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STDs
Sexually transmitted diseases (STDs) are infections acquired by sexual contact. You can catch sexually transmitted diseases any time you have unprotected sex with a partner who is already infected. The organisms that cause sexually transmitted diseases may pass from person to person in blood, semen or vaginal fluids. It's possible to contract sexually transmitted diseases from people who seem perfectly healthy people who, in fact, aren't even aware of being infected. That's because many sexually transmitted diseases cause no symptoms, at least at first. The symptoms of several sexually transmitted diseases are also easy to mistake for those of other conditions, so the correct diagnosis may be delayed. Symptoms Sexually transmitted diseases have a wide range of symptoms. The signs and symptoms listed here are the most common, but they occur in different combinations with different infections. The timelines from infection to symptoms and from initial infection to advanced disease also vary from disease to disease. The first signs and symptoms of some STDs, occurring shortly after you're exposed to a sexually transmissible agent, are known as primary or acute infection. Primary infection symptoms May go unnoticed A sore or a cluster of sores or bumps, with or without pain, on the genitals or in the oral or rectal area Painful or burning urination Discharge from the penis Vaginal discharge Unusual vaginal bleeding Sore, swollen lymph nodes, particularly in the groin but sometimes more widespread Fever and other flu-like symptoms Appear a few days to three months after exposure, depending on the organism May be attributed to a noninfectious cause, such as a cold, fatigue or skin irritation May resolve in a few weeks, even without treatment, but progression with later complications or recurrence usually occurs (Transmission of some STDs may still be possible during this period.) Advanced disease: Months to years after primary infection Sores or bumps anywhere on the body Recurrent genital sores Generalized skin rash Pain during intercourse Scrotal pain, redness and swelling Pelvic pain Groin abscess Infections associated with human immunodeficiency virus (HIV) Infertility For some infections, neurological or cardiovascular problems Cancer When to see a doctor See a doctor immediately if you are sexually active and you: Find out your sex partner has an STD Believe you may have been exposed to an STD Develop a genital sore or rash Have a discharge from the vagina or penis Have pain or a burning sensation when you urinate

Have swollen or tender lymph nodes in your groin

Make an appointment with a doctor for STD counseling and, if appropriate, for screening tests:

When you consider becoming sexually active, or when you're 21, whichever comes first Before you start having sex with a new partner When you're concerned about possible exposure to STDs in your past

Causes More than 30 viruses, bacteria and parasites cause STDs. Many of these organisms rely almost completely on sexual transmission to survive. In other words, if you have one of these infections, you most likely got it from sexual contact. The microbes include:

Bacteria that cause gonorrhea (Neisseria gonorrhea) Bacteria that cause syphilis (Treponema pallidum) Bacteria that cause urethritis, cervicitis and pelvic inflammatory disease (Chlamydia trachomatis) Bacteria and intestinal parasites that cause rectal and anal pain, sometimes with severe diarrhea Single-celled organisms that cause urethritis, vaginitis, cervicitis and pelvic inflammatory disease (Trichomonas vaginalis) Viruses that cause cervical and anal cancer (human papillomavirus, also known as HPV, types 16, 18, 31, 33, 45, 52 and 58) Viruses that cause genital herpes (herpes simplex virus, also known as HSV, usually type 2 but sometimes type 1)

Sexual activity plays a role in spreading many other infectious agents, although it's possible to catch these infections without sexual contact. Viruses capable of spreading both sexually and through close nonsexual contact include the Epstein-Barr virus responsible for mononucleosis and a related virus called cytomegalovirus. Hepatitis A, a viral infection usually contracted from contaminated food and water, sometimes passes between sex partners, mainly men who have sex with men. The same pattern of transmission occurs with several common food- and water-borne bacteria and parasites, including shigella, cryptosporidium and Giardia lamblia. Intravenous drugs abusers have a high risk of HIV and hepatitis B, which spread through needle sharing as well as sex. Risk factors Even between faithful and committed partners, STDs can happen. It's possible to be infected with herpes, for example, and never realize it, then pass the infection to your long-term partner. More often, though, people get sexually transmitted infections from casual or new partners. Your risk of catching any STD depends on your sex, age and sexual practices, as well as on the sexual practices and lifestyles of your potential partners. The same factors determine which STDs you're most likely to be exposed to. General risk factors include:

Being sexually active. Some activities carry a high risk of transmitting infection. The riskiest activities are anal and vaginal intercourse. Starting sexual activity at an early age. The possibility of catching an STD or becoming pregnant doesn't seem real to many adolescents. If they worry about risk at all, they do so after having sex. Also, the younger you start, the more partners you may have. Having high-risk sex. Vaginal or anal penetration by an infected partner who is not wearing a latex condom transmits some diseases with frightening efficiency. Without a condom, a man who has gonorrhea has a 70 to 80 percent chance of infecting his female partner in a single act of vaginal intercourse. Oral sex is less risky but still too dangerous to chance without a latex condom or dental dam.

Currently having an STD. Being infected with one STD makes it much easier for another STD to take hold. If you're infected with herpes, syphilis, gonorrhea or chlamydia and you have unprotected sex with an HIV-positive partner, you're more likely to contract the virus. Having a history of an STD. If you've had one STD, you're at increased risk of catching another one, partly because you and your potential sex partners often belong to social networks made up of people of similar age, location and background. Within these overlapping networks, couples regularly form, split up and find new partners. If one STD is making its way through such a network, there's a good chance that others are, too. Having multiple sex partners, not just concurrently but over time.Every time you break up with one partner and move on to another, even if each relationship is monogamous, your STD risk is increased. Using alcohol or recreational drugs. These habits lower your inhibitions and impair your judgment, so you're more likely to take sexual risks. Injecting drugs. Needle-sharing spreads many dangerous infections, including HIV and hepatitis B. If you acquire HIV by injecting drugs, you can transmit it sexually. Being young. Almost half of the new cases of STDs each year are in people between the ages of 15 and 24 years. Being female. At all ages, women are more likely to have severe STD complications, such as infertility, than are men. In teenage girls and young adult women, the cervix is made up of constantly changing cells. These unstable cells make the cervix more vulnerable to certain sexually transmitted organisms, so vaginal intercourse poses added risks. Being African-American. STDs, particularly gonorrhea and syphilis, are reported in a disproportionate number of African-Americans. This may be partly because African-Americans are more likely to receive care at clinics that report STD statistics, including breakdowns of cases by age, sex and race. Having sex with men. Whether you're male or female, male sex partners are riskier. For women, having vaginal intercourse or performing oral sex on a man without a latex condom is a high-risk activity. Homosexual men are also at increased risk of STDs, as are male and female sex workers and their customers. Some men who have heterosexual relationships also engage in clandestine sex with other men, posing risks to themselves and their partners of both sexes. Meeting people in public places or online for sex. Casual, anonymous sex promotes the spread of STDs across social networks and different demographic groups.

Complications Prompt treatment prevents the complications of some STDs. Unfortunately, you may not notice the symptoms of primary infection, which is the easiest to treat. Possible complications include:

Arthritis Eye inflammation Pelvic inflammatory disease Infertility Cervical cancer Other cancers, including HIV-associated lymphoma and HPV-associated rectal and anal cancers Opportunistic infections occurring in advanced HIV Heart disease Difficulty walking or maintaining balance Personality change Memory loss Maternal-fetal transmission, which causes severe birth defects

Preparing for your appointment Not many people feel comfortable sharing the details of their sexual experiences, but the doctor's office is one place where you must. So take a deep breath, relax and answer your doctor's questions completely and honestly.

Here are some of the things you may be asked: Do you think you might have a sexually transmitted disease? If so, why? Are you sexually active with men, women or both? Do you currently have one sex partner, or more than one? How long have you been with your current partner or partners? Have you ever injected yourself with drugs? Have you ever had sex with a gay or bisexual man or someone who has injected drugs? Do you have vaginal sex? Do you have oral sex? Do you have anal sex? Do you use sex toys, such as vibrators, when you have sex? What do you do to protect yourself from STDs? If female, have you received HPV immunization? Do you ever use drugs or drink alcohol before having sex? Has a doctor or nurse ever told you that you have chlamydia, herpes, gonorrhea, syphilis or HIV? Have you ever been treated for a genital discharge, genital sores, painful urination or an infection of your sex organs? How many sex partners have you had in the past year? How many people have you had sex with in the past two months? When was your most recent sexual encounter? When did you last have sex with someone other than your most recent partner? Questions to ask your doctor What's the medical name of the infection or infections I have? How, exactly, is it transmitted? Will it keep me from having children? If I get pregnant, could I give it to my baby? Is it possible to catch this again? Could I have caught this from someone I had sex with only once? Could I give this to someone by having sex with that person just once? How long have I had it? Does my partner have to go to a doctor to be treated?

Tests and diagnosis If your sexual history and current signs and symptoms suggest that you have an STD, laboratory tests can identify the cause and detect co-infections you might also have contracted. Blood tests confirm the diagnosis of most viral STDs. If you have active herpes sores, however, testing fluid and scrapings from the sores is simpler and less expensive than is testing blood. Laboratory tests of material from a genital sore or discharge are used to diagnose the most common bacterial STDs at an early stage. Chlamydia may go unnoticed at this stage in both men and women, though, delaying the diagnosis until complications such as pelvic inflammatory disease (PID) occur. Women can easily miss the symptoms or signs of gonorrhea as well. Treatments and drugs Antibiotics can cure many sexually transmitted bacterial and parasitic infections, including gonorrhea, syphilis, chlamydia and trichomonas. A single antibiotic dose, given orally or injected, is generally all you need to stop gonorrhea when it's limited to the urethra and cervix. Typically, you'll be treated for chlamydia at the same time because the two infections often appear together. Chlamydia treatment consists of a seven-day course of an oral antibiotic. Once you start antibiotic treatment, it's crucial to follow through. If you don't think you'll be able to take medication as prescribed, be sure to tell your doctor. A shorter, simpler treatment regimen may be available.

Sexually transmitted viral infections are not curable, but two such infections human papillomavirus (HPV) and hepatitis B are preventable with vaccines prior to exposure. You'll have fewer herpes recurrences if you take daily suppressive therapy with a prescription antiviral drug, but you can still give your partner herpes at any time. Treatment with highly active antiretroviral therapy and other antiviral drugs can keep HIV infection in check for many years, although the virus persists and can still be transmitted. The sooner you start treatment, the more effective it is. If you take anti-HIV medication for 28 days, starting as soon as you know you've been exposed, you may avoid becoming HIV-positive. Coping and support It's traumatic to find out you have an STD. You might be angry if you feel you've been betrayed, or deeply ashamed if there's a chance you infected others. At worst, an STD can cut decades off your life expectancy, even with the best care in the world. Between those extremes is a host of other potential losses trust between partners, plans to have children, and joyful embrace of your sexuality and its expression. Here's how you can cope:

Put blame on hold. Don't jump to the conclusion that your partner has been unfaithful to you. One (or both) of you may have been infected by a past partner. If you were infected as a result of your partner's infidelity, the time to hash it out is after everyone who might be at risk is notified, tested and treated. Be candid with health care workers. Their job is not to judge you, but to stop STDs from spreading. Anything you tell them remains confidential. Keep things in perspective. Each year, millions of people acquire STDs. Safer sex could prevent many infections, but because sex is a biological necessity, it's also an opportunity for micro-organisms to spread and multiply. All you can do is stop making it easy for them. Contact your health department. Although they may not have the staff and funds to offer comprehensive services, local health departments maintain STD programs that provide confidential testing, treatment and partner services. The public health officer or disease intervention specialist you work with may help you with referrals to community agencies for treatment of substance abuse, prevention of domestic violence and assistance with housing.

Prevention Screening Testing for a disease in someone who doesn't have symptoms is called screening. Most of the time, STD screening is not a routine part of health care. But there are exceptions: Everyone. The one STD screening test suggested for everyone between the ages of 13 and 65 is a blood or saliva test for human immunodeficiency virus (HIV), the virus that causes AIDS. Most health care settings in the United States offer a rapid HIV test with same-day results. Pregnant women. Screening for HIV, hepatitis B, chlamydia, gonorrhea and syphilis generally takes place at the first prenatal visit. A blood test to detect HSV type 2 infection is recommended for pregnant women with current or past partners who have genital herpes. Young women who are sexually active. All sexually active women under age 25 should be tested for chlamydia infection. The chlamydia test uses a sample of urine or vaginal fluid you can collect yourself. Some experts recommend repeating the chlamydia test three months after you've had a positive test and been treated. The second test is needed to confirm that the infection is cured, as reinfection by an untreated or undertreated partner is common. A bout of chlamydia doesn't protect you from future exposures. You can catch the infection again and again, so you should get retested when you have a new partner. Women ages 21 to 66. The Pap test screens for cervical abnormalities, including inflammation, precancerous changes and cancer, which is caused by certain strains of human papillomavirus (HPV). From ages 21 to 66, women should have a Pap test at least every three years. Women who start having sex before age 21 should have a Pap test within three years of first intercourse.

Men who have sex with men. Compared with other groups, men who have sex with men run a much higher risk of catching STDs. Many public health groups recommend annual or more frequent STD screening for these men. Regular tests for HIV, herpes, gonorrhea, chlamydia and syphilis are particularly important. People with HIV. If you have HIV, it dramatically raises your risk of catching other STDs. Experts recommend frequent syphilis, gonorrhea, chlamydia and herpes tests for people with HIV. Women with HIV may develop aggressive cervical cancer, so they should have Pap tests twice a year to screen for HPV. Some experts also recommend regular HPV screening of HIVinfected men who risk anal cancer from HPV contracted anally. Vaccination Vaccines are available to prevent two viral STDs that can cause cancer human papillomavirus (HPV) and hepatitis B. The HPV vaccine is recommended for all girls between ages 9 and 26, and the hepatitis B vaccine is usually given to newborns. Partner notification and preventive treatment If tests show that you have an STD, your sex partners including your current partners and any other partners you've had over the last three months to one year need to be informed so that they can get tested and treated if infected. Public health regulations require doctors to report all cases of syphilis and HIV to the local or state health department, which employs trained disease intervention specialists who will work with you and sometimes with your doctor to identify your partners, inform them of their exposure and get them tested and treated. In some states and counties, the health department also notifies partners exposed to gonorrhea and chlamydia.

Official, confidential partner notification effectively limits the spread of STDs, particularly syphilis and HIV. The practice also steers those at risk toward appropriate counseling and treatment. Finally, since you can contract some STDs more than once, partner notification reduces your risk of getting reinfected. Depending on your circumstances, you might prefer to be the one who breaks the bad news to your partner, and that's certainly an option. Your disease intervention specialist may help you prepare and make a contract with you to go through with the conversation within a set amount of time. If your partner hasn't been treated by that time, the health department picks up with its usual partner notification procedure. In an approach called expedited partner treatment, the staff at an STD clinic will treat an exposed partner without doing a full medical evaluation. When you're diagnosed with chlamydia, gonorrhea or trichomoniasis, your doctor may prescribe enough medication to treat both you and your partner. This approach is called patient-delivered partner treatment. Safer sex Thanks to improved testing and treatment, most people with access to health care no longer face all the dreadful consequences of STDs. Still, there is no room for complacency. One risky encounter is unlikely to cost you your life, but it could really mess up your future. These guidelines offer the greatest possible margin of safety. Don't have sex in any way that puts you and your partner in direct contact with each other's blood, semen or other body fluids. Avoid vaginal and anal intercourse with new partners until you have both been tested for STDs. Oral sex is less risky, but use a latex condom or dental dam to prevent direct contact between the oral and genital mucosa. Use a latex condom every time you have intercourse. Never use an oil-based lubricant, such as petroleum jelly, with a latex condom. Don't drink alcohol or use drugs. If you're under the influence, you're more likely to take sexual risks. Don't look for sex partners online or in bars or other pickup places. Before any serious sexual contact, communicate with your partner about practicing safer sex. Reach an explicit agreement about what activities will and won't be OK. Stay with one sex partner who doesn't have any STDs and who won't have sex with anyone but you.