The most important fact of sexually transmitted diseases is they are not contracted by people who have only one partner.
At the Clinic
Some clinics which specialize in the diagnosis and treatment of sexual diseases are free. Others charge for their services. Some are walk-in; others require an appointment to be made first. Many women opt to visit a health clinic rather than a family physician. They prefer the anonymity of their surroundings. When the infection is cured, there is no record in the family files.
Some STDs are “notifiable.” By law, they must be reported to the local health authorities. This varies from area to area, and from time to time. Other STDs are anonymous; a number instead of a name is used. Still, other diseases are confidential; name, address, and telephone number are kept in secret files. Again, this varies with the area and the time.
Some STDs have more than one name. Others have their names changed as more is discovered about them. They then get placed in their own special category; they no longer belong to the group they were originally designated. In much the same way, therapies and medications vary from clinic to clinic and from time to time. Though this can seem confusing, it shows an increase in medical knowledge of the disease. Also, environmental conditions and the endemic nature of the infection in one particular area are taken into account.
In towns and cities, there are hotlines to call for advice, help, and information. There are telephone tapes which are useful too. In isolated areas, look for notices in public locales, such as town halls, libraries, and restrooms. Consult the phone book. Entries might be under V for venereal disease or $ for STD. Above all, avoid delay in seeking help.
Behaviors
High risk sexual behavior includes:
- Sex which is paid for.
- Constant change of heterosexual partners.
- Heterosexual anal sex which is unprotected.
- Sex with an intravenous drug user.
- “Tough” sex which causes lesions, bruises, bleeding.
- Male sex (anal homosexual intercourse).
AIDS is transmitted by the HIV virus in blood, semen, and vagina fluids. It can be passed in skin sores and genital lesions too tiny to be seen with the unaided eye. It is also passed from mother to child in breast milk. Infected blood and semen contain the highest concentration of the virus. Vagina fluids have a lesser concentration. HIV may be present in sweat, saliva, and tears, but the concentrations are usually too weak for there to be any risk.
STDs, however, pass in very low concentrations. One germ can be enough. Studies suggest that syphilis and herpes are significant risk factors in the transmission of HIV. The sores of either disease can be on the mouth or inside the rectum, as well as on the genitals. In women, HIV is linked with a history of genital warts. It seems likely that STDs, which disrupt epithelial (lining) tissue, are important factors in the transmission of HIV. An appropriate way to avoid infection is to avoid direct contact with a partner’s semen, blood, or sores anywhere on the skin. Condoms provide some protection.
Gonorrhea is a bacterial infection which affects one million people each year in the United States. It is believed a further one million cases each year go unreported, because the disease is asymptomatic in 10 to 15 percent of men, and in 50 to 80 percent of women. Of the women with mild symptoms, 40 to 60 percent ignore them, believing that they are due to some other minor problem. The cervix is the most common site of gonorrhea.
Symptoms appear 3 days to 2 weeks after sexual contact. There is a thick, yellowish discharge. The cervix looks red, with small bump-like pits which are erosions. The urine tract often becomes infected, with the classic symptoms of UTI: stinging pain, frequency, and urgency. The infection can spread, to Skene’s and Bartholin’s glands. With oral sex, gonorrhea can spread from the penis to the throat, with sore throat and swollen glands, or it is asymptomatic. Discharge from an infected vagina or anal sex can infect the rectum with itching anus and discharge.
Untreated gonorrhea can lead to pelvic inflammatory disease (PID). Some 1 to 3 percent of women develop “disseminated gonorrhea,’ which spreads throughout the system. It can cause arthritis and, in rare cases, heart disease. The infection can be passed to a baby during birth, causing serious infection and possible blindness. Therapy is by antibiotics. Protect the cervix.
The corkscrew shaped bacteria of syphilis penetrate the skin of the vulva and within 30 minutes reach the glands in the groin. Thirty-six hours after infection, the bacteria have doubled in number. They double again every 30 hours. It takes an average 3 weeks (10 to 50 days) for the first symptoms to appear. By then, there are countless bacteria in the blood stream.
The first symptom is a chancre, an ulcer which starts as a pimple and then develops into an open sore with a hard rim. It is painless and self-healing. Once the sore disappears, bacteria travel in the blood, rapidly multiplying. Second stage syphilis occurs 2 to 6 weeks later. The symptoms include a skin rash over the body, swollen glands, and a flu-like condition; but often the disease is asymptomatic. Syphilis continues to wreak its havoc in the vital organs. In later years, the tertiary (third) stage is devastating: heart and brain disorders, joint inflammation, and sometimes early death.
Only about 10 percent of women who get chancres notice them. They can be hidden in the folds of the labia, under the hood of the clitoris, inside the vagina or rectum, on the cervix itself. The bacteria enter through any tiny skin lesion. The sores can appear anywhere, the most usual places being the mouth, nostril, tongue, even the finger. Avoid sexual contact if sores appear on any skin parts. The same applies to a partner.
Antibiotics destroy the bacteria of syphilis. Regular blood tests are necessary for the next two years to check for lingering germs. Keep all follow-up appointments to ensure that the disease has finally gone. Syphilis is 3 times more common in men than women; it is rare in female homosexuals. It can be passed to the fetus after the 20th week of pregnancy, so a blood test for syphilis is now a routine part of prenatal care.
Anal sex carries specific health risks for all lovers, be they heterosexual or homosexual. Faeces contain highly infectious matter. The walls of the rectum are only a few cells thick. They are not designed to resist the pressure of a thrusting penis. They tear easily, and microscopic bleeding occurs. If the penis is not washed immediately after anal sex, whatever germs are in the bowel are thrust directly into the vagina. Infected semen, blood, or faeces can then pass directly into the blood system. Repeated attacks of yeast overgrowth can also occur this way.
Whatever the moral stance, hygiene is top priority. The penis should not touch the vulva, nor should it ever enter the vagina straight from the bowel. Hands, particularly fingernails, are an added danger in anal sex. Wiping with a tissue is not enough. Penis, hands, mechanical toys, all must be thoroughly scrubbed. It is strongly recommended a condom be used during anal sex, and immediately discarded afterwards.
Specific micro-organisms inhabit the mouth, just as they inhabit other body orifices (openings). They rarely cause problems within their natural ecology. If they are transmitted to other orifices, they can cause infection. One typical example is a harmless bacteria of the mouth which can come in contact with the penis. The germs enter the urinary tract, and cause male UTI.
The membranes which line the mouth are naturally subjected to tiny lesions. It has been estimated that there is gum bleeding after brushing the teeth in at least one-third of any given population. Small ulcers can be present at the sides of the mouth. The tongue can be sore for a variety of reasons. All these factors can make the mouth an “unsafe” place for sex.
Diseases known to be transmitted by oro-genital infection are: the herpes virus cold sore, yeast infections, AIDS, gonorrhoea of the throat, and syphilis chancre of the lips. At least two cases of AIDS have been contracted this way. It would seem unlikely that a woman would wish to kiss a partner with a sore on the mouth, or that she would perform oral sex on a penis with a “drip”. Yet all infections have an incubation period. There is a time lapse between contracting a disease and the appearance of symptoms. Incubation periods vary widely with different STDs; they can take years for AIDS. With a new partner, the incubation period must be taken into account.
In some cases, both partners are asymptomatic. There are no signs of disease to remind lovers that oral sex can be hazardous. Avoid direct mouth contact with semen. Where there is high risk sexual activity, one option is to completely avoid oro-genital sex. If this is unacceptable, wait until a new partner has been tested and is known to be infection-free.
Trichomonas vaginalis, or trich, is caused by a one-celled protozoan which grows rapidly within the vagina. Some women have an immediate and painful reaction to trich. Many more have asymptomatic trich; it is often only found if there are tests for other problems. The symptoms include a thin, foamy discharge which is yellow, green, or grey; there is intense itching and soreness, especially if the vulva is scratched. Trich can infect the urinary tract, causing burning, urgency and frequency. No tiny, one-celled creature should be able to cause such misery. But it does.
Trich can be passed on damp material: towels, bathing suits, washcloths, and toilet seats. This is rare. In most cases, it is transmitted by direct sexual contact. Metronidazole in Flagyl destroys trich. It has side effects, and should not be taken if there is any risk of pregnancy. A partner must be treated. Eschew douches and tampons. Avoid a flare-up recurrence by following the same “cool and dry” regime as for yeast overgrowth.
There are many other organisms that can attack the area. They come under the generic terms nonspecific vaginitis and vulvitis. Nonspecific refers to conditions in which the cause is uncertain. They may be due to sexual infection, or they may not. The symptoms are often the same as for yeast and trich, with a profuse, foul-smelling discharge, intense itching, soreness, and in some cases, severe pain. Again, like yeast and trich, none of these attacks seem to affect the cervix. Yet they can cause real misery, and greatly reduce the quality of life.
Have a test for diabetes or a prediabetes condition first. Check diet and general health; try to boost the immune system by getting more rest, more profound sleep. Many women are run down and exhausted without realizing how deeply tired they are. Once yeast and trich are ruled out, a course of antibiotics may be the answer, though yeast overgrowth may then have to be treated. If attacks of vaginitis or vulvitis do recur, be extra scrupulous with genital hygiene. Keep the entire area cool and dry.
Chlamydia is the most common STD in the U.S. today, with as many as 4 million new cases each year. It causes about half the known cases of NGU (non-gonococcal urethritis) in men. It breeds on the cervix in women. The symptoms are often mild and frequently go unnoticed. They are the same symptoms as for gonorrhea and can be confused with it. However, they appear a little later, within 1 to 3 weeks of sexual contact. More rarely, Chlamydia can be passed by a hand infected with the discharge from parent to baby.
If left untreated, chlamydia can lead to PID and infertility. Tests involve taking swabs from the cervix and culturing a specimen. The antibiotic of choice is tetracycline. Protect the cervix.
The first attack of the herpes virus is the most painful and takes the longest time to heal. Within 2 to 20 days after infection, there is a mild tingling or itching. This can be on the labia, clitoris, or vagina opening; more rarely on the vagina wall, the cervix, the buttocks, thighs, or anus. It develops into one or more watery, painful blisters in the next few days. There can be burning or pain on urination, with swollen lymph nodes in the groin. There is an increase in discharge, or a feeling of pressure in the pelvic area. In some cases, the entire body reacts with flu-like symptoms: fever, headache, and chills.
Ninety percent of women develop sores on the vagina and cervix during a first infection. The blisters burst quickly, and shed highly contagious viruses everywhere. The now-empty blisters turn into shallow ulcers, which can be painful. The ulcers form into crusts, which heal spontaneously within 1 to 5 weeks. Visit the physician as soon as the symptoms appear. At an early stage, diagnosis can be made by sight alone. Help can begin immediately, but a culture test is very expensive.
At least 5 types of herpes virus are known to affect humans. The Epstein Barr virus and-cytomegalovirus causes infectious mononucleosis, also known as glandular fever. The varicella virus causes chicken pox in children, and shingles in adults. There are 2 types of herpes simplex virus. HSV 1 causes cold sores on the lips or nose, also called fever blisters. HSV 2 causes genital ulcers, also called genital herpes.
By adulthood, most people have been infected with the cold sore virus, HSV 1. They develop antibodies against it, and only a few actually get cold sores. Fewer adults have HSV 2 antibodies because the virus is spread by sexual contact. The findings of a recent study suggest that 99 percent of prostitutes have HSV 2 antibodies in their blood, compared with 3 percent of nuns and 29 percent of women in a committed relationship.
About 50 percent of those with HSV 2 have no symptoms. The recent increase in genital herpes is thought to be partly due to this, and partly due to an increase in the practice of oro-genital sex. In some cases, both HSV 1 and HSV 2 cause genital herpes. If suffering from a cold sore, avoid kissing, and any facial or genital contact. This applies to a partner as well.
Not all HSV 2 die after a first attack. The virus coats itself in the person’s own protein substance and retreats along nerve endings to the base of the spine. Here it sets up a permanent home, staying inactive for varying lengths of time. When the virus becomes active again, it usually returns to the same place as the previous attack. Recurring outbreaks can be virulent and painful, or very mild. If mild, a woman may be unaware that she is shedding highly contagious germs.
HSV 2 is particularly dangerous for women. It is linked with cancer of the cervix, The virus can cause miscarriage in the first 3 months of pregnancy. If shed during birth, 1 in 2 babies will be infected. Two out of 3 of those infected babies will die. Half the others suffer brain damage, or visual defects. These horrors are now avoided by Caesarian birth. The baby is lifted from the uterus and thus avoids contact with the virus.
As yet, there is no drug to destroy the herpes virus. The drug acyclovir helps reduce the pain of an attack; it may even lessen the number of recurrences. One of the miserable factors of herpes is the permanent risk of passing on the disease. Some physicians believe that this is only during the active phase; others strongly disagree. An infected person cannot be free of this worry.
Molluscum Contagiosum: There are two kinds of warts, simple and genital. Both can infect the genitals; it is crucial to recognize the difference. Simple warts are the kind which appears on the hands of children. They are small, dimpled papules, which look like spots with a drop of pearly fluid inside. They are highly contagious, as their Latin name shows. They can be transmitted to the genitals by self or partner from warts on the hands and elsewhere. The virus enters the skin through invisible lesions which occur during sexual activity. The warts appear some 30 days after contact. Attacks of simple warts on the genitals are rare, being most likely in the teens and 20 to 30 age group.
If the penis is infected with simple warts, some men try self therapy. This is not advisable for women. Simple warts can be painful if rubbed, otherwise a woman is unaware of them. They are not life-threatening, nor do untold damage, but they are highly contagious. Visit the physician or clinic. Therapy varies.
Human Papilloma Virus: HPV is specific to the genital area. It is transmitted by direct sexual contact. The warts appear 3 weeks to 3 months after contact, but the incubation time can be up to 8 months, even more. The warts can be single; usually, they grow in clusters like grapes. With their raised, bumpy tops, they look like miniature cauliflowers. They grow on the labia lips or anus, inside the vagina, or on the cervix. In many cases, they are asymptomatic, and the woman is unaware that she is infected.
The warts are painless, but easily irritated by rubbing, and sometimes they itch. If there has been anal contact, they can grow inside the rectum and around the anus. More rarely with oral contact, they infect the linings of the mouth. If the warts breed in colonies on the cervix, the disease may not be detected until a Pap smear is done. Women with HPV have a five times higher risk of cancer of the cervix.
Larger warts, especially on the cervix, maybe vaporized by laser therapy, but it is difficult to know if they have all been destroyed. The healing process takes 6 weeks. Repeat therapy is necessary if they flare up again; avoid losing patience as laser therapy usually works. Other therapies include burning the warts off by electric cautery, or freezing them with dry ice. The physician then snips them off. External warts can be painted with the drug podophyllin. It takes 3 or 4 weekly treatments for the warts to dry up and drop off.
HPV infection is also called condyloma. The prescription drug Condylox has just been made available for home treatment, which means that patients no longer need to have a physician apply the therapy. At least 56 different types of the virus have been identified.
Hepatitis A and B are caused by virus infection of the liver. The virus breeds in waste matter from the bowel and is common where there is poor sanitation. It is passed in contaminated food and drink; less usually, by sexual contact; more rarely, by transfusions of infected blood. Hepatitis is on the increase, probably due to more foreign travel. When visiting areas with poor sanitation, observe strict personal hygiene. Drink bottled water, eschew ice cubes. Avoid anal and oral sexual contact.
The symptoms of both A and B are the same: fever, nausea, headache, fatigue, loss of appetite, and chills. Jaundice shows as a yellow tinge to the skin, fingernails, and whites of the eyes about a week later. Urine can be dark in colour; stools almost whitish. A few people are asymptomatic. With hepatitis A, the symptoms are mild. The defence system builds immunity to the virus, but it remains in the blood and can be transmitted.
The hepatitis B virus (HBV) produces severe symptoms, which start suddenly 1 to 6 months after contact. If liver damage is extensive, death occurs in 5 to 20 percent of cases. The B virus is transmitted in blood and blood products during sexual contact: semen, vagina secretions, saliva, and faeces are suspect. It is also passed by IV drug users sharing infected needles. The incidence of HBV is rising rapidly, perhaps due to more foreign travel and IV drug use. Male homosexuals, heterosexuals with multiple partners, travellers, and drug addicts are high risk groups.
AIDS stands for Acquired Immune Deficiency Syndrome.
Acquired: it is passed on, but not inherited.
Immunodeficiency: the immune system grows weak and deficient.
Syndrome: a group of symptoms of which the cause is unknown.
However, it is now known that AIDS is caused by the human immunodeficiency virus (HIV). The word AIDS is still used to avoid confusion. The virus does not kill, but it damages the immune system, leaving the person vulnerable to rare infections and cancers which are life-threatening. If death occurs, it is not from AIDS, but from one of these opportunistic diseases.
HIV is transmitted in body fluids: blood, blood products, semen, vagina secretions, and breast milk. It does not appear to be easily transmitted in saliva.
The Future
Scientists using an experimental AIDS vaccine have succeeded in changing the way the body fights the AIDS virus. The discovery could open the door to new ways of treating the disease. By giving the vaccine to 30 men and women infected with HIV, researchers found that they were able to prompt the immune systems of most in the group into mounting a more sophisticated counterattack against the virus. It is too early to know if this response will help HIV-infected people to survive the ravages of the disease.
The study’s results counter the long-standing and pessimistic conviction of many AIDS researchers that there is little to be done to improve upon the immune system’s battle against the HIV virus.
New therapies such as the use of the antiviral drug AZT early in infection and inhaled pentamidine to prevent AIDS-caused pneumonia will delay the time when HIV infection develops into full-blown AIDS.
