimen taken for the


to

cell.

cannot positively assure

Gram

stain

happened

be free of the bacteria even though the person

21-

still

has

Therefore,

gonorrhea.
used in both

the

culture

test

more commonly

is

men and women.

TREATMENT
always best to treat gonorrhea as early as possible before

It is

the disease has had a chance to spread. In most cases, gonorrhea


is

form of

treated with an oral antibiotic, usually a

combined with another


individual

is allergic

antibiotic

tetracycline.

called

to penicillin, he or she

penicillin

may

If an

be treated with

tetracycline alone. Ceftriaxone and spectinomycin have been

found to be particularly effective against


that have

PPNG

become

resistant to tetracycline

some concern and

penicillin.

PPNG

of gonorrhea

penicillin.

At

is

first

a strain of
it

caused

received a great deal of media coverage as

was thought to be incurable. However,

there

and

(penicillinase -producing N. gonorrhoeae)

gonorrhea especially resistant to

that

strains

it

it

has since been found

does respond to ceftriaxone or spectinomycin, so


cause for alarm. Also,

is less

new treatments which may

eventually replace penicillin and spectinomycin are

still

under

development.

follow-up

gonorrhea

is

visit

to a doctor or clinic after being treated for

important to make certain that the treatment has

been effective and the cure


determine when and

if

is

complete. The physician will

further cultures should be taken, de-

pending on individual circumstances. In the vast majority of


cases the medication does work. If the person
it

is

still

has gonorrhea,

usually because he or she has been reinfected

partner

who

is still

infected.

22-

by

a sex

CHLAMYDIAL INFECTIONS

Chlamydial infections are caused by the bacterium Chlamydia


trachomatis.

These

formerly

scarcely

known

infections

are

spreading across the country in epidemic proportions. Chlamydia


is

believed to surpass gonorrhea, syphilis, and herpes as the most

widespread venereal disease in the United States today. At


three million Americans each year

The
tested,

infection
it's

is

become

infected.

spread through sexual intercourse.

though they exhibit


chlamydia

quences. In

rio

is left

it

as well

unchecked there may be serious conse-

women, chlamydia looms among

fallopian tubes

become blocked by

(tubal)

even

symptoms.

the major causes

of pelvic inflammatory disease, or PID (see page 71).

ectopic

When

been frequently found that the sexual partners of

individuals infected with the disease suffer from

If

least

may

pregnancy

If

the

scar tissue, infertility or

result.

Other complications

include miscarriage and premature labor.

Chlamydia trachomatis
urethritis

(NGU)

twice as

common

in

as

men

is

a leading cause

page 76).

(see

gonorrhea

in males,

23-

of nongonococcal

NGU, which
is

is

nearly

an inflammation of

the urethra which can result in sterility

if left

The

untreated.

organism can also be responsible for causing such other conditions as proctitis, a rectal inflammation,

and Reiter's syndrome,

a kind of arthritis.

Chlamydial infections pose

newborns

as

An

well.

risks for

infected

mother may

give birth to an

may

infant suffering from an eye infection, which


blindness.

Or the newborn may have

which may seriously jeopardize the


Chlamydia

is

highly

women and

pregnant

a severe case

infant's

result in

of pneumonia,

life.

infectious disease. Unfortunately,

many of its victims exhibit no symptoms of the disease. In fact,


the name "chlamydia" is derived from the Greek word chlamys,
which means "to cloak."

For some other STDs caused by Chlamydia trachomatis,


to

lymphogranuloma venereum

page 87), and

cervicitis (see

(see

page 79

refer

page 26), epididymitis (see

).

SYMPTOMS
The

infection tends to develop slowly, and at

first

there

may be

few or very mild symptoms. When symptoms do exhibit themselves in males, there
less

may be

commonly, pain upon

a discharge

urination.

The discharge is usually

thick than that occurring with gonorrhea.

an itching or burning sensation

from the penis and,


less

Women may experience

in the genital area, a vaginal

discharge, and dull pelvic pain.

When symptoms

are present, they generally tend to appear

within twenty-one days after exposure. Newborns

may become

infected as they pass through the vaginal canal during birth.

Chlamydia

The

is

the most

infectious

common STD

in

the cells lining the genital tract where


it

newborns.

organism, Chlamydia trachomatis, attacks


it

multiplies.

From

there

spreads to the deeper tissues, slowly provoking a damaging

inflammatory reaction.

-24

DIAGNOSIS
Chlamydia

is

sometimes

difficult to diagnose since

symptoms resemble other

many of the

sexually transmitted diseases, such as

gonorrhea, or because of the lack of symptoms. However,

be positively diagnosed by a specialized culture

test.

it

can

Another

recently developed type of test for chlamydia, called Chlamydia-

zyme, provides

results in

only four hours. Other noncultural

tests are also available.

TREATMENT
Chlamydia
cycline
days.

is

On

scribed. It

is

effectively treated with antibiotics. Usually tetra-

prescribed to be taken orally for a period of several


occasion, erythromycin or sulfa drugs
is

may be

pre-

important to take the prescribed medication for

the full course of treatment.

The

infected individual's partner(s)

treatment period infected individuals should abstain from having


sexual intercourse.

-25-

LYMPHOGRANULOMA VENEREUM
also

known

as

Lymphogranuloma venereum (LGV)

LGV

Chlamydia trachomatis.
like

some other

osis (see

LGV or lymphopathia

is

caused by a strain of

throughout the world, but

exists

Donovan-

sexually transmitted diseases such as

page 52) and chancroid (see page 50),

Only about

in tropical areas.

six

it is

largely

found

hundred cases are reported

annually in the United States.

The
be

disease,

which

transmitted

is

generally

through vaginal,

The most common form of


is

more common

rectal infection in

LGV

anal,
in the

or

in

oral

men, may

intercourse.

United States today

homosexually active men.

SYMPTOMS
The

initial

symptoms may occur

and three months

after

at

any time between one week

an individual has been exposed to an

infected partner, although in most newly infected individuals

the

first signs

In

of the disease appear after about a week.

some people, nongonococcal

manifestation of

LGV.

urethritis

may

be the

In others, a small sore surfaces

26-

first

on the

may

sex organs. This painless blister

or on the inner vaginal walls

appear on the cervix, vulva,

women,

men it commonly exists on the penis tip or within the urethra. Some individuals will not even notice the sore as it is painless, may appear
in

in

an area of the body where

it

is

while in

not readily visible to the

naked eye, and tends to heal and vanish rather rapidly.


However, although the sore may have disappeared,
the infection has

that

certain

spreads to the

lymph

is

not. Within days the disease

which

glands,

it

will

then become swollen

and inflamed.

The

badly inflamed glands

sensitive,

lump on the body, which

a hard, painful

may

bubo. The lymph nodes


covering the

may

bubo may turn

is

merge, creating
referred to as a

be demolished, and the skin

a red-purplish color.

The bubo, which usually appears between one week and


one month following the
ing off a
present,

initial sore, will

good deal of pus. At the stage

appetite, fever, chills,

LGV

may

individuals

afflicted

and pain

also

often rupture, drainat

which the bubo

is

experience a loss of

in the joint areas.

number of complications may


arise. The swollen enlarged lymph vessels in the genital organs
of both men and women may block the normal lymph flow,
If

is

untreated, a

left

causing an extremely large swelling. This condition


as elephantiasis

and

In addition,

is

is

known

often accompanied by severe pain.

if left

unchecked

LGV may

cause pain in the

area of the rectum as well as a bloody anal discharge. However,

many

of these cases are the result of primary rectal infection

and not
tissue

a complication of genital infection. In

formed

in

some

cases scar

the rectum as a result of the disease

may

block normal defecation, causing difficult and painful bowel

movements. In certain instances, surgery may be required


correct the situation.

27-

to

It

may

difficult to

is

arise.

determine when and

if

such complications

The complications described here may

arise as late as

fifteen years after initially contracting the disease.

DIAGNOSIS
The

diagnosis of

some of

its

lymphogranuloma venereum may be tricky

characteristic

as

symptoms resemble those of other

symptoms of some
not transmitted in this manner. How-

sexually transmitted diseases as well as the

other diseases which are

now been

developed

most often treated with tetracycline taken

orally for

ever, specific cultures

and blood

to test for and positively identify

tests

have

LGV.

TREATMENT
LGV

is

three to four weeks.

LGV
as

it

is

often regarded as a stubborn disease to get rid of,

may respond

slowly to medication. Infected individuals

should check back with their physicians periodically after being


treated in order to be certain that their cure

-28-

is

complete.

SYPHILIS
also

Syphilis,

which

pallidum,

is

is

known

known

caused by bacteria

when not

warm, moist environment, and therefore

for an individual to contract syphilis

However,

as

bad blood

Treponema

most often transmitted through sexual contact. The

syphilis bacteria tend to die quickly

as lues or

it

it is

from a

retained within

highly unlikely

toilet seat

or towel.

possible to get syphilis through kissing if the

is

infected person has a syphilitic sore in his or her

mouth which

touches a sore or mucous membrane in his or her partner's

mouth. Syphilis may be spread through

oral sex

and anal sex as

well as genital sex.

SYMPTOMS
The

weeks
at

symptoms of

earliest

after exposure.

However, the

any time ten to ninety days

many

infected

The

first

women

notice no

stage of syphilis

primary stage

is

is

characterized

chancre.

The chancre

syphilis

bacteria

is

two

to six

symptoms may

appear

syphilis generally occur


initial

after contact. Unfortunately,

symptoms

known
by

at

as the

a small,

all.

primary stage. The

open sore known

as a

situated at the precise site where the

originally

entered

-29

the

body. The chancre

usually

inside the body.

if it is

may

not very painful and

is

not be noticed, especially

The chancre usually goes away

four weeks. However, the syphilis infection

is still

in

two

to

spreading in

the body.

The secondary
six

weeks and

disease.

stage of syphilis

months

six

after

The symptoms tend

may erupt anywhere between

an individual has contracted the

to vary

somewhat among

different

people. However, most individuals experience a skin rash characterized

by mildly

the rash

is

raised blotches

painless. It

of a pinkish -red color. Usually

may occur

in a

symmetrical pattern on

dry areas of the body, such as the palms of the hands or the

of the

soles

feet,

or anywhere else on the body. If the rash

should appear on the scalp, patches of hair

When

may

fall

out.

the rash appears on moist areas of the body,

seen as slightly raised round or oval open sores which


a clear liquid.

it

may be

may secrete

Such sores are highly contagious because the

fluid

oozing from them contains syphilis bacteria in large numbers.

may swell and


most commonly affected are

During the secondary stage, the lymph glands

become tender

to the touch. Areas

the groin, armpit, and neck. Syphilis sufferers going through the

secondary stage sometimes experience an overall feeling of poor


health. Fever, headache, a sore throat, loss of appetite, and an

achy feeling occasionally occur during the second

overall

the

If

symptoms of the secondary

stage are left untreated,

may persist for one to six months. However, it is


common for these symptoms to recur within the next

they

two.

If

back

as six

all

of

year or

all

sexual contacts

months.

how any one individual will respond


secondary stage of syphilis. Some people may experience
the symptoms described here, while others may suffer

It is difficult

to the

not un-

an individual learns that he or she has syphilis during the

secondary stage, that person should notify


as far

stage.

to predict

-30

from one or two.


whatsoever.

Still

the

addition,

In

symptoms may vary


If the disease

left

is

The

may

experience no symptoms

severity

among

greatly

syphilis will progress to

latent stage.

others

of secondary

stage

individuals.

untreated during the secondary stage,


its

next phase, which

latent stage

is

characterized

known

is

as the

by what appears

to be the disappearance of any sign of the disease, although the

infected person definitely

The

has syphilis.

still

rash vanishes

permanently, and the infected person looks and


or she

is

feels as if

he

enjoying good health.

After about a year following the


is

disease to others.

However,

istered during this stage,


is

still

the latent stage

remission of symp-

no longer contagious and

toms, the person

the person

initial

it

if a

blood

first

not pass the

test for syphilis

is

admin-

will read "positive," indicating that

infected with the disease.

who

will

An

individual in

finds that he or she has contracted

syphilis should notify all persons with

whom

he or she has had

sexual contact during at least the past year.


It

is

impossible to

know

exactly

how

long any individual

infected with syphilis will remain in the latent stage.


for just a
active

few years or even

damage occurs

certain

to

a lifetime.

the

infected

During

individuals, but approximately

may

last

this stage

person.

what causes the disease to reactivate

It

No one

itself in

no
is

some

one fourth of those with un-

treated syphilis will advance into the tertiary, or late, stage of


syphilis.

The
syphilis

late stage

may

of syphilis

devastating.

The untreated

attack the eyes, lungs, muscles, brain, nervous

system, digestive system,


as

may be

liver,

walls of the blood vessels, as well

other organs and areas of the body.

A gumma,

an internal or external syphilitic sore which

develops during this stage, attacks the body organs and erodes

-31-

them.

may be

the disease

If treated,

stopped

at this point,

the damage already inflicted on the infected person's

but

body

is

irreversible.

At

this point syphilis

quences.

may

It

may

attack the heart with fatal conse-

also destroy certain nerves

brain and spinal cord so that walking

may

and

becomes

also be responsible for a condition

may

affect the

difficult. Syphilis

known as general paresis.

which involves the brain, can lead to insanity or even

Paresis,

death. Individuals afflicted with paresis experience a series of

often very unpleasant hallucinations which progress until they


are entirely cut off

from

reality.

Such individuals become the

of their disease -induced terrifying fantasies. Today,

victims

however, these conditions are

all

very rare.

PREGNANCY
know if a pregnant woman has
contracted syphilis, as she may be capable of giving the disease
to her unborn child. Syphilis may be passed from a mother to
It

extremely important to

is

her fetus regardless of what stage of the disease she

born with the disease suffers from what

is

known

is in.

A baby

as congenital

syphilis.
If

the disease

is

diagnosed and treated prior to the fourth

month of pregnancy,
The

fetus

However,

may
may

is

the baby won't develop any symptoms.

cured simultaneously with

if syphilis is

result, or the

its

mother's treatment.

left untreated, a miscarriage or stillbirth

baby may be born already infected .The

child

not experience the characteristic primary or secondary

stages of the disease but rather

The
before

it

disease

may be born

may remain dormant

advances to the next stage

attacks the

young

child's

with latent syphilis.

for a

number of

(late stage)

years

and furiously

body. However, two thirds of the

-32

infected infants have

week of

life;

symptoms between

Other serious medical problems


to these

women

three

may

extreme consequences

to be tested for syphilis

months

birth defects as deafness,

bone structure, and mental

distorted

blindness,

Due

symptoms by

the vast majority have

Some may be born with such

of age.

the third and eighth

retardation.

develop soon after birth.

it is

advisable for all pregnant

once they learn that they are

going to have a child.

Any

DIAGNOSIS
person who develops

sexually active

or a suspicious rash anywhere on the

The doctor

syphilis.

one

is

a sore

on the

body should be

will take a scraping

genitals

tested for

from the chancre,

if

present. If an individual practices anal and/or oral sex and

has sores in these areas, scrapings from these chancres should be

taken as well. The scrapings are then examined under a microscope for the presence of the syphilis bacteria. However, most

by

syphilis cases are diagnosed


If syphilis bacteria are

blood

present

ined, they will appear as small,

test.

when

moving

the specimen

spirals.

going to have this test performed should

make

is

person

exam-

who

is

certain not to

put any cream or medication of any kind on the sore prior to


seeing the doctor.

on the

sore's surface

Any

person

who

medicated cream

and thereby

test to

individual's blood

blood

destroy the germs

the test results.

suspects that he or she

syphilis should also have a

present.

falsify

may

may have contracted

test to see if the disease

diagnose syphilis

is

used to determine

if

is

the

already contains antibodies to fight off the

disease.

TREATMENT
Penicillin

is

generally used to treat syphilis. Individuals

-33

who

are allergic to penicillin are often treated with tetracycline or

erythromycin taken orally.


Pregnant
treated

mouth

A
and

women who

are unable to take tetracycline are

with erythromycin stearate. This drug

is

taken by

over a period of several weeks.


reaction

chills

with symptoms of fever, headache, nausea,

may occur

within hours after treatment has begun

but usually disappears the following day.

The treatment of
testing to

make

syphilis

requires

certain that the disease

-34

is

follow-up

care

completely gone.

and

HERPES

The venereal virus herpes simplex is a widespread


it is

disease although

not considered as serious as some other sexually transmitted

diseases, such as

gonorrhea or chlamydia.

There are many different types of herpes viruses which affect

both animals and people, making the herpes virus family an


extensive and complex one. However,

when people speak about

herpes, they are usually referring to herpes simplex type

and herpes simplex type

mouth and

(oral),

II (genital).

At one time, herpes simplex type


occur in the

facial area.

was thought

Herpes simplex type

to only
II

most

often appeared below the waist on the genitals, buttocks, and


thighs.

However, today these distinctions no longer hold

Individuals

who

true.

engage in genital sex as well as oral and/or anal

sex are susceptible to contracting both forms of the virus

in

one person

to

either area of their body.

It is

also possible for

contract both forms of the virus.

Herpes has sometimes been referred to as the "love virus"


because

it

is

usually transferred from one person to another

through intimate contact. The infection


kissing or petting as well as

may

be spread through

through sexual intercourse.

-35

During the

infection of herpes, the virus travels to

first

certain tissues in the

body where

it

remains

Oral herpes migrates from the skin or


rest in

in a

mouth

dormant

state.

via the nerves to

the ganglia, or deep nerve centers, situated near the

brain. Genital herpes rests in the ganglia at the base of the spinal

cord.

Usually

when

the

body

infected

is

by

a virus,

antibodies and special white blood cells to

germs. These antibodies and white blood

life,

white

cells

body

viruses

and bacteria, herpes

cell walls that

way they remain unexposed

might contain antibodies and

Factors which

in the

may

and special

However, the herpes viruses

within the body by passing through

tissue fluids that

remain

to manufacture antibodies

against them.

another, and in this

the invading

protecting that individual from reinfection

by these germs. Like many other


viruses stimulate the

cells

produces

sometimes even for the duration

individual's system for years,

of the person's

kill

it

travel

touch one

to surrounding

killer

white

cause a dormant herpes virus to

cells.

become

active and generate another outbreak are generally regarded as

varying forms of stress to the body.

Among

the conditions

frequently believed to be responsible for initiating

new

attacks

are a high fever, severe sunburn, pregnancy, and irritation to

the genital area.

SYMPTOMS
Although the

signs

of a

first

two and twenty-one days

herpes infection

may occur between

after initial exposure to the virus, in

the majority of cases an outbreak will appear two to seven

days after significant exposure.


Within a short period of time,
develop. In

fluid-filled blisters will usually

women, herpes simplex type

II

(genital) lesions are

spread over the external genitalia as well as inside the vagina.

36

Females

with

infected

herpes

urinating. First infections tend to

Males

who have

may

experience

when

pain

be extremely painful.

may

contracted genital herpes

experience

small groups of blisters on or near the penis during an outbreak

of the

virus. In

very severe cases, the penis

may

and the urinary opening

may

swell painfully

narrow, producing pain and some

difficulty in urinating.

The

outbreak of genital herpes

initial

of both sexes

may

in infected individuals

be accompanied by high fever, severe head-

ache, and muscle aches and tenderness.

Lymph nodes

groin usually swell during initial episodes. All of these

however, are

One

uncommon

in the

symptoms

in recurrent outbreaks.

or two days after the blisters appear in an outbreak of

genital herpes, the lesions will burst, revealing a raw, reddish

which

area over

up

a crust or scab

lesions have

It is less likely

formed

scabs.

However, the danger of contracting

never been exposed to the virus

someone who has

is

extremely high

during his or her partner's outbreak. The virus


during

transmitted

During

this period,

individual

may

which

is

"warning

may

at

any time

even be un-

period,"

which

to the outbreak of the blisters.

known

as the

prodrome, the infected

experience nothing more than a mild tingling,

itching, or burning sensation.

contagious and

the

two prior

usually occurs a day or

when

to be transmitted once the

genital herpes through sexual intimacies for

wittingly

scar the skin.

highly contagious during the period

is

the blisters appear.

form. This crust will dry

Such herpes lesions do not

as the lesions heal.

Genital herpes

may

may be

However, that person may

still

be

capable of infecting others at this time,

although no visible signs of the virus have yet appeared. The

prodrome may
although

it

may

also

occur before the

initial

not be recognized as a warning.

37-

herpes attack

The nature of recurring attacks of the


greatly

among

had one

infected individuals.

Some

virus

fortunate people have

sequent outbreaks. However, most individuals


herpes

have

reported

which usually continue for

vary

and have never suffered sub-

episode of genital herpes

tracted

may

repeated

who

attacks

have con-

periodically

several years. Increasing evidence

appears to indicate that the attacks diminish with the passage

of time. Longer time spans


the attacks
result

may

appear

may

less

from recurrent attacks

may be

occur between outbreaks, and

severe as well.
are fewer

The

and often

blisters that

painless.

They

barely noticeable to the casual eye; however, these

lesions are highly contagious nonetheless.

Perhaps the greatest danger of contracting genital herpes

comes from engaging


"silent

carrier."

in sexual activity

with a partner

There are some people

but never show any visible signs of the

who

virus.

who

is

contract herpes

Unless for

some

unusual reason a physician happens to take a virus culture from

them during one of


even

know

their "invisible" outbreaks, they

that they have herpes

at all.

may

never

Unfortunately, they are

quite capable of transmitting the virus to others, and in

still

likelihood their partners will not

become

but will actively suffer from the symptoms of the

may

all

silent carriers as well,

virus.

Women

develop mild blisters on their cervix or deep inside their

vaginal canal

where they can't be seen, while some men who

have contracted genital herpes never notice a sore on the penis;


it is

possible that the virus

Rectal herpes

is

is

carried in their semen.

usually the result of the herpes virus being

transmitted through anal intercourse. This can occur in cases of

both heterosexual as well as homosexual relationships. Although


the vast majority of rectal herpes cases are contracted through
anal intercourse, genital herpes

from the

may be

genitals of infected individuals.

38-

spread to the rectal area

may

Rectal herpes

be extremely painful,

as

the

mucous

membrane surrounding the anal opening and inside the rectum


may become severely ulcerated. Other symptoms may include
itching, chills or fever,

Genital herpes

and swollen glands

may

in the groin.

be spread to other areas of the

also

body through sexual foreplay or masturbation during an obvious outbreak, or by a silent carrier during the period of his or
her "invisible" attack. Genital herpes has been spread in this

manner

abdomen,

to such regions as the lower

fingers, knees,

buttocks, and mouth.

DIAGNOSIS
The diagnosis of

genital herpes

be quite accurate

if

by

a physical examination

who

the individual

may

suspects that he or she

has contracted the herpes virus consults the doctor during the

time when the lesions or

blisters are visible.

The doctor may

gently wipe a blister with a cotton-tipped swab to take a virus


culture or for other tests (for example, a Pap smear,

preparation, or fluorescent
tests

antibody

can detect virus-infected

test).

Tzanck

Sometimes these

more rapidly than the

cells

viral

culture.

Although there are treatments

available that

symptoms and can sometimes shorten


of herpes simplex type

found a cure which

will

or type

II,

may

lessen the

the duration of an attack

medical science has not yet

permanently

rid the

Once herpes has been contracted, the

body of

the virus.

infected individual can

expect periodic outbreaks of the virus at various times for an


indefinite period.

drug called acyclovir has proven to be highly effective

for initial attacks of herpes.

going a

first

When

used to treat patients under-

attack of genital herpes, the drug was

-39

shown

to

shorten the period of pain, itching, and shedding of infectious

Acyclovir

virus.

is

often helpful in speeding healing of recurrent

For persons with very severe or frequent episodes,

attacks.

acyclovir can be taken continuously to prevent attacks.

PREVENTION
It is

important to try to prevent the infected individual's sexual

partner(s)

from contracting the

of the virus should learn


contracting

who

are free

to best protect themselves

from

as well.

who knows or even suspects that he has genital


should use a condom when having sex with someone
free of the virus. A condom can cut down on the inci-

male

herpes

who

it

how

disease. Individuals

is

dences of spreading herpes. However, there

method

effective,

is

no completely

to avoid contracting the virus

if

someone

is

having repeated sexual contacts with an infected partner.

An
genitals

individual with obvious herpes blisters

on

his or her

should never have sex with an uninfected partner.

Infectious herpes virus

from the

first

may

be present in recurring attacks

warning symptoms through the

full

duration

of the lesions and scabs.

There are also laboratory studies underway to develop


vaccines against herpes viruses.

PREGNANCY
Many young women who

fear contracting genital herpes are

concerned about the effect the virus


nancies. If a
is

pregnant,

more

woman
it

is

severe than

may

have on future preg-

contracts herpes for the

first

time while she

generally believed that her infection will be


if

she simply suffers a recurrent herpes attack.

Also, primary genital herpes during pregnancy appears to infect


infants

more often than recurrent

-40-

attacks. While unproven,

it is

suspected that contracting herpes during the

first

few months

may

cause a miscarriage or growth retardation in

A woman who

contracts herpes either before or during her

of pregnancy
the infant.

pregnancy should be closely watched by her obstetrician and

monitored by periodic Pap smears and

done to

that a viral culture be

may

herpes virus which

help the doctor decide

is

is

crucial

test for either active or silent

be present

approximate time the baby

viral cultures. It

in the birth canal at the

to be delivered. This culture will

if it is safer

for the

baby to be delivered

through the vagina or by a cesarean section (the baby is removed


surgically

through the abdomen).

If there's

no indication of the

birth, danger to the

nately, there

contract

is

newborn may be

quite minimal. Unfortu-

no foolproof guarantee that the baby

herpes even

some extremely

virus close to the time of

if

cesarean section

is

not

will

performed. In

rare cases, the virus travels through the placenta

to the fetus prior to the start of labor.

pregnant

woman

with herpes should see her doctor

at

regular intervals throughout her entire pregnancy. She should


also

make

certain

that her doctor

is

fully

informed of her

medical history regarding any genital infections as well as

if

her

partner(s) has had an infection of this nature. This information


will help the

doctor make essential judgements regarding

how

the pregnancy and delivery will be managed in order to best


safeguard the unborn child's welfare.

-41-

GENITAL WARTS
also

known

condylomata acuminata or venereal warts

as

Genital warts are warts which

grow

in the region

of the genitals

and are caused by the human papillomavirus (HPV). Other strains


of the same virus also produce warts in other areas of the body.
Genital warts

mitted

may

diseases.

be one of the most

common

Recent findings indicate that

sexually trans-

HPV may

be

strongly linked to cancer, particularly cervical cancer.

Genital

warts

sexual contact.

of the persons

It

are

most commonly transmitted through

has been estimated that

who

more than 65 percent

engage in sexual contact with a partner

who

has genital warts will develop warts as well. Pregnancy stimulates


the growth of genital warts.

SYMPTOMS
Genital warts, which grow singly or in small groupings,
surface at any time between one and four
individual
partner. In

has had

women

sexual

months

may

after an

contact with an already infected

they often grow near the vaginal opening,

42

on the outer
warts on a

of the vagina, or close to the anus. Genital

lips

man

will

tend to grow on the

tip or shaft

of the

may

be found in

homo-

penis or on the scrotum. Anal warts


sexually

A
penis,

genital wart

which

growing

in

itching.

an area such as the shaft of the

dry and moisture

is

common

the

men. The warts can cause incessant

active

free, will

look very

much

like

type of wart we are used to seeing anywhere on

the body. However, a genital wart growing in a moist region of


the genital area

may

appear as a small, dark pink bump. These

warts tend to grow together, giving the appearance of small


clusters of

Many

bumps.
people infected with

HPV perhaps

not develop visible warts. But they


transmit

it

still

majority do

carry the virus and can

to a sex partner. Genital warts

may

smear in women, producing an abnormal reading.

affect a

Pap

Women may

also be at risk for complications (for example, cervical cancer)

even

if visible

warts never appear.

DIAGNOSIS
Most doctors can diagnose
their appearance.

are

necessary

genital

to

However,

genital warts

by simply examining

special tests (such as a

Pap smear)

detect asymptomatic cases. Everyone with

warts should be treated

as

soon

as possible.

If left

untreated, these warts increase in size and number, and

may

be transmitted to others.

TREATMENT
The treatment determined by the physician will be based on the
size and number of the warts as well as on where they are located
within the genital area. Most cases of genital warts, however, are

43-

treated

by

surgery

is

freezing with liquid nitrogen. Also, removal

commonly

(a caustic agent)

may

use podophyllin as

also be prescribed. Pregnant

it is

treatment

several days. In

necessary to

especially

women cannot

known to induce premature labor and

fetal congenital abnormalities.

successful, the warts will


cases,

can

fall

off within

more than one treatment may be

certain that

all

the warts are gone. If even a

may once again grow and multiply. It


important for women to have an annual Pap smear

few warts are


is

is

most

make

laser

used. Although less effective, podophyllin

even cause miscarriage as well as


If the

by

left,

they

even after successful treatment.


Over-the-counter medications should not be used.

-44

ACQUIRED IMMUNE DEFICIENCY SYNDROME


also

Acquired

Immune

known

Deficiency Syndrome (AIDS)

as

is

AIDS

a highly

publicized disease which has surfaced significantly during the


past several years.

cause of

AIDS

(HTLV-III).

The National Cancer

as a virus called

Similar

Institute in Paris,

associated virus (LAV).


associated retrovirus

human lymphotropic

findings were

where the

virus

The

(ARV).

Institute identified the

reported

virus-Ill

by the Pasteur

was named lymphadenopathy-

virus has also


It is

now

been called AIDS-

believed that HTLV-III,

LAV, and ARV are the same virus.


The AIDS virus attacks and kills certain white blood cells
called T lymphocytes, which help to maintain the body's
natural immune system. The immune system protects the body
from an extensive variety of

immune system
to

diseases.

As

the virus spreads, the

breaks down, leaving the individual susceptible

dangerous infections. The body

is

may cause infection or


which may eventually develop

effectively eradicating foreign cells that

of destroying abnormal

cells

no longer capable of

into cancer.

-45

AIDS
six

may take
symptoms of AIDS

develops slowly over a period of time.

months

to five years or

more before the

appear in an infected individual. So, even

permanently halted today, new cases of

if

It

the disease could be

AIDS

would,

still

appear

for the next five years.

AIDS

syndrome, which means that a number of

exists as a

different conditions

may

by the same underlying

appear which have

cause. So far

all

been brought on

some characteristic patterns

have been identified as being associated with AIDS. Stricken


individuals are often afflicted with unusual infections called

Among

opportunistic infections.
is

the most frequently reported

an infection of the lungs called Pneumocystis carinii pneumonia

AIDS

(PCP).

may also be
most commonly

victims

forms of cancer,

stricken with otherwise rare

Kaposi's sarcoma, a form of

cancer rarely seen in young people in the United States prior to


the
is

AIDS

epidemic. The underlying cause for these conditions

a malfunctioning of the

immune

system, which

is

the essence

of AIDS.

The AIDS

may

virus

also

attack the brain

cells,

causing

mental deterioration with or without other symptoms.

The AIDS

virus

is

most commonly transmitted through

sexual contact, primarily anal intercourse.

found

in

some body

fluids,

The

virus has

been

such as semen and blood. Infection

has also occurred through the use of contaminated hypodermic


needles

and

The AIDS

through

virus

is

of contaminated

transfusions

blood.

not transmitted through coughing, sneezing,

or just by touching an infected individual.

While technically anyone

some
People

individuals

who

fall

are

more

is

capable of contracting AIDS,

likely

to

into this category are

risk groups.

-46-

become AIDS

members of

victims.

certain high-

about 70 to 75 percent of AIDS victims in the United


States have been homosexually active men. About 15 to 20

So

far

percent of cases are in the intravenous drug user group.


Cases of

who

AIDS have

also

been noted among hemophiliacs,

are individuals with an inherited blood clotting problem.

These individuals appear to have contracted AIDS through a


blood factor which entered their bodies through transfusions of

donated blood.
to

It is

now

certain that

AIDS may be

transmitted

anyone through blood transfusions.

The

infants born to mothers having

another group

At

most of the

were intravenous drug

AIDS

is

users.

AIDS

of people with the

still

jeopardy of contracting the disease.

in serious

this point

AIDS comprise

women who

have contracted

AIDS

Others have been sexual partners

virus or

were prostitutes.

generally considered a fatal disease; very few people

have lived past three years following their diagnosis of AIDS.

Recent research has revealed that numerous homosexually

men show

active

degree.

deficiencies in their

As of early 1986,

immune system

to

federal health officials have speculated

that in addition to the already diagnosed persons with

500,000 to
the

AIDS

million or

virus.

loss, fever,

swollen

called AIDS-related

with

this

more Americans have been

may

exhibit such

lymph nodes, or

by

carriers

of

symptoms

diarrhea. This

AIDS,

infected

Some individuals are symptomless

the virus, while others

some

as

weight

syndrome

is

complex, or ARC. The majority of persons

syndrome have not developed any of the

life -threatening

complications associated with AIDS.

Whether or not these individuals who appear


from an early or mild form of AIDS

more

will eventually

serious complications associated with the

unknown

at this time.

Some

develop the

syndrome

studies suggest that

-47-

to be suffering

between

is still

and

20 percent of these individuals may eventually develop overt

AIDS

over a period of months to years.

SYMPTOMS
symptom which will clearly identify an
individual as having AIDS. The symptoms associated with
AIDS relate to the various illnesses that characterize the AIDS

There

is

no one

specific

syndrome.

The

early

symptoms of AIDS may often seem

experiencing a bad cold or


are also seen in less serious

tend to develop gradually.


these

symptoms

several

similar to

many of the same signs


medical disorders. AIDS symptoms
Often AIDS victims were aware of

flu. In fact,

months

prior to their diagnosis, but had

not sought medical attention because they believed that nothing

was seriously wrong with them.

Any

individual

who

is

member

of one of the high-risk groups previously described, experiencing

one or more of the following symptoms, does not necessarily


have

AIDS but

should

seek medical attention for positive

verification.

The

signs to be alert for are

Significant

weight loss of over ten pounds that

is

unrelated to diet or exercise

Swollen lymph nodes or glands


Feelings of fatigue and general malaise
Persistent fevers

Sweating at night

Continuous coughing or shortness of breath


Swelling and tenderness of joints, bruising easily, or

unusual and prolonged bleeding

Headaches, confusion, significant

shifts in personality

Persistent skin irritations or lesions inside the

nose, or anus, or purplish marks or


skin

anywhere on the body

-48-

mouth,

bumps on

the

Persistent diarrhea

Thrush, a thick white coating on the tongue or

in the

throat which persists

TREATMENT
At

this time, there

is

no cure or vaccine for AIDS. Antibiotics

and other drugs are currently used to


tion resulting from

fight each separate infec-

AIDS, but eventually the body's immune

system completely deteriorates.


Research continues on experimental drugs which either
attack the

AIDS

aim

virus directly or

at rebuilding the

immune

system.

One advance

that

antibodies to the

AIDS

There

is

order to gain

has occurred

virus in blood supplies.

a great deal

more

a test that identifies

is

of research which needs to be done

insight into this

still

in

baffling illness.

PRECAUTIONS
In order to reduce the possibility of contracting

AIDS, the

following precautions should be adhered to:

Do

not use recreational drugs-it

use a drug which

is

is

imperative never to

taken intravenously.

Avoid sexual contact with anyone who


drug user or

who

Sexually

has had a large

active

is

an intravenous

number of sexual

individuals

should

limit

partners.

the

number of

their sexual partners.

Avoid sexual contact with anyone suffering from swollen


glands or

who

Be sure to

has any of the

AIDS symptoms

previously listed.

get plenty of rest, proper nutrition, and adequate

exercise.

Use a condom when engaging

in intercourse or fellatio.

Maintain good personal hygiene.

49-

CHANCROID
also

common

Although a

known

as "soft chancre"

disease throughout other regions of the

world, chancroid generally exists in tropical climates and

widespread in the United States. Under

is

not

,000 cases are annually

reported in this country.

The

known

disease
as

is

caused by a miniscule rod-shaped bacterium

Haemophilus ducreyi. The bacterium, which most

often enters the


the genitals,

body through

a scrape or crack in the skin

on

usually transmitted through oral, anal, or genital

is

intercourse.

SYMPTOMS
The

initial

symptoms

generally appear between

two and seven

days after an individual has had sexual contact with an infected

some cases, it may take as long as two weeks


symptoms to surface. Some people contract the

partner. In

for the

first

disease

without showing any


are

visible

symptoms, although such

cases

uncommon.
The

symptom is the appearance of one or more


bumps or pimples in the genital area. In women

earliest

small reddish

-50-

such small blisters generally arise on the cervix, vagina, vulva, or

men

anus; in

the

bumps most

often appear on the penis shaft,

the foreskin, or the anus. The small blisters soon turn into open
sores.

may

Unlike the chancre of syphilis, these sores are painful and

bleed

when touched. Pus emitted from them may

a foul-smelling odor.

the

The

sores

body near or adjacent

thighs,

In

may

give off

spread to other regions of

to the genital area, such as the groin,

and stomach.

many

cases the

such instances there


destruction

indicates

lymph nodes may become

may be

Further complications

of the affected tissues by the disease.

may

lymph nodes, making the


infection

by other

infected. In

painful swelling, which usually

as the

arise

pus drains from the

highly

individual

susceptible

to

bacteria.

DIAGNOSIS
Chancroid

may

a physician.

often be suspected

However, chancroid

upon
is

visual

examination by

sometimes confused with

other genital lesions, such as those found in syphilis or herpes.

A culture

of the chancre should be taken as further confirmation.

TREATMENT
Chancroid

may

be treated differently by various physicians.


erythromycin, trimethoprim

Antibiotics are used, especially

with suflamethoxazole, or ceftriaxone.


sulfa drugs or tetracycline.

Chancroid

Some
is

doctors prescribe

usually considered to

be over once the ulcerous sores have completely healed. However,


as reinfection

should

with this disease

is

common,

infected individuals

be certain to secure a follow-up examination after

being medicated.

51-

DONOVANOSIS
also

known

Donovanosis

as

granuloma inguinale or granuloma venereum

is

generally thought of as a sexually transmitted

disease, although

it

has not been positively proven that the

disease cannot be transmitted in other


is

caused

by

known

bacterium

ways as well. Donovanosis

Calymma to bacterium

as

granulomatis.

The

disease usually occurs only in tropical climates. Less

than one hundred cases have been reported in the United


States yearly, with the majority of these appearing in the South.

SYMPTOMS
The symptoms of the
several days

The

symptoms of the
The

disease

Donovanosis

slowly and often

women

may

appear at any time between

and three months after the

infected partner.
tact with a

disease

earliest

is

initial

contact with an

spread by coming in direct con-

lesion. This infection tends to

some time

grow

elapses before even the initial

disease appear.

symptoms look

like small

bumps or

pimples. In

they usually erupt on the vulva, cervix, or near the anus,

-52-

while in

men

bumps

the small

beneath the foreskin, as well as

The

initial

transform

into

often appear on the penis

in the area

bumps, which are usually


tender

reddish sores.

or ooze pus. At times they


give off a foul odor.

The

may become

tip,

of the anus.
painless at

The

sores

first,

may

soon
bleed

quite painful as well as

sores tend to spread. If they should

spread to the urinary or rectal openings, urination and defecation

may become

quite difficult and painful.

The

painful sores

well as the general tenderness of the immediate area

as

may make

intercourse uncomfortable.

DIAGNOSIS

physician will usually base his or her diagnosis of Donovanosis

on the appearance of the symptoms combined with

a microscopic

examination of the infected tissue to identify the characteristic


bacteria formation.

TREATMENT
Donovanosis

is

usually treated with tetracycline. For individuals

unable to take tetracycline, such as pregnant women, another


antibiotic, ampicillin,

is

commonly

substituted.

Most doctors

prescribe the drug to be taken orally four times a day for a

period of two to three weeks. The ampicillin

is

usually taken

over a longer period of time with the exact number of weeks


being determined by the infected individual's physician. All
infected individuals should return to their doctors for follow-up

examinations after they have begun their course of treatment.

Once the inflammation has disappeared, the


and only the

scars remain, the individual

as cured.

-53-

lesions have healed,

is

generally regarded

MISCELLANEOUS
Pubic Lice, Scabies, Molluscum Contagiosum,
Viral Hepatitis, Cytomegalovirus,

The Genital

Mycoplasmas, The Enteric Pathogens

PUBIC LICE
also known as

crabs or pediculosis pubis

Pubic

miniscule, wingless insects of a grayish

lice are

white color which attach themselves to pubic

on the small blood

vessels in the area

hairs.

by attaching

brown or
They feed

their

mouths

to the hair follicle.

Pubic

lice are difficult to see

may appear

to be a speck of dirt or a flake of skin, but

removed from the pubic

may be

with the naked eye. Often they

visible.

Although

movement of

area,
lice

when

the insects' legs

generally attach themselves to

pubic hair, they can also exist on other hairy parts of the body,

such as the underarms, eyebrows, or the hairy areas of the chest.


Pubic

human
for

lice die

host.

within twenty-four hours unless attached to a

When

attached to a

human body,

they will survive

approximately thirty days. They mate with tremendous

frequency and lay up to three eggs a day. These eggs,


nits, are oval

known

as

shaped and of a grayish-white hue. They are usually

found attached to the hair shaft close to the skin (near where

54

the hair

touches the skin) and will hatch

follicle

mately nine days after they are

laid.

in approxi-

Once hatched,

new

these

begin to reproduce after seventeen days.

lice will

Pubic
another.

may be

lice

They

easily transmit

a couple

if

pubic

may

from one individual to

most often transmitted during sexual

are

course however,

easily transmitted

were nude, an infested person could

to his or her partner through a close

lice

up from

also be picked

caress.

Lice

articles

of clothing, or even occasionally from a

has been infested with

inter-

lice

a towel, bedding,

which

toilet seat

or their eggs.

SYMPTOMS
symptom of pubic

Perhaps the most noticeable


itching in the pubic area.
is

brought on by an

It is

The
area,

itching

lice

may

which provides

itching sensation. In

mild

which the

Although most infested individuals

develop this reaction, there are


not unusual to have

is

generally thought that the itching

allergic skin reaction to the saliva

secrete as they feed.

lice

lice

many

people

who do

not, so

it is

and be symptomless.

often cause infested persons to scratch the


little relief

and

some people,

may

in fact

lice

may

intensify the

cause a slight rash

of small, bluish dots.

DIAGNOSIS
There are no specialized medical

They may

easily

tests to

diagnose pubic

be diagnosed visually upon inspection by a

physician. However, as an initial infestation

than ten
it is

lice,

they

lice.

may be

may

involve less

difficult to locate at the start.

Often

easier to see the nits.

TREATMENT
Treatment for
infested

lice

clothing,

entails

ridding

the

body

bed linen, towels, and

-55

as

toilet

well

as

any

seats of the

lice

may prescribe a lotion,


cream which contains gamma benzene hexachloride,

or their eggs. For the body, a doctor

shampoo, or

such as Kwell. This medication

However,

kills

the

lice

and their

eggs.

has some disadvantages and should not be used on

it

small children, pregnant

women,

or individuals with lesions on

the scrotum.
If

the prescribed

shampoo or

lotion

number of over-the-counter remedies


most drugstores or pharmacies.

recommend

is

that

not used, there are a

may be purchased

pharmacist

is

at

qualified to

one.

Since lice can survive for a time on towels, clothing, bed


linens, as well as

on other

articles

of

this sort,

be laundered. Once separated from a

up

live for

to

human

such items must


host, lice

twenty -four hours. The separated eggs

within seven to ten days.

Any

article

will

may

hatch

suspected of being infested

should be washed well in hot water or dry cleaned. In addition,


the toilet and toilet seat should be thoroughly scrubbed with a
strong disinfectant.

* * *

SCABIES
Scabies

is

a contagious skin infection caused

Scarcoptes scabiei.

burrows

It

is

by the

parasite

a tiny, white, eight-legged mite

in the skin to deposit eggs.

Although scabies

is

which
trans-

mitted through sexual contact and has recently become quite

common on

the external genitals,

through nonsexual contact

it

may

be passed to others

as well. Scabies

is

often found in

children, usually in the skin around the wrists,


fingers,

and on the elbows.

56-

between the

SYMPTOMS
An

individual with scabies

red

bumps

are present

may

on the

experience severe itching. Small

skin.

The

rash

is

usually prominent

and can occur anywhere, but most often on the hands, lower

abdomen, and

vaginal area.

DIAGNOSIS

An

experienced physician often can diagnose scabies by the

appearance of the rash. However, to be certain, the mite must

be extracted by scraping

it

from the

skin and then

examined

under a microscope by a physician.

TREATMENT
To rid

the

body of scabies, a shampoo, lotion, or cream containing

gamma benzene
scribed.

It

two weeks

hexachloride, such as Kwell,

should be noted that itching

may

is

usually pre-

persist for

one to

after successful treatment.

* * *

MOLLUSCUM CONTAGIOSUM
Molluscum contagiosum
small,

is

a condition

smooth, white raised bumps

which

is

characterized by

or growths on the genital

organs of both males and females. The bumps, which often have
a depression in the center,

The

disease

is

may

appear in

caused by a virus.

It

clusters.

may

be transmitted

in

ways other than through sexual contact, such as through


various forms of close contact as well as in swimming pools.
In

fact,

previously

most victims of molluscum contagiosum

were children who showed evidence of the disease


areas of their body.

-57-

in

other

However,

in recent years there

has been a marked increase

of molluscum contagiosum appearing on the genitals of adults,

who

usually acquire the disease

by sexual contact.

SYMPTOMS
Molluscum contagiosum
symptoms. The

initial

is

painless

and

exhibits

no other

bumps may appear anytime between

twenty -one and ninety days after exposure, although there have
been instances

in

which a longer period of time elapsed.

DIAGNOSIS
The

disease

is

recognizable to a physician

by the appearance of

the small bumps.

TREATMENT
Many

doctors prefer not to treat molluscum contagiosum, as the

disease
as

it

sometimes tends to disappear by

appeared. However,

it is

itself as

mysteriously

usually treated in adults to prevent

spreading of the disease. Molluscum lesions

may be

scraped off

with a surgical instrument called a curette. In some cases, medication

may

be applied to prevent recurrences.

* * *

VIRAL HEPATITIS
Hepatitis
viruses

is

may

ways they

an inflammation of the

liver.

Although the hepatitis

be contracted through a variety of modes, one of the

by sexual transmission.
number of different viruses that cause the

are acquired

There are a

is

spread of different forms of hepatitis.

-58-

The

various forms of

hepatitis

may be

may be

similar in the

symptoms produced,

yet they

transmitted in different manners.

One form of hepatitis is called hepatitis A or infectious


hepatitis. The virus is present in the feces of infected persons and
can easily be spread through anal-oral sex or other forms of
sexual contact which

amount of

may

involve ingesting even a miniscule

However, the

feces.

vast majority of hepatitis

cases are contracted through such nonsexual

means

as eating

food or drinking water which has been contaminated by sewage.


It

can also be transmitted through food which has been contam-

inated

by an individual infected with the

Another form of
be

hepatitis

through

transmitted

is

called hepatitis B. This

blood

needles, as well as through

all

disease.

form may

contaminated

transfusions,

the bodily fluids, such as

saliva,

semen, perspiration, urine, menstrual blood, and vaginal

secre-

B may be

easily

tions of an infected individual. Thus, hepatitis

transmitted through sexual intercourse. Although hepatitis B

may be contracted by anyone regardless of gender, statistically,


men are more likely to be the victims. This appears to be particularly true for

homosexually active men. There

permanent

damage and

liver

liver

is

a risk of

cancer as late complications of

the disease.

There are different forms of hepatitis caused by viruses

which are neither


deal

is

knowmabout

nor B, but at the present time not a great


these types of viral hepatitis.

SYMPTOMS
The symptoms of

hepatitis

depending on the individual


a mild

may vary from mild to severe,


case. Some people who suffer from

case of hepatitis claim that they feel as though they

simply have a bad case of the


include

chills,

fever,

flu.

general

More

feeling

-59-

severe

symptoms may

of weakness, nausea,

an itching sensation, and a condition

known

as jaundice, in

which the skin and whites of the eyes take on


hue. If the infected individual should

her urine

become

may

a yellowish

become jaundiced,

his or

may

turn brownish; occasionally the stools

a light gray color. Severe cases

of hepatitis

may

result

in death.

large percentage of people

who

contract hepatitis never

experience any symptoms. However, these individuals are

still

capable of transmitting the disease to others through sexual


contact and other means.

DIAGNOSIS
If

an infected individual experiences jaundice, the yellowish

tint

of his or her skin

that the patient

is

will usually lead a physician to suspect

suffering

from

hepatitis.

who contract
may not set in.

imately half of the people


cases during
If

which jaundice

However, approx-

hepatitis have mild

an individual suspects that he or she has hepatitis or has

been exposed to the disease, that person should see a doctor.

Through the use of blood

tests,

type of hepatitis the individual


extent of

liver

the doctor can determine what


is

suffering

from

as well as the

damage.

TREATMENT
The only cure

for hepatitis

is

plenty of rest and nutritious food.

People suffering from hepatitis

much of the
in

time, so although

bed continuously,

it

is

it

may feel weak and exhausted


may not be necessary to remain

important for the infected person

to rest.

Although one's appetite tends to diminish during a bout


of hepatitis,

it

is

important for the infected individual to

continue eating, as nutrients for the body are essential


time.

Some people

prefer to eat small meals

60-

at this

numerous times

throughout the day


meals.

It

is

if

they don't

important not to take any type of medication or

ingest even small

amounts of alcohol

may

approved by a doctor. Liquor


so
to

it

feel able to tackle three large

until

such actions have been

potentially

might be necessary to wait up to

six

harm the

months or even longer

drink alcohol, depending on the individual

again

liver,

set

of

circumstances.

PREVENTION

highly effective vaccine

perfected.

It is

to

prevent hepatitis

currently used in the United States to immunize

hospital workers and other medical personnel


at high risk

vaccine

is

B has been

who are considered

of contracting the disease. Most importantly, the

recommended

for homosexually active

men and

partners of people with chronic hepatitis B. There


hepatitis

B immune globulin

for people

who

is

for

also a

have had recent

exposure to someone with hepatitis B.


If

an individual knows that he or she has been exposed to

hepatitis A, that person

disease

by seeing

may be

a physician

serum globulin (ISG) soon

known
disease, it may

able to avoid the onset of the

and getting an injection of immune


after the initial exposure.

gamma

If the

globulin, does not fully

shot of ISG, also

as

prevent the

lessen the impact and severity of the

symptoms.
Hepatitis
it is

is

most dangerous

for a pregnant

woman when

contracted either very early or very late in her pregnancy.

Early on

it

increases the risk of spontaneous abortion, while

much later it may induce early labor. As immune serum globulin


may be taken by pregnant women without risk to either themselves or to the fetus, any pregnant woman who has been exposed
to hepatitis should seek medical attention immediately.

* * *

61

CYTOMEGALOVIRUS
(CMV)

Cytomegalovirus

herpes virus family.

infection

is

caused by a

member of the

may

be transmitted

an infection which

It is

through sexual contact as well as other types of contact.

been found

in

It

has

the urine, saliva, blood, cervical secretions, semen,

and breast milk of infected individuals.

The

severity of

CMV

infection depends a great deal

age and health of the infected individual.

The most

on the

severe cases

who become infected through the placenta


before birth. Infection may spread to the central nervous system
and liver and cause death in utero. Infants may also become

are found in fetuses

infected either during delivery

by

inhaling the infected mother's

cervical secretions or shortly after birth

milk.

Infants

disabilities,

most

may be born

from infected breast

with mental retardation, motor

hearing loss, or liver disease. Congenital

significant viral cause of

mental retardation

CMV is the

in infants.

SYMPTOMS
Most

adults with

when symptoms

CMV

infection have

no symptoms. However,

occur, they are similar to those of infectious

mononucleosis, with fever and swollen lymph glands.


individuals

with

problems. Severe

CMV
CMV

also

experience

sore

throat

Some

or liver

infections in adults are rare and are

usually found in individuals

who

already have other types of

debilitating diseases.

In children,

and

is

CMV

infection

is

almost always asymptomatic

usually shed in urine and saliva for several

harm to the

months without

individual.

DIAGNOSIS

CMV

infection

semen,

saliva,

is

diagnosed by identifying the virus from urine,

blood, cervical secretions, breast milk, or tissues

of infected individuals.

culture test

-62-

is

usually performed.

TREATMENT
no treatment for cytomegalovirus infection. Testing
continues on various drugs and vaccines, but most cases of CMV

There

is

infection are mild and the

symptoms go away by

themselves.

* * *

THE GENITAL MYCOPLASMAS


The mycoplasmas
including
urethritis.

pelvic

are organisms

which cause

inflammatory

disease

The mycoplasmas which

disease are Ureaplasma urealyticum

by

Infection

genital

pass through the birth canal.

In

men,

also be

genital

and

of diseases

nongonococcal

usually cause

human

genital

and Mycoplasma hominis.

mycoplasmas usually occurs through

sexual contact. However, infants

the nose and throat of

a variety

some

may become

infected as they

Mycoplasmas have been found

in

infants.

mycoplasmas

infect the urethra.

They can

found under the foreskin of uncircumcised men.

In

women, the genital mycoplasmas are often found in the vagina.


The symptoms associated with genital mycoplasmas vary
depending on the disease caused by the mycoplasma. The
presence of genital mycoplasmas can be determined through
culture tests.

Treatment for infection with genital mycoplasmas depends

upon the syndromes


sible. In cases

urethritis,

for

which the mycoplasmas may be respon-

of pelvic inflammatory disease and nongonococcal

tetracycline

is

used. If the disease

is

resistant

to

may

be

tetracycline, other medications such as erythromycin

prescribed.

63-

THE ENTERIC PATHOGENS


The

enteric pathogens are bacteria, viruses,

which cause inflammation of the

and other organisms

intestine

and rectum. The

enteric pathogens are an important cause of diarrheal disease.

Enteric pathogens were once associated with contaminated food

now

or water, but

these organisms have been found to be trans-

mitted through sexual contact as well. The most

of sexual transmission

is

common form

through oral-anal contact. Homosexually

men are increasingly infected by the enteric pathogens.


Four common enteric pathogens shigellosis, Campylobacter,

active

giardiasis,

and amebiasis are described below.

Shigellosis
Shigellosis

is

an intestinal infection. Although

it is

usually not

serious, severe cases of shigellosis, also called bacillary dysentery,

may

be characterized by abdominal cramps, diarrhea with blood

and mucus,

fever, nausea,

asymptomatic infections of

and vomiting. However, mild and


shigellosis are

common. The

infec-

tion usually lasts an average of four to seven days.


Shigellae, the disease organisms,

may

be transmitted through

sexual contact, especially in homosexual men. Most cases in

other persons, however, are acquired through nonsexual means,


primarily through contaminated food or water. Shigellosis
also be acquired

by infants during

birth.

two phases. The

Shigellosis often occurs in

one to three days, and an individual


cramping,

abdominal

second phase

may

individual

may

diarrhea,

last for several

usually absent but the

and the feces

pain,

may

phase

lasts

experience fever,

and dehydration. The

weeks. In this phase, fever

is

increases

contain bright red blood and mucus. The

lose weight

the

may

first

number of bowel movements


and

feel

during defecation and urination

may experience

may

first

is

weak

in this phase. Straining

common. Some

phase but not the second.

-64

individuals

In children with shigellosis, high fever and convulsions

may

be major symptoms. Headache, delirium, drowsiness, and other


neurologic

symptoms

are

common

in children

although they are

rare in adults.
Shigellosis

diarrhea.

severe

usually suspected in any patient with fever and

is

Blood and mucus

type of

shigellosis,

in the feces

bacillary

may

indicate the

dysentery.

The

more

diagnosis

should be confirmed through culture tests which isolate the


disease organisms.
Shigellosis

is

treated with antibiotics such as ampicillin or

combination

the

of

sulfamethoxazole

Although the disease organism

body within two weeks,

is

and

trimethoprim.

usually excreted from the

antibiotics decrease the duration of

diarrhea and other symptoms. Antidiarrheal medications should

not be used.

An

individual with shigellosis should drink plenty

of fluids to prevent dehydration. Sheets and bedclothes which

may

be infected should be cleaned or discarded.

Individuals
until

the

with

infection

shigellosis
is

should

avoid

sexual

contact

Sexual partners should also be

gone.

examined.

Campylobacter

Campylobacter infections are


intestinal disease.
in

humans

is

common

cause of diarrheal and

The bacterium which causes intestinal infection

called

Campylobacter fetus subspecies jejuni.

Campylobacter infections

are often spread through sexual

contact which involves intake of fecal matter, but they are most

commonly

acquired

through contact with infected animals,

eating inadequately cooked poultry or beef, or drinking unpas-

teurized milk or contaminated water.

The most common symptom of Campylobacter is diarrhea,


which may be preceded by one to two days of fever, nausea,

65

headache, backache, vomiting, or abdominal pain. Bloody diar-

mucus may be seen in some cases. Without


treatment, symptoms usually last about seven days. Some

rhea or diarrhea with

individuals with Campylobacter infections have

Campylobacter fetus
through culture

subspecies jejuni

no symptoms.
can

be detected

with

appropriate

tests.

Campylobacter

infections

are

treated

antibiotics such as erythromycin or tetracycline. Since

tomatic infections are

common,

asymp-

sexual partners of individuals

with Campylobacter should be examined to prevent spread of


the disease.

Giardiasis
Giardiasis

is

protozoan infection caused by the organism

Giardia lamblia. Giardiasis usually occurs in the small intestine

and

is

often asymptomatic. However,

it

may

also

be associated

with symptoms such as diarrhea, abdominal pain, bloating,


fatigue, weight loss,

and nausea.

Among homosexual men, giardiasis


mitted

is

usually sexually trans-

through oral -anal contact. Children and heterosexual

adults usually

become

infected through ingesting contaminated

food and water.

When symptoms are present, the most common one is


diarrhea which may last ten days or more. Sometimes the diarrhea
is accompanied by nausea, vomiting, and fever. Giardiasis may
last six

to seven weeks.

Diagnosis of giardiasis

is

made through examination of feces

for the disease organism. Usually,

more than one


Giardiasis

quinacrine

it

is

necessary to examine

fecal specimen.
is

treated with antigiardial medications such as

hydrochloride

or metronidazole.

66

Amebiasis
Amebiasis

ameba

is

an infection caused by a species of intestinal

Entamoeba

called

occurs in the intestine, but

histolytica.
it

may

The

infection

spread to the

liver

usually

and lungs.

may be transmitted through sexual contact


matter may be ingested and is a common STD

E. histolytica

which

fecal

homosexual men. As

in the case

in
in

of other intestinal infections,

however, most infections in heterosexual adults and children are


acquired by nonsexual means, especially contaminated water.
In areas where nutritional and hygienic conditions are good,

amebiasis

may

occur without symptoms. However,

in

areas

where sanitation and nutrition are poor, amebiasis may cause


serious disease and death if untreated.

Symptoms include diarrhea

which may be bloody or streaked with mucus. Fever,


cramping, and abdominal pain

may be

may

chills,

be present. The diarrhea

alternated with periods of constipation and

may

last

for

one to four weeks. In severe cases of amebiasis, diarrhea may

may

occur up to eighteen times a day and

be accompanied by

weight loss and anemia.

Amebiasis should be suspected


especially

when

in cases

of severe diarrhea,

the feces contain blood or mucus. However, the

diagnosis of amebiasis depends

on the microscopic identification

Some

and/or isolation of E. histolytica from the feces.


diarrheal

medications

detection of E.

and

histolytica.

other

substances

interfere

anti-

with

Thus, a history of medications

should be obtained for individuals being tested for amebiasis.

Symptomatic infections of amebiasis should be treated with


metronidazole. Asymptomatic infections should be treated with

diiodohydroxyquin or metronidazole. Once treatment


fecal

specimens should be examined

three

months

in

to be certain the disease

-67-

is

one-month
gone.

is

finished,

intervals for

Part Two:
Diseases Caused
By More

Than One Organism


PELVIC INFLAMMATORY DISEASE
NONGONOCOCCAL URETHRITIS
CERVICITIS
VAGINAL INFECTIONS
EPIDIDYMITIS

69-

PELVIC INFLAMMATORY DISEASE


also known as PID or salpingitis

Pelvic inflammatory disease (PID)

is

the general term used to

describe inflammations of the organs in the pelvic region.


a disease

which

It is

women. PID is the most common


women and among the most serious.

affects only

STD in
It is the most common cause of infertility in women.
Numerous organisms may be responsible for causing PID,
some of which may be originally transmitted to the vagina
complication of

through sexual intercourse. PID

by other sexually transmitted


dia and gonorrhea.

is

almost always directly caused

diseases,

most commonly chlamy-

The organisms which cause

ly transmitted diseases,

these other sexual-

such as chlamydia trachomatis and the

gonococcal organism, travel up from the vagina or cervix through

may fill
ovaries. It may

the uterus and into the fallopian tubes. The infection


the length of the tubes and
also

spill

out to infect the

pour out into the pelvic cavity.


Generally, a

woman's

cervix serves as a natural barrier to

prevent bacteria in the vagina from travelling upward to the


pelvic organs.

the cervix.

However, with PID, the bacteria manage

It is still

known how these organisms are transregion, but it may be possible that they are

not

ported into the pelvic

to enter

-71-

by sperm

transported

of gonorrhea

to the uterus and tubes.

commonly

attach themselves to

In addition, the cervical canal

is

The gonococci

human

slightly dilated

sperm.

each month

during a woman's period to allow the flow of menstrual blood.

The

bacteria responsible for gonorrhea thrive extremely well

on menstrual blood, and the

by gonorrhea often appear

initial

for the

period. Thus, menstrual blood

symptoms of PID caused

first

time following a woman's

may be

these organisms. But transportation

another transporter of

by menstrual blood and

sperm are possible only for gonococcal PID and not other
types of PID.

Women who

use intrauterine devices (IUDs) as a form of

contraceptive run a

much greater risk

of getting PID than

women

who do not use them.


When the infection spreads through the fallopian tubes, there
may be a great deal of pus created as the body attempts to
defend

itself against

the invading organisms. As bands of scar

come

may

form within the tube, the tube

tissue, called adhesions,

be-

either partially or completely blocked. These blockages

are called tubal occlusions.


If

the infection also exists in the pelvic cavity as well as in

the tubes, adhesions or pelvic abscesses


abscesses

may

form.

Any of these

rupture and damage or destroy the tubes.

Further complications
are

may

may

also arise if extensive adhesions

formed which block the movement of the tubes

as well as

other organs in the pelvic area. Tubal blockages, abscesses,

adhesions involved in cases of PID

extensive
infertility

or

sterility for

may

and

result

in

the infected individual.

SYMPTOMS
PID symptoms may vary depending on the type of bacteria which
,

is

initially

responsible for the infection. Other factors which

affect the type

and severity of PID symptoms

72-

are the strength

of the particular strain of the infectious bacteria, the particular


organs which are affected by the spread of the disease, and the
effectiveness of the infected

woman's bodily

resistance to the

disease.

Some of
are

the

more common symptoms

low abdominal

associated with

PID

pains, cramps, fever, chills, backaches, vaginal

abnormal menstrual bleeding, frequent urination,

discharge,

cramping of abdominal muscles, and nausea. These symptoms


will usually range

or appear

at

all

especially that

from mild to severe and may develop gradually


once without warning. However, some PID

due to chlamydia may be symptomless, and yet

lead to infertility due to tubal blockage.

still

DIAGNOSIS

woman complains of the symptoms outlined above, her


physician may suspect that she has pelvic inflammatory disease.
An internal examination may show pus dripping from the

If a

cervix.

physician will usually take a sample of the discharge

and perform

a culture test. This

exactly which type of germ

is

that he or she can prescribe the

may

help the doctor to isolate

responsible for the infection so

most

effective medication.

The diagnosis of PID may sometimes be


disease

may

easily

be mistaken

for

tricky, since the

number of

different

conditions, such as appendicitis, an ovarian cyst rupture, or

an ectopic pregnancy (tubal pregnancy).


Mild cases with few symptoms tend to disguise the
risk involved

with PID. Even though the

woman may

experiencing severe discomfort at any given


tion

still

exists in her

body and may

real

not be

moment, the

infec-

later cause painful attacks

or even more serious consequences.

Doctors
cases that

may employ

ultrasound or X-ray examinations

present special diagnostic difficulties. In

stances, the only

way

some

to be assured of a definitive diagnosis

73-

in

inis

through a laparoscopic examination. In such cases a small


surgical incision

is

made

abdominal wall through which

in the

specialized viewing instruments are inserted.

TREATMENT
Many

authorities agree that individuals with pelvic inflammatory

disease should be hospitalized


ly.

However, many doctors

treat mild cases

of PID with oral

and tetracycline are most commonly

Ampicillin

antibiotics.

and given antibiotics intravenous-

prescribed

The

disease should be treated as early as possible, for although

the spread of the disease


cases the

may be checked

damage already caused

body may be beyond

repair. It

dose of medication for the

is

full

at a later stage, in

some

to the infected individual's

important to take the entire


period of time prescribed in

order to prevent flare-ups and reduce the chance of infertility.

The infected
until

about

her

fever

may

individual should also try to remain in bed


is

gone

jar the uterus

and

the

pain has

ceased.

Moving

and tubes, further aggravating the

inflammation.

Throughout treatment the patient should drink plenty of


water to prevent dehydration, especially

if

fever

is

should not engage in sexual intercourse while she

As such sexual contacts may move the

is

some

cases,

born bacteria

PID may turn

may become

recovering.

pelvic organs, there

ways the danger of spreading pus throughout an even


In

present. She

is al-

larger area.

into a chronic condition. Stub-

sealed off

by adhesions or

lie

deep

within pelvic abscesses where they cannot be fought by the


antibiotics given to treat the disease. In these cases,

possible to operate and drain the abscesses. If this

is

it

may be

not possible

and antibiotics taken both orally and intravenously have not


been successful, a hysterectomy
infected

individual

may

be necessary to relieve the

of chronic pain and infection. In some

more-severe cases, uterus, tubes, and ovaries

74

may be removed.

woman

However, a

should

first

explore

all

other alternatives

with her physician before consenting to such procedures. In

some

instances,

it

may be

removed while allowing


early

possible to have the uterus surgically

at least

one ovary

to remain to prevent

menopause This may grant the woman relief from the pain
.

All

women become

susceptible to repeated infection, and at

may flare up into very painful,


Therefore, women should take some

times these smoldering infections


acute

attacks

of PID.

preventive measures to try to avoid a recurrent attack. Medical

treatment should be obtained for


first

sign

vaginal infections at the

of symptoms. Gonorrhea and chlamydia cultures

should be taken routinely


contacts warrants them.

if

If a

the nature of a

woman

pelvic infections, a birth control


is

all

woman's sexual

has suffered from previous

method other than the IUD

recommended.
All sexual contacts of an infected individual should also

be treated, and follow-up cultures should be taken to prevent


repeat infections.

75-

NONGONOCOCCAL URETHRITIS
also known as NGU or nonspecific urethritis (NSU)
Nongonococcal

urethritis

(NGU)

thra, the tube that carries urine

is

an inflammation of the ure-

from the bladder.

It is

usually

caused by the bacterium Chlamydia trachomatis (see page 23) or

NGU

Ureaplasma urealyticum.

Americans each year and


mitted disease in men.

is

infects

the most

NGU is at least

more than

three million

common sexually transtwice as common as gon-

orrhea in men.
This disease
sensation
is

is

characterized

upon urination or

by

a mildly painful burning

a discharge

from the urethra.

NGU

usually transmitted through sexual intercourse with a partner

who

is

already infected with the disease-producing organisms.

The

disease

have

come

may
in

also

be transmitted to the eyes by hands which

contact with the NGU-producing organisms and

which have not been thoroughly washed.

SYMPTOMS
The symptoms

in the male, painful urination

and a discharge,

are similar to those of gonorrhea but in general less severe. In


fact,

an individual infected with gonorrhea who has been suc-

-76-

cessfully treated for the disease but

who

urination and a watery discharge

is

NGU known

still

experiences painful

likely to have a

postgonococcal urethritis, or PGU.

as

form of

Its

name,

postgonococcal urethritis, implies that the condition appeared


after the gonorrhea. Usually,

however, the organisms responsible

for the

PGU

vidual's

bout of gonorrhea. As the incubation period for

is

were present

throughout the

in the urethra

longer than that of gonorrhea,

its

NGU

symptoms may not have

appeared until after the gonorrhea had been cured. The

was not cured along with the gonorrhea

mycin were used


effective against

the gonorrhea,

patient

as the treatment.

PGU. However,

PGU will

if

PGU

penicillin or spectino-

These medications are not


tetracycline

if

indi-

is

used to treat

not occur.

DIAGNOSIS
who complains of a burning

sensation

upon

urina-

tion as well as a urethral discharge will generally be tested for

gonorrhea by a physician.

If the tests indicate that

gonorrhea

is

not present, then the doctor will usually assume that the patient
is

suffering

from NGU.

In addition, a test to detect Chlamydia trachomatis in the


urethral discharge should be performed.

TREATMENT
have been found to be effective in

NGU. Several drugs


combating NGU. The most

commonly

tetracycline.

Antibiotics are usually prescribed to treat

is

prescribed medication

is

Erythromycin

also used.

The majority of
nongonococcal

cases are cured within seven days. In treating

urethritis,

it

is

essential to take the full dosage

of medication prescribed for the entire period indicated. The

symptoms may disappear before


and

if

the medication

is

the infection

is

fully cured,

discontinued at this point, the infection

-77-

may

return in

full

force.

During the course of the treatment,

alcohol should be avoided, as


All

it

may

further irritate the urethra.

sexual contacts of the infected individual should be

notified and receive treatment immediately. This

order to prevent reinfection. Treatment for


portant as

it

is

for

men

is

essential in

women

since complications of

NGU

is

as im-

are

more

common in women than men.


Women are capable of unknowingly carrying and transmitting the organisms that produce NGU. These organisms in pregnant women may cause eye infections in newborn infants. If
the

NGU

transmitted to a male partner

trachomatis, the long-term effects

is

caused by Chlamydia

may be

devastating to the

female as this organism can also cause PID (see page 71).

Other complications which

may

result

from untreated

NGU

are epididymitis (see page 87), Reiter's syndrome, sterility, and


proctitis,

an inflammation of the rectum.

-78-

CERVICITIS

Cervicitis

is

an inflammation of the cervix.

It is

believed to be

caused by Neisseria gonorrhoeae, Chlamydia trachomatis, or


herpes simplex virus.

The organisms which cause

cervicitis are usually transmitted

through sexual intercourse. However, pregnant


cervicitis

caused by the herpes virus

may

with

transmit the organisms

to their infants during the birth process.

herpes lesions at the time of delivery

women

may

Women

with active

consider delivery by

cesarean section.

SYMPTOMS
Cervicitis has

been

poorly understood infection since the cervix

normally changes over the reproductive period and during the


menstrual cycle.

It

may

be difficult to distinguish between

normal changes and changes resulting from infection. Also,

symptoms

are often absent.

Many women

with

cervicitis

have a

completely normal cervix upon physical examination.

When symptoms are present, they are often not associated


with cervicitis. Some women with cervicitis have a vaginal dis-

-79-

charge that originates from the cervix.

mucus and

On

pus.

The discharge may contain

may
Some

occasion, this

burning sensation upon urination.

be accompanied by a
patients with cervicitis

caused by herpes simplex virus have lower abdominal pain and


genital lesions.

DIAGNOSIS
Since

many women with

examination

ical

Cervicitis

is

cervicitis

have normal cervixes, a phys-

not adequate to identify the infection.

must be confirmed by culture

tests

which

isolate the

disease-producing organisms.

TREATMENT
Tetracycline

is

most often used

to treat an individual with

cervicitis.

Treatment of

cervicitis

depends a great deal on the diagnosis

of urethritis in male partners since urethritis has

symptoms more

often than cervicitis. The organisms which cause urethritis in

men

are very often transmitted through sexual contact and

cause asymptomatic cervicitis

in

women.

In fact,

Chlamydia

trachomatis one of the causes of cervicitis is isolated from as

many

as half

of the female partners of

urethritis. Therefore,

ners of

men with

many

men with nongonococcal

physicians believe that female part-

urethritis should

before confirming the diagnosis.

-80-

be treated for

cervicitis

even

VAGINAL INFECTIONS
Trichomoniasis, Yeast Infections, Bacterial Vaginosis

There are several kinds of vaginal infection; not

by sexually transmitted

are caused

diseases.

Perhaps the most obvious

symptom of

vaginal infection

the presence of an excessive vaginal discharge.

of vaginal discharge

all

certain

have a foul odor, and


a yeast infection

is

amount

normal; however, a discharge which

is

symptomatic of vaginal infection tends to be heavier,

may

cause itching.

is

is

often

will

discharge caused by

odorless.

Vaginal infection does not pose a serious threat to a woman's

good

health

However,

generally.

bacterial vaginosis,

may

difficult to cure

least

one form,

called

increase the risk of acquiring pelvic

inflammatory disease. In addition,

may be

at

and

it is

at

not

times vaginal infection

uncommon

for

women

to

suffer recurrences.

TRICHOMONIASIS
also

known

as

trichomonas vaginitis or trich

Trichomoniasis

monas

is

caused by a one-celled parasite called Tricho-

vaginalis. It is a

form of vaginal infection which

81

is

most

commonly

acquired by sexual contact. Although

it is

technically

possible for an individual to contract trichomoniasis from a


toilet seat

or wash cloth,

highly unlikely.

it is

It is difficult

know how widespread trichomoniasis is, since many


women who have it show no symptoms. It is possible
individual to

to

of the
for an

unknowingly harbor the Trichomonas organisms

for years.

SYMPTOMS
In an infected

may
for a

cause the

woman, changes within the vaginal environment


symptoms to surface. The symptoms may appear

few days and then vanish for months. At times, a vaginal

may be

discharge

symptom

the only

usually yellowish, but

it

may

present.

The discharge

take on a greenish

or

tint,

it

is

may

be white or gray as well. The discharge usually emits a foul


odor.

The

vaginal area

when

sensation

symptoms

may

itch,

and there

may be

a burning

urinating. In the majority of cases in

are exhibited, they will generally appear

four days and one

month

which

between

after the initial contact with an

infected partner.

An

examination by a physician

may

reveal a slender rim of

The vagina

walls

very severe cases red dots

may

yellowish discharge surrounding the cervix.

may

have reddened, and

in

develop on the cervix as well as on the walls of the vagina.

Most men infected with Trichomonas do not develop any


symptoms. However, some men may experience a burning
sensation

when

urinating or following ejaculation. In addition,

the tip of the penis

may

itch.

DIAGNOSIS
Many

doctors

characteristic

may

suspect

trichomoniasis simply

from the

symptoms. However, the diagnosis must be con-

firmed by examining the vaginal discharge under a microscope.

However, even microscopic examination

-82-

will

not guarantee an

accurate diagnosis
is

all

the time. For difficult cases, a culture test

available.

Since the discharge usually carries an unpleasant odor, often

women douche
in

prior to being

may

doing so, they

nisms. Therefore,

it is

rinse

examined by

away

a large

their physician,

number of the

important not to douche

at least

and

orga-

24 hours

before an examination for any genital problem.

TREATMENT
Trichomoniasis

drug

may

is

treated with metronidazole. However, this

not be taken by everyone.

istered to people

who have

It

should not be admin-

certain blood diseases, an active

disease of the central nervous system, or to

three

women

in the first

months of pregnancy.

To reduce
best to

the

symptoms during the treatment

keep the vulva area dry.

It is

period,

it

is

advisable to wear cotton

underpants rather than synthetic garments, as cotton fabrics


tend to absorb moisture.

The sexual partner of the infected

individual also

treated with metronidazole to prevent reinfection.

being treated

for trichomoniasis should abstain

intercourse until he or she


tions

is

is

cured.

must be

The person
from sexual

The purpose of such

restric-

to prevent infected individuals or those in the process

of being treated from reinfecting one another and then passing


the disease back and forth.

* * *

YEAST INFECTIONS
also

known

as candidiasis or moniliasis

Yeast infections, which are caused by overgrowth of a fungus

known

as

Candida albicans, are more annoying than they

are dangerous to a

woman's

health.

-83-

They

are extremely

common

women and

in

Even

after effective treatment, recurrences are

Although
to a

are often stubbornly difficult to get rid of.

woman,

it is
it

is

man to

possible for a
far

more

common.

transmit a yeast infection

likely that the female wilj pass

to the male. Yeast infections

commonly occur when

it

on

woman

is

taking antibiotics for another infection, such as a urinary tract


infection, because

by the

killed

and

the normally occurring bacteria are also

antibiotic, the

growth

yeast

common

when

environment

encouraged. Yeast

is

during times of hormonal

the vagina changes

in

infections

are

also

change, such as during

pregnancy or while taking oral contraceptives.

Many women normally have

small

amounts of yeast

vagina, so the presence of yeast doesn't necessarily

one has

in the

mean some-

a vaginal infection.

SYMPTOMS
Yeast infection symptoms

may

vary

may be
The

little

among

different

women,

common symptoms. There

but itching and irritation are the most


or no vaginal discharge.

discharge,

if

present,

is

of a whitish hue sometimes

with thick curds of a white substance that looks something


cottage cheese.
a

It is

usually heaviest just preceding and following

woman's menstrual

period.

Upon

a physician's examination,

may appear red and swollen, and particles from


may cling to the vaginal walls and cervix.

the vagina
discharge
In

some

cases in which the discharge

an itchy rash

may

like

is

the

especially abundant,

develop on the outside genitals. The vulva

may become swollen, irritated, and extremely tender. A general


soreness may develop in the genital area, and sexual intercourse
may become quite painful.
Men are less likely than women to be troubled by yeast
infections.

hand, the

warm moist

male's genitals are external, while on the other


climate of a

-84-

woman's vagina

is

more

conducive to the growth of these organisms. However, yeast

men

fections in

can sometimes cause a rash

in

in-

the genital area.

DIAGNOSIS
In

many

just

best

instances, a physician

able to suspect a yeast infection


a definite diagnosis

it is

for the doctor to take a sample of the discharge to be

examined
This

is

from the symptoms. However, for

is

present

under

microscope

for

positive

identification.

important, since at times a yeast infection


the vagina along with

in

may be

other infections, and the

symptoms may be somewhat camouflaged.

TREATMENT
There are several antifungal medications used to

They

infections.

treat

yeast

are available in creams, tablets, and coated

tampons.

* * *

BACTERIAL VAGINOSIS
also

known

as

Haemophilus

Bacterial vaginosis

Previously,
vaginitis.

these

is

vaginitis or nonspecific vaginitis

the most

infections

common form of vaginal infection.


were

diagnosed

nonspecific

as

However, medical research has revealed that many cases

of vaginal infection which were regarded as "nonspecific" were


in fact associated

with an organism called Gardnerella vaginalis

as well as other bacteria.


is

uncertain;

including

the

The exact cause of

condition occurs

Gardnerella

vaginalis,

when

grow

numbers.

-85-

to

bacterial vaginosis
several

larger

organisms,

than normal

SYMPTOMS
A

large proportion

vaginosis

do not exhibit any symptoms

the infection. However,


likely
a

women who

of the

if a

symptom

suffer

from

bacterial

in the initial stages

is

noticed,

it

will

of

most

appear as a thin, gray-colored vaginal discharge which has

bad odor. At times an infected individual

itching or burning sensation, but this

with bacterial vaginosis than

in

is

may

experience an

far less likely to

some other forms of

occur

vaginal

infection.

DIAGNOSIS
Most physicians can diagnose bacterial vaginosis by

testing a

sample of the discharge.

TREATMENT
Bacterial vaginosis

is

treated with metronidazole.

As with other

forms of vaginal infection, doctors recommend that during the


treatment period infected individuals either abstain from having
sexual intercourse or that males wear a

-86-

condom.

EPIDIDYMITIS

Epididymitis

is

an inflammation of the epididymis, the long

cordlike structure located along the back of the

common

type of epididymitis

mitted epididymitis.

It is

in

young men

usually caused

testis.

is

The most

sexually trans-

by Chlamydia tracho-

may

matis or Neisseria gonorrhoeae. Epididymitis

result as a

complication of urethral infection by one of these two bacteria,

and

the male counterpart of PID in

is

much

less

common

it is

than PID.

Acute epididymitis may


and

women. However,

result in the

formation of abscesses

infertility.

SYMPTOMS
The most common symptom of epididymitis
of the

scrotum.

Some

individuals

may

is

painful swelling

experience painful

urination and a urethral discharge.

DIAGNOSIS

physician

the

may

suspect epididymitis through an evaluation of

symptoms along with an examination of

-87-

the scrotum and

urethra.

culture of the urethral discharge to detect C. tracho-

matis or N. gonorrhoeae

is

usually taken to confirm the diagnosis.

Examination of urine specimens

may

also

be helpful.

TREATMENT
Epididymitis

is

usually treated with tetracycline.

elevation of the scrotum

is

recommended

Bed

rest

with

to reduce swelling

and

pain. Sexual partners of individuals with epididymitis should


also be treated.

-88-

Glossary
antibiotic-a medication chiefly used in the treatment of infectious diseases

which inhibits the growth of bacteria and other microorganisms.


asymptomatic exhibiting no sign of a contracted disease or illness.
bubo-greatly enlarged inflamed lymph nodes usually located in the groin,
often associated with several sexually transmitted diseases,

cervix the lower

of the uterus, which extends and opens into the

tip

vagina.

chancre an ulcer or sore with


area,

and which

culture the

is

growing

a hard base, usually located in the genital

most often associated with

of microorganisms

in

syphilis

and chancroid.

controlled

environment

for medical purposes.

curette a scoop-shaped surgical instrument used to scrape diseased tissue

from body

douche a

such as the uterus.

cavities

jet or current

of water applied to the vagina for medicinal or

hygienic purposes.

ejaculation the process of discharging semen by the reproductive organs

of the male.

tube one of

fallopian

and

at

a pair

of ducts opening at one end into the uterus

the other end into the peritoneal cavity over the ovary.

foreskin the fold of skin which covers the head of the penis or
gynecologist a doctor
science which

is

who

specializes in gynecology, the area

clitoris.

of medical

involved with the functions and diseases of women,

especially regarding the reproductive organs.

incubation period the time between contracting a disease and the appear-

ance of symptoms.

inflammation swelling, redness, pain, and


a reaction

of bodily

most often

tenderness,

as

tissues to injurious agents.

labia the folds of skin and mucous

membrane of

the external genitalia

or vulva surrounding the entrance of the vagina.

lesion any injurious or abnormal change in a localized area of tissue,

such as a

blister,

mucous membrane a

chancre, sore, etc.


lubricating

membrane which

lines

an

internal

surface.

pap smear a procedure or

test for

women

used primarily to detect can-

cerous or precancerous cells in the cervix.

scrotum the pouch of

skin covering the male reproductive glands.

semen the sperm-containing


sitz

fluid

of males.

bath the immersion of the thighs and hips


of

in

warm water

as part

a therapeutic treatment.
in the cavity

of

urethra the tube running from the urinary bladder to the exterior,

in

testis (testes,

pi) one of two reproductive glands located

the scrotum.

men both

urine and

semen

travel

through the urethra.

vulva-the external genitalia of a female.

-89-

Male
Bladder

Vas
Y^ s deferens

al vesicle
Seminal

Epaculatory ducts

l\
Prostate gland^rl) A ^-?
/

/^v \

Testis

Scrotum^

-90-

Urethra
Penis

Female
Fallopian tubes

Urethra

*V^^^L Vagina

Clitoris*"

VLabia
Anus,

91-

Further Reading
Balis,

Andrea. What Are You Using: A Birth Control Guide for


New York: Ed-U Press, 1981.

Teenagers. Fayetteville,

Barlow, David. Sexually Transmitted Diseases: The Facts.

New

York: Oxford University Press, 1981.


Bell, Ruth, et. al. Changing Bodies, Changing Lives: A Book for
Teens on Sex & Relationships. New York: Random, 1981.
Burgess-Kohn, Jane. Straight Talk About Love and Sex for Teenagers. Boston: Beacon Press, 1979.
Chase, Allan. The Truth About STD: The Old Ones-Herpes &
Other New Ones the Primary Causes the Available Cures.
New York: Morrow, 1983.
Edwards, George J. Facts About Syphilis and Gonorrhea. Palo
Alto, California: Learning Line, 1972.
Gale, Jay. A Young Man's Guide to Sex. New York: Holt,
Rinehart and Winston, 1984.
Gordon, Sol. Facts About STD Sexually Transmitted Diseases.
Fayetteville, New York: Ed-U Press, 1983.
Hyde, Margaret O. VD: The Silent Epidemic. Second Edition.
New York: McGraw-Hill, 1982.
Johnson, Eric. Love and Sex in Plain Language. Revised Edition.
New York: Harper & Row, 1985.
Llewellyn-Jones, Derek. Herpes, AIDS, & Other Sexually
Transmitted Diseases. Winchester, Massachusetts: Faber

&Faber, 1985.
Won't Happen to Me: Teenagers Talk About
Pregnancy. New York: Delacorte, 1983.
Madaras, Lynda, and Madaras, Area. What's Happening to My
Body? A Growing-Up Guide for Mothers and Daughters.
New York: Newmarket, 1983.
Nourse, Alan E. Herpes. New York: Franklin Watts, 1985.
Red fern, Paul. The Love Diseases. Secaucus, New Jersey:

McGuire, Paula.

It

Citadel Press, 1981.

Do If You or
& Pregnant. New York: Lothrop,

Richards, Arlene K., and Willis, Irene. What to

Someone You Know

is

18

1983.
Zinner,

Stephen.

STD: Sexually Transmitted

York: Summit Books, 1985.

93

Diseases.

New

Index
chlamydial infection, 23-25

Immune

Acquired

"clap." See gonorrhea

Deficiency

condom,

Syndrome (AIDS), 45-49


associated conditions in, 46
high-risk groups for,

Condylomata acuminata, 42-44

47

Contraceptive techniques,

precautions in, 49

symptoms

of,

in sexual disease preven-

tion, 7-8, 10

in sex-

ual disease transmission, 7-8

48-49

transmission of, 46

crabs, 54-56

treatment of, 49

cytomegalovirus (CMV), 62-63

acyclovir, 39-40

amebiasis, 67

anal warts, 43

diaphragm,

in sexual disease trans-

mission, 7-8

discharge, as sign of sexually trans-

bacterial vaginosis,

mitted disease, 9

85-86

Donovanosis, 52-53

"bad blood." See syphilis

"dose." See gonorrhea

Calymmatobacterium granulo-

ma tis,

enteric pathogens, 64-67

52

Campylobacter, 65-66

epididymitis, 87-88

candidiasis, 83-85

eye infection, gonorrheal, 17-li

cervicitis,

79-80

chancre, in syphilis, 29-30

mycoplasmas, 63
genital warts, 42-44

chancroid, 50-51

genital

Chlamydia trachomatis, 23 79 80
,

-94

giardiasis,

66

gonorrhea, 17-22

lice,

diagnosis of, 20-21

lymphogranuloma venereum
(LGV), 26-28

culture test in, 20-21

Gram -stain
PPNG,22
symptoms

pubic, 54-56

"lues." See syphilis

test in,

21-22

lymphopathia, 26-28

of, 19-20

transmission of, 17-18

treatment of, 22

minors with sexually transmitted

gonorrheal eye infection, 17-18

disease, 12-13

granuloma inguinale, 52-53

molluscum contagiosum, 57-58

granuloma venereum, 52-53

moniliasis, 83-85

gumma,

Mycoplasma hominis, 63

in syphilis,

31-32

mycoplasmas,

genital,

63

Haemophilus ducreyi, 50
Haemophilus

vaginitis,

Neisseria gonorrhoeae, 17,79

85-86

nongonococcal

hepatitis, viral, 58-61

hepatitis

76-78,80

A, 59

hepatitis B,

(NGU),

urethriti,

chlamydia

59

in,

23-24

nonspecific urethritis (NSU),

herpes, 35-41

76-78

diagnosis of, 39-40

nonspecific vaginitis, 85-86

oral vs. genital, 35-36

pregnancy and, 40-41


prevention of, 40

prodromal or warning period

odor, as sign of sexually trans

in,

mitted disease, 9

37
rectal,

38-39

recurrent attacks of, 38


silent carriers of,

symptoms

of,

pediculosis pubis, 54-56

38

pelvic inflammatory disease (PID),

36-39

20,71-75

female, 36-37

male, 37

bacterial
I,

herpes simplex

II,

pathway

in

-72

diagnosis of, 73-74

35

herpes simplex

35

organisms

symptoms

in,
in,

71

72-73

treatment of, 74-75

intrauterine device (IUD), in sexual

Pill

(contraceptive), in sexual
disease transmission, 8

disease transmission, 8

Planned Parenthood

Pneumocystis
46

Kaposi's sarcoma, 46

95-

clinic,

carinii

12

pneumonia,

PPNG

(penicillinase -producing

shigellosis,

N. gonorrhoeae), 22

64-65

soft chancre, 50-51

pregnancy

syphilis,

29-34

herpes and, 40-41

chancre

syphilis and, 32-33

diagnosis of, 33

pubic

lice,

gumma

54-56

public health department, report-

29-30

in,

in,

31-32

latent, 31

ing of sexually transmitted

pregnancy and, 32-33

disease to, 13

primary, 29-30
secondary, 30-31

symptoms

rectal herpes, 38-39

tertiary or late, 31-32

of,

29-32

treatment of, 33-34

salpingitis,

71-75. See also pelvic

Treponema pallidum, 29

inflammatory disease (PID)


scabies, 56-57

^tnch." See trichomoniasis

Scarcoptes scabiei, 56-57

Trichomonas

sexually transmitted disease, 7-14

trichomoniasis, 81-83

vaginalis,

81-83

contraceptive techniques and,

7-8

discharge in, 9

Ureaplasma urealyticum, 63

increase in, 7

urethritis.

medical examinations
clinic

in,

10-13

urethritis

urination in prevention of sexually

or public health depart-

ment

See nongonococcal

transmitted disease, 10

for, 12

family physician and,

of minors, 12-13

Planned Parenthood

clinic

vaginal infection, 81-86

in,

vaginitis, nonspecific,

12

VD National Hotline and,


yearly testing

in,

12

vaginosis, bacterial,

85-86

VD National Hotline,

85-86
12

venereal warts, 42-44

odor as sign of, 9


prevention of, 8-10

condoms

in,

10

partner's health status in, 8-9

urination

in,

warts

10

washing hands and genitals

anal,

43

genital or venereal,

in,

42-44

10
public health department
yeast infections, 83-85

reporting of, 13
sexual mores and. 7

96

Printed ,n the U.S.A.

ISBN 0-89490-1 15-X